rock_shoes

I love it when a plan comes together. The heart of the concept is minimizing cerebral oxygen demand while maintaining a sufficient cerebral perfusion pressure and flow for tissue oxygenation. Assuming an ICP of 20mmHg, it would take a MAP of 80mmHg to maintain a CPP of 60mmHg (I bet MAP guidelines for the management of TBI are suddenly making more sense). Some sedative/analgesic medications balance those considerations better than others. This brings in the concept of flow metabolic coupling (Propofol is particularly good at this as sedative agents go). Agent's with good flow metabolic coupling such as Propofol reduce cerebral oxygen demand in balance with the amount they reduce cerebral blood flow. Agents such as Morphine or Midazolam do a poor job balancing the two considerations and reduce cerebral blood flow relatively more than they reduce cerebral oxygen demand.

PHO? I'm guessing that's what your service calls banked time?

All evidence continues to support taking full droplet precautions with suspected COVID patients. This one's the real deal. The numbers out of Italy tell the story as to what will happen if we don't take this seriously soon enough. My service switched our sick leave (75% pay) to general leave with pay (100% pay) to discourage employees from potentially infecting colleagues.

http://www.vch.ca/about-us/news/news-releases/vgh-leads-the-way-in-traumatic-brain-treatment Very long story short, look up the monro-kellie doctrine, and principles of cerebral perfusion pressure.

From what I know of the US system I would suggest getting your RN and doing some form of Paramedic bridging program. Take that with a grain of salt however as I've come up through the Canadian system where working your way to the Critical Care Paramedic (CCP) level is the best way to gain entry to air ambulance work (1 year PCP education, 2 year ACP education, 2 year CCP education). As you can see the path is roughly 5 years of post secondary paramedic education in Canada, which you'll find is markedly different from the US path.

It's barely possible to justify ultrasound on most units never mind an X-ray generator. Big expense with marginal applicability to practice.

Perhaps try organizing your reporting into a systems based structure. Neuro Cardiovascular Respiratory GI/GU MSK Other (Obs/Endo/immune)

Good luck to you sir. I work flight in British Columbia, Canada and love the job. The US air ambulance safety record scares the living daylights out of me. Enough so I wouldn't be willing to work air ambulance in the US.

Without more information, I'm willing to wager this is likely a matter of local protocol not evidence based practice. Based on the information provided the patient doesn't have an oxygenation problem.

Almost every controlled drug in my daily carry has significant abuse potential in the wrong hands. Why should best practice patient care be compromised because someone might abuse it? What opiate would you suggest a service carry instead when all opiates, benzo's etc. have abuse potential?

Years ago I found this site as a brand new provider. It helped shape where I am now and put me in touch with mentors I am forever indebted to. Site activity has been quite low for some time now so It's difficult to say if it would serve a new provider the same as it did me.

I'm going with a probable welcome back to the field. Sometimes it's nice when what's old is new again. I spend most of my time flying now but still enjoy the occasional shift working a street car. I like the reminder as to where I came from and why I decided to move into my current area of practice.

Wow. 11 year old thread resurrection. Impressive!

Employment status update?

Do you perhaps deal with physicians from outside of North America? Other parts of the world use different descriptors for the same condition ("fitting" is a common descriptor in many places for what we would call a seizure in North America).