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Off Label

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Everything posted by Off Label

  1. My mistake, so sorry. In my haste, I didn't read the post as carefully as I should have and then commented. My apology for the controversy. I'll maybe check with you first next time.
  2. I'm not an organ donor, nor am I trying to sell anyone on it, but there are many harvestable tissues that don't require a beating heart. Corneas, vein, connective tissue, bone etc. are all useful to somebody somewhere. Sounds pretty unethical to me.... I'm not aware of any such directive where I am and I'd be shocked of there was one. Careful determination of brain death needs to be established and if the goal of the resuscitation effort is to deliver a "brain dead" patient to the ICU, I'd say someone would have some serious explaining to do. Even the idea of continuing resuscitation to give the patient the benefit of the doubt with the secondary consolation of ending up with an organ donor is creepy IMO.
  3. The sympathetic compensatory response is to the shock state, not the cause of shock. So it is a bit of a curve to single out 'cardiogenic shock' in the way the question was asked. The compensatory response would be "fight or flight" regardless of the cause of 'shock'.
  4. All that is troublesome... what struck me mostly was the definitions of what a medical error actually was. When people hear 'errors' they think misdiagnosis, wrong drug or dose, or wrong site surgery or something along those lines. All of those are included in their working definitions but also are simple change of treatment plans and treatments that did not result in the desired end. Given these definitions of course you could establish that error is the 3rd leading cause of death in the US.
  5. Might as well dive right in with the latest sexy news about the job we all do... http://www.bmj.com/content/353/bmj.i2139 Sure, there are problems, but this is BS. Anyone see why?
  6. Not looking at those links (I'm too lazy) I'm going to say A - Increased parasympathetic tone. Here's why- All of the others have to do with a rise in sympathetic nervous system tone. We never use the term 'dromotropy' or dromotropic in clinical practice unless we're trying to confuse someone that we're teaching for the fun of it. We just say things like "increases or decreases A-V node conduction" or something like that. So, positive dromotropes are most of our sympathomimetics, with the notable exception of phenylephrine.
  7. Off Label

    Ram-Ambulance.jpg

    yechhhhhhccchhhhh....looks like a big nasty bug.
  8. because it samples the gas via an airway that varies significantly from patient to patient. That airway variation affects the value that you're reading to the extent that the values become unreliable for diagnostic determinations. In the intubated patient, the airway is reliably established and the sample is consistently taken from an unobstructed source which eliminates most if not all sample error. So, airway obstruction (diagnostic) acute fall in cardiac output (diagnostic), hypermetabolic states (diagnostic) as well as hypoventilation (monitoring), extubation (monitoring), mainstem intubation (monitoring) etc. are reliable. Nasal sampling, by and large, is for monitoring purposes only... that is for presence or absence of a patent airway with respiratory effort and respiratory rate.
  9. so, I'm not wanting to come off as someone who doesn't see the value of ETCO2 in the non intubated patient as a monitor only. What I strongly disagree with is the idea that it is a diagnostic tool in the non intubated patient. Intubated? That is another conversation.
  10. What's your budget like? Physicians are pretty well accustomed to a higher standard of living than your average bear, and while it may seem a little crass to say, it takes more than pens and lanyard to remember who you are. Take a page from the master playbook folks... drug companies. Host a lunchtime "educational" presentation and bring pizza for the staff.... it's amazing how folks with a couple of houses, boats and Mercedes will eat right out of your hand for a slice of a good sausage and mushroom pie.
  11. so, are you saying that without the ETCO2, given that presentation, you would not have intubated that patient? So, for the sake of the conversation, in what kind of patient, whose exam is not worrisome, will nasal ETCO2 demonstrate a problem?
  12. Kind of an open ended question with a lot of possible answers, but how do folks handle calls to these facilities (general surgery, Ortho surgery, gun etc.) when there is an anesthesiologist and or surgeon that needs you to take their patient to an ER? Obviously, these would be bona fide life threatening emergencies. You and your partner take the patient alone? Get orders from the docs? Bring a doc?
  13. depending on the device, ie, a vl with the same geometry as a standard dl device, residents can be trained without being allowed to view the screen, while the attending does see it. On the downside, Ī don't think those vl's that resemble normal mac blades are as effective as the more exaggerated curved blades like the glide scope.
  14. I think there is a hesitancy of some folks to become less practiced with direct laryngoscopy. The thought being that if the glide scope is over used, that DL skill will weaken. I don't buy it, but some might.
  15. A lot of the folks I work with find that the rigid, stainless steel stylet that Glide scope makes is very useful with the McGrath. Makes using it a lot easier, especially when doing neutral neck intūbations. Disposable stylets can be a bit too flimsy when aiming for the glottis in those situations, IMO.
  16. Dude, from your post, you are not one that folks worry about. You're showing situational awareness and an accurate sense of what exactly is at stake. Hard to tell from an anonymous internet forum, but it sure sounds to me that your head is in exactly the right place and you are right where you need to be. Trust the folks above you to know what you're capable of... you'll be fine.
  17. Glide scope> McGrath > everything else>C-MAC....
  18. even non intubate ones? Why do you think its indispensable there?
  19. Like the New York cabby said to the kid visiting New York city for her big chance in show biz when she asked him how to get to Carnegie Hall: "Practice, practice, practice."
  20. so, that was just a contrived theatrical scene for effect, right? It's open to interpretation, and that's how I interpreted it.
  21. I'd defer to county ALS protocol, but I'm guessing you didn't need someone to tell you that. As to checking with CMS for fraudulent billing and "up coding", be sure that your initial inquiries are anonymous. If it is Medicare fraud, investigators have not been very picky whom they implicate in terms direct or indirect participation in fraud. Not to sound overly dramatic, but look into whistle blower protection to cover yourself in the off chance things go sideways.
  22. Brutal.... tears... BUT..... high production value... someone obviously very skilled directed that. Did you notice how routine the scene was for the subjects in the spot? It was obvious that a significant emphasis was on making those crews look like that was their 5000th MVA. They were very focused on the job at hand but made it clear that they were taking their safety for granted. The message is as much for EMS crews as it is for motorists.
  23. like I said.... it's a tube check first and foremost. Using it or not using it wasn't part of my post, except to say, like you, if you have it, take advantage of it. And it's very easy to fill the stomach with exhaled CO2 by mask ventilation.False positive ET CO2 happens with esophageal intubation
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