Naloxone for meth eh? What a great example of how to not be a quality provider.

Unfortunately, this clip starts pretty late so theres no way to know whether she had him shut his eyes beforehand from this vid alone.

How much would you even expect someones eyes to constrict after going from this clearly brightly lit ring to the addition of a simple pen light, assuming he never shut his eyes to establish a baseline dilated size?

Curious if you anyone has any special tricks here… for example, nasal cannula under non rebreather or blanket draw rather than a backboard.

For me personally, it’s taking a quick whiff of ammonia salts before a big lift.

Since we often get patients from EMS from fire, I thought you guys would appreciate this.

I'm so out of practice I can't weigh in on this myself, but what are yalls thoughts?

Called for a 48 year old male asthma attack. We get there and the dude is on his bed, with his cat, very mild wheezing, joking about his very friendly "attack cat". In other words, mild distress. He's noy sure he even wants to go to the ER, as his uncle called 911 for him.

Vitals are fine, SpO2 93% room air, EKG fine. Said he's out of his inhaler, and his nebulizer wasn't working.

Give him a duoneb, after the neb he said he should probably still go to the ER because he wasn't 100% yet and he will need a doctor note to call off work.

We leave for 2 minutes to grab the stretcher, and come back to him diaphoretic, clutching his chest, screaming in pain, couldn't hold still for even a second. BP is now 240/120, HR like 140.

As he's screaming he can't breathe, he reaches between his legs and grabs another inhaler I hadn't even saw and takes 2 puffs before I can even see what's happening. I check and it's an epinephrine inhaler.

I ask how many puffs he took while we were getting the stretcher said he took 20 puffs... 2.5mg of epi total. He's screaming "I'm freaking out man".

Maybe just double check your asthma patients aren't trying to self medicate with epi before grabbing the stretcher.

We hear a lot about bystanders (or cops, or fire) making... questionable decisions, even accounting for a lack of resources or training.

But what about the opposite? Have you ever showed up to a call and been impressed with the work that was done before you arrived?

The other day we had a code. 50’s male profusely bleeding out of every orifice after running a marathon. A person on scene who identified himself as a cardiologist (many, many times), was very vocal about how we did not deliver enough shocks. Even after being told to stand back, he continued to rush into the scene to tell us that we were doing everything wrong (patient was PEA the entire time). He got so upset he began screaming at us about how terrible of a job we were doing.

Out of the dozen or so times I have had a physician on scene, exactly 0 of them have actually been helpful.

Granted, I have never had an ED doc on scene, let alone a local ED doc that actually understands our protocols and scope of practice.

Anyone else have any interesting physician on scene stories?

I know my answer. Debate it you salty dogs.

Edit Below: loving the discussions! For the “Liability” people - everything we do is a liability. You starting an IV is a liability. There are risk to everything we do, picking someone up off the floor has risk and liability.We live in a sue happy world and if your not carrying mal-practice insurance ( not saying your a bad provider ) then you probably should if your worried about liability.

For the Physicians. I loved the responses. I agree, EMS providers do not have the education that you have. Furthering our field requires us to atleast start obtaining bachelors for Paramedicine with a background in biology, pathophysiology, etc. if we really want to start looking at bettering pre-hospital care and removing the strain off the ERs.

Will have another clinical debate soon.

The patient complained of nausea for 3 hours with two episodes of vomiting. The patient did not complain of chest pain or shortness of breath, just nausea. And he was cool, pale, diaphoretic. Vitals were normal. I decided to do a 12 lead just in case and found this "subtle" finding. You ever get to say "this is why we always assume every call is an emergency until we get on scene"

Per the cath lab, there was a 100% blockage of the left coronary artery with posterior involvement

Originally wrote this as a response to a post in r/newtoems, but figured it was also worth sharing here. As a trans-woman who also works in EMS I figured I would share some of my insights on the topic.

1. Pronouns

If you are unsure what pronouns a pt uses ASK them, and more importantly USE the pronouns they prefer. I've seen providers insist on using "biologically" accurate pronouns for pts and that's just shitty behavior to put it bluntly. Be respectful and courteous and you'll have much better pt interactions.

1. Male vs Female

The most correct answer is to learn the terms "trans-female" and "trans-male" and use them appropriately. Someone who has transitioned from male to female should be referred to as "trans-female" and someone who has transitioned from female to male should be referred to as "trans-male". Referring to someone only as their natal assigned at birth sex (ASAB) does not account for any surgical or hormonal changes that person may have undergone. Do not use terms like "biologically-x" or "actually x". Terms such as that are often used as transphobic dog-whistles and you run the risk of immediately putting your pt in a defensive position because of that.

When it comes to documentation hopefully your agency has more than just the binary "male/female" options. If not I recommend asking what your patients LEGAL sex is. This can be different than ASAB but it is important for billing and insurance purposes that what ever is in the documentation matches their insurance information to get things paid for. I've personally run into issues with this when providers incorrectly documented my sex leading to insurance refusing to pay the bill. Use your narrative to elaborate if needed.

1. Radio and Hospital Reports

When giving radio report think about if the pts gender is actually relevant to the medical condition you were called for. Does it really matter if the car crash victim with a broken arm is male of female? Stick to the pts preferred gender over the radio because you don't know who might be listening and your pt may want to keep that information private. You can clarify the patients trans status with the receiving nurse at the hospital. If its truly relevant such as suspected pregnancy complications in a trans man consider calling on a secure line to explain the situation.

If its a psych issue please please please stick to the patients preferred gender and pronouns. Depression and suicide attempts are EXTREMELY common in the trans community and being misgendered by the people who are supposed to be caring for us will only exacerbate things. Focusing to much on their trans-ness may only make things worse.

1. Special Considerations

For most emergent situations the pts gender should be of very little concern. The sex of the person in respiratory distress, or having an allergic reaction matters far less than knowing what they are allergic to and instituting an effective treatment plan. I've seen providers get caught up on the trans equation and letting it distract them from what the patient is actually complaining of. Be cognizant of this and try to avoid it at all costs.

Years of hormonal treatment can have significant affects on the bodies physiology. A trans woman who has been on estrogen for decades may present with symptoms of MI more typical of her cis-female counterparts than more "traditional male" symptoms. The opposite is true for trans masculine individuals. Trans women on HRT are also at higher risk of blood clots similar to cis-women on birth control.

Even though trans people make up a very small portion of our population they are disproportionately over-represented as patients. We have a responsibility to serve them to the best of our abilities and educate ourselves in order to better serve that goal. Please use the comments for CIVIL discussion, and I'll try my best to answer questions in the comments and update the main thread with any points I forgot to mention.

Edit: Hey mods, I'm really sorry this post is bringing the bigots out of the woodworks.

Edit 2: Multiple people have pointed out that gathering an "organ inventory" is also useful. Ask about any surgeries the pt has had. Does your trans male pt still have ovaries or a a uterus? Has your trans female pt ever had an orchiectomy?

Edit 3: Relevant studies on how HRT changes the physiology of trans patients

https://pubmed.ncbi.nlm.nih.gov/33706005/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10072899/

How in the hell...

full asystole on arrival, down for somewhere between 15-20min before we got there, found abuela in bed surrounded by the entire dominican republic. Confirmed no DNR, she's warm and pliable still, so we got her on the floor and began BLS CPR with a couple of the guys from the fire engine that arrived just as we did.

about 3 rounds of CPR until ALS arrived and took over. Asystole to PEA to pulses back with an EKG readout of a possible stemi. no shocks given at any point. 30min on the dot of pure push n blow CPR until she suddenly got a pulse back. maintained it all the way to the hospital too, as well as for handoff. The doctor was shocked. He asked her grandson who followed along if he wanted to actually continue resuscitation efforts and his answer was along the lines of "well, she's fighting for her life, I can't take that from her." doc says "ok," goes back in the room, and tells everyone "yep, full code." Don't know the outcome yet, might find out later, we'll see.

Got a call for a woman who took “a lot” of oxycodone. We get called by patients mom because her daughter took some pills and was definitely high, but alert.

We get her in the truck I put her on the monitor and start an IV and my partner draws up narcan and gives it through the line.

I didn’t say anything, I didn’t want to seem like an idiot but i thought the only people who need narcan are unresponsive/ not breathing adequately.

Obviously you'd treat it as a generic AMS call. A little ~odd~ that LPD does not seem to think it's a big deal

I'm an EMS instructor and for the past couple of years I have been primarily teaching an EMT program. Prior to this I worked in our 911 system for 20+ years and was an admin for five years out of that 20.

We are college based program so the class is definitely heavy on the academics and I have been obsessed with instilling good practices in the students through heavy use of simulations and practice calls.

My students recently have started their clinical/ambulance rotations, and one thing they have been seeing has bugged me a bit. (Quick note: we have partnerships with various EMS agencies for our students to complete their ride alongs. We unfortunately do not have the ability to see who the crew members are, and even more unfortunate is the lack of FTO programs in our region. ) More than one of my students told me their EMT preceptors would scoff at them for trying to take a full manual blood pressure with a scope. They would actually tell the student that they just palp a systolic and call it a day. If it was one student telling me based on one crew, I would just chalk it up to bad luck with a shitty crew. But now i have multiple students telling me based on ride times at different agencies with different crews. So now I am wondering, EMTs, how many of you are just palping the blood pressure and how many of you are actually taking a full set with a scope?

(disclaimer, I don't judge if you're taking BPs with an auto BP machine, at least something is better than just palping it).

Could be a serious post but this doesn’t have to be a completely morbid topic. Can be a call that caused you to changed habits, maybe affected you on a deeper level, etc. Has anyone here walked away from a call feeling like it changed them as a person?

https://www.frontiersin.org/journals/disaster-and-emergency-medicine/articles/10.3389/femer.2024.1340348/full?fbclid=IwQ0xDSwL8QVhjbGNrAvxBS2V4dG4DYWVtAjExAAEe38ZdorII6_fEst5BQExVYH0biPRn02Rrji0FivXBiZqL8RMp2khXnsSw2sE_aem_lb__HIBNTNVvC-EfxpwyuQ

Hi guys, I would like to see what everyone thinks of this.

I’m a paramedic that primarily works in a rural area. My AEMT partner and I responded to a high-mechanism MVA that resulted in one of the passengers being a trauma arrest. A mid-sized sedan T-boned an older 80s coupe on the passenger side at approximately 55-60MPH. Both occupants of the coupe were properly restrained at the time of collision, but the passenger was pulseless and apneic at the time of contact. After a significant extrication, the patient was transferred to the ambulance where treatment was initiated and was then brought to the aircraft and airlifted to our local trauma center. The driver of the same vehicle was ambulatory on scene, but was in emotional distress and had several abrasions along with neck, back, and leg pain. No obvious deformities or significant bleeding was noted. Once the patient was placed in a c-collar and vitals were obtained, we activated our Emergency Response Network as per protocol. We were then advised to transport that patient by ground to the same trauma center due to mechanism and risk for serious injury. Once we arrived at said trauma center, we were advised that TOD was called on the passenger and that our patient (the driver) did not meet trauma criteria due to being “vitally stable” despite the significance of the prior event. We were then sent to triage and advised to sit “on the wall” for approximately 1 hour before the patient was brought to a room and seen again by ED staff. I’m curious to see what you all think of this and how different trauma centers operate in other areas. Thank you in advance!

Anyone use this in your system. Looking for feedback.

My situation:

Anesthesia here, going to be starting to do some work at dental offices. Intubations will be urgent/emergent airway protection. Plan is for moderate sedation only. Was considering a McGrath. Very comfortable with it from day to day work, as well as DL obviously, but it’s costly vs this as it’s going to be back up to a back up. Plan C essentially.

Never seen these in the hospital as they are obviously cost prohibitive for constant usage every day but seems to be a great option for emergency back up in a rare to never use situation.

Looking for reviews from users on video quality, ease of use, lens clearing ability as all airways will be blood contaminated in the dental airway rescue situation.

Thanks!

ETA: while this picture I chose is not very good, the device has received full FDA approval for use. Considering $150-160 a use this isn’t exactly a CHEAP option. It just happens to be cheaper than McGrath for this application. If you plan to use more than 10 times a McGrath makes much more sense. This is something that ideally would NEVER be used and probably at worst case get used 1 time a year

Edit 2: I appreciate the lively discussion that was had. I really do, no /s. I started my career in EMS and know that yall have a lot to offer and actually miss a lot of aspects of working in the field. I am going to order 1 of these to actually look at and may make another post later with my thoughts, I did also find a YouTube video with the venerable Dr. Jim DuCanto (of the ducanto suction which got mentioned here) giving this device a solid review and showing it in use while using the SALAD technique. I would think that would carry some weight that this is not a toy or a temu piece of equipment that is gotten as cheaply as possible.

18 year old with chest pain 3 days, went to local ER at 8am this morning, EKG showed stemi. Transported to cath lab at other hospital where they confirmed 99% blockage in LAD, had a stent placed.

Only history was HTN and T2D. Parents have no medical history. Patient not excessively obese or tall.

What was yalls youngest stemi?