There has been a plethora of articles on management of SVT. ALiEM and REBELEM are two that stick out in recent years to me (references linked within article). Yet, I still speak to people who have not read much of the literature on SVT treatment, and have not considered making changes to their treatment plans. Also, I was recently speaking with Cynthia Griffen (@CMGrffn) about this, and she taught me some stuff too. This will be a quick article on what I feel would be a reaso

I once worked with a prehospital practitioner who at one time worked for a service that drilled 20 minute scene times in their head. If they didn't make a 20 minute or less scene time, the service would question the crew as to why it 'took them so long.' I was never a fan of this. I would frequently be internally irritated when someone would remind me of how long we have been on scene. "15 minutes" "20 minutes - we gotta go!" For certain types of calls, time does matter. I us

I will reluctantly admit that I am an AHA instructor... Whenever I teach ACLS or PALS classes and run students through scenarios, I hear people say a lot of the typical lines: Student: "I would start a NE drip now" Me: "What do you want to run it at?" Student: "5mcg / min" In the AHA classes I don't too often test to see if people actually know the logistics of how to perform that function in real life or not. However, when we get new clinicians at work, I love to test their

Consider a couple possible scenarios that may occur while testing a patient's pupillary reflex: Scenario 1: While shining a light into the R eye.. R PUPIL: No response L PUPIL: Constricts While shining a light into the L eye now... R PUPIL: No response L PUPIL: Constricts Diagnosis? Scenario 2: While shining a light into the R eye.. R PUPIL: Constricts L PUPIL: Constricts While shining a light into the L eye now... R PUPIL: No response L PUPIL: No response Diagnosis? The Anat

Eyes and Brains Sometimes I choose my blog subjects based off of a subject that I’m going to be teaching, or other times something I just have a peaked interest in at the moment. Pupils are something I have been meaning to dive into much deeper, and this blog is my first descent. Some might consider this type of physical exam knowledge low yield, but I consider it the coolest thing ever. Pupillary response and cranial nerves are incredibly interesting. Today we will mostly by

A while back I was introduced to a concept called ‘the stages of knowing.’ These three stages are based on the work of Dr. William Perry. It was broken down into three stages. Stage One: The Garden of Eden Stage Two: Anything Goes Stages Three: Thinking Critically I started to think about what stage most emergency providers fall into. I came to realize the answer really involves how much emphasis providers place on their education (and I don’t just mean during school). Much o

Chest tubes are great. They can overcome all kinds of obstructions in the chest - air (pneumothorax), blood (hemothorax), air and blood (hemo-pneumothroax), and even pus (empyema). We will be focusing on the anatomy and management of these systems in this blog (by request of a reader). This will be a no nonsense approach to managing the chest tube. Let's start with a few DO NOT items. DO NOT 1. Do not trust that the stitches will hold the chest tube in. There should never be

Once upon a time I had a critical care paramedic as a trainee. This individual had been in EMS for approximately two years, and was an FTO at another local service. I was very surprised to learn of the providers complete lack of knowledge base and experience. Get ready for my list. It's scary. They had never run a code, never performed CPR, never intubated in the field, never seen an RSI performed, never used an ART line, never physically touched a ventilator, did not know an

When do you consider your patient hypotensive? Many providers would answer with some sort of systolic blood pressure measurement, like under 100 or 90 mmhg. Others would argue that MAP should be used to indicate if the patient is hypotensive. Does one indicate organ perfusion better than another? A recent graduate of paramedic school told me that his class mostly focused on blood pressure, so he wasn't really sure why titrating MAP would matter. Let's examine what a regular

The patient absolutely cannot wait. Their blood pressure has been dropping for the last several minutes and there is no doubt in your mind that you must intervene. You have a choice to make. Should you grab... PUSH DOSE EPI x1 Cardiac EPI x1 Bag of 0.9% NS x2 Needles x1 10cc syringe Or are you going to grab... EPI DRIP x1 Cardiac EPI x1 Bag of 0.9% NS x1 Needle x1 IV pump tubing and pump Lately in FOAMed there has been talk about the pros and cons of each method of pressor de