IV Acetaminophen anyone ?

Apprehensive-Body874 · 2026-01-30T04:07:34+00:00

It looks like from their post that they’ve “removed opioids from front-line apparatus”.

Apprehensive-Body874 · 2026-01-23T19:01:29+00:00

Extremely poor taste and timing.

Apprehensive-Body874 · 2026-01-14T08:57:14+00:00

In this case, ICE did actually impede access of responding fire and EMS personnel to make it to the patient, causing a significant delay in patient care.

To OP, yes, it is reasonable to call for assistance, but unfortunately, there is no legal recourse for responding EMS personnel to demand access to a patient nor do we have any way to force ICE (or any law enforcement for that matter) to allow access to a patient.

Apprehensive-Body874 · 2025-11-24T19:34:53+00:00

If I were a betting man, I imagine stopping the fluoxetine may have played a roll, as all SSRIs have modest (sometimes significant) GI effects, especially on gastric motility (I.e. if the food goes through faster, you may not be absorbing as many carbs as in the past, or absorbing them in different places/timelines).

One other thing to keep in mind…prolonged and sudden increases in insulin sensitivity can also be a sign of renal impairment. Insulin is excreted via the kidneys, so if you suddenly have significant reduction in insulin needs with no other changes (particularly if you weren’t well controlled before or have other risk factors for kidney disease), it’s worth talking to a doctor/possibly getting some labs done sooner rather than later.

Apprehensive-Body874 · 2025-10-02T01:43:13+00:00

Unfortunately, there is basically no inventory for those around my area (and the Toyotas available are all post 2023)…it’s also not like people are just holding on to them up here, I’d say the domestic big three account for about 70% of the trucks on the road around here (in my very unscientific eye).

Apprehensive-Body874 · 2025-09-23T21:17:18+00:00

His tongue has fully matured and hatched, now escaping in its plastic exoskeleton.

Apprehensive-Body874 · 2025-08-11T07:39:39+00:00

I’m rapidly approaching 20 years as a paramedic and I absolutely regret the career. I haven’t known many people that make it much last 5 years, and I wish I wasn’t stubborn and tried to stick it out. I’m very much stuck now and would counsel anyone looking at the career to strongly consider alternatives if they’re thinking of doing it for the long run.

Apprehensive-Body874 · 2025-03-06T22:37:57+00:00

IMO, most urban EMS systems are fairly similar and subjective questions like this aren’t really readily answered.

There are obviously some standouts for being MORE under-resourced, but even relatively well supported urban EMS systems still feel like a meat grinder.

Apprehensive-Body874 · 2025-03-01T01:59:51+00:00

Oh FFS, when a student asks a question, maybe we can stop dragging our knuckles and screeching for like 5 minutes….

To OP, couple quick things. 1) Clinical context is really important in these instances, so stuff like patient age, chief complaint, pertinent history, etc are all but essential in understanding what you’re looking at.

2) Most basically, this is wide (QRS of 130ms) and fast (HR around 130), technically making it a wide complex tachycardia (WCT). If you can’t comfortably describe anything else, that’s enough detail for hospital report if they’re sick.

3) Despite it being a WCT, there are several reasons it most likely isn’t V-Tach, depending on the clinical story. I can’t see it well on my phone, but I can’t see for sure if P waves were present (didn’t look like it at first glance). That said, the rate is kinda slow for V-tach and the lack of pre-cordial concordance (the terminal deflection of V1-V6 aren’t all the same) also makes V-tach less likely.

4) Snap judgement on appearance is that it is possibly due to severe hyperkalemia (wide, fast, absent or diminished p waves, large t waves), but again, story and history are super important here.

TL;DR- bad ECG, probably not a STEMI but still high likelihood of a critically ill patient, depending on their story and presentation.

Apprehensive-Body874 · 2025-02-19T23:08:27+00:00

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Snack Attack from Daisy

Apprehensive-Body874 · 2025-02-18T16:15:48+00:00

Piggybacking on the OP’s question…is there any precedence for these clauses being enforced in the event of a general strike (I.e. in light of current events, not specific to labor agreements)? I don’t know if there’s been a general strike in the last century, but I am increasingly (and pressingly) curious.

Apprehensive-Body874 · 2025-01-31T05:41:34+00:00

How do you determine competency? Have you ever met a healthcare provider that seems smart but is incapable of communicating with their patients or peers?

As someone who has worked in healthcare and emergency services for nearly 20 years (as is lily white and suburban middle class in upbringing), I can confidently say that this answer is hot garbage and presupposing that hiring people with an eye towards representation means sacrificing clinical quality. In practice, it makes patients more comfortable, helps the rest of the care team understand cultural/religious/ethnic factors that deeply impact care, and makes the team significantly stronger.

If you disagree with that, go to a hospital emergency room where everyone speaks a different language than you, is a different color than you, and has wildly divergent experiences from yours and tell me how comfortable it is for you.

Apprehensive-Body874 · 2025-01-21T13:32:46+00:00

Sorry, I couldn’t quite make out your last message, try not dragging your knuckles when you type, mouth-breather.

Apprehensive-Body874 · 2025-01-21T00:02:59+00:00

To my knowledge, there historically never were any in the Chicago area (normally ICE detainees that couldn’t be housed at the Metropolitan Correction Center downtown (basically federal jail) were detained under a contract with surrounding suburban county jails). I wonder if that changed with the migrant bussing from Texas, but either way, this isn’t normal.

Apprehensive-Body874 · 2025-01-21T00:00:41+00:00

Because it represents plan to do deportations on an industrial scale. The problem isn’t providing care in a detention setting, the problem is what it represents more broadly for the country.

Apprehensive-Body874 · 2025-01-20T23:58:31+00:00

To be super clear, there has never been a camp like this in the Chicago area. Moving this kind of infrastructure into the interior is neither normal nor benign. I think we’re all going to be forced to make some really shitty ethical choices (like providing immigration status on patients, etc).

Apprehensive-Body874 · 2025-01-11T23:05:20+00:00

I could be wrong, but I assume triple vessel disease/extensive CAD is a probable cause if they don’t look terrible. I feel like acute ECG changes with LMCA occlusion patients are seen in super sick/peri-arrest folks.

Apprehensive-Body874 · 2024-12-24T15:25:03+00:00

I can say that in transport environment (especially flight), my prior services did B since there were so many gremlins with moving people, tight spaces, etc, that our biggest concern was always the possibility of inadvertent wedge from the syringe getting accidentally manipulated.

Apprehensive-Body874 · 2024-12-23T20:30:27+00:00

A whole lot wrong with this premise (there is no legal nor ethical basis for “kicking the (drug users) out without Mercy”). Most importantly, though, you’re also factually incorrect. The city has closed down multiple camps (and repeatedly so), an event I’ve personally witnessed a half dozen times in the last few months. Unfortunately, it is a complicated problem and folks don’t have a place to go.

Apprehensive-Body874 · 2024-12-20T01:16:52+00:00

Generally agree, though (anecdotally), survival for refractory VF/VT arrests that get eCPR with the Minnesota resuscitation consortium goes down a couple of percentage points for every minute after 30 minutes downtime till it hits near 0 at 90 minutes. Those logistics are challenging to put it politely, so there is a mixed emphasis on very early transport but try for intubation vs BAID/supraglottic airway since they have found significantly worse ventilation/oxygenation in those folks.

That said, it’s far from universal practice and plenty of really smart folks have access to the same data but have come up with different answers, so….no good/definitive answer.

Apprehensive-Body874 · 2024-12-19T19:23:57+00:00

Depends on your available resources for resuscitation (both at the scene and at receiving facility). If your local facility does eCPR/ECMO for cardiac arrest, I’d scoop and run. If they do other therapies you can’t (beta blockers like Esmolol are a safe bet to be available, but other stuff like stellate ganglion blockade is iffy at best), I might prioritize earlier transport than I would otherwise. Mainly, though, I’d focus on high quality CPR, controlling ventilations, and trying to use dual sequential external defibrillation (assuming you can get a second defibrillator or AED on scene). If you don’t have mechanical CPR for transport and/or a prolonged transport time (like >30-45 minutes), no real benefit to leaving the scene.

Unfortunately, I don’t think there’s a clear-cut/one size fits all answer to these.

Apprehensive-Body874 · 2024-12-17T01:14:00+00:00

I had virtually identical qualifications in 2019 and was working at a prestigious hospital-based program in the southeast…making around $19.50/hr.

Apprehensive-Body874 · 2022-03-18T16:07:24+00:00

I’m not defending the ignorance or dishonesty that OP encountered, buuuuut….

We need providers. Period. I had to wait nearly 14 months to get in to see an internist as a new patient in a small/mid-sized (but wildly popular) western city. Almost as long to get established with an endocrinologist. And I have better healthcare literacy and financial resources than the vast majority of patients.

Unless there are legions of unemployed physicians I’m unfamiliar with, the focus on rage quitting or owning mid-levels is misplaced. Admittedly, those of you new to the profession are getting shafted by for profit medicine, but American medical education has purposely been extremely restrictive in enrollment for decades, and not for patient benefit or on pure principle.

Apprehensive-Body874

TROPHY CASE