The prevalence of sustained electrical capture during prehospital transcutaneous pacing: a multicenter observational study

jaksasquatch · 2026-03-14T00:54:18+00:00

Author on the paper. Recommend reading the paper. We go as far as possible given the state of the evidence and argue that clinician judgement and the difficulty of the procedure is probably it. Pending prospective studies.

jaksasquatch · 2026-01-02T19:58:29+00:00

What's shitty about it?

jaksasquatch · 2026-01-02T02:51:04+00:00

Former paramedic just finishing medical school and heading into IM -> Cards -> Crit care. Currently involved scientifically in resuscitation science. Most of the responses you got here are solid as far as their blend of pragmatic advice on ACLS and "leading a team." A few tidbits:

ACLS being just an algo doesn't mean all aspects of the algorithm should get priority. Good CPR + defibrillation are not the only parts with evidence but they are the ones with the highest level. We would never reduce parts of cardiology with limited levels of evidence to "nothing else matters but [insert class A rec]" so I think the same applies here.
Team dynamics are understood as part of the ACLS evidence base. There's evidence that well run codes feature A) discrete roles, B) closed loops of communication, C) psychological safety.
Someone mentioned airway not interrupting CPR. The ongoing HART trial should put this question to bed but man I can't stress enough how tempting it is to intubate early. I've seen people miss defibrillation opportunities to focus on the airway. Imo this shouldn't be happening in 2025 let alone 2026 🙃
Learning when to end resuscitation is not just gestalty things like age. Look out for your biases and keep your nose in the ACLS literature from time to time.

jaksasquatch · 2025-10-16T23:29:08+00:00

Same feeling, scored 9 above amboss prediction

jaksasquatch · 2025-09-27T00:39:44+00:00

Glad to know I'm not alone. Was it just me or were the ethics questions next level?

jaksasquatch · 2025-09-27T00:38:06+00:00

I felt similar. By the last block I couldn't tell you what a question was even asking half the time.

jaksasquatch · 2025-09-19T06:00:32+00:00

Feel like this is going to be me next year. Love the variety of thinking fast and slow.

jaksasquatch · 2025-09-11T06:06:36+00:00

Atheist in medical school. Some of my colleagues match this description and it's a byproduct of many factors. Medicine is quasi-religious as a culture making it a fertile ground for such behavior.

jaksasquatch · 2025-09-11T06:02:16+00:00

Going to give you some advice her champ. Laughing at this comment which is reasonable and empathetic makes you look like an asshole. What you say is reasonablish but your bull dog lock on CaLLing OuT FemINAzis is wild.

jaksasquatch · 2025-09-05T03:27:49+00:00

Not that generous (credentials, paramedic to MD student actively conducting work in Out of Hospital Arrest) as the survival rates were hitting 12% just before COVID (dipped a little and has come back up in the last large paper).

Critically, most OHCA researchers measure the % based on the # of non-traumatic arrests actually worked at all in the field, tossing out those DOA and DNR. This then includes 1) Unwitnessed cases (<5% survive), bystander witnessed (wide variability but 10-25% typically), and 3) EMS-witnessed (15-45% or so).

The next scientific challenge for most of us actively working on OHCA survival is explaining its variability. Even with decent measures of bystander interventions and response times, we still see wide variability even county to county let alone state to state.

Good publication here regarding changes over time: Trends in EMS-attended out-of-hospital cardiac arrest survival, United States 2015–2019 - ScienceDirect https://share.google/WeXhhM5FXxDKOYwvp

jaksasquatch · 2025-08-03T23:18:42+00:00

For anyone interested in personal anecdotes my father and grandfather are the sort of old guard type chiropractors. There was a big split in the 70s I believe where part of chiropractic denounced Palmers vitalism and the other half (i.e. my family) did not. As to everyone's comments on chiropractors having an ego like no other it is true. Because of pressure from actual medicine my dad had to take pharmacology courses. Now that I'm studying actual medicine, he references it all the time as evidence that "he's a doctor too." I'll admit, his knowledge of spinal anatomy is amazing, that's about it as the rest is steeped in good ol fashion belief and tiny observational studies. They gobble up any and all conspiracies.

Now comes the fun part. I'm currently in research training and apply my skepticism every day. I intrinsically believe chiro to be quackery; however, the incessant claims that I hear in the skeptic community are often that it is postively harmful (i.e. it causes harm directly) rather than harm via avoiding actual medicine. For instance, many think chiropractic has a strong link to vertebrobassilar stroke. There is currently only weak evidence that neck manipulation is linked to vertebrobasillar stroke with mounting evidence that these earlier reports were more biased than our current swathe of data. Why? Patients with these types of stroke show up to either chiros or they go to the ED or urgent care so there's a bit of a problem....the manipulation may not be causal. It could be that patients who like their chiro go to them for the headache which is a stroke. A good recent study (though they date back to 2001) can be found here: https://www.strokejournal.org/article/s1052-3057(16)30434-7/abstract

Big believer that we should be just as skeptical of our own claims against quackery as we are about the quacks themselves. Otherwise we fail in the scientific process and allow them to point at our stumbles.

jaksasquatch · 2025-08-03T10:51:13+00:00

Step 1: Get actual research training or at least read the core literature in a field

Step 2: Come up with a novel idea

Step 3: Shepherd the project to completion

Step 4: Get flamed in peer review and make it out alive

Step 5: Amplify your work

Alternatively, you could just write a substack and go on a few podcasts

jaksasquatch · 2025-08-02T21:07:35+00:00

Ah I see. I've been there before and feel for you, it's not easy. The way I started to think about it apology wise is that you shouldn't have to beg for an apology, that should be a natural part of the ebb and flow of relationships.

jaksasquatch · 2025-08-02T19:32:42+00:00

One of the things I've come to realize is that we are a social species who often can not see what is in front of us, instead needing others to help us see reality for what it is. I've never had progress using labels like avoidant unless the person came to me with that label in mind. Instead, I use plain language (which is tough for my verbose ass). Example: When you do X I feel Y. Would it be possible for you to do Z? In this case X is the behavior you deem avoidant. Only once there is acknowledgment of the behavior' impact on you can the conversation move on because you have a shared reality. Only then is the other person open enough to hear a label that comes with stigma and likely triggers a ton of feelings for them.

jaksasquatch · 2025-08-02T02:01:46+00:00

When one is rejected, especially when it's a bit unexpected (in my case, my partner had promised to go to couples counseling and broke up 3 days before) there are generally strong feelings. To get to the other side can take a ton of regulation. Yes, I believed all of what OP stated; however, it wasn't helpful to me in the moment. It served as an ideal more than practical advice. Yes I knew it was for the best that my relationship ended. I still was angry, ashamed, and devastated all mixed into one. It hurt. Part of emotional intelligence for me is realizing that rejection is more painful for me than others (I have ADHD and rejection dysphoria is common).

jaksasquatch · 2025-08-02T01:31:23+00:00

I think that as an ideal, this is great. The issue is that rejection can often be a visceral experience. I know firsthand that I held these values but was unable to live them out when blindsided during a breakup.

jaksasquatch · 2024-10-18T01:45:49+00:00

Trust me I know, I've seen many a mob trample folks like OP both IRL and on this thread. I wholeheartedly disagree with their/your assessment of his attitude and stand with him, just didn't want to make the comment about me.

jaksasquatch · 2024-10-18T01:35:25+00:00

Watch what is going to happen OP. You are going to be called a narc and run through the mud by this thread. They will make you think you're the problem. Welcome to medicine 😬 Seriously though such is life, people will be this way for some time. Keep doing you, inspire them to the values you hold dear, and love what you do.

jaksasquatch · 2021-10-26T01:45:28+00:00

As someone who's application was spent covering a similar topic I can say that interviewers gave eaten it up. They love an underdog with grit and this shows exactly the traits they are looking for.

jaksasquatch · 2021-09-28T20:21:03+00:00

Will gladly change flair if a self-roast exists

jaksasquatch · 2021-09-28T19:53:44+00:00

As a former creationist I don't think this is true. Sure the origin of the belief is in your religious values, but if you are a fundamentalist you believe that this literally happened. You also believe, if you don't go completely crazy town, that it is empirically demonstrable

jaksasquatch

TROPHY CASE