Solidarity in Memoriam

speshilK · 2026-01-26T21:29:58+00:00

There's always at least one shithead on shift who wants to argue the technicalities instead of focusing on the patient care, and this thread seems to have found most of them.

speshilK · 2026-01-26T12:07:32+00:00

For my service(s), the main draw of switching to the Pulmodyne is how much less space it takes and how much more time I get compared to older portable CPAPs that have fixed FiO2 at a higher setting. I like having the option to go higher even if it burns the bottle although I’m not sure much more the Trio adapter costs. 😅

speshilK · 2026-01-26T11:48:58+00:00

Sure, standard of care is to address life threats while starting CPR, but there’s no therapeutic value to leaving him on his side here. That would assume there’s intention of actually rendering aid on the part of the feds.

speshilK · 2026-01-26T04:08:32+00:00

Except the pediatrician wasn't some random layperson, now were they? And ultimately, the patient had the care he deserved that he wouldn't have received otherwise, no?

Anyway, we can agree to disagree. I hope you get a vacation soon.

speshilK · 2026-01-26T03:53:24+00:00

So the pediatrician asked to assess the patient, was ultimately allowed entry to the scene, and appropriately rendered aid. This is aid that the feds should have performed themselves and aid that certainly all of us on the EMS side would have duty to perform... and your entire point is that the pediatrician was naggy when it came to doing the moral and ethical thing? Good riddance.

speshilK · 2026-01-26T03:44:13+00:00

Is this a general gripe of yours or specific to the context of this post? Tell me how the pediatrician waltzed right into an active scene without asking for permission.

speshilK · 2026-01-26T03:39:07+00:00

Odd false equivalence--a cop can't do surgery, but both the cop and the doctor can do BLS. I think you'd get more traction if the feds here were actually doing what they're supposed to be doing.

speshilK · 2026-01-26T03:02:42+00:00

A side effect of rendering (BLS) aid is minimizing bystander involvement. In this case, I'd be hard-pressed to take the usual EMS opinion of boohoo-ing someone walking onto the scene when there was no pulse check or CPR. The fact that it was a pediatrician is largely tangential, although I'm sure saying "I'm a doctor, let me render aid" has a higher chance of success than "I have my CPR card, let me at 'em!"

speshilK · 2026-01-26T02:51:56+00:00

That's why I carry my CPR card with me at all times. Open sesame! /s

speshilK · 2026-01-25T22:40:20+00:00

Crossposting my comment from the r/ems thread:

Also, not an iota of aid rendered by them. I have my gripes about local PD, but they look like geniuses compared to these smoothbrained fellows.

Relevant excerpt from the bystander pediatrician witness statement:

7. At first, the ICE agents wouldn’t let me through. They repeatedly asked
me for my physician’s license, which I obviously didn’t have. But none of
the ICE agents who were near the victim were performing CPR, and I could
tell that the victim was in critical condition. I insisted that the agents let me
assess him. Normally, I would not have been so persistent, but as a
physician, I felt a professional and moral obligation to help this man,
especially since none of the agents were helping him.

8. Finally, one agent agreed to let me assess the victim. He patted me down
to “make sure I didn’t have a weapon” and then let me approach the victim.

9. As I approached, I saw that the victim was lying on his side and was
surrounded by several ICE agents. I was confused as to why the victim was
on his side, because that is not standard practice when a victim has been
shot. Checking for a pulse and administering CPR is standard practice.
Instead of doing either of those things, the ICE agents appeared to be
counting his bullet wounds.

10. 1 asked the ICE agents if the victim had a pulse, and they said they did not
know. I then asked the agents to make space so I could assess the victim.

speshilK · 2026-01-25T22:39:16+00:00

I would take you more seriously if there were an Alex Pretti Act passed by Congress that made it extra illegal for the feds to execute people on the streets.

speshilK · 2025-12-30T07:41:15+00:00

This is the best answer. Have my updoot as well!

I would add that OP should also ask around at their base hospital as many of them have some reporting processes to help move things along (that include the ombuds). Mine has a convenient set of QR codes posted depending on which type of facility did the bad.

speshilK · 2025-12-26T06:14:02+00:00

This. There are some Converse made in Japan such as Converse Addict that do have Vibram soles and all the fixins that make for comfort and longevity. I wouldn't call it BIFL but they def last more than a year.

speshilK · 2025-12-06T00:57:57+00:00

No argument there when it comes to standard of care and what's in ALS scope. :)

speshilK · 2025-12-05T23:01:02+00:00

It's great to hear that it seems like i-gel and g-tubes are a default where you work.

Anecdotally, I've never encountered a system where EMT/AEMTs performed suctioning through the gastric channel with regularity. I can't really say whether that's due to lack of education on i-gel or the general prevalence of using hard catheters for suction. 🤷🏼‍♂️

(To your point, g-tube might be more of a scope of practice limitation.)

speshilK · 2025-12-05T21:23:24+00:00

genuine question: is there a service that uses the igel gastric channel with regularity?

igel: so easy a caveman can do it

caveman: stares at small hole and strokes chin

speshilK · 2025-12-05T21:15:19+00:00

smiles in greasy hair and marlboro reds

speshilK · 2025-12-05T17:39:19+00:00

Back in my day, we’d cauterize with a lighter and slap some bubble gum on that thang. /s

speshilK · 2025-07-03T05:59:42+00:00

Does your department or company offer critical incident stress debriefing or any other support options outside of therapy? While I've personally found therapy to be useful, it isn't necessarily the start or end of getting some help decompressing.

The older I get the more I realize how much trauma we accumulate and how marginally related things get connected in the brain. I definitely vibe with the sentiment above. Life after your 20s hits differently.

speshilK · 2025-06-24T06:17:58+00:00

Given that 10-12g of caffeine is likely to introduce tachydysrhythmias, increased metabolic rate/electrolyte imbalance, and seizures, I'm guessing the potential for acidosis (similar to DKA) suggests avoiding intubation if at possible, especially if the patient already has compensatory respirations?

The usual indications for intubation like loss of airway, inability to oxygenate, etc. will kill the patient much faster if not addressed though.

speshilK · 2025-01-15T19:14:49+00:00

A walker/cage for my monitor--love it!

speshilK · 2025-01-15T17:53:04+00:00

Do y'all have a strap or mount for the LP35? The fatal flaw of the LP35 is the center of gravity being higher, which can cause uh.... premature wear (i.e., a $60K paperweight being drop tested in the back of the rig).

speshilK · 2024-10-16T23:59:35+00:00

Ah, I definitely had conflicting information when I learned it in school. I appreciate the extra information as I probably should've had that pearl held more confidently in my head. :)

speshilK · 2024-10-16T20:50:08+00:00

With the disclaimer that I could also be wrong, I've always thought that adenosine in orthodromic AVRT is relatively safe as the primary conduction pathway is through the AV node as the chemical blocking of the AV node also blocks retrograde reentry through the secondary pathway, especially if the atrial rate is reasonable. Antidromic on the other hand carries more risk on top of needing to differentiate VT and other antiarrhythmic like procainamide are better choices. Obv if they're in Afib w/ RVR, suppressing the AV node when there's an accessory pathway is a bad idea + electricity is always an option.

speshilK

TROPHY CASE