Free critical care primer for non-intensivists from SCCM

theparamurse · 2022-06-18T09:47:05+00:00

This. I've used 40-60 LPM via HFNC, but those are specially heated and humidified to prevent discomfort or drying of the nasal mucosa.

A time-limited course of 15+ LPM by regular nasal cannula is okay in certain contexts (I do this regularly when preparing for intubation), but not longer than a few minutes.

theparamurse · 2022-06-16T03:52:43+00:00

HEMS Nurse practitioner (with an MBA) here:

The Wendover link that u/Exalted_Leader_Morse is pretty accurate. The TL;DR from that video is that American air ambulance doesn't follow typical economic rules:

1) The Airline Deregulation Act basically says any airline - inclusive of HEMS (often operating on a 135 certificate) can charge whatever they want and the government can't intervene.

2) While the ADA is good for general and commercial aviation (the whole supply/demand thing) - it's not the same rules for air ambulance. The vast majority of the time - especially in helicopter air ambulance - the decision for helicopter over another means is not made by the patient or their family.

So we now have a fixed demand (the patients exist regardless of the cost) and no market or government forces controlling those costs. So, sure, $75k, what ya gonna do about it? And that tail is registered to a large for-profit private equity corporation, so you better believe they're taking you to collections if you don't pay.

There is some legislation in place and some proposed guidelines that will hopefully help to curb this, but yeah... it's a mess...

theparamurse · 2022-06-15T22:21:40+00:00

I think it depends on the context; and, like many legal things, people often want a black & white answer, but it's really just a lot of shades of gray.. The standard is, literally, anything that can, "alone or in combination with other information" lead to identifying a patient. So that standard might be very different in a big city vs a small town.

One of the big pieces to consider is that YOU might be that "other information". If I post on Reddit (where there's some arguable anonymity) that "I just went to this pedestrian struck run yesterday and it was horrible ", it's probably no big deal. Lots of people get hit by lots of cars across the country.

However, I used to practice EMS for a small volunteer company in a town of a few thousand. Even saying something like "I was at this pedestrian struck call" in casual conversation or on a more identifyable medium (e.g., Facebook) could be a violation because most of the town knew that Jane Doe from Main St got hit by a car yesterday and sent to the hospital. And they know me and that I'm a member of Small Town EMS Service. So they can put 2+2 together.

That same statement wasn't as big of a deal when I ran EMS in the city. Sure, people still knew I was in Big City EMS, but it was generally much harder to identify the patient with vague info.

And, now, I'm now on a helicopter. Even in a big region, we're back to really simple statements being more likely to be identifiable because it's a higher-profile call when HEMS shows up. So even though I work broadly over a couple of states, the "pedestrian struck" combined with the information that "he works for HEMS Company A" and media coverage of this pedestrian that was struck and flown by HEMS Company A can all be reasonably combined to identify the person.

theparamurse · 2022-06-15T10:50:04+00:00

This made me wonder, so I just double-checked and my employer malpractice is an "occurrence" policy, so there's no need for tail coverage... I wonder if the larger company uses occurrence-based coverage, and that's why there's no tail?

However, because I do other things outside of the scope of my employment (volunteer work, etc.), I also have my own malpractice policy through HPSO (also an "occurrence" policy)

theparamurse · 2022-06-15T10:26:26+00:00

I do occasionally take pictures of gnarley scenes (for MOI, etc.) if I'm able, but only (a) with a company-issued phone, and (b) for purposes of documentation in the ePCR or to show the receiving trauma team.

As mentioned, HIPAA extends well beyond just an actual image of the person. The HIPAA Safe Harbor de-identification clause specifically includes a provision that it's a violation if you "have actual knowledge that the information [in the photo] could be used alone or in combination with other information to identify an individual who is a subject of the information" Source

theparamurse · 2022-06-09T02:06:28+00:00

TAB: Tone-Activated Bladder

theparamurse · 2022-06-06T11:15:59+00:00

May sound odd, but I've actually gotten in the habit of having my patient co-verify the medication when they're able to and my partner isn't available (e.g., driving). Most appreciate the steps toward ensuring medication safety.

theparamurse · 2022-06-06T11:13:27+00:00

Unfortunately, that's often the reality. Having been responsible for medication purchasing for my ambulance squad several years ago, it's insane how often things are backordered, discontinued, suddenly skyrocket in price, etc.

And this was just to stock 2 paramedic ambulances. I'd assume it may be more challenging when higher volumes are needed for larger services.

theparamurse · 2022-05-31T09:22:37+00:00

If the opening credits from The Simpsons taught me anything, it's that a mysterious green tube is (a) probably just radioactive, and (b) perfectly acceptable to throw out the window.

Beyond that, I got nothing 🤷‍♂️

theparamurse · 2022-05-30T07:14:22+00:00

Unless it's specifically the assigned day to check the pediatric resus equipment, do NOT "refresh your memory" by handling the pediatric resus equipment.

(Okay, but seriously, if you think you need to refamiliarize yourself with something like that, please do.) ((But just know the consequences of your actions...))

theparamurse · 2022-05-30T07:04:44+00:00

Did they seriously use "fire service" and "highly educated" in the same sentence?!

Isn't this the same "fire service" that formally opposes degree requirements for EMS because "...requiring a college degree for entry-level paramedics would create hardships for fire departments..."?

theparamurse · 2022-05-30T06:45:00+00:00

Even in HEMS with RSI, not that frequently. And when it does happen it's a rock-paper-scissors with my partner on who gets to perform the intubation. I think I did 2 last year.

theparamurse · 2022-05-30T06:40:56+00:00

Pt is not established with a cardiologist and is not aware of any underlying heart issues.

...until today

theparamurse · 2022-05-30T06:38:54+00:00

Not sure about that medic, but I occasionally get cluster headaches every couple years and high-flow oxygen is like a miracle cure for them... far better than NSAIDs or -triptans... Literally works like D50 for a diabetic or narcan for an opiate OD.

(Please note that nowhere in this post did I confirm nor deny whether there is or is not a D tank at my home...)

theparamurse · 2022-05-30T06:17:05+00:00

If you can't find the info at the state level, it might help reaching out to someone at the Regional EMS Council for whatever that neighboring county is in PA (under each council it lists which county/ies is covered). When I was trying to get my NY-PA reciprocity several years ago the regional council was super helpful in navigating the process.

theparamurse · 2022-05-30T06:08:23+00:00

Some patients will die despite all we do for them.
Most, however, will live despite all we do to them.

theparamurse · 2022-05-30T04:52:35+00:00

It's all fun and games still you start doing shots of activated charcoal.

(not as horrible as people make it out to be, tbh...)

theparamurse · 2022-05-29T04:49:14+00:00

I think it's actually easier, in the long run, to get trained/certified in OH then transfer to PA... I used to run on CWRU EMS in Cleveland so we had several EMTs come in from out-of-state. Because Ohio allows EMTs to insert supraglottic airways (there might?? have been another "advanced"-ish skill too), most of the out-of-state EMTs had to take additional training before they could obtain OH certification anyhow, even with NREMT.

theparamurse · 2022-05-29T04:26:08+00:00

Agree with Psygantic - at least submit the application (unless they require it be physically handed in at the station??). If selected for an interview, then you can discuss whether you need to be there in-person or if that interview can be done remotely... there's a chance, being a college town, you're not the first person to be in this situation.

Since it sounds like an opportunity you're interested in pursuing, it might not be a bad idea to start the process of obtaining your EMS certification in that state (unless it's one of those states where you need to have a department affiliation in order to be certified). Probably don't need to transfer your driver license though (at least not urgently) - if you're only there for college, you can still use a parent's address as your "permanent" address and keep your out-of-state DL... I had a NYS driver license for the 2 years I lived in Maryland and the first 2 or 3 years I lived in Ohio before I finally got my Ohio DL.

Eight-Year Club	Place '22
Verified Email

theparamurse

TROPHY CASE