Refusal Heuristic Traps:   How to avoid heuristic traps:     Competency Vs Capacity: Competency is a global assessment and legal determination made by a judge in court. Capacity is a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient’s case. How does a patient demonstrate capacity? •Understanding – The ability to understand, i.e., knows the information being presented. Consider a patient who is having a COPD exacerbation, they know they have it, the treatment for it, and the benefits and r ..read more

Joined by Peter D. Akpunonu, MD, Haedan Eager and Ben Doty, we discuss their recent paper on "Managing the Effects of Riot Control Agents" and throw in a little trivia - and discuss relevant and practical management principles for patients exposed to incapacitating agents ..read more

Don't you wish someone explained what viral load, viral shedding, and all those other words we use loosely when talking about COVID-19? Well.... our guest on this podcast did, and we think you'll really enjoy getting back to the basics, and then some. Dr. Ryan Mynatt is a practicing PharmD specializing in infectious disease, and like most academics who know anything about anything, he's responses were a little guarded - which is most appropriate right now. You can view any of his many publications here. Oh, he's also on Twitter. Let us know what you think of the podcast ..read more

In this podcast we discuss a gift box of items regarding treatment considerations for reducing aerosol generating procedures. As with the previous podcast, this is a dynamic situation, and the information is not guaranteed to be accurate. Please share your thoughts and what you are doing at your own department.  ..read more

Let's start by saying that I am not an expert. But, specific guidance from the CDC for managing these patients is available, but I feel like the dispersal of this information is critical to front line EMS providers. For links to important sites and to see images of the BVM and ventilator setup, go to curbtobed.com ..read more

In this episode we take a new look at the pathophysiology behind tension pneumothorax and how it presents in the real world population, and discuss why we should pause before inserting the needle in the 2nd intercostal space.  ..read more

Hyperkalemia Intro Potassium is primarily an intracellular ion responsible for maintenance of the resting membrane potential for normal cell conduction. Serum measured potassium is typically between 3.5 and 5.0 mEq/L. Serum K greater than 5.0 mEq/L is generally considered the threshold for hyperkalemia. Potassium is mostly excreted via the kidneys, and the "classic" hyperkalemia patient is one who has missed several dialysis appointments complaining of paralysis or diffuse weakness. Causes of HyperK Most commonly, renal failure.  Transcelluar shift  DKA Acidosis  Other acid ..read more

Transporting a sick DKA patient is challenging. Surprisingly, there's a bit more to it than "just" administering fluid and monitoring an insulin infusion. Read more and find references at curbtobed.com ..read more

In our first official “vodcast”, we discuss pearls and pitfalls of transcutaneous pacing, and how it’s much more difficult than “you either have capture or you don’t”. “Phantom” complexes are rarely reported on or discussed in Paramedic school, but one monitor manufacturer appreciates how they can make verifying true electrical capture very difficult. The folks over at ems12lead.com have put a lot of work into providing education and spreading the word around the problem of false capture.  ..read more

First, there are two proposed mechanisms of CPR, brilliantly summarized in this paper: Cardiac Pump Mechanism: “blood is squeezed from the heart into the arterial and pulmonary circulations, with closure of the mitral and tricuspid valves, preventing retrograde blood flow, and opening of the aortic and pulmonary valves in response to forward blood flow. Air is thought to move freely in and out of the lungs, so that the intrathoracic pressures do not significantly rise and the pulmonary circulation is not adversely affected by chest compressions. With the relaxation of chest compression, t ..read more