So we had a very odd code today, and it's sort of two-fold...

70 y/o male, HX of diabetes and recent cancer remission (didn't catch what type of cancer). Had his last chemo treatment today. Takes insulin and Eliquis.

Dispatched as chest pain and sudden severe SOB. While enroute, advised CPR in progress. Obviously witnessed, bystander and cop started compressions immediately. Pt is purple from the nipple line up, all S/S points to probable PE. Apneic (agonal at least), and no pulse....

We take over compressions, apply AED (we're a BLS Fire Dept., I'm FF/AEMT, should've mentioned that) and I begin prep for airway and IV access. Here's where it gets interesting...

After about a minute and a half of compressions, the guy opens his eyes, starts trying to talk, and we have ROSC. Carotid pulse and even a weak radial pulse, and he's fairly well conscious at this point. BUT, the AED is still attached and analyzing, and advises SHOCK, while this man is starting to talk to us. Kinda weird right?

Ambulance arrives, monitor goes on and this man's vitals are near perfect. Monitor shows RBBB, and maybe a slow VT, but nothing that really jumps out. No cardiac HX either.

So my question(s)...was it a PE, or maybe a run of VT that put this guy down? Say it WAS a PE, could compressions dislodge an embolus to the point it is no longer obstructive?

And why would an AED advise SHOCK on a conscious and awake patient? Malfunction or actually detecting a shockable rhythm?

14 years doing this and I've never seen an AED do that. I'd love to hear the thoughts of people smarter than me, haha

Was first on scene to a collision between to e-bikes on my way home from work. Ironically I’m a bicycle mechanic in my day job. Ski patroller when not working on shitty e-bikes. One rider was up and yelling to call for help. Second rider was motionless. Pulled over, grabbed my first aid kit. Patient was laying prone with his head turned to the side. Multiple facial lacerations, skull visible through laceration on his head. Bleeding from nose and mouth. Was able to clear his nose and mouth enough to get labored breathing. Since blood was running out of his mouth I didn’t want to roll him as I was on my own without any method to provide suction or supplement breathing and was worried he’d aspirate. Another witness had 911 dispatch on the phone and we were only a couple minutes from multiple staging locations for our ALS provider. Found his wallet and got his name from his ID and started talking to him. Still GCS of 3. By the time I was thinking I should drop an NPA the FD arrived on scene and took control. Paramedics were just behind. He was still unresponsive but the time they were loading him in the bus. They’d intubated and were bagging.

I know I’m not in the chain of people who can get an update on his status. Already tried sweet talking the ED phone receptionist. But it sucks to not know if he is still holding on or not. We send a lot of patients to the same hospital during the winter so I’m going to see if my patrol director can reach out through the channels we typically use for updates.

I also ended up doing a witness statement for PD as I saw the collision. Hoping if I can’t get anything from our medical channels PD can at least till me basic condition of the dude.

His face after they flipped him is definitely ending up in the memories I wish I didn’t have file.

And please wear a helmet.

IFT EMT, there were two situations I was curious about from a HIPAA/professional boundaries standpoint. I’m not planning on doing either just curious!!

1). An old lady at an SNF used to teach Vietnamese and offered to teach me in her free time after i said i always wanted to learn, she then gave me a note with her number. Would it be a HIPAA violation to text her?

2). old lady mentioned feeling lonely and missing her family. Would it be inappropriate or against any rules to send her flowers to the SNF?

I can name 2 or 3 that DON’T… and it’s for religious reasons

Hi everyone,

I wanted to see how much of a difference acoustic design actually makes, so I tested the frequency transmission of a few stethoscopes I had on hand.

Setup & Limitations: I ran frequency sweeps from low bass up to ~3 kHz. Keep in mind that this is a DIY acoustic test bench: above 3 kHz, acoustic coupling and reflections make the setup less stable, but the range below 3 kHz covers the clinically relevant spectrum for heart and lung sounds anyway (S1/S2, murmurs, breath sounds). Every measurement was taken twice and both lines are plotted, so in the overlapping part they are very reproducible.

Graph:

• In the first graph (big membrane), the blue line is the no-name Rappaport, the red line is the MDF 747, the green line is the LuxaMed Sonus SX, and the yellow line is the MDF MD One.
• In the second graph (bell), the light blue is the LuxaMed, the dark blue is the MDF 747, and the violet is the MDF MD One.

A few interesting takeaways from the data:

• There seems to be no very big difference in frequency response between membrane side and bell side.
• All of them performed pretty similarly; however, the no-name one performed best, which was kind of surprising.
• Subjectively, the biggest difference was in noise reduction from the surrounding background noise; there the MDF MD One was best, followed by the LuxaMed, then the other MDF, and the no-name didn't reduce it at all.

Conclusion: I was really surprised to see the MDF MD One in last place in both measurements. I was pretty sure it would outperform all the others, but as far as I tested, the best bang for the buck (also considering sound insulation) is the LuxaMed. I also added some memory foam ear tips, which improve sound isolation even more, and with that mod it outperforms the MD One easily.

Questions for you:

1. Did I misinterpret the results, or do you have any other idea why the MDF MD One underperformed that badly?
2. Which stethoscopes would you like to see measured next?
3. What is your daily driver in the field/hospital, and what sound profile do you actually need in your specialty (med student, resident, attending, nurse, or paramedic)?

Curious to hear your thoughts!

Does anyone have any experience with First Due or Unified Solutions for ePCR and CAD?

We are currently using RescueNet Dispatch/emsCharts but are exploring other options due to costs. We are a non-profit, high-volume, primarily BLS-911 agency. ZOLLs costs are very high so we are looking to explore options.

The other obvious answers are ESO and Traumasoft. But I fear ESO’s cost will compare to ZOLL’s. And Traumasoft is just terrible for the end users. (At least based on feedback I’ve read online and my minimal exposure to it when a company I worked for briefly switched to it for scheduling.)

I am a big fan of how tech-forward both First Due and Unified Solutions seem. They have great AI integration from the admin side with abilities for natural language analytics reporting and DVR creation.

First Due is also fairly new but seems a bit more cemented in the industry, but I really can’t find much feedback on Unified Solutions. In facts I only learned about them at EMS World a couple weeks ago.

Open for feedback or suggestions on other platforms. We do want one that has an integrated CAD, so Imagetrend is not one we will explore.

Appreciate the assistance!