@karimbrohi I thought those were life saving. Please come teach almost all trauma surgeons in the US!
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Bryan Feinstein
565 posts
Bryan Feinstein
@bfeiny
flight paramedic, sar tech, EM and EMS boarded, live to ski. @seattlemtrescue medical committee.
Phoenix, AZ Katılım Aralık 2014
278 Takip Edilen243 Takipçiler
Interesting related fact came up in our Trust Trauma Audit today:
In the last 5 years at the Royal London, no patient with traumatic cardiac arrest and thoracotomy who survived prehospital & ED phases of care had chest compressions during resuscitation.
Karim Brohi@karimbrohi
no you don't, No You Don't, NO YOU DON'T. OMG.
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@bfeiny Hi Brian. We're sorry to hear this. We always encourage our passengers to remove all important items from their carry on, if gate checked. We hope the next time you travel is a more seamless experience. ^AL
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@united Thanks for spelling my name correctly. 🤨. About the same level of service I was treated with at DIA when you refused to let me on the flight that you had gate checked my passport and refused to try to remedy the situation
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@united You literally treated me as a criminal for checking my passport
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@bfeiny Okay, you may file a formal claim here: fly.united.com/jThXh9. They will review and reply directly. ^AL
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@united No I would like some type of compensation for the inconvenience
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@bfeiny For rebooking assistance you can work with our team here: uafly.co/3rwnAIq . ^AL
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@united They did not do this. I worked an ER shift the previous night until 2am. I was treated as a problem.
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@georgenh_ @ChrisRootMD Yes. EMS systems in St Louis are doing this and it’s reasonable with good training and active medical direction.
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“Step away from the needle”
- @ChrisRootMD
Should EMS move to simple thoracostomy?
#CCTMC2024
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You all can’t tell me how to live
Jace Mullen@_JaceMullen
And sorry I could not travel both And be one traveler, long I stood Choose my night for me twitter
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@jducanto @_JaceMullen @AirwayLegend Too bad propofol freezes way before then. Had it happen in me once in Wyoming loading a patient into the ship at -25
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@_JaceMullen Nilesh’s VieScope handled our -70 freezer pretty well and still worked @AirwayLegend I’d say an airway device freezing test is in order!
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Enjoy this progression of my mustache freezing while I got COLD in the National Ice Core Lab freezer!
I was a test subject looking at ALS trauma care in an arctic environment.
Bonus picture of why I am not MRI compatible right now
Denver-area medics should enroll!
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@DitchDoc14 @cpatrick_89 Strong work sir. Just used a big slug of ketamine to induce a 7 year old in status after valium, phenobarb, and keppra loads who ended up having HSV meningitis.
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A real privilege to speak about ketamine for refractory status epilepticus with @cpatrick_89 at #NAEMSP2024
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@DitchDoc14 @EricJaegerTNG It by definition is emergent procedural sedation without consent.
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Sedation for agitation “chemical restraint” should be treated like RSI or procedural sedation—full monitoring, airway prep, vitals. 🔑 points from @EricJaegerTNG #NAEMSP2024
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@DitchDoc14 For sure. Tons of flights that happen out of convenience or no other options (ground ambulance ETA >7 hours) that are not medically warranted. It's tough for everyone right now.
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@bfeiny Yeah that aspect of it is really hard. I don’t know what the right answer is for that scenario but a real problem for sure
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Interfacility transport has inherent risks. We should not be transferring in the middle of the night unless a critical intervention is happening shortly after arrival at the tertiary center #NAEMSP2024
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@omarkandah @critconcepts But this opinion is literally implied with direct physician oversight so try again.
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@critconcepts @bfeiny Not even trying to be rude. My opinion is from a scope of practice. Similar to APPs practicing medicine without physician oversight.
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If a paramedic asks you if they can intubate your patient they brought to your ED who needs the procedure….the answer should always be yes
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@michael22joseph @DanielRGerard @reverendofdoubt Thats completely different than a paramedic bringing you a patient or a flight crew picking up a patient. They are involved in that specific patient's care and are allowed to work under their scope of practice.
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@DanielRGerard @reverendofdoubt @bfeiny Most hospitals do not allow non-employees who are not credentialed to perform procedures, regardless of their license. If I go to the hospital across town, I can’t just go to their trauma bay and start helping out.
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@DadDocGamER Yea I think residency training should take priority unless the residents on shift want to teach EMS and they make that decision
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@bfeiny Agreed but I have never had that happen. Maybe it’s because of the residency, I wonder if this might happen more out in community? But agree I would always say yes.
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@joshmcgoo In the setting of an EM residency program, residents should always get first right of refusal.
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Very important for EMS to get reps AND active feedback, but also important for residents to get their reps, too. It’s a team sport - pros and cons either way
Bryan Feinstein@bfeiny
If a paramedic asks you if they can intubate your patient they brought to your ED who needs the procedure….the answer should always be yes
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@CSevareid @omarkandah And in the setting of an EM residency program, the senior residents are usually the best proceduralists in the ED. When's the last time your attending did an airway on their own?
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@omarkandah @bfeiny You realize people make the same argument against their family members having residents and med students involved in their care, right? And yet it's the only way people learn in healthcare. That includes paramedics.
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If you disagree with my opinion, I encourage you to still allow them to be involved in the procedure. BVM ventilation is such a crucial life saving skill that needs practice and these can be powerful teachable moments.
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It goes with out saying, any procedure outside their scope of practice, like awake intubations etc, do not qualify.
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