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I'm glad I could help! Thank you for watching. -Alex

Thank you for watching! I definitely plan to continue Paramedic Pathophys eventually. Stay tuned. -Alex

I'm happy that I could help! Thank you for supporting my channel. Is there anything that you'd like to see in the future? -Alex

Thank you for continuing to support the channel! -Alex

No problem! Thank you for watching. -Alex

You got it! Atropine is also useful in cholinergic syndromes (caused by organophosphate pesticide/herbicide, sarin, VX gas exposures), and even as a premedication prior to intubation for certain patients. -Alex

Thank you for the support! Please spread the word! -Alex

Great question! Unfortunately for this patient and those in similar circumstances, the swelling from the airway burn will continue to get worse until you have a complete obstruction of the upper airway. For these patients, early intubation can prevent this catastrophic airway loss from occurring. If you wait to intubate or do not have the protocols to intubate, your patient will likely become a CICO (cannot intubate, cannot oxygenate). This is the worst case scenario, which leaves you with only one option: emergency cricothyrotomy. Sorry for the late reply. -Alex

Cashis, Thank you for the support. I actually do have skills videos (and will have an I-Gel video posted later this summer). They are located in my playlist: "Hands on Skills". ruclips.net/p/PLLCPLbS1KRSnbJMeQfVwYrTik51cMNs9o -Alex

Tony, thank you so much for watching! Is there anything that you would like to see in future videos? -Alex

Im happy I could help! -Alex

Thank you so much. I wish you the best of luck tomorrow! -Alex

Same here mine is tomorrow. Strong work on these videos.

Good luck tomorrow! -Alex

Great question! This patient is in septic shock, which is a form of distributive shock. Distributive shock causes a decrease in peripheral vascular resistance due to losses of vasomotor tone and increased vascular permeability (the capillaries and small vessels get floppy and leaky). MAP is so important in septic patients because it is a direct measurement of peripheral vascular resistance, and a much more specific indicator of end-organ perfusion. By using MAPs to guide fluid resuscitation and vasopressor administration, we are less likely to overhydrate our patients and more likely to begin appropriate vasopressor therapy than if we are only focused on improving just a systolic blood pressure value. Why 65 mmHg? Because it was determined that this was the absolute minimum pressure needed to ensure critical organ and tissue perfusion. For septic patients, the higher the MAP, the better the overall prognosis. -Alex

One other quick thing to tie it together! As you improve the MAP, the tissues will become better perfused and therefore oxygenated, decreasing the need for anaerobic metabolism to occur in these tissues. Anaerobic metabolism produces a significant quantity of lactic acid - detectable with blood work, or correlatable to a drop in ETCO2 on a capnogram. This drop in ETCO2 is caused by the body's attempt to correct lactic acidosis by creating a crude respiratory alkalosis (increasing respiratory rate). By perfusing/oxygenating these tissues, they will revert back to aerobic metabolism and the lactic acid production will decrease - which will cause a normalization in ETCO2 on a capnogram because the body is no longer attempting to correct lactic acidosis. -Alex

Thank you for the response!

Jose, Thanks a lot! Stay tuned for more. Including a brand new STATIC CARDIOLOGY video coming very soon. -Alex

No problem! I will have more radio report videos posted soon. -Alex

@@EMTV1 I've recently watched all of EMTVs ECG cards. They were awesome. Very thorough, comprehensive, and easy to follow. It is indeed great material designed specifically for medic/EMT students. Not sure why there's not a huge fan base for the channel but the channel is magnificent. That's coming from a guy who's picky about the material I study.

@warriorgp4640 Thank you very much for that. I do this because I love to teach. I do my best to thoroughly research and vet every topic I talk about and I will never post anything that resembles "click-bait". If the channel never gets huge I'll still be here posting videos. But... there's really nothing better than word of mouth, so if you liked what you saw, tell your friends or coworkers about me! -Alex

@@EMTV1 I sure will...👍🏼

Congratulations! Very well done! I’m so glad I could help. -Alex

Congratulations! Very well done, I’m glad I could help. -Alex

Steven, thank you very much. I don’t like too much extra fluff when I’m learning either. Is there anything that you’d like to see in future videos? -Alex

Sorry about being absent for awhile! New videos coming soon. -Alex

I'm so glad you enjoy the videos. Is there any topic you'd like to see in the future? -Alex

Jenny, CPAP definitely could be used. For the Static Pharmacology videos I try to only go over the medication treatment options. My Paramedic Pathophys video on asthma offers a more comprehensive treatment pathway. -Alex

@@EMTV1 got you, thank you so much for these videos. It has helped tremendously. Great job. Hoping to send you a donation real soon, you deserve it. Sending blessings and positivity your way.

Michael, I agree that CPAP/BiPAP can be invasive but incredibly beneficial in the right circumstances, in my experience though I've found that it's not always easy to nebulize effectively through the devices. As far as Epi/Mag is concerned, I have and always will be a huge fan of magnesium. I've seen it turn around the trickiest asthmatics very quickly, so I'm fairly comfortable getting it going sooner rather than later. Fortunately, I've never had to give Epi to an asthmatic who was refractory to everything else, so in my mind it's always been considered the "in case of emergency, break glass" drug. I think the steps beyond the typical nebulizer based treatment pathway should be dependent on provider comfort/familiarity and individual patient presentation - you may not use the drugs in the same sequence, but the options are still available for use. -Alex

Glad to help! Anything you want to see in future videos?

@@EMTV1 respiratory acidosis vs alkalosis

Alex, Great question! Antipsychotics like Haldol are not routinely administered to patients in acute alcohol withdrawal as they can lower seizure thresholds. Additionally, hypokalemia and hypomagnesemia are common in alcoholics and these electrolyte abnormalities have a tendency to produce a prolonged QT interval on the EKG. Antipsychotic medications like Haldol have also been shown to prolong the QT interval in certain individuals, so administering it to an individual with hypomagnesemia or hypokalemia induced prolonged QT may lead to ventricular fibrillation and cardiac arrest. -Alex

That's awesome, congratulations! As far as the written exam, make sure you study up on EMT-B material as well as Paramedic material, EMT-B material generally has more EMS operations content. My other piece of advice is general test taking strategy: trust your gut, don't change your answer if you're second guessing yourself, chances are you chose the correct answer the first time. I wish you the best of luck! -Alex

Not a problem! Thank you for watching. Anything you'd like to see in future videos?

Thank you for the support!

Michael, fantastic question! For "classical" types of heart failure norepinephrine titration to a MAP of >65 is actually a really solid protocol. In this scenario our patient has a history of dilated cardiomyopathy with a very low ejection fraction, and unfortunately this type of heart failure is a little trickier to diagnose in the field unless your patient was the absolute best historian possible, or if you had run them multiple times in the past. In cases of dilated cardiomyopathy with low EF, the ventricles become dilated without any hypertrophy occurring in the ventricular walls. Essentially this creates a giant, floppy container with severely limited contracting ability. Purely inotropic agents like dopamine and dobutamine are more effective here because these medications work by increasing cardiac contractility which causes an increase in stroke volume regardless of ventricular filling pressure (this is also one of the reasons why it is so dangerous to initiate these medications without adequate fluid resuscitation). The increase in contractility will hopefully increase the ejection fraction and raise overall cardiac output. While norepinephrine has inotropic properties, its effects tend to lean more towards vasoconstriction, so if given all possible information regarding this patient's underlying condition and if given the options of multiple vasoactive medications, dopamine and dobutamine would be the more ideal choices for this patient. You would not be wrong in using norepinephrine however, because the patient would still likely improve from the overall increase in cardiac output that you would be able to achieve. Just curious, your protocols are very very progressive, where do you practice? -Alex

Linna, I would be happy to make a video or two on reports. Thank you for the awesome suggestion! Stay tuned. -Alex

Linna, Thank you for the support! Fantastic question regarding dextrose choices. You absolutely could use other concentrations of dextrose if you wanted to, but in the context of hypoglycemia our rationale for using higher concentration D50 is to quickly increase blood sugar levels, preventing further patient deterioration. Will this cause some hyperglycemia? Yes, it probably will. But hypoglycemic patients are much more fragile than hyperglycemic ones, and monitoring and treatment of blood sugars will continue once the patient arrives in the hospital. Normal blood sugars are rarely achieved when managing an acutely ill hypoglycemic patient in the field. Its very common that we end up overshooting the blood sugar, but for this patient, slightly too high is much safer than too low. Hope this helps, Alex

Melissa, I'm so glad I could help. Thank you for your support! -Alex

Andi, glad you enjoyed it! I’ll be posting a new one soon. -Alex

Derrick, Thank you for asking! I try not to include specific protocols in my videos as it would limit my approach to teaching. The treatments suggested reflect general management strategies based on the patient's symptoms, except in my Static Cardiology videos where the treatments are referenced directly from AHA guidelines. Specific medications, like ketorolac, are mentioned because these medications have been proven to be effective in providing pain control for patients with kidney stones. It would be impossible to stock all the meds shown in these videos in a medic unit, so feel free to pick and choose from the drugs that are available to you. To find out what medications are available to use in your area, head to your state's Office of EMS website and search for "Scope of Practice Formulary." Thank you for watching and good luck on your upcoming psychomotor exam! -Alex

@@EMTV1 Thanks alex. Your videos are awesome. NEVER take them down. NEVER.

Derrick, thanks again! Let me know if there is something specific you'd like to see in a future video. -Alex

Thank you so much for watching. I’ll definitely be posting a new one soon! -Alex

Thank you for the support! -Alex

Thank you for the feedback! I’ll post a new one soon. -Alex

Thanks a lot! Good luck on the psychomotor! Any suggestions for future videos?

Tony, check out Static Cardiology Cards 22 and 33! ruclips.net/video/_BrmIEZp8t8/видео.html ruclips.net/video/N0ZUV-IlUBI/видео.html

Caitlin, Thank you so much for the support! I'm going to chat with my RT colleagues and put together a ventilator video soon. Stay tuned! -Alex

Glad I could help! Good luck on your National Registry test!

Melanie, glad I could be of help! Good luck with your upcoming internship and thank you for watching! -Alex

No problem, thanks for watching!

Joffrey, Great question, I actually had to do some digging to get a reasonable answer… While epi is always a tool in your toolbox for these kinds of scenarios, studies have found that it has no benefit over inhaled beta agonists if the patient is able to tolerate a nebulizer. In adults albuterol is considered first line over epi for acute asthma due to the significantly reduced risks of myocardial injury associated with epi administration. BUT… If your patient can’t breath or tolerate an albuterol treatment, I would give them the epi. Hope this helps! -Alex