MediMike

In all honesty I'd strongly consider attending a paramedic course prior to trying to make that step. As mentioned above it's all just...different. The logistics are different, diagnostic modalities (or lack thereof), treatments, whether you'd need to stand by the protocols or the medical director would be more laissez faire...There's just a lot. https://ems.creighton.edu/programs/ems-certificates/paramedic-certification-course-health-care-professionals There's this one, seems to check the boxes in a reasonable amount of time. Clearly you wouldn't need to do the whole shebang of paramedic school as you likely know pharmacology, 12 lead interpretation, IV skills and I'm assuming in the NICU you were intubating?

Not a dumb question. Physicians (in my experience) are much less likely to have PTO, retirement etc depending on their group set up than PAs.

Depending on the facility Mero is totally on lockdown, once shop required an ID consult to start it, another if used for more than 24 hours... luckily no one cares here. I've avoided linezolid in any situation where I'm concerned about bacteremia due to its bacteriostatic nature, although I'm not sure how founded in science that approach is. ECG sinus tach, troponin is 0.9 from 0.01. She was making urine but it was falling off. Ended up deciding to intubate her with 0.15mg/kg etomidate and 1.5mg/kg of roc. Cranked up the NE prior to induction, passed a 7.5 tube with VL after taking a second to poke at a much smaller glottic opening than I was anticipating. Immediate post intubation pressure was in the 60s despite the half dose induction agent but popped back up after a minute or two. Threw in an art line, HR seemed to be coming down a bit, asked them to call me if it didn't carry on that trajectory. About 2 hours later they called me and said she had been sitting at 160 ever since I walked out of the room. They brought her upstairs and she looked worse (if that was possible). Threw a probe on her chest @LT_Oneal_PAC and @polarbebe nailed it, picture below. Had a conversation with son who agreed with a DNR status. Called urology who shrugged their shoulders, IR agreed to throw in a nephrostomy tube despite only mild-mod hydro without obstruction (after getting 2 provider sign off that they weren't responsible for her dying when they proned her). Unfortunately her pressor requirements continued to increase, ended up maxed on everything outside of AT2. Transitioned to comfort care the following morning. The progression was incredibly rapid, to be honest it really caught me off guard. Little research showed that depending on severity mortality ranges between 18% and 69%, major recs are antibiotics (dur) and perc drain if there's anything there.

Unfortunately she did not survive, made it about 24 hours. Outside of some of our COVID folks I haven't seen sick escalate this quickly. Walking and talking to dead in <36 hours.

@ohiovolffemtp you are 100% correct and I will never forgive myself for forgetting to add you in on the case It looked like emphysematous pyelonephritis, I've only seen one other case to be honest. INR was 1.5, platelets 120k or so. Temp was 38.1. Gut looked good on the scan.

***Details changed to protect patient anonymity*** 67 year old female with a hx of HTN, uncontrolled T2DM and recurrent cystitis presented with a week's worth of abdominal and left flank pain with 3 days of worsening dyspnea. On presentation had a MAP in the 40s, HR in the 110s and a RR of 30. Initial labs had a WBC of 24k, lactate of 5, procal of 14 and bicarb of 14. Imaging had a clean CXR, CT A/P with some air in the left ureter as well as the renal parenchyma. Empiric ceftriaxone and vanc were started. Received 30mL/kg bolus and was started on NE. Once they added in vaso they gave me a call as that is the trigger for a critical care consult in our system (either 2 pressors or intubated). On my exam she had some light mottling to bilateral lower extremities, reaching to about the knees, was mildly encephalopathic, moaning but answering questions. HR had crept up to 120 or so with a pressure around 100/60 on 24 of NE and 0.04 of vasopressin. She was broadened to meropenem and I went upstairs after giving recs to the hospitalist. Around two hours later the hospitalist let me know that the patient now had a HR in the 150S-160s, I asked her to go down and see her as we had a COVID patient which needed an airway. When I made my way downstairs the patient was now completely obtunded, mottled up to her abdomen with a sinus tach of 160, BP 104/58(ish), RR 24 on 28mcg/min of NE and 0.04 of vaso. Next step from anyone? Curious regarding other folks' approach. @LT_Oneal_PAC and @EMEDPA we're still downstairs so you're totally allowed to play

Why do you think that first event will come to pass? I think it's important to realize that anything we can do to slow the mortality and hospitalization rates is a good thing. Who gives a flying %#@! if people still get COVID but they aren't hospitalized and don't die from it?

Ah. So the point of your initial post wasn't to say that Florida who per you didn't shut down was doing better than New York? Maybe those words are a little too big. Kinda like "false equivalence" maybe has too many syllables for you? Standard procedure. Make a hyperbolic or blatantly false statement, attack those who counter it, deflect once evidence is presented. Maybe move some goal posts while you're at it? Never back down either, that must be part of the creed too. Think I'm about done in this thread, I can go flip on FOX if I want to hear these regurgitated talking points.

So you've got nothing to say about those numbers specifically. The numbers you were trying to spin. Got it. A simple admission that you were wrong would have gone real far there man.

@CAAdmissiondid you have any thoughts on the FL vs NY shots which were posted? The discrepancies you mentioned were addressed by RC in that NY was the first and hardest hit, they definitely seemed to have learned from it while FL doesn't seem to have. I'm curious if you have a different take on these numbers?

Here is the data from the last month. New York vs. Florida ,

Because the world isn't black and white? Even insurance folks can have a good idea now and then, just like you!

Sorry for the delay in response, but yes, there will apparently be a financial penalty if the contract isn't met post-training. Sounds like this was a requirement for our organization to sponsor the program, definitely not a choice by our team.

MEDEX does great interviews. They truly want to learn who YOU are rather than what you think they want to hear. A lot of thought goes into the makeup of each cohort, looking at experience, personalities, backgrounds etc. Of course its been...a couple...year since I interviewed but wish you all the best of luck!

I miss the CICU. Such a fun land with all the toys and invasive hemodynamics...