There are a few ways to find specific material on this site. One is to search — plug the things you’re looking for into the bar at the right-hand side of the navigation bar, and it’ll bring back all posts that mention those terms. You can also click on one of the categories listed in the column to the left of the page, which defines broad realms of posts — for instance, those discussing specific skills vs. those offering general education. Or you can browse chronologically. Finally, you can click one of the tags in the “cloud” in the column at the right of the page; these are more specific keywords, and clicking one will return all posts that touch upon that topic.
This index provides a more organized approach. Every single post on this site is indexed here, and it’s updated in a relatively timely fashion, so you can browse through to find whatever interests you.
These discuss broad classes of drugs, in many cases grouping them into opposing types (such as stimulants vs. depressants). We discuss the physiological systems involved, how these drugs interact with them, give examples of the most common meds, and provide tips for recognizing them (such as standard suffixes). These posts feature some of the more in-depth discussions of physiology on this site.
Drug Families: Stimulants and Depressants – describes the sympathetic vs. parasympathetic systems, alpha and beta receptors, their most important effects, and the common drugs that interact with them.
Drug Families: Steroids and Antibiotics – goes through the basic concepts of inflammatory response and the role of steroids and antimicrobials (antibiotics, antivirals, and antifungals) in mitigating or supporting it.
Drug Families: ACE inhibitors and ARBs – outlines the renin-angiotensin-aldosterone system and discusses the role of drugs that inhibit it.
Drug Families: Anticoagulants and Antiplatelets – a combination text-and-video post walking through the entire coagulation cascade and the common drugs, including warfarin/Coumadin, unfractionated and low molecular weight heparin, dabigatran/Pradaxa, aspirin, glycoprotein IIB/IIIA inhibitors, and clopidogrel/Plavix.
What it Looks Like
Some of our most popular posts, these focus on important, often-discussed, but rarely-seen clinical phenomena — the sort of things you read about, but don’t really know “what it looks like” until you’ve developed some experience. We discuss the basic pathophysiology and significance of each phenomenon, then give examples of photos or video clips that illustrate it well.
Live from Prospect St.
These are “interactive” stories, where we describe a clinical scenario and ask how you’d handle it. They unfold in two or three posts each, pausing at important decision points and letting you take each new development as it comes. They conclude with a discussion of the relevant findings, risk factors, assessment tips, and disease states.
Live from Prospect St: Dizzy at Hillcrest (conclusion) – neurological exams, intracranial bleeds, strokes, and dizziness
Live from Prospect St: The Reluctant Tumble (conclusion) – traumatic head injury, high-risk refusals, medical control, health care proxies, and the ethics and legality of compelling patient transport
Live from Prospect St: The Big Crunch (conclusion) – MVA scene management, mechanism of injury, triage, the Pediatric Assessment Triangle, trauma destinations, and documenting child neglect
Quick-and-dirty tips on reading medical studies, for those who lack strong backgrounds in biomedicine or statistics but still want to practice evidence-based care.
Reading Research: Diagnostics – the commonly-calculated attributes of diagnostic tests. Sensitivity, specificity, false/true positives and negatives, gold standards, positive and negative predictive values, pre-test probability, and likelihood ratios.
Reading Research: Outcomes – understanding how the study endpoints affect you
OR, ARR, RRR, NNT, WTF? [at Lit Whisperers] — calculating and understanding odds ratios, absolute risk reduction, relative risk/relative risk reduction, and NNT
Determining Risk/benefit Using Test Thresholds [at Lit Whisperers] — illustrating the general method of weighing risk-vs-benefit using scientific evidence
Publication Bias [at Lit Whisperers] — publication bias in research and how to be aware of it
An extensive tutorial on the pathophysiology, recognition, and treatment of shock, with an emphasis on hemorrhagic shock secondary to penetrating trauma.
In-depth information on the intelligent use of the pulse oximeter.
Respiration and Hemoglobin — the basics of pulmonary and cellular oxygen transport, oxyhemoglobin binding and delivery, and understanding the oxyhemoglobin dissociation curve
Pulse Oximetry: Basics — how the oximeter works
Pulse Oximetry: Application — using it in the field and interpreting the results
In-depth information on the intelligent use of the glucometer.
Glucometry: Introduction — background information on glucose metabolism, the basic pathophysiology of diabetes, and how hypoglycemia and hyperglycemia occur
Glucometry: How to Do it – basic use of the glucometer, accuracy, capillary vs. venous blood sources, calibration, and more
Glucometry: Clinical Interpretation – correlating glucometry results with clinical findings and recognizing sources of error
Mastering BLS Ventilation
Mastering BLS Ventilation: Introduction — challenges and goals of BLS ventilation and airway management
Mastering BLS Ventilation: Hardware — OPAs, NPAs, non-rebreathers, and apneic oxygenation using nasal cannulae
Mastering BLS Ventilation: Core Techniques – one- and two-hand BVM techniques, the sniffing position, and ramping
Mastering BLS Ventilation: Supplemental Methods – cricoid pressure, pocket masks, mouth-to-mouth, mandible grabs, risk factors, and creating PEEP with the BVM
Mastering BLS Ventilation: Algorithms – bringing it all together, and a proposed graphical algorithm
Assessment and Diagnosis
Some Things to Say — questions about general complaints and how to help
Some Things to Say (part 2) — questions about chest pain
Some Things to Say (part 3) — useful stock phrases for medical communication
Treat the Patient? — viewing assessment findings in context, occult killers, and “treat the patient” vs “treat the machine”
The Rapid Initial Assessment: Look, Talk, Feel – a basic, universal approach to forming your initial impression
Get Up, Stand Up: Orthostatics — taking and interpreting orthostatic vital signs
Vital Signs: Respirations — tips for counting respirations
Vital Signs: Pulse — tips for measuring pulses
Vital Signs: Blood Pressure — tips for obtaining blood pressures, as well as maintaining the BP cuff and using it as a tourniquet
The Rhythm Method — using rhythm to facilitate the taking of vital signs
Polypharmacy in the Elderly — the most common adverse drug complications in the elderly
Pediatric Airway Emergencies — recognition and treatment of croup and epiglottitis
The “Big Picture” Diagnosis — video piece on interpreting assessment findings in their overall context
Differentiating Syncope: A Few Pearls — tips for assessment of the syncope patient
Managing STEMI Mimics in the Prehospital Environment — PowerPoint on recognizing and treating LBBB, LVH, BER, etc. using the ECG
Managing STEMI Mimics in the Prehospital Environment: Video Lecture – a narrated video lecture of the above PowerPoint
Am I Normal? Finding the Baseline – tricks for differentiating new vs. chronic abnormal assessment findings
The Curious Incident of the Dog in the Diagnosis – lessons from Sherlock Holmes about the diagnostic arts
Staying in Place: Compensation and Endpoints – understanding how the body uses certain systems to compensate for others
Working in EMS
Acceptable Risk — understanding that flukes don’t mean the system is broken
Decision Fatigue and Good Habits — how decision fatigue can affect our work, and how to manage it
Job Stability in EMS – employment in private EMS and how to keep it
But it’s Just a Broken Nail! – when it’s “okay” for patients to refuse transport
Confidence vs. Competence — matching your demeanor to your abilities
The Laws of EMS — universal principles for the job
Clinical Judgment: How to Do Less – using experience and knowledge to titrate care
Preparation vs. Improvisation – the importance of preparation even when planning to roll with punches
The 10 Easiest Ways to Violate HIPAA – common and easy pitfalls that break the law
Child-rearing and You – advice for training new partners
A Saving People Thing – thoughts on the unique appeal of EMS, and parting comments as site updates take a back burner
Glass Houses: Suicide in Both Seats – remarks on the frequency and red flags for suicide attempts, and why EMS providers themselves are at risk
The Art of the Transfer (part 1) — practicing assessments on routine transfers
The Art of the Transfer (part 2) — the educational benefits of patient charts
The Art of the Transfer (part 3) – the human perks of meeting non-emergent patients
Tips, Tricks, Logistics, and Skills
Check, Check, Check — Check it Out — optimizing your start-of-shift equipment check
Lifting Things Up and Putting Them Down — safe lifting and strength training for EMS
Cheat Sheets — creating personalized pocket references
Eight Tips on Ambulance Wrangling – some less-known tricks for using Type II and III Ford ambulances
Eight More Tips on Ambulance Wrangling — more tricks for the Ford ambulances
Spinning a Yarn: The Chronological Narrative — samples and ideas for writing long-form narratives
Hurry Up and Wait — minimizing transfer times for time-critical patients
Oldest Trick in the Book — wearing visible IDs
CPR for Dummies: How to Save a Life – fundamentals of post-2010 resuscitation
What’s it Got in its Pockets? – tools to carry with you at all times
Dialing it Down a Notch – bringing order to chaos and managing anxious patients
Tiny Monsters – cross-contamination and proper handwashing
The Slow Ride — comfortably transporting extremely pain-sensitive patients
A Million and One Towelplications — the countless uses for towels and other linen
Cuff Links and Hijinks – zeroing out miscalibrated blood pressure cuffs, using them as tourniquets, and creating an airway pressure gauge
Advanced CPR Techniques for Basic Providers – BLS techniques for going the extra mile during resuscitation
Super Soakers: Building a BLS Irrigation Device – drilling a hole in sterile water bottles for easy irrigation
Child Rearing and You – concepts and suggestions for training and dealing with new partners
Warm and Fuzzy Stuff: Palliative Care and Dealing with People
Glove Monsters — making kid-friendly balloon puppets from gloves
People Care — the most important book for any EMT, by our hero Thom Dick
All Nestled in Bed: Blanket Warmers — using warmed blankets
The Tough Ones — dealing with difficult patients
Unique, Just Like Everyone Else – lessons from Randy Pausch on treating people routinely but uniquely
Because it’s Cold Out There — advocating for people who have nobody else
Psychological First Aid — evidence-based methods for managing the acute aftermath of an emergency
Missing your Manners — the importance of the introduction
David Hiltz on Resuscitation — interview with Dave Hiltz of the AHA regarding HEARTSafe communities and current issues in out-of-hospital cardiac arrest
Russ Reina: Moments in the Death of a Flesh Mechanic – book review
Thoughts from WMEMS — lecture notes from the 2011 Western Massachusetts EMS Conference, with emphasis on talks by Kyle David Bates
Product Review: Shoes for Crews Maverick – review of some slip-resistant boots
Copy, Roger Roger – regional lingo in EMS
The Way You Do the Things You Do — the EMS persona and why we adopt it
Happy New Year — the blog’s first year anniversary, with reflections and acknowledgements
Year Two — second anniversary post
Cutting the Ribbon: The EMSB Digital Research Library – announcing the launch of the DRL
Love in the Time of Melena – thoughts on dating in EMS