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“Do not go gentle into that good night. Rage, rage against the dying of the light.”

— Dylan Thomas, In Country Sleep, and Other Poems (via books-n-quotes)

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EMERGENCY MEDS 20: Magnesium Sulfate

(pls excuse my nails)

CLASS: electrolyte, tocolytic, smooth muscle relaxant.

MOA:

- decreases myocardial and neuromuscular irritability

- inhibits muscular irritability.

INDICATIONS:

- Torsades de Pointes (which I personally refer to as the Angry Tortilla rhythm, since it looks like a side view of someone angrily flapping a tortilla around)

- Hypomagnesemia

- pre-term labor

- pregnancy induced hypertension (pre-eclampsia/eclampsia)

- hyperreactive airway (severe asthma)

CONTRAINDICATIONS

- use carefully in patients with impaired renal function and pre-existing heart blocks

ADVERSE REACTIONS

- hypotension

- flushing

- heart block

- asystole (yay)

- respiratory depression

- drowsiness

- hypothermia

- depressed reflexes

- nausea

ADULT DOSE

Torsades

- 1-2 grams IV diluted in 50-100 ml NS or D5W over 1-2 min, then same amount infused over 1 hr. 

Hypomag

- 1-2 G IV diluted in 50-100 ml NS or D5W over 5-60 min

Resp/asthma

- 2 grams IV diluted in 50 ml NS or D5W over 5-10 min

preterm labor

- 4-6 grams over 15-20 min

PIH/pre eclampsia/eclampsia

- 3-6 grams over 10-15 min

NOTES

- O2 should be administered to patients receiving magnesium

- continuously monitor cardiac status for prolonged PR and widening QRS

- keep calcium chloride readily available in case you screw up and accidentally case magnesium toxicity

- eclampsia can occur up to 6 WEEKS after delivery (so don’t be a jackass)

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Every dam time….

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When you explain the labwork and imaging results to the pt and explain all the deadly stuff you were able to rule out but the pt refuses to leave because “YOU ALL DIDN’T FIGURE OUT WHAT WAS WRONG WITH ME!!!!!”

EMERGENCY ROOM. Not “figure out what is exactly going on with you” – please follow up with your PCP

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SO. This lady came in and said “I have this pain that started 2 days ago. right here *points to epigastric region.* I ate some ribs and went to bed and it just gets so much worse when I lie down!”

so of course I asked “do you have a history of Acid Reflux?” and OF COURSE she said yes. Then she goes on to say “I don’t think I’m having a heart attack. but this is really bugging me.” and I AGREED. We were about to discharge this lady straight up but the doctor was like “eh, it’s slow, lets just do it by the book.”

I got the blood and asked the medic to do the EKG as I ran a bedside troponin level. the troponin resulted as 10.83 (and we get worried when it’s 0.02). and as it results, I look at the EKG and my jaw literally dropped as I watched the significant depressions in V2-V4 come accross the screen.

I felt terrible the rest of the day. We almost let her go home like that. 

KNOW YOUR HEART ATTACK SIGNS IN WOMEN.

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A new police officer walks up to our already secured scene and asks what happened. I responded “well constable… inebriated chap A alluded that status of inebriated chap B’s Jib was unexceptable, to which inebriated chap B responded that the "cut of his jib was entirely beyond reproach”… Fisticuffs followed resulting in the present mayhem and melee… the officer just blinked at me

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NHS ambulance

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Yeah… that seems correct.

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What does your steth say about you?

P.S. if anyone helps me turn the digital cardio deluxe into reality that would be awesome…

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Reblogging for the comments.

One of my old partners got pulled in for an investigation today. The photo is not of him - it’s of a paramedic in California trying to eat something for the first time in nearly ten hours.

My old partner was told that a member of the public took photos of him and his current partner. My buddy was sleeping, and his partner was eating. This member of the public sent the photos with an email that both complained about how “unprofessional” it appeared - and a threat to send the photos to the media.

Thanks to Prop 11 in California, first responders no longer have a right to breaks. AMR lied to the public in a huge way. California was the only state where emergency crews had been granted a legal right to breaks to use the latrine and have a meal. Shifts run a minimum of 12 hours, often 24, and AMR runs their crews into the ground.

My buddy and his partner are in trouble because they were trying to get rest and food while posted on a street corner because we don’t get breaks. This is what AMR tells us to do. Please don’t see something like this and assume that we’re being lazy or not doing our jobs. Don’t take photos or send them to the press. That crew is probably exhausted and overworked.

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I volunteered to work as a nurse at EDC for the 3rd year in a row and honestly, it’s so cool. I learn so much by doing this field hospital stuff. And I got to be a charge nurse for the medical yellow tent this year, so that was really cool!

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The future of medicine and emergency care. ❤💉😷

via BritishRedCross

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New born ALS training with paediatric consultants! Brilliant chance to learn!

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Watch: Kristen Bell opens up about the mental health double standard and how she manages her own struggle.

Follow @this-is-life-actually