The other Josh Paramedic

Australian paramedic in the UK. Professional mistake maker. Any views expressed are probably not my own, but are definitely not my employers.

[James Yates @heli_med_james]

New #APLS status epilepticus guideline published.

* Timings are tighter, new intervention every 5 mins
* Levetiracetam is 2nd line agent

Why? 90% self terminate within 4mins, but >5mins = 80% chance of >30min duration = ⬆️ risk of death.

Early intervention crucial

#FOAMed

[Rob Buttner @rob_buttner]

‘VT’ versus ‘SVT with aberrancy’.

The long list of VT "suggestive" ECG features is difficult to recall and apply in real time.

How can we simplify things?

Here is my ABCDE approach – five simple Qs to ask:
🧵👇

[The other Josh Paramedic @26alpha01]

@DanielKlapaukh 'If you push on their sternum and it hurts it's not cardiac' but also 'push on their sternum to assess response cause it really hurts'.

Big brain thinking.

[The other Josh Paramedic @26alpha01]

@smcbt @DrLindaDykes Hypoglycaemia is not a reversible cause as it doesn't cause cardiac arrest. Hypoxia due to loss of airway secondary to hypo is. The same as opiates; naloxone will not help in arrest, correct the actual problem of hypoxia.

[The other Josh Paramedic @26alpha01]

@Aidan_Baron It's those filthy 'bronchodilator seekers' that cheese me the most. Always calling up pretending they can't breathe just to get their fix...

[The other Josh Paramedic @26alpha01]

@EdHill0 Was it the Australian emergency department one from last year?

https://t.co/9gqSkpO9IY

Randomised, double blind dummy controlled; but looks at paracetamol as an adjunct to opiates.

[The other Josh Paramedic @26alpha01]

@ParamedicLeigh If I ever grow up, I hope I can be the sort of paramedic she is.

[The other Josh Paramedic @26alpha01]

@LeechCaroline Is no one going to mention the leg pockets full of CAT tourniquets?

[The other Josh Paramedic @26alpha01]

@RamblingsOfRob I love a van body. Everything you could need within reach with a seatbelt still on. But considerable differences between UK/Oz. This is also a Sprinter so £/$. Wait till you see the back of an Oz Landcruiser ambulance for cramped.

[The other Josh Paramedic @26alpha01]

@RamblingsOfRob *recently modern ambulance system.

And very different work environment. Low set open plan housing means you can usually just get the stretcher in the house if they can't walk. Or transfer in the large paved front garden and drive if you need because it's probably not snowing.

[The other Josh Paramedic @26alpha01]

@mlg1611 @mitchpage3 Thomas 'Select' tube holder (with the yellow threaded clamp) is comatible with SGA including I-gel.

[The other Josh Paramedic @26alpha01]

@josh_paramedic One day they'll have #3pips too and understand that the chest pain/LOC/unilateral weakness that caused the incident is fine and will work itself out.

Until then, all the uninjured people will go to A&E.

#belikejosh

[The other Josh Paramedic @26alpha01]

@amerelman Or the straw that breaks many ambulance services back.

'Hello ambulance, yes my watch says I have a 'dysrhythmia'. No I feel fine.'