Jeff Poland

FP-C, rural paramedic, critical care nerd, educator

[Jeff Poland @skadikittymean]

@pepe4peace @Kno @condorscondor @bals2thewall @keithlaw @Phil_Lewis_ source or GTFO.

[Jeff Poland @skadikittymean]

@bals2thewall @Phil_Lewis_ @keithlaw oh! Is this one of those alternative facts that are so in vogue since he took office?

[philip lewis @Phil_Lewis_]

Meanwhile, in New York City.

[Jeff Poland @skadikittymean]

There is no quicker way to kill a patient than with a NMBA, a piece of PVC, and a BVM or ventilator.

Except maybe potassium.

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS absolutely, however I see advantage to taking out intrinsic compensation.

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS I think I know where we lost each other. I see resp. Comp for metabolic derangement.

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS so you don't feel there is any compensation? At all? None?

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS please, explain why slowing his drive and then causing an apneic period is best for him.

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS ... Tube is passed, then paralysis? And slowing RR is good for this patient?

[Jeff Poland @skadikittymean]

@criticalcareuk @Rural_Doc @duncanadshead @EM_RESUS the apnea caused by laryngoscopy is more effective than keepingintrinsic drive until...

[Jeff Poland @skadikittymean]

@Rural_Doc @criticalcareuk @duncanadshead @EM_RESUS what advantage 4 slower rate of PPV confer over intrinsic & apnea in laryngoscopy 4 him?

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS beneficial for most patients. In no way essential for all, and harmful for a few. Medicine=complex

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS hence intubation. Slow bag NOT better than intrinsic resp. compensation.

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS if pH drops further, arrest highly likely. Apnea or slow bag = increase in pH. NMBA bad idea.

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS yes, many advantages to most patients. It would prob. Kill this one. Not all fit algorithms.

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS in this patient, step b for CICV is chest compressions during cric. Do you understand pH phys?

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS if you're still confused PM me; physiology too complex for 140 characters.

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS cont. No advantage to paralysis; adequate ketamine no struggle, preserves respiratory drive.

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS point of RSI is no bagging; tachypnea comp above what BVM can safely do. Continued...

[Jeff Poland @skadikittymean]

@criticalcareuk @duncanadshead @EM_RESUS ... Because NMBAs tend to cause apnea... Normally I'd be all for #rocketamine, but no apnea here.