I agree that drugs and tubes probably do nothing for cardiac arrests, but that ALS procedures are not the same as ALS providers. We need people who understand why pauses in chest compressions and hyperventilating are bad – and understand things like coronary perfusion pressures, to run them effectively. I don’t see that taught at any level, but especially with the first responders who make-or-break a code.

But the recommendation really IS correct, in that the only way to meaningfully increase post-arrest saves is to get more good compressions started earlier.

Hoffman, J.R. and Reynolds, S. (1987) Comparison of nitroglycerin, morphine and furosemide in treatment of presumed pre-hospital pulmonary edema. Chest October 1987 92(4) 586-593; doi:10.1378/chest.92.4.586

I’m still unsure if the Paramedics concerned were from LAFD or LACoFD as it refers to “Los Angeles County” and presumably (as is the case now) LA County EMSA covers both the City and County Paramedics.

Two very interesting points from the study are (1) the Paramedics in question RESISTED a randomised control trial and (2) they were PROHIBITED from “diagnosing”. WTF?

NB I am no relation to the study author (I wish I was!)

The patient is not volume overloaded, the fluid is in the wrong place, up to a litre has come from the circulation and is now in the lungs, so giving bloody frusemide is only going to make him more hypovolaemic and pee out electrolytes

I once read a study about Paramedics in Los Angeles (unsure if it was LAFD or LACoFD, I think the latter) where they studied the ability of the Ambulance Officers to diagnose CHF; the most bizzare case I remember from said study was them giving frusemide for leg pain? Must be the bad humours right?

Thanks. It would be cool if you had links that categorized your topics. I always have trouble going back to try to find certain posts on topics. Like when i’m looking for your posts about spinal immobilization. – you often just use those words in a post. so the search is huge and i cant find your referenced articles about the problems with it

I apologize for my lack of organization. I am trying to work on some pages, maybe some tabs to resources, that would help with finding research on different topics. Do not expect anything any time soon, but feel free to remind me. It is something that I want to do and need to do.

If I were any more disorganized, they would make me a chief.

.

My reply is at – Doesn’t that study prove Lasix works?

.

This is not a good thing in the hypertensive APE patient.

Of course, you probably get a pretty pronounced period of hypotension if you slam the Lasix in, but apparently that rate of administration is harmful on their ears.

You’re gonna love my From Classroom To Street article in EMS World Magazine next month.