Tasers

A Taser Two weighted barbs attached to long insulated wires They fire at 180 feet / second Deliver 50 000 volts of electricity, in pulses Removal Stretch surrounding skin, and tug sharply. If difficult: 1. Anesthetize the area at the site of attachment. Possibly using an insulin syringe. 2. Insert an 18 gauge needle along the side of the barb with the bevel of the needle facing the barb. 3. Advance the needle about half a centimeter. 4. Pull out the needle and the barb together at the same time. If this doesn’t work, use a scalpel. http://epmonthly.com/blog/dont-taze-me-bro/ https://emj.bmj.com/content/21/2/136 http://epmonthly.com/article/they-tased-me-doc/ https://www.ncbi.nlm.nih.gov/pubmed/?term=Vilke+Bozeman+taser

Possible PE in pregnancy

Possible PE in pregnancy is a nightmare to investigate and to manage. There are several flowcharts...but lets look at the evidence. 1. Is this a PE? Has someone just done a random d-dimer? If they have...think back to the symptoms. We know shortness of breath in pregnancy could have many causes, but we only worry about PE. Take a good history. Anecdotal evidence suggests PEs should be tachycardic. 2. Do a CXR A whole load of investigating is prevented if they've got a pneumothorax or pneumonia. 3. Risk stratify If they're high risk, they need imaging. If they're low risk...continue. 4. In a low risk patient, a negative d-dimer is considered able to rule out VTE. Chances of it being negative are slim. The DiPep study recommends not using d-dimers, as does the RCOG greentop guideline. 5. Consider trimester adjusted d-dimers. We know the d-dimer rises in pregnancy. These values will depend on your d-dimer assay. 1st 750 ng/dL, 2nd 1000 ng/dL, and 3rd 1250 ng/dL D-dimer test with the new threshold for: the first of 286, the second of 457 and the third trimester of 644 ng/mL can be useful in diagnosis of pregnancy related VTE. I can't find any strong evidence these are strongly evidence based - but Jeff Kline is amazingly knowledgable, so I'm sure he's right! 6. Imaging Bilateral leg dopplers - if they're positive for DVT...start treatment VQ scan - probably causes more radiation to the fetus Other Summaries https://emcrit.org/wp-content/uploads/2011/07/PE-DX-by-Jeff-Kline.pdf https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-tools/respiratory/pe/pe-pregnant