Changes

The last day of the conference featured a closing address by a guy who was president of a big hospital chain in the south. He talked about some of the changes coming to hospitals that might effect EMS someday. He had a neat demonstration of carotid artery stenting. Before he spoke they presented the man of the year to the men and women of Acadia Ambulance for their heroism in Louisiana during Hurricane Katrina, and they touted the ability of a private ambulance company to make a difference in an emergency. The president of the company asked everyone who went to Lousiiana to help to stand up.

The lectures didn't begin until 1:30 -- the time between ten and one-thirty was scheduled for Expo time, so I took a cab up to the Baltimore Museum of Art, and then took the bus back.

Baltimore Museum of Art

The afternoon lectures were very good. I went to a recap of the new AHA guidelines by Dr. Robert O'Conner. It was going over the same material, but since I am giving an CME on it next month, I wanted to know as much as I can. Here are some of his PEARLs:

Keep tidal volume to 400 on ventilations.

There are two ways to hyperventilate: Too many respirations and too much volume in a single respiration.

Most pulses that emerge after a shock don't show up for 60 seconds.

There are fewer v-fib codes today than several years ago because of the better cardiac care peopel recieve from their doctors. Most codes are sicker people.

Epi has a IIb rating because they cannot do a study where epi is used against a placebo. No ethics board would allow it. Without such a study, there can be no Level I rating. Its one of the quirks of the evidence rating system.

On cardioversion -- if the patient can remember what you look like after you have cardioverted them, don't cardiovert because they probably don't need it.

One of the reasons, cardiac arrest discharge from hospital rates are so low is because the post resuciation care at the hospital is so poor -- it often consists only of trying to make a person a DNR.

I asked him about the phrase Seek Expert Consultation in the Tachycardia algorithm, and he said, it means if you don't have to give a patient drugs, don't, wait for the hospital.

The last session was called Lightning Round #3 Ask to the Street Medicine Docs -- it was a round table session with five docs who used to be medics. They talked about the future of intubation and other issues.

On Intubation, they said, for people to keep intubating, their program needs a solid QI program and people need to go to the ER if they are not getting enough tubes. One doctor said, "a misplaced tube is a travesty. It means, your patient would have done better in a Yellow Cab."

I asked them about the issue of using morphine for abdominal pain. Studies have shown that it actually helps the surgeon to an abdominal evaluation. They cited that sturdy and said by all means, we should be giving morphine to patients with abdominal pain.

Instead of taking the train back, I got a ride with a friend from work who had driven down a day before me. He has been going to the conference every year for quite a number of years. On the ride back, we talked about all the changes we've seen over the years. He has to teach a Paramedic refrecher on Monday and says he now has to rewrite his lectures.

They will be holding the conference again in Baltimore next year. I think I'll get a better hotel this time.