At the rural community hospitals I work at, they ask the EPs to come to the floor to do Paras. I've met a few internists who will do them. Never met an internist who would do a PAP, though

Your implication that community hospitals are using heli transport to get them there faster is probably wrong. They are using the only resource available to them. The solution isn't pressing them to not use air transport, but to call for increased availability of critical care ground transport.

I completely agree. With consolidation of health care into major centers and out of community hospitals, the ability to transport sick patients from those community hospitals to the major centers with all the specialists hasn't kept up.

Unfortunately, there's more to it than this. Where I work in southern VT, there is typically no ground transport available for critical patients. It's fly or stay in my small rural ED. That would definitely worsen their outcome.

Ah, the link goes to last week's data on the website

Meyer?

Tollle

Having worked many stretches of nights and been the adult on many scout camping trips, I would never sign up to do overnights directly into a camping trip. More power to you!

This... is disturbing. Thanks for sharing this education... I think.

Sadly it's not settled. At both hospitals I work at, I still have to get renal function before contrast CTs and then get radiologist approval if it's abnormal.

IMHO this is part of the problem with health care in America. This conversation is not about if there is an indication to do a test, but if there is an indication not to do that test.

I don't know. When I have a septic patient with a fever of 103 and HR 125, I am reassured when the HR normalizes as the fever comes down with acetaminophen. The tachycardia makes me worry I am missing something else driving that tachycardia. Am I treating my own anxiety?

Working as an EP in a small critical access rural hospital without a nephrologist or dialysis, I especially love when dialysis sends patients with hyperK to us... I always wonder what they think we can do that they can't.