Original Contribution

2016 Wish List in Acute Care Medicine

Mark A. Merlin, DO, EMT-P, FACEP

01/14/2016

Each week the New Jersey EMS Fellowship holds a three-hour Journal Club with the latest published literature. From this comes a weekly e-mail with clinical pearls and the latest articles that’s sent to 7,000 medical providers. From the book of clinical pearls comes a yearly review of the top 50 things we hope providers will be doing, or are already, for the new year. Enjoy.

For more information, to obtain our clinical pearl manual or to get on the weekly EMS list, contact Dr. Mark Merlin at markamerlin@gmail.com.

2016 Wish List in Acute Care Medicine

1. No more longboards for transport of any patient;

2. PEEP valve on every BVM;

3. More CPAP on patients short of breath;

4. Less utilization of mechanical CPR devices unless patients are being transported;

5. More ultrasound in the prehospital/acute care setting, especially on SOB patients;

6. Routine chest decompression of every blunt traumatic cardiac arrest patient;

7. More sheets around pelvic trauma;

8. Earlier use of IM epinephrine for anaphylaxis;

9. Less bagging;

10. No bagging if sat is 93%;

11. High-flow nasal cannula on all patients during intubation;

12. High-flow nasal cannula on all patients underneath the CPAP;

13. Earlier double sequence defibrillation in refractory v-fib;

14. Push-dose epinephrine on all sick patients with SBP < 90 mmHg;

15. More TXA in trauma;

16. TXA in severe upper GI bleeding;

17. Bypassing ED for STEMI patients;

18. Cath lab for cardiac arrest patients with ROSC and no STEMI;

19. Stop treating patients at mass gatherings the same as MCIs—utilize event medicine techniques;

20. No more Kayexalate;

21. Earlier calcium IV with bradycardic patients before K is known;

22. No more myths about IV calcium being bad in digoxin toxicity;

23. No morphine in chest pain—fentanyl;

24. More ketamine for violent patients, IM at 4 mg/kg;

25. Less etomidate;

26. No defasciculating doses of paralytics;

27. Rocuronium!;

28. Stop nitro paste;

29. More routine Zofran at 0.1 mg/kg;

30. More intranasal Versed for seizures;

31. More routine use of intranasal naloxone;

32. More routine use of intranasal fentanyl;

33. No oxygen on STEMI patients if sat at least 93%;

34. BLS CPAP, ASA, albuterol, finger sticks, epi, IM glucagon;

35. Less nitro for STEMIs;

36. More atropine for bradycardia with STEMIs;

37. Stop saying “PEA” without identifying the rhythm!;

38. PEA with narrow complex: no CPR and push-dose pressors;

39. Better pressors than dopamine;

40. More delayed sequence intubation;

41. More pushing IV fluids before intubation on hypotensive patients;

42. More Keppra in the ED;

43. Lidocaine over amiodarone in kids with v-fib;

44. Early tourniquets for uncontrolled bleeding;

45. Don’t rush to intubate hypotensive patients. IV push pressors and IV push fluids;

46. Don’t focus on the airway in cardiac arrest. If paramedics can’t get the patient intubated, use supraglottic and only intubate after ROSC;

47. Hypotensive patients don’t have good pulse ox or urinary output. Focus on getting the BP up, and the other two may resolve;

48. Topical TXA for bad nosebleeds;

49. Maybe beta blockers in refractory v-fib?;

50. Stop using lights and sirens to transport stable patients to the hospital. The risk of harm to the patient is greater than the chance of benefit by getting to the hospital sooner.

Mark A. Merlin, DO, EMT-P, FACEP, is an associate professor at Rutgers School of Public Health/Medical School; vice chair and EMS fellowship director at Newark Beth Israel Medical Center/Barnabas Health; and medical director for MONOC EMS in New Jersey.