The reason I went into Emergency Medicine is to treat sick patients and hopefully make them better. I enjoy the surge of adrenaline and the feeling of deep satisfaction when I bring someone back from the brink of doom. It used to be that a bad attack of acute congestive heart failure afforded me just such an opportunity. Support the airway (intubate if necessary) and get ‘em on a nitro drip and blast them with Lasix. Very satisfying watching the patient start to breathe easier.
Anyway, no longer. Why? No, not because patients are taking better care of themselves and watching their salt intake. It’s because of our paramedics! They take away my chance to shine because they have gotten too good at managing it themselves in the field! Then can give endless sprays of sublingual nitro. The have 100 of Lasix. And most importantly they have BiPAP. It’s not uncommon for me to field a call from them where it sounds like the patient is going down the tubes and by the time they get to the ER, they are smiling from under their face mask asking for a urinal to diurese in! Sats that go from 78 to 98 by the time they are with me are not uncommon.
The only good thing about this is that I can fart around on the Internet for a few more minutes before I have to get off my ass and go see them….
Good job crew!

I read this little story yesterday of a referee collapsing during a high school soccer game. Unfortunately, he was in full cardiac arrest. Fortunately, two nurses who must have been up to snuff on their hands only CPR because they were able to keep his brain perfused until first responders were able to defibrillate him with an AED. People with Vfib are the most likely to be successfully resuscitated but the most important part here is the that the CPR preserved his brain. What’s the point of bringing a vegetable back? Hence the need to have someone pump like hell on your chest until EMS gets there. Kudos to them!

Yes sir, I fully realize that your gig tonight is very important.  I understand it is your source of income but you see, I don’t know how you are going to be able to play the drums in your jazz band when your BP is 260 systolic and you are bubbling over in acute pulmonary edema.  Your blood sugar is 510. Your oxygen saturation is 84% on room air.  I guarantee you will not be able to throw down a good solo.  Unless you consider collapsing behind the rig and dying of a respiratory arrest a good climax for the show.   Even better than Keith Moon.