SARMed

In some situations you can phone a friend. In a SARMed class, you might get Meeka whispering hints in your ear…

Things are heating up out there! Make sure you know how to recognize heat stroke and heat exhaustion. And know that heat stroke needs rapid cooling. Do you have a tarp, water, and ice to make a heat stroke TACO(tarp assisted cooling with oscillation)?

Nanaimo Search and Rescue members packaging a simulated patient in a vacuum mattress with a suspected traumatic brain injury. They’re packaging lateral for airway management.
Does a TBI patient benefit from being level, slightly head up position or slightly head down position?
Answer below.

Every EMS crew has given nitro hundreds of times.

We place a 0.4 mg tab under the tongue. Patient says "ahhh, better." We feel good. We helped.
But here's what a study of 70,890 chest pain patients across 2,119 EMS agencies just found:

Zero difference in preventing bad outcomes.
→ Same rate of CPR
→ Same rate of defibrillation
→ Same rate of cardioversion
→ Same rate of antiarrhythmic drugs
→ Same rate of transcutaneous pacing

Nitro group: 0.17% bad outcomes.
No-nitro group: 0.18%. Statistically identical.

The researchers used clone-censor weighting, a sophisticated method specifically designed to eliminate confounding and immortal time bias. This wasn't a simple comparison. They worked hard to find an effect. They didn't find one.

Even in suspected STEMI patients, where reducing cardiac workload should matter most, the signal didn't reach significance.

Worth noting: the point estimates in STEMI patients trended toward benefit, and the authors plan to study that subgroup further.

That's an honest finding, not a dismissal.

So what does this mean practically?

Nitro still relieves pain. That matters. But for years, our culture has assumed it prevents arrhythmias and saves lives in the back of the truck.

This data doesn't support that assumption.

It also raises a harder question: why do we reach for nitro before considering other analgesics?
Pain management is the goal. The tool should match the evidence.

The authors are transparent about the limitations. The composite outcome was rare, which limits precision. Residual confounding is possible.

This is one study, not a closed case.

But it's a well-designed study asking a question that needed to be asked. And the answer deserves an honest conversation.

Have you ever had a chest pain patient deteriorate right after nitro? What did you think caused it?

Read the full study:https://media.handtevy.com/website/A-Target-Trial-Emulation-of-Prehospital-Sublingual-Nitroglycerin-Administration-for-Suspected-Acute-Coronary-Syndrome.pdf

Trying out different places for the .company devices. This one holds my syringes to organize them, and keep them clean.