Medic Path Pioneers

08/23/2026

NREMT QUESTION OF THE DAY

A 62-year-old man has crushing chest pain. BP 88/54, HR 44. His 12-lead shows ST elevation in II, III, and aVF.

Which intervention is MOST likely to make him worse?
A) Aspirin 324 mg chewed
B) Nitroglycerin 0.4 mg SL
C) Oxygen titrated to SpO2 of at least 94%
D) A small fluid bolus


Answer: B — nitroglycerin.

Why: II, III and aVF point to the inferior wall, and up to 40% of inferior MIs involve the right ventricle. The RV is preload-dependent, so a vasodilator like nitro can drop preload and cause profound hypotension. Get a right-sided 12-lead and look at V4R before you reach for nitro; if the RV is involved, cautious fluids come first.

Bradycardia here is common too — the RCA usually feeds the SA and AV nodes.

Education/refresher only — always follow your local protocol and medical direction.

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08/23/2026

DRUG PEARL: You're not trying to wake them up. You're trying to make them breathe.

Naloxone reverses opioid respiratory depression — but a full slam dose buys you a combative patient in acute withdrawal, vomiting on your stretcher.

Ventilate FIRST. A BVM fixes the hypoxia while you're still drawing up the drug.

Then titrate — small increments (0.4 mg IV/IM is common; dilute for a gentler wake) until they're ventilating adequately, ~10–12/min with good tidal volume. Stop there. Respirations are your endpoint, not GCS.

Watch the clock: naloxone lasts ~30–90 min. Fentanyl analogs can outlast it. Re-sedation is real — every reversal needs transport and monitoring.

Doses and routes vary — follow your local protocol.

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08/20/2026

The call that sticks with you isn't always the worst one you ran.

Sometimes it's the one that looked like your kid. Or your dad. That's not weakness — that's your brain flagging something that mattered.

Three things that actually help after a hard call:
1) Say it out loud to one trusted person within 24–48 hours. Silence is what lets it harden.
2) Protect sleep first. Sleep loss amplifies intrusive memories more than almost anything else you can control.
3) Watch the pattern, not the day. One rough night is normal. Two weeks of dreading the truck, drinking more, or going numb is a signal to reach out.

Peer support and your agency's CISM/EAP resources exist for exactly this — use them early, not as a last resort. If you or a partner needs someone right now, call or text 988.

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08/19/2026

Dispatch: 68 y/o female, "just doesn't feel right."

Pale, diaphoretic, weak. BP 96/58. HR 48. SpO2 95%. CBG 118. No chest pain.

What's your differential?
• Inferior MI with RV involvement
• Beta-blocker or calcium-channel-blocker toxicity
• Occult GI bleed
• Sepsis

The move: 12-lead FIRST, then a right-sided V4R. If the right ventricle is infarcted, that patient is preload-dependent — nitro can drop her pressure through the floor. Fluids before vasodilators, and follow your local protocol.

Weak + diaphoretic + bradycardic in an older adult is an MI until you've proven otherwise. Silent presentations are common in women, diabetics, and the elderly. "No chest pain" is not a rule-out.

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08/19/2026

12-LEAD PEARL: Inferior STEMI? Grab a right-sided 12-lead before you reach for nitro.

ST elevation in II, III, and aVF = inferior wall. Up to 40% of those patients also have a right ventricular infarct.

Quick tell: ST elevation in III > II, plus ST depression in I and aVL. Confirm with V4R — 1 mm of elevation there is your answer.

Why it matters: an infarcted RV is preload-dependent. Nitroglycerin can drop the floor out from under their pressure. Fluids first, cautious titration, reassess after each bolus.

Do a right-sided 12-lead on EVERY inferior MI. It takes 60 seconds and it changes your treatment. Follow your local protocol.

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08/18/2026

NREMT QUESTION OF THE DAY

62-year-old male, crushing chest pain. BP 86/50, HR 44. Your 12-lead shows ST elevation in II, III, and aVF.

What is your next best step?
A) Nitroglycerin SL
B) Right-sided 12-lead (V4R)
C) Beta blocker
D) Withhold all fluids

Answer: B. That pattern is an inferior STEMI, and up to 40% of them involve the right ventricle. An RV infarct is preload dependent, so nitro can drop that pressure through the floor. Confirm with V4R, hold the nitrates, and consider a careful fluid challenge with frequent reassessment. Always follow your local protocol.

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08/18/2026

DRUG PEARL: If adenosine "didn't work," it was probably the push — not the drug.

Adenosine has a half-life under 10 seconds. It has to reach the AV node before your body destroys it.

• Use the most proximal, largest IV you have (AC or above)
• Push 6 mg FAST, then slam 20 mL of flush immediately behind it — stopcock or two-syringe technique
• No conversion? 12 mg next, same aggressive technique
• Expect a few seconds of asystole and a very unhappy patient. Warn them first.

One more pearl: adenosine won't convert A-fib or flutter — but the brief AV block can unmask flutter waves and hand you the diagnosis. Avoid it in irregular wide-complex tachycardia (think WPW with A-fib).

Always follow your local protocol and medical direction.

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Free, no-sign-up EMS study: 1,000+ NREMT-style practice questions, 52 oral-board scenarios, 9 certificate courses, drug reference and an AI mentor. Built by a working flight paramedic.

08/17/2026

Nobody ever got promoted for being the fastest driver.

The providers who actually move up in EMS tend to do the same three unglamorous things:

1) They write the chart like a supervisor, an attorney, and the receiving physician will all read it — because eventually one of them will. Clear narrative, times that match the monitor, interventions tied to findings.

2) They volunteer for the boring work. QA chart reviews, restock audits, precepting a brand-new EMT. That is where leadership actually forms an opinion of you.

3) They keep a "win file." CE certificates, thank-you notes, the tough call you ran well, the skill you finally got smooth. When an FTO slot, a supervisor posting, or a flight application opens, you show up with evidence instead of memories.

You can start #3 tonight. One entry beats zero.

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08/16/2026

The tourniquet is on — and the wound is still bleeding. Now what?

The #1 reason a tourniquet fails is simple: it isn't tight enough. Turn the windlass until the bright red bleeding STOPS, then secure it. Pain is expected; oozing is not.

Quick check before you move on:
• Place it 2–3 inches proximal to the wound, never over a joint. If the limb is mangled or you can't find the source, go high and tight.
• Still bleeding? Apply a SECOND tourniquet directly proximal to the first. Two work when one won't.
• Junctional wound (groin, axilla)? A limb tourniquet won't reach — pack the wound and hold firm direct pressure.
• Mark the TIME of application and hand it off out loud. Don't loosen it in the field.

If you can still feel a distal pulse, you're not done tightening. Always follow your local protocol.

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Free, no-sign-up EMS study: 1,000+ NREMT-style practice questions, 52 oral-board scenarios, 9 certificate courses, drug reference and an AI mentor. Built by a working flight paramedic.

08/15/2026

The call doesn't end when the stretcher goes back in the truck.

Your body dumped catecholamines for that pediatric arrest. Heart rate up, tunnel vision, time distortion — that's normal physiology, not weakness. But if you jump straight to the next tone without ever downshifting, that stress response never fully closes out.

One thing that actually works and takes 60 seconds: tactical breathing. In for 4, hold 4, out for 4, hold 4. Four cycles. It pulls you back toward parasympathetic tone and clears the fog before you write your report.

The other thing: say something out loud to your partner. "That one was rough." Naming it is the difference between processing a call and stacking it.

If the stack is getting heavy — peer support and 988 (call or text) are there, and using them is a clinical decision, not a character flaw. Follow your agency's CISM and EAP policies.

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