The Medic Minute

🧠 Thrombolytics at the Crossroads: Alteplase vs. Tenecteplase in Acute Ischemic Stroke If you've worked a code stroke in the ED, you know the feeling: heart racing, stopwatch ticking, neuro breathing down your neck, and pharmacy prepping the thrombolytic. For years, it’s been   alteplase or bust . But lately, the winds are shifting — and a lot of us on the floor are asking:   Is it time to start favoring tenecteplase instead? As an emergency nurse who's mixed, hung, and pushed both drugs, I wanted to take a closer look — not just at the data, but at how this debate plays out at the bedside. 💉 Alteplase: The Veteran We’ve had alteplase (tPA) in our crash carts and protocols for decades, ever since the  NINDS trial  back in the ’90s showed it could reduce disability when given quickly. It’s dosed at  0.9 mg/kg , with  10% as a bolus and the rest over 60 minutes . That means: It requires  prolonged administration and monitoring . There’s a risk of ...

  💊 The Pain Control Debate: Balancing Relief, Risk, and Reality in the ED It starts the same way almost every shift. You pull up the next chart and see it: “Chief complaint: 10/10 pain.” It could be a kidney stone, a dislocated shoulder, a sickle cell crisis, or back pain that’s been “the worst ever” since this morning. You sigh—because you already know what’s coming next. A decision that seems simple, but never is:  How am I going to treat this pain? Over the last few years,  pain control in the ED  has become one of our most  heated, complex, and morally loaded debates. Should we reach for opioids like we used to? Should we lean into ketamine, lidocaine, nerve blocks, or multimodal cocktails? And how do we navigate the tightrope between  undertreating pain  and  fueling the opioid epidemic ? Let’s dig into the latest evidence — and the human realities behind it. 🧪 Opioids Work — But at What Cost? There’s no denying that  opioids provide ...

💢 Stop the Bleed Where It Counts: A Street-Level Look at Junctional Tourniquets Let’s be honest: bleeding control is one of those skills we all know  has to be flawless . It’s one of the few things we can do that literally buys time for our patients — and sometimes, it’s the only thing that will. We’ve gotten good at extremity tourniquets. Most of us can slap one on in seconds. But what happens when the bleed  isn’t in an arm or a leg? What if it’s pouring out from the groin, axilla, or pelvis? You know — those spots where our go-to CAT tourniquets just won’t cut it? That’s where  junctional tourniquets (JTQs)  come into play. They’re not new to military medics, but more and more civilian EMS agencies are recognizing their value. And if you’re not yet carrying one on your truck, it might be time to ask why. 🩸 Why Junctional Bleeding Matters Junctional hemorrhage — bleeding from the pelvic, inguinal, or axillary regions — is a leading cause of  preventable deat...

  🫀 Using POCUS to Guide Cardiac Arrest Management: Game-Changer or Hype? We’ve all been there: a high-stakes cardiac arrest, compressions flying, epi flowing, and the whole team working in sync. But how do we know if we’re making progress? That’s where  point-of-care ultrasound (POCUS)  comes in—a quick, portable, real-time look into the heart of the matter. Literally. In the last five years, there's been a wave of new research showing just how powerful (and practical) POCUS can be in cardiac arrest. Let's dig into what we know—and what we still need to figure out. 💡 Why POCUS is Getting So Much Attention Cardiac arrest algorithms are great—ACLS is a life-saving standard—but they don’t always tell us  what’s really going on . POCUS fills in the gaps by helping answer questions like: Is the heart moving at all? Is there tamponade, massive PE, or a collapsed ventricle? Should we keep going—or is it time to call it? And crucially: it can do all this without adding to...

  🚑 Prehospital Needle Decompression: What EMS Providers Need to Know in 2025 By CrashCart Kelly Tension pneumothorax is a killer. Without quick intervention, it can rapidly progress to obstructive shock and cardiac arrest. In the field,  needle decompression  remains one of the most critical—and time-sensitive—skills an EMS provider can perform. But like everything in medicine, our approach to this procedure has evolved. This post breaks down the  latest, evidence-based guidance  on how to perform needle decompression  right —from site selection to needle length, and when you should (and shouldn’t) do it. 🎯 When Should You Decompress? Needle decompression isn’t for every trauma patient with low sats. According to recent studies, overuse leads to  iatrogenic pneumothorax, vascular injury, and poor outcomes . ✅ Perform needle decompression  only  if your patient has: Chest trauma or barotrauma  and Severe respiratory distress or hypoxia...

  🩺 Welcome to The Medic Minute Your Source for Emergency Medicine Practice Updates By a CEN Who Lives It Hi there, and welcome to the blog! I'm a Certified Emergency Nurse (CEN) with years of frontline experience in the controlled chaos we call the Emergency Department. If you’ve ever triaged a patient, started compressions in seconds flat, or had to make a clinical decision with limited information and even less time — you’re in the right place. I started this blog with a simple goal:  to keep emergency medicine professionals sharp, current, and connected . Guidelines change. Evidence evolves. And as much as we live in the thick of it, it’s not always easy to carve out time to stay updated. That’s where this space comes in. Here’s what you can expect: 🔄  Practice Guideline Updates  — from trauma protocols to airway algorithms. 🧠  Clinical Pearls & Pitfalls  — quick takeaways that could make or break a shift. 🛠  Real-World Application  — ...