Things We Can Do Better in 2015!

Here's my list of the top 20 things we can do better in 2015 based on what we learned in 2014 (or even before).

1. High-flow nasal cannula (HFNC), at least 15 Lpm, on all patients undergoing intubation or who might need intubation.
2. PEEP valve on every BVM.
3. No longboards for ANY patient.  Continue to use spinal precautions as appropriate, but that doesn't mean you need a long spinal board.
4. Ketamine, followed by ketamine, rounded out by MORE KETAMINE for RSI induction.
5. No Versed (midazolam) for intubation or post-intubation.
6. No interruptions in compressions for any reason.  Your survival decreases by 7% for every five seconds without compressions. We should be working on improved CPR and "see-through CPR" monitor technology, and don't you dare hold compressions while the monitor is charging!
7. Tranexamic acid (TXA) for all hemodynamically unstable trauma patients.
8. Let the fentanyl flow for intubations, especially after intubation. Pre-intubation benefits in head trauma.
9. More intranasal medications.
10. Use D25 instead of D50 when available.
11. Treat septic nursing home patients like the real emergencies they are.  IV fluids with 30-40 cc/kg bolus.  IV access at a minimum to speed up the time to first antibiotics.
12. Agitated/emotionally-disturbed patients should be recognized as real emergencies as well.  These may be excited delirium.  Treat with ketamine IM; doses as high as 4 mg/kg IM shown to be safe.
13. No etomidate for sepsis or hypotensive patients.
14. Push dose epinephrine for peri-intubation hypotension.
15. Rotate people doing compressions at least every 3 minutes.
16. Stop using BVMs on patients if RR is at least 4 or SPO2 is at least 94%. Instead, use high-flow nasal cannula with a nonrebreather on top.
17. Every BLS should have a pulse oximeter.  They are very affordable these days.
18. Use a metronome for every cardiac arrest!  If your monitor doesn't have one, download an app.
19. No more nitroglycerin paste.
20. Starting dosage of Zofran (ondansetron) for adults should be 8 mg.