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The last three RSI's I have had have required repeat doses post intubation and I do not seem to be getting more than about 8 minutes of sedation per dose, I don't know if this is an anomaly or due to the unique challenges we have.

Recently I have been finding myself questioning more and more the post-intubation sedation protocols or guidelines that most systems use for pre-hospital management. Where I currently work we have the option of either Ketamine or a Fentanyl/Versed combo. I am finding Ketamine to be a poor agent...

Looking advice, pay, comments, and overall thoughts on the jobs and services available within ~30 minutes of these areas (and in between). I know very little about EMS in Michigan but am trying to find out a bit more. Anything you can point me towards as far as pay, benefits, protocols, or...

We have ketamine and etomidate for RSI here, moving towards only ketamine for induction. Currently carry Succs but moving to Roc once we get everyone trained up on VL and get them on all the trucks. Also will have a protocol for Ketamine for pain management (Dosed on top of fentanyl) for severe...

1. Your number one job is not to provide excellent medical care, it is not to find out what is wrong with the patient or make the correct diagnosis, it is not to follow your protocols to a T and know them all by heart, it is not to have the "fastest, best, most awesome" approach to a certain...

If the patient can open their eyes and is oriented in answering any questions I have then that pretty much tells me they can wait for me to try some medications. Electricity is reserved for people that are dying, not almost dying. as a side note, my mother has dealt with SVT on and off for the...

Any thoughts on IM sedation in this patient early on when hypoxic agitation is immediately recognized?

Patient arrested on us 1 minute into transport 8 minutes after we arrived at scene. Patient was combative immediately after placement into ambulance, we had difficulty assisting ventilations with a BVM due to combative hypoxic state. IV access was unobtainable until just after her arrest. I'm...

Patient moved to stretcher rapidly, unable to hold any weight and has difficulty holding head up. CPAP placed on patient immediately however patient is non-compliant with CPAP and unable to tolerate. Pulse-Ox shows 30-40% with no decent waveform. 4 Lead monitor placed on patient showing sinus...

Heart rate palpated at wrist between 120-140. Patient is pouring sweat. Labored shallow breathing 30-40 times a minute and regular. Pulse ox doesn't register a reading, no blood pressure obtained at this time. Husband is yelling at you to help, patient can't speak. no other information.Patient...

Dispatch comes out for "breathing problems". Notes state 52 year old female. Address is in a not great area of town. You have a 6 minute response time. No other notes in the CAD, you are on a double medic truck and you also have QRV back up coming to you about 1 minute behind you and fire...

I believe our service is moving forward towards some very exciting progressive protocols. Our current protocol came about from first responders utilizing narcan prior to EMS arrival on suspected overdoses. This has become common practice in several states around here that have law enforcement...

I will say that our service is beginning to move towards a possible treat and release approach with uncomplicated accidental narcotics overdoses. Someone who was getting high or partying. We are in certain cases waking these people up on scene, doing a ALS workup for a refusal, and sticking...

I don't see the point in the study other then to add some more fuel to the "ALS makes no difference in outcomes" fire which makes it more difficult to get paid essentially... My protocol where I work is penetrating or blunt trauma of a life threatening nature (with a pulse) goes in the truck...

I believe the concern there was the heavily intoxicated unresponsive person WITH opiodes in his or her system. I have concerns about waking this person up even a little bit because we have a large patient population that will become semi (barely) responsive and then also begin to vomit, we are...

Ketamine, no haldol or geodon here. 3mg/kg IM for aggressive, agitated, violent patients. Usually does the trick....no complaints from me about Ketamine. As a note about Haldol I have read several very good articles about some possible reasoning behind the black box warning....the only route I...

.5mg at a time titrate to adequate respirations in suspected narcotics overdose. That said we are now trying out narcan, alert and oriented, 30 minutes total scene time with several sets of vitals, no other complaints, refusal. I'm not advocating this for all patients but for your uncomplicated...

This is an alert and oriented person who did not request us and has no medical complaint. This is a no patient found all day in my book. I would ook at the person and wish them a nice night, and look at the RA and say the patient is alert and oriented and states he is not a harm to himself or...

Interesting 4 lead and 12 lead. I'm thinking liberal with some benzo's and maybe some narcotics. ASA, IV, Monitor. I'm not sure I'm opposed to a moderate fluid bolus to see if it does anything for frequency of PVC's or Heart Rate or blood pressure, especially given the possibility of vomiting...

Nothing on any calls, no fear, no excitement, occasionally a little irritation. When I first started as a volunteer firefighter it was different but I learned quickly from those older and wiser than I. I think for those who are starting in this field, or even "old timers" with years of...