# Ammonia Inhalants...



## EMSpassion94 (Aug 18, 2011)

Are there any contraindications to the use of ammonia inhalants? Any information would be great. Thanks!


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## Shishkabob (Aug 18, 2011)

No absolute, but best not to use on someone with a reactive airway disease.


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## MrBrown (Aug 18, 2011)

Yes, this is not the seventies


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## Tigger (Aug 19, 2011)

EMSpassion94 said:


> Are there any contraindications to the use of ammonia inhalants? Any information would be great. Thanks!



Hopefully they are all expired, so yes.


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## firetender (Aug 19, 2011)

For what and why?

Make believe we're your Base Station and we have no imagination.


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## RiceMedic (Aug 19, 2011)

Isn't it depends on where you are and the policy for using ammonia inhalants? 
It's illegal to use it in certain city and state so I guess you would have to check the vicinity's rules and regulations. 

Apparently, you can buy 'em online ;D


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## bigbaldguy (Aug 19, 2011)

We used to have them on the plane. If someone had severe ear distress from altitude issues we'd snap one under their nose and most of the time it would open them up. Recently though they were all removed.


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## abckidsmom (Aug 19, 2011)

They take the itch right out of a bug bite if you can get over the idea of applying a caustic chemical to broken skin.

Oh...so that rules out mucus membranes too.  

Please, no ammonia caps.  Johnny and Roy need them all for the museum.


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## feldy (Aug 19, 2011)

we still carry them (not expired) and use them.


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## usafmedic45 (Aug 19, 2011)

The only practical and clinically valid use I have ever had for them was clearing an aggressive dog out of a room with a collapsed patient.


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## STXmedic (Aug 19, 2011)

A couple weeks ago the ED doc gave me one to use on our pt while we waited for a nurse and a room


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## traumaluv2011 (Aug 19, 2011)

I don't see much practical use to these. If someone has a serious injury and is unconscious, they are going to be much easier to handle unconscious. You can find out what happened from an assessment and scene size-up.


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## Shishkabob (Aug 19, 2011)

I use / have used them to 'wake up' obviously faking psych patients when the threat of an NPA isn't enough.  How do I know they were faking?  They were laughing / smiling at my jokes.


Not going to hurt my back when someone fully capable of walking would rather fake unconsciousness.


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## EMSpassion94 (Aug 19, 2011)

firetender said:


> For what and why?
> 
> Make believe we're your Base Station and we have no imagination.



Well....

We were dispatched the other day for an "Unconsious person." Before we arrived on scene we were notified it was "CPR in progress." Which, it wasn't. Turned out to be a woman who we had just transported the previous week due to "domestic violence." This time, she had had one too many beers, (8, she stated...) and was out cold. Lying on the floor in her bedroom. None of the bystanders could tell us if she fell or not, so we took all spinal precautions. Checked her pupils, which were a little sluggish. Once we loaded her into the ambulance, Medic arrived and used an ammonia inhalant on her. She came ALIIIIVEEE. :blink: 

What i'm trying to get at I guess, is are there any contraindications to using ammonia inhalants, such as head trauma, spinal trauma? I could understand not using one on a serious injury/unconscious case. Make things more difficult, like traumaluv2011 said. And yes, we still carry ammonia inhalants on our rigs. They are not expired, and we do use them sometimes.


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## usalsfyre (Aug 19, 2011)

Ammonia has been so abused that I don't think they should be available to EMS and the ED. 

Clinically? Very linited use in the patient who is suffering from suspected psychogenic syncope is probably fine. It's much easier to treat "the whole patient" when they're awake and speaking to you. The problem is you dont see "limited use". You see the "walrus", and ammonia being used in patients before other causes of unconsciousness are investigated.


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## Shishkabob (Aug 19, 2011)

usalsfyre said:


> Ammonia has been so abused that I don't think they should be available to EMS and the ED.
> 
> Clinically? Very linited use in the patient who is suffering from suspected psychogenic syncope is probably fine. It's much easier to treat "the whole patient" when they're awake and speaking to you. The problem is you dont see "limited use". You see the "walrus", and ammonia being used in patients before other causes of unconsciousness are investigated.



I once had a "paramedic" at AMR tell me that he 'saved a life' by keeping a patient awake with ammonia inhalents...


Needless to say, he hasn't been allowed to operate above the EMT level for quite some time (for a different reason, but still)


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## JPINFV (Aug 19, 2011)

Linuss said:


> I once had a "paramedic" at AMR tell me that he 'saved a life' by keeping a patient awake with ammonia inhalents...
> 
> 
> Needless to say, he hasn't been allowed to operate above the EMT level for quite some time (for a different reason, but still)




Well, of course. How many awake dead people have you seen? Does it not logically follow that if you can keep someone from going to sleep they'll never die?


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## usalsfyre (Aug 19, 2011)

JPINFV said:


> Well, of course. How many awake dead people have you seen? Does it not logically follow that if you can keep someone from going to sleep they'll never die?



But, but....I've seen someone dead who's eyes were open?


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## JPINFV (Aug 19, 2011)

usalsfyre said:


> But, but....I've seen someone dead who's eyes were open?


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## Shishkabob (Aug 19, 2011)

usalsfyre said:


> But, but....I've seen someone dead who's eyes were open?





Infact, I've seen dead people RE-open their eyes.... :wacko:

God I hate when you let the family go see the body and the eyes open JUST as they go in to kiss/hug the body...


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## Cohn (Aug 20, 2011)

Ammonia pellets are useless to us if they are out... keep em' that way.


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## DrParasite (Jan 19, 2018)

Only because this topic came up at EMS con ed, with mixed opinions from people, and I didnt' feel like starting a new thread....

Are ammonia inhalants they still permitted, are there any new risks, and are you still carrying them on your trucks?


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## Summit (Jan 19, 2018)

They are still very common on OB units for near syncopal episodes.

Amyl Nitrate is a weak countermeasure for cyanide poisoning
https://chemm.nlm.nih.gov/countermeasure_amyl-nitrite.htm


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## DesertMedic66 (Jan 19, 2018)

We haven’t carried them in well over 7 years


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## luke_31 (Jan 19, 2018)

We carry them, but we also get a lot of fake pass outs that refuse to wake up without them.  So it's a useful diagnostic tool for when everything else doesn't work before that.


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## Bullets (Jan 19, 2018)

We stopped carrying them once we got licensed in 2012. I discourage their use. EMTs have a tendency to shove them up the patients nose. I like a good hard trap pinch


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## DrParasite (Jan 19, 2018)

Bullets said:


> We stopped carrying them once we got licensed in 2012.


was that just a coincidence, or did something with the licensure necessitate that change?





Bullets said:


> I discourage their use. EMTs have a tendency to shove them up the patients nose. I like a good hard trap pinch


you mean they don't go up someone's nose????   I don't think they work as well when placed behind the patient's ear......

in all seriousness, shoving them up a patient's nose sounds more like training and re-education is in order.  or clinical discipline, where you can either demonstrate on said EMTs why you shouldn't shove them up a patient's nose or they can take a 5 shift unpaid suspension for mistreating their patients.

So other than the potential for providers misusing them (which is possible for any item in EMS), was there a reason you removed them?


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## EpiEMS (Jan 19, 2018)

DrParasite said:


> So other than the potential for providers misusing them (which is possible for any item in EMS), was there a reason you removed them?



I was under the impression that the possible problems caused by an unconscious patient with a (potential) unstable spinal injury recoiling reflexively was part of the reason for why people don't use them.


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## Bullets (Jan 21, 2018)

DrParasite said:


> was that just a coincidence, or did something with the licensure necessitate that change?you mean they don't go up someone's nose????   I don't think they work as well when placed behind the patient's ear......
> 
> in all seriousness, shoving them up a patient's nose sounds more like training and re-education is in order.  or clinical discipline, where you can either demonstrate on said EMTs why you shouldn't shove them up a patient's nose or they can take a 5 shift unpaid suspension for mistreating their patients.
> 
> So other than the potential for providers misusing them (which is possible for any item in EMS), was there a reason you removed them?



No, nothing to do with actually having the license since they are not mentioned either way in the regulations

with the addition of paid staff and the creation of a hybrid agency, the paid staff went through and lightened up every aspect of our trucks. The volunteers had a habit of filling every cabinet and bag to the limit. We took 25 multi trauma dressings (the big huge ones) off one truck. We also got rid of superfluous stuff, and we felt that there was nothing an ammonia inhalant could provide that couldnt be done with your hand, or a pen. So them, those glass vial bee sting swabs, jaw screws, FROPVDs all went into the trash. 

We did train our people, but once we threw them away, it wasnt an issue.


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## VFlutter (Jan 21, 2018)

They are great before a heavy deadlift


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