# How many drugs do you carry on your rig?



## Wingnut (May 30, 2006)

I found out we carry 33. And we actually carry dilaudid as well as morphine which kind of suprised me. Especially since we keep our rigs unlocked unless we're at a store. We have nitrous too but we only use it for abdominal pain because our MD doesn't want them getting the other two due to thier half life. 

From EMT school I really thought we would primarily carry cardiac meds and MAYBE a handful of others.


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## disassociative (May 30, 2006)

*...*

Ya know, I've never really counted; I know we keep Morphine/Dilaudid on the rigs too; ACLS drugs are usually kept in a bright yellow lockbox. Of course with lifeflight; they are everwhere, but there is one rule on lifeflight; If a paramedic doesn't tell you to, don't touch it. Maybe when I get my -P I will take a count; however at this point in time, I wouldn't want one of the flight physicians walking out to find me(an emt-iv) with liquid morphine in my hand .


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## MMiz (May 30, 2006)

Just one... love.

And EPI.


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## Jon (May 31, 2006)

I don't know #'s on the ALS rigs.. the county has a long approved list, but not every service carries everything.

As for MSo4 vs. Dilauid - does Dilaudid have the same effect the cardiac workload that Morphine has? Dilaudid is a "better" narcotic opioid, but Morphine is still the "gold standard"

Nitrous - I would be giving it to everyone - it has few contra-indications and is easly-applied, and a near-instant half-life.... perfect painkiller.


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## emt4life (May 31, 2006)

We carry 27 with O2, including 2 forms of NTG (spray and bottles for drips).  I wish we carried nitrous, but it is hard to get it refilled out where I work.  

Dilaudid doesn't have the same the same effect as morphine for cardiac issues, it is used for pain control in those patients who are allergic to morphine.  It is significantly stronger than morphine, so if you look at the bottle there is a lot fewer mg per bottle than morphine.

Does anyone carry etomidate?  We were just told my our medical director to pull it because they found it may be causing renal complications.  Has anyone else heard that?


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## Ridryder911 (May 31, 2006)

Etomidate can cause renal problems at a high dosage, and prolonged use. He/She might want to re-review the literature and studies of it. For a short one time use such as RSI, I have not seen or heard of any asociated renal problems. It is a great medication, we carry it and most of the flight services I know carry it as well. 

R/r 911


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## maksim (May 31, 2006)

Yeah, morphine the gold standard.
Our usual set:
Морфин 1
Omnopon (syn. Pantopon) 1.
Promedol (trimepiredine) 2.
Phentanyle (Sentonyle) 2.

N2O from the abdominal pain.
Etomidate or ketamine for a long time are not used.


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## Anomalous (Jun 6, 2006)

Never thought to count.   19 ILS including oxygen.


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## Wingnut (Jun 6, 2006)

Now the abdominal pain and using Nitrous, I know it's used because the half life is so short, but is that because an abdominal pain pt is more likely to have surgery or because there is a high chance they have internal bleeding? I kind of understand why they'd want that on those kind of symptoms but I don't know the actual reasoning.


Also I've seen that our medics almost never use the nitrous. They REALLY hate using it.


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## maksim (Jun 8, 2006)

Wingnut said:
			
		

> Also I've seen that our medics almost never use the nitrous. They REALLY hate using it.



_Our too....._


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## rescuecpt (Jun 8, 2006)

Wingnut said:
			
		

> I found out we carry 33. And we actually carry dilaudid as well as morphine which kind of suprised me. Especially since we keep our rigs unlocked unless we're at a store. We have nitrous too but we only use it for abdominal pain because our MD doesn't want them getting the other two due to thier half life.
> 
> From EMT school I really thought we would primarily carry cardiac meds and MAYBE a handful of others.




Is the dilaudid and morphine locked up?  Our morphine, atevan, and diazepam are all locked in a safe on the rig that you need a magnetic key and a personal pin to get into.  If yours isn't locked up, PM me and I'll send you my address...  

By the way, if you've never had morphine IV, it is very nice.  hehehe.


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## Jon (Jun 8, 2006)

rescuecpt said:
			
		

> Is the dilaudid and morphine locked up?  Our morphine, atevan, and diazepam are all locked in a safe on the rig that you need a magnetic key and a personal pin to get into.  If yours isn't locked up, PM me and I'll send you my address...
> 
> By the way, if you've never had morphine IV, it is very nice.  hehehe.


Magnetic key?


High tech!


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## rescuecpt (Jun 8, 2006)

MedicStudentJon said:
			
		

> Magnetic key?
> 
> 
> High tech!



Yeah, you have to spin the dial a couple times to turn the safe on (it generates electricity from the spin), then you have to put YOUR magnetic key up to the reader, spin some more one way, then the other, enter your pin, spin-spin-spin, and viola!  drugs!


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## emtd29 (Jun 8, 2006)

NO narcs on our bus.


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## emtd29 (Jun 8, 2006)

rescuecpt said:
			
		

> Yeah, you have to spin the dial a couple times to turn the safe on (it generates electricity from the spin), then you have to put YOUR magnetic key up to the reader, spin some more one way, then the other, enter your pin, spin-spin-spin, and viola! drugs!


 


wow. seems like a lot of work to get at your meds when you need them...

No Narcotics or other controlled substances on our rigs.


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## Wingnut (Jun 9, 2006)

rescuecpt said:
			
		

> Is the dilaudid and morphine locked up? Our morphine, atevan, and diazepam are all locked in a safe on the rig that you need a magnetic key and a personal pin to get into. If yours isn't locked up, PM me and I'll send you my address...
> 
> By the way, if you've never had morphine IV, it is very nice. hehehe.


 
Yeah they are, but there just in a drawer with a regular key on the rig. Nothing fancy like your set up, hell it'd almost have to be a long *** transport to be worth getting them out.

And I know IV morphine and dilaudid are nice


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## Jon (Jun 10, 2006)

rescuecpt said:
			
		

> Yeah, you have to spin the dial a couple times to turn the safe on (it generates electricity from the spin), then you have to put YOUR magnetic key up to the reader, spin some more one way, then the other, enter your pin, spin-spin-spin, and viola!  drugs!


I like this idea, but it has to cost a LOAD of money.

At work, the narcs are sealed in a bag, the bag is accountable shift to shift, and the bag is usually stored in a locked cabinet in the rig (regular key). sometimes, at least at events, the medics will carry the narcs on their person or the ALS Bag... keeping them with the crew.


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## MMiz (Jun 10, 2006)

Around here narcs are stored with the other "big" drugs in a county tackle box that is secured with a plastic tie.  When we use any drugs out of the box we turn it into hospital security and they give us a new box.  They're stored in a locked cabinet in the ambulance.

We used to keep the drug boxes outside stored in the locked ambulances, but then someone started to pry the doors off of the ambulances.  Now they're turned in at the end of every shift and locked in the storage cage.


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## Jon (Jun 10, 2006)

Nice... Bucks County PA uses a similar system.

I think the Narcs are seperate... and are swapped with the ED staff after they've been used.

The main drug box stays in a cabinet in the rig, and most services just re-stock their ALS bag out of it (County lets services use whatever they want as a jump bag, but drug exchange is through the county box). After use, the box gets exchanged with a sealed one out of a hospital pharmacy.

The system seems to work for them... but will only work if ALL services and ED's in the county are on-board.


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## daemonicusxx (Jun 11, 2006)

they dont want you using morphine or any other narcotic analgesic due to the fact that the patient is going to have to answer the doctors questions about symptoms of the pain when they get to the ED. they want the patient clear headed when you get them there. dont want them sayin "well, doesnt hurt anymore after that shot the ambulance driver gave me"


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## MMiz (Jun 11, 2006)

daemonicusxx said:
			
		

> they dont want you using morphine or any other narcotic analgesic due to the fact that the patient is going to have to answer the doctors questions about symptoms of the pain when they get to the ED. they want the patient clear headed when you get them there. dont want them sayin "well, doesnt hurt anymore after that shot the ambulance driver gave me"


I think it all depends.  When I hurt me knee (turned out I shattered a part of my patella) I got morphine for a five minute ride to the hospital.

Jon's right about the county system.  It's an all or nothing type of deal.  We all use county radios, county drugs, and county backboards.  Personally I think the system is broken, as there is little personal accountability, but that's a totally separate thread.


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## Flight-LP (Jun 11, 2006)

daemonicusxx said:
			
		

> they dont want you using morphine or any other narcotic analgesic due to the fact that the patient is going to have to answer the doctors questions about symptoms of the pain when they get to the ED. they want the patient clear headed when you get them there. dont want them sayin "well, doesnt hurt anymore after that shot the ambulance driver gave me"



Sorry, but I call BS on this one. Any proficient physician can objectively examine a patient with analgesics on board. Even if they are drooling. To withhold pain medications so a physician doesn't have to actually challenge himself by actually placing his hands on a patient is cruel, unethical, and negligent. Treat the patient for the patient, not for the doctor. Hell, they make enough $$$, let them earn it!

BTW, to answer the original post, 54 meds + blood if needed.............


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## Wingnut (Jun 11, 2006)

Flight-LP said:
			
		

> Sorry, but I call BS on this one. Any proficient physician can objectively examine a patient with analgesics on board. Even if they are drooling. To withhold pain medications so a physician doesn't have to actually challenge himself by actually placing his hands on a patient is cruel, unethical, and negligent. Treat the patient for the patient, not for the doctor. Hell, they make enough $$$, let them earn it!
> 
> BTW, to answer the original post, 54 meds + blood if needed.............


 

Wow blood too?  We only withhold drugs on abdominal pain, but they are allowed to get nitrous, that's what I was asking about. Maybe I'll ask the medic at work tomroow.


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## rescuecpt (Jun 11, 2006)

daemonicusxx said:
			
		

> they dont want you using morphine or any other narcotic analgesic due to the fact that the patient is going to have to answer the doctors questions about symptoms of the pain when they get to the ED. they want the patient clear headed when you get them there. dont want them sayin "well, doesnt hurt anymore after that shot the ambulance driver gave me"



Yeah, we don't get narc orders too often, but when we do its usually for cardiac problems or stat ep, not necessarily for pain.

As far as our "fancy" lock-down system, it's only for narcs, and once the safe is open the ALS provider has to carry the narcs in a fanny pack on their person, until the extras are wasted in front of the nurse who signs off the paperwork, and we reinventory the narcs and lock them back up.  When we get back, we have to call our narcotics director, who either comes down to restock or puts a different rig in service as first due.  NYS doesn't play around with narcs, there are only a few services in my area who carry them because the state is so strict about how to keep them locked and stuff.

It doesn't really take that long to get them out of the safe, and for us, the nearest non-flying trauma center is at best 15 minutes out, so there's plenty of time to get out the narcs.


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## circusmidget (Jul 4, 2006)

just curious, not sure if reading this right, but my take on this thread is that its ok in the states to give entonox/nitrous for unDx abdo? or just Dx abdo ?


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## Ridryder911 (Jul 4, 2006)

It all depends on the protocols, however nitrous is very temporary and I do not see that it would hamper any differential diagnosis.

R/r 911


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## disassociative (Jul 5, 2006)

On our ground rigs; there are 2 boxes; a bright red ACLS and a bright orange or yellow Narc Box. Both of these boxes are locked; and the key is carried by the senior medic. Our service doesn't have just one rig dedicated to critical care though; all busses have the same equipment. Each one goes out with either 2 Paramedics or a Paramedic with an EMT-IV or EMT-I whichever is available. Obviously when it is Paramedic and EMT-IV; the EMT-IV does the driving.
I am unsure as to the narcotics disposal protocol; as I am emt-iv and take no part in the administration or handling of narcotics. However, I am sure it is much like vandy's protocol: Nurse or physician present to sign off. Narcs are provided as needed to the service. 

In the event that there is a narc count and something comes up short;
heads will roll and @$$'s will fry.


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## Firechic (Jul 6, 2006)

> To withhold pain medications so a physician doesn't have to actually challenge himself by actually placing his hands on a patient is cruel, unethical, and negligent. Treat the patient for the patient, not for the doctor.



I agree with you 100% on this one. My department does not withhold pain medications. Also, there have been numerous lawsuits with regard to NOT treating pain in the field.


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## ResTech (Jul 9, 2006)

BLS units in PA only carry Epi in form of EPi-Pen... ALS carries alot.. 

  1.  Adenosine
  2.  Albuterol
  3.  Amiodarone
  4.  Aspirin
  5.  Atropine sulfate
  6.  Benzocaine--for topical use only
  7.  Bretylium
  8.  Calcium chloride
  9.  Dexamethasone sodium phosphate
10.  Diazepam
11.  Dilaudid--for interfacility transports only
12.  Diltiazem
13.  Diphenhydramine HCL
14.  Dobutamine
15.  Dopamine
16.  Epinephrine HCL
17.  Fentanyl
18.  Furosemide
19.  Glucagon
20.  Heparin by intravenous drip--for interfacility transports only
21.  Heparin lock flush
22.  Hydrocortisone sodium succinate
23.  Glycoprotein IIb/IIIa Inhibitors--for interfacility transports only
      a.  Abciximab
      b.  Eptifibatide
      c.  Tirofiban
24.  Intravenous electrolyte solutions
      a.  Dextrose
      b.  Lactated Ringer's
      c.  Sodium chloride
      d.  Normosol
      e.  Potassium--for interfacility transports only
25.  Ipratropium bomide
26.  Isoproterenol HCL--for interfacility transports only
27.  Levalbuterol--for interfacility transports only
28.  Lidocaine HCL
29.  Lorazepam
30.  Magnesium sulfate
31.  Metaproterenol
32.  Methylprednisolone
33.  Midazolam
34.  Morphine sulfate
35.  Naloxone HCL
36.  Nitroglycerin by intravenous drip--for interfacility transports only
37.  Nitroglycerin ointment
38.  Nitroglycerin spray
39.  Nitroglycerin sublingual tablets
40.  Nitrous oxide
41.  Oxytocin
42.  Phenergan
43.  Pralidoxime CL
44.  Procainamide
45.  Sodium bicarbonate
46.  Sodium thiosulfate
47.  Sterile water for injection
48.  Terbutaline
49.  Tetracaine--for topical use only
50.  Verapamil


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