# Advanced ALS stuff?



## O 2 (Oct 14, 2010)

I was wondering if anybody could list for me some the more progressive interventions that are not commonly found in every system. 

Also, what is the status of the surgical cric? is that commonly in most medics scope?  I found the new nationals scope model list percutaneous, not surgical crics. 

What about RSI? 

THanks


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## usalsfyre (Oct 14, 2010)

> I was wondering if anybody could list for me some the more progressive interventions that are not commonly found in every system.



Real pain management. You know, for all pain, not just extremity fractures.

Surgical crics are up to your state and medical director to determine. My system allows it, and we have to prove competency yearly (which let's face it, is not nearly enough). However, this is probably one of the more truly lifesaving interventions when done appropritely. If a cric is needed, there is no other way to manage the airway, and the patient will die without one.


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## Shishkabob (Oct 14, 2010)

Pericardiancentesis 
Ultrasound
RSI (even though it's becoming more common)


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## medic417 (Oct 14, 2010)

Chest tube
Escharotomy
Surgical cric
central line
Insulin


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## rescue99 (Oct 14, 2010)

medic417 said:


> Escharotomy



Seriously? :huh:


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## medic417 (Oct 14, 2010)

rescue99 said:


> Seriously? :huh:



Yes seriously.  Rural areas long transports.


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## 46Young (Oct 14, 2010)

medic417 said:


> Yes seriously.  Rural areas long transports.



If that's the case, I'd rather risk complications from an escharotomy than have the pt suffer and die from restricted/no Cx excursion or lose a limb from compartment syndrome in the ext's. Good for them! Just curious, is that within the national scope of practice?


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## Shishkabob (Oct 14, 2010)

rescue99 said:


> Seriously? :huh:



There's been chest tubes, pericardialcentsis, central lines, surgical crichs and RSI, and you're shocked by releasing pressure from a burn by a cut?


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## sir.shocksalot (Oct 14, 2010)

O 2 said:


> Also, what is the status of the surgical cric? is that commonly in most medics scope?  I found the new nationals scope model list percutaneous, not surgical crics.


Most percutaneous needle cric kits (in my area) are now the "Quik-Trach" system, and it's technically a needle cric but it introduces a 6.0 or a 6.5 ET tube into the trachea so it is just as effective as a surgical cric with out all this scalpel nonsense


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## medic417 (Oct 14, 2010)

sir.shocksalot said:


> Most percutaneous needle cric kits (in my area) are now the "Quik-Trach" system, and it's technically a needle cric but it introduces a 6.0 or a 6.5 ET tube into the trachea so it is just as effective as a surgical cric with out all this scalpel nonsense



Check tube size I believe they are smaller but I may be confused.:wacko:


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## medic417 (Oct 14, 2010)

46Young said:


> Just curious, is that within the national scope of practice?



Don't recall seeing it listed.


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## Shishkabob (Oct 14, 2010)

Or you can use the IV drip chamber cut in half


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## usalsfyre (Oct 14, 2010)

Linuss said:


> Or you can use the IV drip chamber cut in half



Holy off label paraman!!!!


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## TransportJockey (Oct 14, 2010)

usalsfyre said:


> Holy off label paraman!!!!


Heh we were told that 'field expedient' use in my medic class too


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## Shishkabob (Oct 14, 2010)

jtpaintball70 said:


> Heh we were told that 'field expedient' use in my medic class too



Medic school... protocols of many of the local EMS agencies... directly from the mouth of a couple of docs...


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## Akulahawk (Oct 14, 2010)

Yeah, that field expedient use of a drip chamber was taught to my class too. Of course, that went along with: You'd better have exhausted all your needle cric kits first...


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## TransportJockey (Oct 14, 2010)

Linuss said:


> Medic school... protocols of many of the local EMS agencies... directly from the mouth of a couple of docs...



After talking to my new medical director, I betcha I could probably get away with it... Which kinda scares me a little


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## usalsfyre (Oct 15, 2010)

Gives me the warm and fuzzies about my surgical cric kit, with a real scapel, trach hook and hemostats. And giving me warm and fuzzies about having to cut is hard....


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## MrBrown (Oct 15, 2010)

Hell we have been proactively leaving people at home for thirty years, not too many places I know who do that.

Oh and we are also doing RSI and thrombolysis now too.


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## EMTinNEPA (Oct 15, 2010)

Quik-Trachs are typically a 10g needle.  Not nearly the size of a tracheostomy.


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## jjesusfreak01 (Oct 15, 2010)

MrBrown said:


> Hell we have been proactively leaving people at home for thirty years, not too many places I know who do that.
> 
> Oh and we are also doing RSI and thrombolysis now too.



We don't do it in the US because there would be no legal protection if anything went wrong...

Medics leave patient at home, pt stubs toe, pt sues...

Medics leave pt at home, pt gets a tummy ache, pt sues...

In other countries the judges would laugh at them, in the US its a million dollar settlement.


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## MrBrown (Oct 16, 2010)

jjesusfreak01 said:


> We don't do it in the US because there would be no legal protection if anything went wrong...
> 
> Medics leave patient at home, pt stubs toe, pt sues...
> 
> ...



Only a lousy million? Bloody hell you need to get a better lawyer!


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## medic417 (Oct 16, 2010)

jjesusfreak01 said:


> We don't do it in the US because there would be no legal protection if anything went wrong...
> 
> Medics leave patient at home, pt stubs toe, pt sues...
> 
> ...



Actually there are services in the USA that treat and release.  

Do not use blanket statements the are almost always wrong.


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## Melclin (Oct 16, 2010)

Falls intervention in the elderly. 

Saves more lives than crics..not as cool though.


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## MrBrown (Oct 16, 2010)

Melclin said:


> Falls intervention in the elderly.
> 
> Saves more lives than crics..not as cool though.



*Brown and Oz rock up clad in thier orange jumpsuits with "DOCTOR" and "PARAMEDIC" respectively written on the back and 20kg Thomas Packs slung over thier shoulder, dump them on the ground and go about checking the laryngascopes, ketamine and suxamethonium.... 

Now my dear, earl grey and two sugars was it?


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## Melclin (Oct 16, 2010)

English breakfast and one will fix the entire health system.^_^


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## TransportJockey (Oct 16, 2010)

Oh and back to the original topic, my new system allows RSI for medics, Flumazenil is carried as ILS/ALS respons to benzo ODs, beta blockers are carried for the medics... That's all that comes to mind off the top of my head, maybe when I get my protocol book I can see what other fun toys we get


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## MrBrown (Oct 16, 2010)

Flumazinil is nasty and evil, its almost as evil as the New World Order ..... but not quite 

I think we carried it for a brief period in the eighties and quickly withdrew it


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## TransportJockey (Oct 16, 2010)

MrBrown said:


> Flumazinil is nasty and evil, its almost as evil as the New World Order ..... but not quite
> 
> I think we carried it for a brief period in the eighties and quickly withdrew it


Trust me, I'm aware of that. Even the RNs at my old ED wouldn't use the stuff. But the OP asked for stuff not covered in standard curriculum.


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## MrBrown (Oct 16, 2010)

I am not sure Brown is in the standard cirriculi either.  Heck I think he is a whole seperate qualification ... possibly in some area of mental health


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## Kthanid (Oct 16, 2010)

MrBrown said:


> Only a lousy million? Bloody hell you need to get a better lawyer!



That's 1.5 million NZ though remember


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## YoungMedic (Oct 17, 2010)

RSI
Surgical Cric
Quick-Trak

There are 2 different sizes of Quick-Trak, Peds and Adult.  Make sure to check and see witch one you are about to use.


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## reaper (Oct 17, 2010)

Why need surgical and quick trach?


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## MrBrown (Oct 18, 2010)

Kthanid said:


> That's 1.5 million NZ though remember



Mate, the Powerball was $27 million last wee do you really expect Brown to settle for a million? 

With that sort of money HEMS Auckland and BASICS could get a million each, man I'd be popular, that orange jumpsuit would read "DONOR" instead of "DOCTOR"


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## usalsfyre (Oct 18, 2010)

reaper said:


> Why need surgical and quick trach?



Why do you NOT need surgical airways? Needle crics can not ventilate a patient. They're not often needed, but when a surgical aiway is called for, either it's performed or the patient suffers an anoxic episode and dies. This one of the few times EMS truly "saves lives", far more than RSI.


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## reaper (Oct 18, 2010)

Quick trachs are not a needle cric. They are very adequate airways. 

I just do not see the need for both, either one or the other.


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## usalsfyre (Oct 18, 2010)

(Opens mouth and inserts foot)

Understand what your asking now. I though it was more of a general questioning of percutaneous and/or surgical airways. Very sorry for the overreaction.


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## himynameismj (Oct 18, 2010)

Therapeutic Hypothermia, RSI for starters. Not exactly what other states are allowed and not allowed to do. New Jersey is very liberal in terms of ALS procedures however.


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## NomadicMedic (Oct 18, 2010)

Off the top of my head: RSI, Thrombolytics for STEMI, liberal pain management protocols, a couple of different beta blockers...

I work in several different counties and every place is a _little_ different.


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## TransportJockey (Oct 18, 2010)

Any chance you could maybe send me a copy of your protocols for thrombolytics? I know my new service is looking to add those for their medics soon, but are trying to find examples across the country to base it on.


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## reaper (Oct 19, 2010)

I think Heparin is as much as your need to add for STEMIs.


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## NomadicMedic (Oct 19, 2010)

jtpaintball70 said:


> Any chance you could maybe send me a copy of your protocols for thrombolytics? I know my new service is looking to add those for their medics soon, but are trying to find examples across the country to base it on.



Sure. I'll grab 'em and post them here. It'll be a few days, as I don't have a copy at home and I'm not at the station til the end of the week.


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