Do you carry ammonia inhalants

Do you carry ammonia inhalants on your truck?

  • yes

  • no


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DrParasite

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Last night, my crew was dispatched to a 14 year old unconscious. we arrive, and my captain starts doing paperwork, while I start assessing the patient. hx of migraines., but hasn't taken any meds for it. the physical assessment looks good, nothing super alarming, a quick look at his eyes shows bilateral rapid eye movement. everything else makes me think he's just really sleeping. I try some painful stimuli (nail bed pressure, I'm not doing a sternal rub on a sleeping 14 year old), and he doesn't wince. the ambulance arrives a few minutes later, I give a quick report, and one of the crew pinches the area between his thumb and pointer finger and no response. The general consensus appears that he is just doesn't want to wake up.

One of the paramedics breaks open an ammonia inhalant, and the child starts to wake up. Unfortunately, we don't carry them (and my captain says we can't get them). I remember back in NJ, they were being phased off the truck, for reasons that I am still not sure about, but the cops were using them to wake up drunks. So my questions is, do you guys still carry them? and are there explicit protocols for when they should or should not be used?

and for full disclosure, I do not agree with anyone using them for abusive purposes, but as an alternative to using painful stimuli to awaken someone
 

ffemt8978

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They were taken off our rigs because there were concerns about aggravating respiratory issues for patients and crew members.
 

mgr22

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Toward the end of my hockey career, they were sometimes self-administered as stimulants. They worked quicker than Sudafed.
 

Tigger

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They’re still floating around here but I can’t say I ever use them. At the time I went to school there was lots of controversy about them and some high profile local cases of being abusive to patients. We were encouraged to never use them and I guess I stuck to that.

One of my partners uses them to wake up for night calls, woof.
 

DesertMedic66

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Haven’t seen them at any agency I have been with for the past 10 years.
 

Carlos Danger

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Toward the end of my hockey career, they were sometimes self-administered as stimulants. They worked quicker than Sudafed.
They are still popular with powerlifters.
 

Summit

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There are a gajillion L&D RNs walking around with an ammonia ampule taped to their badge.
 

EpiEMS

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So my questions is, do you guys still carry them? and are there explicit protocols for when they should or should not be used?
Not carried -- not in scope as far as I am aware. They don't show up in the National Model Clinical Guidelines (in the context of ammonia inhalants, anyway).

I'm skeptical as to utility in the prehospital setting - sure, it's a noxious stimulus, but what's the benefit over standard of care (trapezius squeeze, e.g.)?

I haven't been able to locate any good EBM research on the topic, can't find anything useful on PubMed for "smelling salts", "ammonia inhalants", or "ammonia inhalant".

There are a gajillion L&D RNs walking around with an ammonia ampule taped to their badge.
Indication: Spousal syncope?
 
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DrParasite

DrParasite

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They were taken off our rigs because there were concerns about aggravating respiratory issues for patients and crew members.
Now I remember, this was the reason my clinical coordinator said they were disappearing from our trucks. and I won't disagree, but we shouldn't be shoving them up a person's nose. I never saw it happen myself, but seen them used many times throughout my career
I'm skeptical as to utility in the prehospital setting - sure, it's a noxious stimulus, but what's the benefit over standard of care (trapezius squeeze, e.g.)?

I haven't been able to locate any good EBM research on the topic, can't find anything useful on PubMed for "smelling salts", "ammonia inhalants", or "ammonia inhalant".
Ever had someone who wouldn't respond to a trap squeeze? or sternal rub? or your preferred method of painful stimuli? Short of starting an IV, what other options are there?
There are a gajillion L&D RNs walking around with an ammonia ampule taped to their badge.
I guess my follow up question would be, why is it ok for hospital RNs to use them, but not for prehospital providers?

They are still popular with powerlifters.
Oddly enough, this has been studied on PubMed

We discussed this on the forums about 10 years ago:
and 13 years ago in JEMS
 

EpiEMS

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Ever had someone who wouldn't respond to a trap squeeze? or sternal rub? or your preferred method of painful stimuli? Short of starting an IV, what other options are there?

Sure, but all else being equal, what’s the benefit of bothering the patient? My interventions aren’t changing much if they are not responsive but breathing & have a pulse. Check a BGL, call for ALS, transport. If they have transient consciousness from a noxious stimuli, that doesn’t help me much.
 

E tank

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Sure, but all else being equal, what’s the benefit of bothering the patient? My interventions aren’t changing much if they are not responsive but breathing & have a pulse. Check a BGL, call for ALS, transport. If they have transient consciousness from a noxious stimuli, that doesn’t help me much.
Sure, not in the conduct of the tasks that you need to complete before/during transport but these things do give essential assessment information on depth of unconsciousness and a baseline in time.

The thing about ammonia is that they were pretty much uniform in the level of stimulation. A sternal rub or trapezius pinch from a 240 pound fireman just off of a Red Bull at 9 AM is a lot different from a 120 pound medic at 2 AM that hasn't been asleep since she got on at 7 the day before.
 

PotatoMedic

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Plus ammonia does not physically harm my patients.
 

akflightmedic

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I have not carried ammonia in so long, I am truly trying to remember the last time I had access and actually used it. I think it would have been late 90s in South Carolina. As a clinician, there has never been a time when I said to myself "gee, I wish I really had some ammonia inhalant right now to help me figure out what to do next"....that thought process just does not exist in my head. If they are faking, so what?! If they get through a trap squeeze, nail bed press, or brow push...good for them. They are maintaining their airway, vitals are great...fine, there is no need for me to force them to "consciousness", none.

My interventions, my assessments, they all remain unchanged whether they are alert or not. Now what I have seen, when we did carry the inhalants, was the abuse of them. More times than not, it was abusive in nature, or just an annoyed provider. I even witnessed a Medic who taped one to the cheek of a patient who was faking. That patient received a chemical burn on their cheek and rightfully so, the medic was written up and disciplined.

I do not perform sternum rubs either, those went to wayside many years ago. Those seem to be just as punitive as the inhalants and overused and abused.

Will someone here please tell me the clinical benefit of the inhalant and maybe an anecdotal story of how the use of one completely changed the course of your treatment for the patient?
 

CCCSD

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It made my patient get up and leave so we could go back to quarters and sleep.
 

EpiEMS

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Sure, not in the conduct of the tasks that you need to complete before/during transport but these things do give essential assessment information on depth of unconsciousness and a baseline in time.

The thing about ammonia is that they were pretty much uniform in the level of stimulation. A sternal rub or trapezius pinch from a 240 pound fireman just off of a Red Bull at 9 AM is a lot different from a 120 pound medic at 2 AM that hasn't been asleep since she got on at 7 the day before.

I suppose the question is: what more do I find out versus a trapezius pinch, say? Transient consciousness either way?

(Appreciating of course the practical uniformity of application.)
 
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