I've been reading through my ALS standards, and have a few (probably very newbie) questions I've been wondering about. I'll try not to drown you in all of my questions at once, but I'll post a few at a time.
-For anaphylaxis patients, since the throat is so swollen, is intubation possible?
Sometimes, sometimes it is not. One of the few times I had to perform an emergency crich was on a anaphylaxis. The tongue does immediately swell as well as the posterior throat. This condition in anpaphylaxis is called angioneurotic edema, one of the true emergencies. I also suggest inhaled & IV steroids to reduce swelling.
-why, for hypothermic patients, is IV access to be started, but nothing is to be administered?
I don't suggest that. Any increase in stimulation may cause V-fib. Unless one has (appropriately) heated fluids or is able to administer resuscitated medications if needed, then there is no need to attempt to establish. There is a reason I stated "attempted".
-how do you properly give SC injections without causing swelling under the skin?
Sub-q is in the fat area, NOT to be confused with intradermal (such as TB skin test). This is one of the most mis-performed skills by Paramedics. The amount that is given should not exceed(>1ml) & cause swelling, if you do have to administer more than that volume (? medication) then multiple injections should be performed, at different sites (abd, post upper arm, thigh). Abscesses are caused by improper injections and due to diabetics poor healing process. Remember- ONE DOES NOT ASPIRATE on sub-q. The needle should be short and only reach sub-q if the skin is properly pinched or gathered up. If you see swelling it was done improperly.
-when is glucagon given, as opposed to glucose?
Usually Glucagon is administered as an alternative to IV Glucose, when one cannot establish an IV line, Glucagon is usually administered sub-q. It can be administered IV route, but then why not administer Glucose?
Remember, Glucagon has other indications than hypoglycemia. As well, current research is describing maybe D50w is not such a good thing. Rather, D25 or even D10w is just as effective. .
-how long must one wait after 2 failed intubation attempts to attempt again?
This is an usual standard to point out, that you have attempted and it is time to allow someone else to attempt and perform. We are all humans, and all of us have good days and bad days. As well, some are more experienced than others. Usually, after two attempts it has been noted that providers have become frustrated and rushed. It is better to have another set of eyes. This rule is suggested, however; not written down in stone, except for SOP.
-can epinephrine and atropine be given together for PEA/asystole?
Yes, but it is much better to alternate. Remember, Atropine is only given to PEA when the ventricular rate is bradycardic. As well, allow time to flush the line after each medication and allow at the least of 3 minutes with good CPR for circulation before administering the additional dosage. AHA has even stressed that it is NOT so much the medication, as resucititation that causes the saves.
Any assistance on this would be appreciated. thanks in advance![/QUOTE]
Good questions, and your welcome. I suggest reviewing through AHA ACLS, AMLS textbooks, and many good EMS texts.. (not all are good).
R/r 911
. I meant to ask what one can do to prevent abscesses and discomfort when giving SC injections. 