BLS Skills -- What Should We Add?

Narcan? NO NO NO NO NO NO NO. Did I mention NO?
 
EMT B said:
Narcan? NO NO NO NO NO NO NO. Did I mention NO?
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Lol oh yeah? Have you had a bad experience with it? Any experience with it? Just curious to your reasoning behind being so vehemently against it :unsure:
 
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
 
EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
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Overstressed the heart and coded is a bit far-fetched and in all likelihood wasn't the cause of the cardiac arrest. You can get some pretty bad pulmonary edema and asthma exacerbations from aggressive narcan administration IV. However, none of these have been described in significant numbers for IM or IN administration.

Our first responders (all EMT-B's) will give it prior to arrival IN. Usually they just give 1 mg IN and ventilate via BVM prior to our arrival. A second 1 mg IN dose if the patient's respiratory rate doesn't improve in 2-3 minutes.

You can write a silly protocol that has you give a huge dose all at once...or you could write a smart protocol. That's your medical director's choice.
 
EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
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So one would have to assume that particular paramedic needs retraining on appropriate administration.

We just added narcan to the EMT scope here and I have been doing the in-service classes with no issues.

The protocol does state to give a 2mg dose, 1 per nostril but I have been training people to give 1mg and wait 2-5 minutes prior the giving more.
 
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EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
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If that's the case, I would imagine something was missed and the heroine was laced with something else. Excited delirium or extreme states like that aren't really a side-effect of coming off a depressant, but coming off a depressant and onto a stimulant. A good history and exam could help prevent something like that. Along with... Oh I don't know... Not intravenously slamming 2mg of narcan. Also, you can mitigate the more typical post-narcan aggressiveness by ventilating prior to administering the narcan. All easily remedied by education (or like Chris said, a good protocol).
 
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EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
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Actually, the rates of adverse reactions with IV and IM narcan are higher than that for IN narcan...so advocating just for IV or IM administration is actually advocating for higher rates of these "overstressed his heart and coded" anecdotes.

The plural of anecdote is not data, try not to judge a medication by war stories alone.
 
PoeticInjustice said:
If that's the case, I would imagine something was missed and the heroine was laced with something else. Excited delirium or extreme states like that aren't really a side-effect of coming off a depressant, but coming off a depressant and onto a stimulant. A good history and exam could help prevent something like that. Along with... Oh I don't know... Not intravenously slamming 2mg of narcan. Also, you can mitigate the more typical post-narcan aggressiveness by ventilating prior to administering the narcan. All easily remedied by education (or like Chris said, a good protocol).
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Speedballing has taken many lives...
 
firefite said:
LP12, we just got them "upgraded" to be able to transmit 12-leads 6 months ago. We were talking about upgrading to the Zoll X series but that hasn't happened yet.
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Um, your LP12s dont take BPs or have a pulse oximeter?


EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.

the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.
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A.) that medic is a A-hole
B.) IV is more severe route then IN


A few recent calls have really made me yearn for a IM Glucagon or IV Glucose. Couple of diabetics, "had the family take a BGL", and just kinda hung out and waited like 5 minutes for the medics to show up, IV access, a minute later patient us up and refusing, EMS cleared. The whole time I was think that i could do this

I really want pain management in someones protocols
 
How about some chapters on transport and more in depth knowledge of pt's normal and not the medicalorm.
 
Narcan and other drugs

EMT B said:
it is not as benign of a drug as people make it out to be. Ive watched a paramedic draw up a whole dose of it and push it all at once.
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But, Narcan is Mother's Milk, right? :huh:

This (consequence aside for now, see below) is one prime example of why scope-enhancement to include drugs is looked at as one more lane in the Highway to Hell. Someone in a hospital does this and she/he gets reamed, maybe reprimanded. On the street..."Oh, he was only following protocols" or "She's just a tech, what do you want?". And the beat goes on...

"...the patient woke up in a rage and became so hyperactive he overstressed his heart and coded. Isn't that how IN narcan would work, giving the whole dose up the nose at once? the drug needs to be given slowly, and not the whole dose, just enough to let the pt protect their own airway. you do NOT want to wake the patient.".

No disrespect, but this is another reason. Since the reply-poster isn't qualified (s)he is not to be expected to know about pharmacodynamics, drugs on the protocols, and maybe "street pharmacy" and its attendant "physiology of abuse".

A tech (well, anyone) can maim someone with an air splint. Why, then, hand out sharps and drugs, then OKAY parenteral or oral access without the year of school even "just a nurse" is required to take before they can follow a med order with meds set up by a licensed pharmacist or RxTech?

Note: an abuser who buy/steals drugs from anyone besides a pharmacy is not likely to get pure anything; many if not most abusers (especially in late stages) will do anything to get and keep high, so "speedballing" (mixing opiods with methamphetamines, or either/both's "analogues") is a good chance and with the longstanding changes sometimes seen with drug abuse, fatality is an increased likelihood.
 
^ ah new avatar didnt recognize you.


Where did Mickey go?
 
What Should We Add? Maybe 1000 hours in additional training
 
Achilles said:
In what?
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I think the point is,there should be no new skills for basic EMTs. If you want more "skills", go to paramedic school.

If you just want to "do cool skills" with no real additional education, go be a vet tech.
 
n7lxi said:
I think the point is,there should be no new skills for basic EMTs. If you want more "skills", go to paramedic school.

If you just want to "do cool skills" with no real additional education, go be a vet tech.
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You know...

I was thinking...

Maybe we could just allow completely uneducated people to perform any medical procedure they want and eliminate the need for EMTs entirely.

You know, let's get rid of all healthcare providers.

We could have a youtube channel.

"Cardiac surgery in 6 easy steps, if you see it, you can do it."

We could even sell kits on ebay.
 
I guess when I started this thread I should've expected how popular it would become!
My focus when I proposed several additional BLS skills was on high benefit/low risk skills that are often performed by non-medical personnel. That's basically the scope under the National Registry scope of practice as listed.

I'm a huge proponent of more training for BLS providers, of course -- and I'd like to see the EMT course lengthened to 200-300 hours.
 
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