IMHO, albuterol has been a nightmare more often than not in many instances, and that problem extends beyond my services. More BLS providers have been cited and/or faced remedial training for improper application and actions concerning albuterol.
Remedial training after the fact is too common (obviously necessary). It's VERY difficult to train an EMT in the specific MOA, indications, contra, side effects (etc) when they have no true formal education in A&P; it's not fair to either party, mostly concerning the pt. It's like beating a puppy for pissing in your bed when you haven't taken the time to properly train it to go outdoors...
Some of the more common problems encountered range from:
Canceling medics in a non-judicious manner for SOB events, because "albuterol will fix it".
Pts being given albuterol simply because it was an option.
Pts receiving albuterol (sometimes multiple..) who were immediately recognized by receiving facilities as having cardiac wheezes with other gross presentations of CHF symptoms. Those calls from facility staff are always fun. :sad:
If the choice to give it to BLS ever came up again, it'd most likely be shot down. However, there are many BLS providers that know better... and perhaps the added scope will be another inch in the push towards expanding the curriculum?
I agree. I believe that BLS/ALS should remain non-invasive/invasive. I am not trying to be mean, rude or condescending. As I recall from Basic class in PA, I was not taught as to what medications do, how they work, etc. Anyone capable of giving a medication in a therapeutic capacity (EMS, ER, etc) an "antidote" (I know some ppl hate this term) and able to reverse any adverse effects to that medication. Every med we carry on the ambulance, we carry a reverse for it. I understand Patients can administer albuterol themselves and EMT's are allowed to assist the Pt with their inhaler. The reason for this is generally the Pt is more knowledgeable than we are in these matters. They know what "their" asthma attacks feel like better than anyone else...coz, well it is their body and they know their body better than we do.
Blood Glucometry.
Combi-Tube.
That's about it, really. Can't do much more without increasing the overall educational standards. Possibly nitro, but only with online medical command.
Edit: When I say "possibly nitro" I meant to be carried on the trucks. PA EMTs are already allowed to administer one dose of nitroglycerin to a patient with chest pain without online medical direction if it is the patient's own prescribed nitroglycerin and the patient hasn't already used it, the patient's blood pressure isn't too low, and the patient hasn't used ED drugs in the past 7 days. Additional doses require online medical direction.
Nitro shouldn't be given without an IV and 12 lead on board. I'm suprised people are allowed to self medicate with it's potential to bottom out pressure.
I agree Sasha. Nitro should never be administered without an IV. the pre-Nitro 12 lead is nice to have if possible. but 1 Nitro can dump a patients pressure and no IV in place 1st, then you have to scramble. As for the rule of SBP of at least 100...it is still open to interpretation. Example: I had a Pt (lil old lady) with chest pain and a SBP of 180. I had a line and 12-lead, gave ASA and 1 Nitro. The nitro dumped her pressure to SBP of 110 and still having chest pain. needless to say I withheld another Nitro, coz I know it would dump her waaaay too far. she was put on a drip instead.
A glucometer darn well better change your treatment.
As for NTG, each place differs in systolic BP contraindiciations. Some say nothing below 90, others say nothing below 100.
Yes, glucometers can be calibrated wrong, but you can't discount every reading as "wrong" when making a determination, otherwise there'd be no point in having one. Same as with a pulse-ox. It ALONE shouldn't change how you do things, but to say it doesn't change how you treat something is ludicrous.
Someone falls. Do you give them glucose right away, or do you do a d-stick to possibly rule out hypoglycemia? My money is on the latter, and as such, it just changed your treatment, by making you look at other possible causes if the BGL is "normal"
AMS can be caused by a heckuva lot more than just low blood suger, and the sooner you rule it out, the quicker you can move on to other causes.
And guess what. That glucometer just changed your treatment.
the question is BLS having a glucometer and how will that change the BLS treatment. Other than recognizing the most likely main cause of the problem...what will knowing the BGL do to change the treatment?
If BLS encounters a conscious Pt with the ability to swallow safely with a little altered mental status, or "not feeling quite right", etc, giving a diabetic 1 tube of oral glucose will not cause any harm if they were really hyperglycemic.
So Linuss, how does knowing the BGL, change the BLS treatment other than calling for ALS back-up?
PS -->I got my 1st responder and original Basic in the Allentown, PA at LCCC. and I will be applying to reciprocity for PA Paramedic.
