Not all of 'em...............There are Licensed Paramedics out there (myself being one).
emt-b meds
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Not all of 'em...............There are Licensed Paramedics out there (myself being one).
medic001918
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Add me to the licensed paramedic list. My state license says nothing other than "Paramedic."
Shane
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Ridryder911
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Yes, yes, and yes. This is part of the problem with anyone that lacks or does not have a full understanding of pharmacology administering medications. I don't care what level they are.
Usually COPD patients (asthmatics/bronchitis, emphysema) will hold off notifying EMS until exacerberated. Now, most EMS only carries albuterol, alupent (combination) and is working up hill, due to they are resistant to the common treatment. Will one more inhaler treatment make a beneficial difference after 5-7 treatments to EMS arrival?
With these types of illness, fluids may need to be given as well as carefully monitoring of cardiac activities.
I believe most of the concern is many EMT's are not aware or even care of the possibilities and dangers something that appears simple and benign, can be really a bad situation.
p.s. My license as well says Paramedic, not EMT. I am fighting with several EMT's from other states for removal of the EMT wording before Paramedic. Some even considering not even having to have EMT at all before entering Paramedic school.
R/r 911
Usually COPD patients (asthmatics/bronchitis, emphysema) will hold off notifying EMS until exacerberated. Now, most EMS only carries albuterol, alupent (combination) and is working up hill, due to they are resistant to the common treatment. Will one more inhaler treatment make a beneficial difference after 5-7 treatments to EMS arrival?
With these types of illness, fluids may need to be given as well as carefully monitoring of cardiac activities.
I believe most of the concern is many EMT's are not aware or even care of the possibilities and dangers something that appears simple and benign, can be really a bad situation.
p.s. My license as well says Paramedic, not EMT. I am fighting with several EMT's from other states for removal of the EMT wording before Paramedic. Some even considering not even having to have EMT at all before entering Paramedic school.
R/r 911
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None of those are actual contraindications, they seem to be limitations more than anything. I've given plenty of geriatric neb treatments, almost all have some form of cardiac past. In-line treatments can be given with a BVM or even the vent, so the inability to take adequate resps isn't an issue.
Asking if overloading a pt. with Albuterol is a problem just reinstates a sound justification as to why EMT-B's have no business administering meds...........
(and yes, it is a problem as it can cause uncontrolled tachycardia and possible V-fib / V-tach)
And knowing why it can somtimes cause vfib/vtach/PVC's is mandatory before you should be giving it. And knowing how to treat those.
Know when to give a drug/perform a procedure, know why to do it, know how to do it, know what the complications/side effects are, know why those occur, know how to treat those side effects/complications if they arise, (and side effects/complications from THOSE treatements and how to treat them and so on), know what to do if it doesn't work, know what to do if it makes the pt worse, and most importantly, know when NOT do give a med or perform a procedure.
If you don't know all of the above...don't even think about doing it.
actually, i coped them verbatim from "contraindications" portion of our protocol... yes, you are quite wrong about that...
as far as a "sound justification" as to why EMT-B'S have no business administering meds..."
thanks for the vote of confidence... please forgive me, but i have tried to contibute here with valid questions and comments, and i and others are often met with hypocritical remarks...
you say you want emt-b's to be better educated... well, i give you a chance to do that... what i get back are put downs, and "reaffirmations" about why i have no business doing this and that...
it must be fun to get a question like that...probably couldn't wait to type in that response and prove something to yourself...
the fact is, boys, that we are authorized to give certain meds, and i will do it under our protocols... none of your snitty remarks will change that...
given that, why don't you try to make me a better emt, rather than try to prove that you are superior?
i would welcome ALL CONSTRUCTIVE replies to help me learn and grow as an emt... that is what you pretend this site is about anyway...
skyemt-
Not to speak for anyone else, but flight is right. None of those things are really true contraindications for albuterol. I understand that YOUR protocols say that they are, but that may be due in part because of the side effects of to much albuterol; they can be treated, but not by a basic. Or it may just be how your doc feels about it. I don't know. I do know that what YOUR protocols say about something does not make it the last word on the matter. Just like MY protocols don't. Or flights, rids...anyone here. Because YOU can't do it does not mean that everyone can't, or that you can't do it because it is truly medically contraindicated.
Don't take to much offence; there are to many lower level EMT's out there who act like more than what they are, and don't bother learning anything more. That's what bothers me, and maybe a lot of people here. Really, that doesn't seem to apply to you, so don't let it get to you.
For your questions: if an asthmatic pt is allready tachy and hypoxic, then albuterol can still be given. It may effect their heartrate some, but, the rate may also fall as the hypoxia decreases. People with a predisportion to cardiac problems/dysrythmias may sometimes show an increase in the heartrate, but this is still not a true contraindication. Far as having taken multiple hit's from an MDI...remember, and MDI gives maybe 100mcg of Albuterol per dose, while a neb gives 2.5mg. Big difference between then two. Now, with that being said, too much albuterol, especially in people with hypothyroidism, or any condition that has the potential to create electrolyte imbalances may cause problems with hypokalemia. That's where the vfib/vtach/PVC's come in, and very likely why you aren't allowed to give it to people over 65. If that's not clear, then ask more questions. (this does not in anyway negate my previos post...I stand by that completely. Sorry.)
If you want to know something, keep asking. At some point someone will answer. If not, emedicine.com is a great place to find info. Look in the emergency medicine sections or wherever you need to. Great place.
Not to speak for anyone else, but flight is right. None of those things are really true contraindications for albuterol. I understand that YOUR protocols say that they are, but that may be due in part because of the side effects of to much albuterol; they can be treated, but not by a basic. Or it may just be how your doc feels about it. I don't know. I do know that what YOUR protocols say about something does not make it the last word on the matter. Just like MY protocols don't. Or flights, rids...anyone here. Because YOU can't do it does not mean that everyone can't, or that you can't do it because it is truly medically contraindicated.
Don't take to much offence; there are to many lower level EMT's out there who act like more than what they are, and don't bother learning anything more. That's what bothers me, and maybe a lot of people here. Really, that doesn't seem to apply to you, so don't let it get to you.
For your questions: if an asthmatic pt is allready tachy and hypoxic, then albuterol can still be given. It may effect their heartrate some, but, the rate may also fall as the hypoxia decreases. People with a predisportion to cardiac problems/dysrythmias may sometimes show an increase in the heartrate, but this is still not a true contraindication. Far as having taken multiple hit's from an MDI...remember, and MDI gives maybe 100mcg of Albuterol per dose, while a neb gives 2.5mg. Big difference between then two. Now, with that being said, too much albuterol, especially in people with hypothyroidism, or any condition that has the potential to create electrolyte imbalances may cause problems with hypokalemia. That's where the vfib/vtach/PVC's come in, and very likely why you aren't allowed to give it to people over 65. If that's not clear, then ask more questions. (this does not in anyway negate my previos post...I stand by that completely. Sorry.)
If you want to know something, keep asking. At some point someone will answer. If not, emedicine.com is a great place to find info. Look in the emergency medicine sections or wherever you need to. Great place.
There is no hypocrisy from me, I could care less about the EMT-B's education. An EMT is not expected to be educated, nor skillful. A Paramedic on the other hand is a different story. I support the furthering of this industry by raising the standards of care and having a Paramedic on every primary 911 response unit. My personal preference is dual medic trucks. I believe that an EMT-B has a place in EMS, but it does not involve being the leader of a 911 crew. That is substandard care, period. You can rationalize it and provide the usual logistical or financial restraint excuses if you wish. It is still below the available par, plain and simple. You say you are tired of hearing this from me, well I am tired of hearing excuses as to why unqualified people are making half arsed attempts at being something they are not.
As long as you pitch the ball my way, you need to be ready to have it hit back to you. If not, go back to the dugout!
Flight,
i gave no excuses...
emt-b's are expected to be qualified and educated, and good at what they do... the scope is not great of course, but your dismissal is old...
as far as "going back to the dugout",
some paramedics here want to make the emt's better, and some don't..
i don't think i have to spell it out for you...
perhaps you should stay in the ALS forum? not helping much here...
Triemal04, thanks for the info... it is appreciated, and i'll keep asking.
i gave no excuses...
emt-b's are expected to be qualified and educated, and good at what they do... the scope is not great of course, but your dismissal is old...
as far as "going back to the dugout",
some paramedics here want to make the emt's better, and some don't..
i don't think i have to spell it out for you...
perhaps you should stay in the ALS forum? not helping much here...
Triemal04, thanks for the info... it is appreciated, and i'll keep asking.
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