first call of the day is...

Breathine was the stuff. Sad that it's no longer available.

Although, everything old seems to come around again. Like Procainamide.
 
GMCmedic said:
Its in our protocol as of the last change. I have been hesitant to use it since im not very enthusiastic on the B1 agonist effects in tachycardic elderly patients.

Im kind of at the point where CPAP > Epi

I much prefer brethine which we stopped carrying when we added epi.

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Okay, so follow up; mag before epi in the elderly?

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NPO said:
Okay, so follow up; mag before epi in the elderly?

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Hmm how to put this? For the sake of discussion we will pretend Asthma doesnt fall under the umbrella term of COPD.

I looked into using Mag for COPD exacerbation several months ago. Of the few small studies I found, the best conclusion was that it might potentiate the effects of other bronchodilators, but had no effect on hospital admission or length of stay. Nor was it recommended for routine use.

I have not personally had to resort to Mag, nor have I ever had a protocol for Mag in COPD patients, only specific to asthma. Others that have actually used it may have differing results.

I think for this particular patient it may have helped since he was having actual bronchospasms, but to answer your original question, yes I would use mag before epi in elderly tachycardic patients, but I doubt that it would be beneficial to most of that demographic.

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GMCmedic said:
Hmm how to put this? For the sake of discussion we will pretend Asthma doesnt fall under the umbrella term of COPD.

I looked into using Mag for COPD exacerbation several months ago. Of the few small studies I found, the best conclusion was that it might potentiate the effects of other bronchodilators, but had no effect on hospital admission or length of stay. Nor was it recommended for routine use.

I have not personally had to resort to Mag, nor have I ever had a protocol for Mag in COPD patients, only specific to asthma. Others that have actually used it may have differing results.

I think for this particular patient it may have helped since he was having actual bronchospasms, but to answer your original question, yes I would use mag before epi in elderly tachycardic patients, but I doubt that it would be beneficial to most of that demographic.

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Thanks. Our protocols only differentiate between wet and dry difficulty breathing. With a recommended progressing of bronchodilators -> epi -> mag for dry lungs. With CPAP thrown in at discression, but we aren't required to follow that in a linear algorithim.

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2nd degree burn, 36%. Guy is an electrician who accidentally shortened a conduit, resulting in a flash fire that ignited his clothes & burned the entire front aspect, including his face. 16mg of morphine and he still felt pain. This is right after we dropped him off & started cleaning the rig:

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Qulevrius said:
2nd degree burn, 36%. Guy is an electrician who accidentally shortened a conduit, resulting in a flash fire that ignited his clothes & burned the entire front aspect, including his face. 16mg of morphine and he still felt pain. This is right after we dropped him off & started cleaning the rig:

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Not a big mess. Bigger mess than I feel is necessary. But good on ya for loading up the morphine. How was the airway? Do you have any tools in your back pocket for airway protection in burn patients?

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NPO said:
Not a big mess. Bigger mess than I feel is necessary. But good on ya for loading up the morphine. How was the airway? Do you have any tools in your back pocket for airway protection in burn patients?

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Airway was patent, he didn't inhale anything. Sinus tach, waxy skin, 10/10 which dropped to 6/10 with morphine. 1000mL NaCl via both arms, he sucked it in like a vacuum cleaner.

Just the usual regiment of OPAs and NPAs, nothing special. What did you have in mind ?


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Qulevrius said:
Airway was patent, he didn't inhale anything. Sinus tach, waxy skin, 10/10 which dropped to 6/10 with morphine. 1000mL NaCl via both arms, he sucked it in like a vacuum cleaner.

Just the usual regiment of OPAs and NPAs, nothing special. What did you have in mind ?


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Anything in protocols to sedate a conscious person to secure an airway?

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NPO said:
Anything in protocols to sedate a conscious person to secure an airway?

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Medics carry midazolam. It's LACo, bruv.


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06E01 - Person not breathing

Arrive on scene to find patient on a ventilator, phlegm in trachea required suctioning.

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I didn't do anything til 1400. Dispatched to a fall. Patient fell out of her chair at about 0530, been on the floor since then. Family came to check and called us.

In a nutshell it was a faitly typical elderly failure to thrive. Just a sad situation. Required more skill as a social services advocate than as a paramedic. One more reason I like doing what I do.
 
NomadicMedic said:
I didn't do anything til 1400. Dispatched to a fall. Patient fell out of her chair at about 0530, been on the floor since then. Family came to check and called us.

In a nutshell it was a faitly typical elderly failure to thrive. Just a sad situation. Required more skill as a social services advocate than as a paramedic. One more reason I like doing what I do.
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These are some of our most rewarding calls involve basic care of human needs. I find them very rewarding.

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Qulevrius said:
2nd degree burn, 36%. Guy is an electrician who accidentally shortened a conduit, resulting in a flash fire that ignited his clothes & burned the entire front aspect, including his face. 16mg of morphine and he still felt pain. This is right after we dropped him off & started cleaning the rig:

4ff2637499036f338ee2b1b5d990e08e.jpg



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That's not really much of a mess... but like others have said, Good Job! on getting that guy some pain relief. He likely could have handled a bit more than that before he even started to have a problem due to the morphine. If anyone says that was too much, just tell them the patient went from 10 to 6 on the pain scale, so it probably wasn't enough... patient was still in moderate to severe pain.
 
Akulahawk said:
That's not really much of a mess... but like others have said, Good Job! on getting that guy some pain relief. He likely could have handled a bit more than that before he even started to have a problem due to the morphine. If anyone says that was too much, just tell them the patient went from 10 to 6 on the pain scale, so it probably wasn't enough... patient was still in moderate to severe pain.
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I probably should've mentioned that it turned to be a clusterfck because the 1st ER (the one around the corner) diverted us to a burn ctr in another county, that's the main reason for the 16mg. Because it would've been too much effort for the triage nurse to actually put in some thought before agreeing to receive him, before realizing that they cannot handle it.


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First call was a female on meth that fell onto an entertainment center, puncturing her cheek and breaking a tooth.

Haldol is my favorite drug.



Run #2, sadly RSI'd a 92 year old man.

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