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The point is that there's no way to improve perfusion that won't increase cardiac work. Pacing is no better than drugs in this regard.
Full Arrest
- Thread starter emtwacker710
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The point is that there's no way to improve perfusion that won't increase cardiac work. Pacing is no better than drugs in this regard.
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I think whatever you were able to use more quickly could be justifiable. In this case (ROSC post CA), I imagine pads would already be on the patient and ready to pace, but an IV is also already established with your drug box close by. If you would prefer to administer atropine and wait a few minutes to see if it works that could be reasonable, but if my patient was severely hypotensive with a non perfusing MAP and bradycardic in the 30s, I'd be more likely to pace. If I wasn't able to achieve mechanical capture fairly quickly, atropine would be coming out with the consideration for several other drugs as well.
Not quite....malpractice is how lawsuits happen. I guarantee if you follow protocol when it's inappropriate you can still get sued. As for disciplinary action, if you can't deviate when appropriate, your EMS system sucks.
I'm not sure if you're being serious.
Does there seem to be sarcasm there?
I dunno but whenever anyone tells me that it's at my discretion to deviate from protocols I have to assume they are kidding.
Have you read your protocols? The vast majority of them have a disclaimer in there telling you it's your responsibility to deviate or at least contact OLMC when the patient presentation doesn't fit the book exactly. It's called being a clinician instead of a technician.
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I would say duty as opposed to discretion. Then again I work in a great system where my medical director expects us to treat our pts and not the protocols. Deviation is common and expected of us. Be a clinician and not a technician or chef.
Oh so now online medical direction is part of it too? Excuse me but that was not what you said earlier.
I have read my protocols and none of them tell me it is my responsibility to deviate from them at my discretion. EMT is a 150 hour course. You don't tell someone like me who has just dipped their toe into emergency medicine to supercede a medical doctor at their own discretion.
teedubbyaw
Forum Deputy Chief
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Paramedics are separated from a technician level. Protocols are more of a general guideline when it comes to certain patients. A basic doesn't have as large of a deviation capability.
Why are you so mad? You're the one that started this with your snippy comment.
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This is the first page in my treatment guidelines book.
Protocols are a base. They are the minimum you are expected to know. Unfortunately too many treat them as a ceiling.
As mentioned , be a clinician.
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There is too much snark. Be civil, it's not that hard.
Straight out of Old Dominion EMS Council's protocols. I'm taking a guess on the council you're in since you've got VCU in your name...but I'm willing to bet I could find others
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Language that authorizes deviation appears in every EMS protocol I've ever seen. It doesn't mean that you choose not to follow protocols just because you think you know more about the relevant medicine than the physician who wrote the protocols. It is really just a legal disclaimer that protects both the medical director and the EMT in cases where you choose not to follow the protocols (usually omitting something) to the letter, when doing so would be clearly inappropriate.
For instance, you are called to a soccer field for a person with knee pain. As part of your assessment, you find that they have a heart rate in the low 40's. Your protocols call for 0.5mg of atropine in bradycardia, unless the bradycardia is due to an AV block, in which case you are to do transcutaneous pacing. However, this patient has a history of a benign conduction defect that causes a slow heart rate, and he tolerates it very well and is otherwise perfectly healthy.
The obvious choice in a case such as that is to NOT give atropine or TCP. But unless you are granted some leeway to make such decisions, you would be blatantly violating protocol by not doing something.
VFlutter
Flight Nurse
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If I blindly followed every single MD order without question or discretion some people would be dead. Especially in July.
I personally would be going to with a post rosc bradycardia hypotension patient with suspected Stemi or other cardiac etiology. If pacing doesn't work I'm skipping atropine and hanging a epi drip, or possibly. dopamine. It would depend on the situation. Pushing atropine is a tiny bandaid on a problem PCI will only fix. Effective pacing or a drip is like a pressure dressing instead of a bandaid. Patient may still not live but it's a slightly longer term temporary fix before getting them to PCI.