Help a new AEMT with some beginner questions

[bdoss2006]

So I just passed registry, and I’d like to ask a few questions before I get into this stuff. First of all, I ask that no one berate me for asking questions. The old saying goes the only stupid question is one you don’t ask. I’m just trying to learn and be the best I can. It’s not necessarily that I don’t know the answer to these things, it’s just that I know there are lots of people that are much smarter and more experienced than me on here and I’d like to hear other peoples way of thinking to incorporate it into my own. With that being said, here’s the questions.



So what’s yalls determining factor for solu medrol in asthma and COPD? I guess mine is sorta if they are having an exacerbation and have taken multiple breathing treatments with no relief, that’s probably a good reason to give it. If they take one and feel mostly relieved then probably not? Then also if they have something else such as an upper respiratory infection or pneumonia, then probably still give it so the COPD doesn’t complicate that more, correct? If they have CHF, I probably wouldn’t call that an absolute contradiction, but definitely a consideration. If their lungs are full of fluid then probably not. The COPD isn’t their main problem.



For pain medications our protocol is written like this. For fentanyl, 25-100mcg IV, may be repeated every 5-15 minutes as needed up to 200mcg. There is a lot of range and leeway in that. I’m assuming base that off their vitals, size and level of pain? If they’re larger, have perfect vitals, and their arm is turned sideways then probably err towards the higher doses at the more frequent amounts. If it’s little ole granny that twisted her ankle then the opposite. I guess that’s something that comes with experience? Our seizure protocol is worded similarly. I guess the same goes for it?



What is yalls determining factor generally speaking to whether they are in significant enough pain to warrant pain meds if they don’t have an obvious injury. I like to go by vitals, but that is definitely not always accurate. I feel like that’s probably a comes with experience thing too, right?



And lastly, for basically any ALS medication, specifically pain meds, solu medrol, anti emetics etc., what do you do if they are already on that med or a similar class medication? What point do you draw the line of giving vs not giving?



I know this is a lot, and once again I ask for no negativity please. It’s not that I don’t know the stuff, I just want to get multiple peoples opinions and learn everything I can. I’m still very early in this career and I want to learn as much as I can to excel at it.

 

[DrParasite]

I've been out of the game for a bit, so I'll give it a shot... if my information is a little dated, sorry...

So what’s yalls determining factor for solu medrol in asthma and COPD? I guess mine is sorta if they are having an exacerbation and have taken multiple breathing treatments with no relief, that’s probably a good reason to give it. If they take one and feel mostly relieved then probably not? Then also if they have something else such as an upper respiratory infection or pneumonia, then probably still give it so the COPD doesn’t complicate that more, correct? If they have CHF, I probably wouldn’t call that an absolute contradiction, but definitely a consideration. If their lungs are full of fluid then probably not. The COPD isn’t their main problem.

First off, AEMTs can give solumedrol? I thought it was paramedic only? regardless....

Solumedrol is steroid... it doesn't work quickly. if they are wheezing badly and have taken multiple breathing treatments without relief, I'm going to be reaching for CPAP, not another breathing treatment... can i give solumedrol? sure... if i remember correctly, you should see the results 20 minutes later. Now, if they have CHF (IE, fluid/rales) and are wheezing, we got other issues... I'm probably still going to grab a CPAP... Also remember, we treat signs and symptoms, not diagnoses; meaning, if the doc says they have CHF, but their lungs are clear, I'm not going to give lasix... Not that we treat CHF with lasix prehospitally anyway, but you get the idea.

For pain medications our protocol is written like this. For fentanyl, 25-100mcg IV, may be repeated every 5-15 minutes as needed up to 200mcg. There is a lot of range and leeway in that. I’m assuming base that off their vitals, size and level of pain? If they’re larger, have perfect vitals, and their arm is turned sideways then probably err towards the higher doses at the more frequent amounts. If it’s little ole granny that twisted her ankle then the opposite. I guess that’s something that comes with experience? Our seizure protocol is worded similarly. I guess the same goes for it?

aren't pain meds based on weight? here is the other question: what are the risks if you give too much pain meds? and what od you do if that happens?

What is yalls determining factor generally speaking to whether they are in significant enough pain to warrant pain meds if they don’t have an obvious injury. I like to go by vitals, but that is definitely not always accurate. I feel like that’s probably a comes with experience thing too, right?

I can't answer this question...

And lastly, for basically any ALS medication, specifically pain meds, solu medrol, anti emetics etc., what do you do if they are already on that med or a similar class medication? What point do you draw the line of giving vs not giving?

give zofran if they are vomiting. or nauseas. make the patient feel better. I still think EMTs should be able to give it IM. I have not heard of a paramedic who had a patient with new onset of wide QT following the administration of zofran in the field. in the hospital, or in the ICU? sure... yes, it's a risk, but I consider it a low-risk one. Remember, you are treating the acute condition, not the chronic medication they are on (however, some items, like NSAIDs, you need to worry about toxicity).

I know this is a lot, and once again I ask for no negativity please. It’s not that I don’t know the stuff, I just want to get multiple peoples opinions and learn everything I can. I’m still very early in this career and I want to learn as much as I can to excel at it.

I'm not going to beat you up... some of your questions are basic, and should likely be answered by your paramedic instructor or your agency's medical director/training division. Also, if you don't understand the mechanism of action for the medication you are giving, should you really be giving it? indications, contraindications (relative and absolute), MoA, dosages... should you really be giving it? But no, I applaud you for asking the questions... I just think you will get better information for your area from your agency's clinical staff, or from a PubMed journal, vs some random idiot on the internet.

 

[ffemt8978]

I just think you will get better information for your area from your agency's clinical staff, or from a PubMed journal, vs some random idiot on the internet.

I'm jist going to add agency protocols should also be referred to.

 

[bdoss2006]

I'm jist going to add agency protocols should also be referred to.

What I quoted is my agency protocols, and it doesn’t go much more in depth than that. Unfortunately they are very lacking. That’s a common pattern in my area

 

[VentMonkey]

What I quoted is my agency protocols, and it doesn’t go much more in depth than that. Unfortunately they are very lacking. That’s a common pattern in my area

As EMS “evolves” this is hopefully becoming more common in general. That is, the level of autonomy.

A lot of what you have asked will inevitably come with time and experience. If you hyper focus on every nuance of every patient every time you are in for a long and painful career. As previously mentioned, someone with clinical expertise and experience specific to your local area is probably best fit to answer questions about your system.

As for learning MOA’s ins and outs of meds specific to certain patient subsets, aside from what’s already been learned, there’s truly no one size fits all approach even to every COPD patient. Reviewing after every call, even if on your own may be helpful.

Also, you will encounter (what you perceive as) less than pleasant people, their advice should count too. I do think generational gaps play a big factor and oftentimes people dismiss others advice as harsh even if or when it carries value.

Basically take all the advice you can get, good, bad, and indifferent. Do with it what you will, couple it with a genuine curiosity to learn, and intuition and you’ll do fine. Stop worrying so much.