How do you maintain med drip rates on your truck

[crotchitymedic1986]

moving this back to the refusal thread, as this is an IVpump thread. Please go to that thread for info regarding published studies.

 

[ffemt8978]

moving this back to the refusal thread, as this is an IVpump thread. Please go to that thread for info regarding published studies.

Really? This should be interesting.

 

[KEVD18]

moving this back to the refusal thread, as this is an IVpump thread. Please go to that thread for info regarding published studies.

yeah, telling the boss how to run his board is always a good idea/.//.

 

[crotchitymedic1986]

Not telling anyone how to do anything. Just trying not to confuse the topics.

 

[exodus]

Both statements are accurate: In the absence of lab and xray, I am against the individual medic being able to talk people out of going to the hospital. The solution I proposed solves that problem. I am not worried about the patient who actually refuses AMA, I am concerned about the patient who should be transported, but is talked out of transport, and then dies hours later.

And as far as the .01%, we hope that is the real number, but we have no idea. It could be 20% for all we know (actually there was a study performed by AMR that showed for every 100 patients who refused, you would have 7 hospital admissions, 2 ICU admissions, and 1 death).

Okay, that means:
7% would have been inserted later into the ER. (Who cares, they're alive)
2% would have gone to ICU (If you have to go to the ICU, chances are you're getting transported because you can not sign an ama refuse)
and 1 % die.... So?

SO
I'm going to throw away money and time into a program where 90% of the transports aren't even needed?

 

[crotchitymedic1986]

Refusal topic moved back to the refusal thread : "ethical question", please post your questions there

 

[ffemt8978]

Refusal topic moved back to the refusal thread : "ethical question", please post your questions there

Let me make this real clear for you...It is not up to you to decide what topics should go where, and if a thread is getting off topic. Nor do you get to determine what responses get posted here or in any other thread. If a Community Leader feels a thread has strayed too far off topic, we will deal with it.

Any questions?

 

[Veneficus]

Drip rates, x-rays, and labs, oh my...

While I see your points, I think the thing the US is going to get used to in a hard fast way is that while we talk about providing the best care to everyone, talk is cheap. What really speaks is money. The current EMS and larger healthcare system in the US is improperly funded and stressed to the breaking point. Simply changing a few EMS practices is probably not going to be cost effective or make much difference in outcome.

“Amateurs talk tactics, experts talk logistics.” I once heard. Overcrowding ERs by transporting every patient does not equate to better patient care. You want to save more lives, start lobbying for prevention, not rescue. Many people don’t like it, but EMS is best suited for this change at the moment. (not perfect, but best)

There was a time when medics were taught how to set up a drip. I can show you how to set up dopamine drip accurate to 0.1 ug/min/kilo with just the flow dial on a 60gtts drip set. Many tests including labs and x-rays do not change care decisions in the ED, they provide some legal shielding. (examples too numerous to type out)

I think modern reliance on technology may be being carried too far. I posted somewhere else that physical exam is a dying art. How many medics do you know percuss? Listen to heart sounds? Actually palpate structures effectively? Thorough history? (look at NREMT and the stupid idea that medical and trauma assessment are separate.)

I am particularly fond of the acronym VOMIT. Victim Of Medical Imaging Technology. (Basing treatments off of erroneous or nonspecific findings because of the limits of these tests and the overreliance on them which causes excessive cost and/or potential/actual physical harm to patients.)

Most of the changes you seek for improvement could be enacted by better education and training, not defaulting to toys and somebody else’s remote judgments.

Just my $0.02

 

[ffemt8978]

Excellent points, veneficus!!!!

 

[crotchitymedic1986]

Totally agree vene, it is due to poor education that we need the pump to protect the patient. You claim you can titrate with a 60 drop set, and many have memorized several clever tricks for calculating dopamine.

But if i changed the concentration of dopamine in everyones truck tomorrow from 800 to 400 or 1600mcgs, or vice-versa, most medics would be lost as to how to calculate an accurate drip rate. Patients lives are too important for guessing and guesstimating.

 

[Veneficus]

Totally agree vene, it is due to poor education that we need the pump to protect the patient. You claim you can titrate with a 60 drop set, and many have memorized several clever tricks for calculating dopamine..

How many have actually used these clever tricks? Not to boast but because I was required in school back in the day to be able to calculate and set up drips. Change whatever variable you want, 10 gtts, concentration, desired dose, etc. All I need is a pen and a few seconds and it will not be a guess, but a fairly accurate and precise measured dose. It even functions in the absence of a DC or AC current.

But if i changed the concentration of dopamine in everyones truck tomorrow from 800 to 400 or 1600mcgs, or vice-versa, most medics would be lost as to how to calculate an accurate drip rate. Patients lives are too important for guessing and guesstimating.

There are several safety mechanisms built in, like the amount of medication in the vial, lower suggested dose limits prior to toxic doses, protocols, etc. There are probably few more than I that demand accuracy and precision in poisoning patients, but I would rather have a capable provider than 1000 machines.

 

[DrankTheKoolaid]

re

If it's field initiated we use Dial-a-Flow, for IFT's there usually either on a syringe pump or IV pump.

Corky

 

[Sapphyre]

1. Supervisors typically respond to arrests and critical calls.

They do? One shift last week I had 2 arrests, back to back. No Sup ever showed.... Now, the fire captain was there, but, he's always on the engine. Oh, and the BC never showed either....

Maybe I should go start yelling at my sups for not showing on my arrests and STEMIs. Because, you know, some dude on an internet forum told me that sups are supposed to show on critical calls. Dude, if you want your service to get pumps, take your own advice and get your service pumps. My service is not gonna do it for emergency trucks.

 

[Jon]

back in "the day"... ALL drips were calculated by DRIP RATE... we still use the "old" technology - so what?

And please DO NOT post random numbers unless you can find a source to back them.

 

[JPINFV]

That is the source: American Medical Response. I worked there when they did it back in the 90s. I doubt you can link it on the web, as that is not the kind of information a private, for profit service, would want floating on the web. It was an internal CQI project, but I am sure that anyone that still works there can get you a copy of it, as they frequently preached about it in every new employee orientation.

If it's not in a peer reviewed journal, then it isn't a scientific study and probably shouldn't be used outside of that company. Too many variables involved to simply say "Oh, because AMR said so!"

 

[marineman]

If it's not in a peer reviewed journal, then it isn't a scientific study and probably shouldn't be used outside of that company. Too many variables involved to simply say "Oh, because AMR said so!"

Given the news headlines in the past several months I wouldn't trust a single thing put out by AMR regardless of peer review. If you can't ensure that a medic is actually a certified medic prior to hiring you have no business conducting research.

About half our trucks (ones that do more IFT's) have pumps on them but they usually don't get used on emergency calls. For the roughly 5-max of 10 minute transport a few mikes/minute won't be a major factor in whether or not our patient lives or dies.

 

[reaper]

I tried to heed the warning!!!

 

[Scout]

And as far as the .01%, we hope that is the real number, but we have no idea. It could be 20% for all we know (actually there was a study performed by AMR that showed for every 100 patients who refused, you would have 7 hospital admissions, 2 ICU admissions, and 1 death).

where would one find details this "study" done in the 90's. I'm sure it is of little relivance being possibly almost 20 years old. But it would be nice to see. Would you also have studies done in this century to allow a tend to be extrapulated?

 

[crotchitymedic1986]

On the refusal topic, please go to the "ethical question" thread, where those questions have been answered (this is an IV pump thread). And I disagree that a study that was not published in a scientific journal is not worthy of review. If that were the case, there would be no reason to do any internal CQI within your service. Many services choose to keep their dirty laundry in-house. I would suggest that you do an internal study within your own service and see what your results are. Just do a follow up call on your refusals and see how many were admitted to the hospital ?

As far as IVpumps, I didnt demand that you buy just 1 or put it on the supervisors truck, I just made the suggestion that was a good way to start. It may not work for your service to do it that way, then again, it may be the perfect way to start. To those who know how to calculate a Dopamine drip with pen and paper, congratulations. But we all know that most medics rely on the field guide.

There is a reason hospitals dont "eyeball" their drip rates. If eyeballing was a safe alternative, hospitals wouldnt waste money on pumps. Just because we have always done it a certain way, doesnt make it right. There was a time when we threw dirty needles in the trash because there was no such thing as sharp containers.

 

[Sasha]

My service is gonna run right out and buy some pumps RIGHT NOW! Because some guy claiming to be a medic online told us too.

(We have one, on the CC truck for IFT transfers. Amazing that we haven't needed more.)

A very good point was brought up in the chat. Unless you know your patient's actual weight, down to the pound, even with a pump you're still guessing drip rates. (That came from KevD. Shocking, right?)