Ketamine

DesertMedic66 said:
If it shows to have a much better outcome on neurological status of code patient and thus their ability to walk out of a hospital then I am all for it.

Back in medic school I was scared to death of weight based medications. Now that I am in the critical care field I am much more comfortable with it and an advocate for it.

An epi preload is one of the easiest medications to give a weight based dose. You want 0.5mg? Just give 5mL. You want 0.2mg? Just give 2mL.

A wise man once told me in EMT school to KISS. Then when I got into paramedic school and critical thinking classes that same man said KISS is something we tell you to avoid you from thinking critically.
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Not disagreeing with you on that school of thought. AHA sets guidelines on ACLS we are just wee paramedics.
 
Missourimedic38 said:
Not disagreeing with you on that school of thought. AHA sets guidelines on ACLS we are just wee paramedics.
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Both my ground agency and flight agency have gone completely away from AHA.
 
Missourimedic38 said:
Question is how did you do RN school working full time?
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By switching shifts and basically working, having lecture, or clinical six days a week.

Missourimedic38 said:
I got to finish my pre reqs. My view on nursing school is I want the knowledge to make me a even better paramedic.
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Nursing school didn’t make me a better medic. There is a lot of value to more training in anatomy, chemistry, and so on as well as the varied clinical exposure but much of that can be had without nursing school.

I would think about the stereotype of the flight nurse versus the medic. Nursing encourages you to overthink prehospital care and slows you down. Even in the ED you are planning on how much you can get done at once, every question you could need to ask, and every focused exam you need to perform so that you are going back to that room a minimum number of times.

Nursing school is also about teaching a basic foundation level across nursing, and very few programs place an emphasis on critical care. Even with medic experience there is a very good chance that you will not have the opportunity to start in the ED or ICU, especially without relocating.

I would not expect nursing school to build skills in any way. EMS is all about skills, because in the field you don’t necessarily have other clinicians to fall back on. Even in medicine Docs often have surgery, anesthesia, ENT, and so on intubate, place lines, chest tubes, et cetera.

While I would say that I’m pretty skill heavy compared to the vast majority of nurses, it came out of being an ED charge more than from bedside practice. If I can line a patient, reduce dislocations, place an NJ, or whatever else and it gets the patient out of my ED instead of waiting for the Doc to have time, IR to have a slot, PICC to come down et cetera it opens up my bed and improves my department flow.
 
Missourimedic38 said:
Well CPR and Epi 1:10000. You know a drug that works better?
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I don’t know a drug that works better, but that doesn’t mean epi does. The only reason it remains the standard is because it’s the standard, not because of efficacy.
 
Missourimedic38 said:
Ive been a licensed paramedic 13.5 years. You?
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Experience trumps knowledge and evidence every time.
If a paramedic practiced medicine like medicine was 13.5 years ago...
Also, perhaps condense your replies into a single statement? It’s very difficult to follow what you are asking.
 
The short-sighted goal of AHA has been ROSC without care of downstream effects or outcomes. Getting a pulse back checked the clinical save box, who care if they died 3 days later in the ICU.

Vasopressin is probably a better choice followed by reduced or single dose Epi. Less ROSC but better neurological outcomes. Or for viable patients crash onto mechanical support.

DesertMedic66 said:
... flight agency have gone completely away from AHA.
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Not that I disagree but that was cost savings measure more than a clinical decision.
 
VFlutter said:
Vasopressin is probably a better choice followed by reduced or single dose Epi. Less ROSC but better neurological outcomes. Or for viable patients crash onto mechanical support.
Not that I disagree but that was cost savings measure more than a clinical decision.
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🍭...give that dude a lolipop.....But...I think the decision to take vasopressin away was more of a 'dumbing down' measure than a cost saving one.....which is at least one reason why I haven't been ACLS certified in over 25 years.
 
VFlutter said:
Vasopressin is probably a better choice followed by reduced or single dose Epi.
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I was actually reviewing the literature the other day. I’m not sure there is good evidence for this. There’s not good evidence for much of anything, especially in humans.
 
E tank said:
🍭...give that dude a lolipop.....But...I think the decision to take vasopressin away was more of a 'dumbing down' measure than a cost saving one.....which is at least one reason why I haven't been ACLS certified in over 25 years.
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The cost saving statement was in reference to my flight company going away from AHA. We were able to get a better deal utilizing the ARC for training and the ability of being able to test out on BLS CPR and ARC ACLS at our own base without having to attend a skills session.

I’m also sure there was an agreement for us to go with ARC since they are going to be supplying us with blood products.
 
Missourimedic38 said:
1mg 1:10000 prefilled. Cant beat it
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For ease of access and simplicity, you're right. You can't beat a preloaded syringe.

For favorable patient outcomes, though, epi (in the way we have been giving it) has been shown time and time again to be harmful to patient's neuro outcomes.

Missourimedic38 said:
They are dead; epi 1:10000 has worked for years
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epi 1mg q3-5 min has been great at getting pulses back, but the evidence shows that in the long run these patient have severe neurological deficits, or they never make it out of the hospital alive. If you achieve ROSC and the patient still dies later on, they are still dead. If you achieve ROSC and the patient has a severe neurological deficit, it is still a bad outcome.

Just because something has been done for years, does not mean that it is beneficial, and it may in fact be harmful (such as epi in this case). Just because the AHA says something, does not make it best practice.
 
Tigger said:
Experience trumps knowledge and evidence every time.
If a paramedic practiced medicine like medicine was 13.5 years ago...
Also, perhaps condense your replies into a single statement? It’s very difficult to follow what you are asking.
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I got ADD. Sorry
 
medichopeful said:
For ease of access and simplicity, you're right. You can't beat a preloaded syringe.

For favorable patient outcomes, though, epi (in the way we have been giving it) has been shown time and time again to be harmful to patient's neuro outcomes.



epi 1mg q3-5 min has been great at getting pulses back, but the evidence shows that in the long run these patient have severe neurological deficits, or they never make it out of the hospital alive. If you achieve ROSC and the patient still dies later on, they are still dead. If you achieve ROSC and the patient has a severe neurological deficit, it is still a bad outcome.

Just because something has been done for years, does not mean that it is beneficial, and it may in fact be harmful (such as epi in this case). Just because the AHA says something, does not make it best practice.
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Well we will see whats next.
 
Whats happening in this thread?
 
In the voice of Sean Connery, "Schoopidditee"
 
DesertMedic66 said:
We just changed to epi 0.5mg for cardiac arrests. I’m sure it won’t be too long before we start doing weight based.
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0.5 for cardiac arrests is an interesting one. Where did that come/what is the rationale?
 
AusPara said:
0.5 for cardiac arrests is an interesting one. Where did that come/what is the rationale?
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I think the rationale is that weve been dosing based on a study in dogs from the 1960's if you google, but if you dig deeper the first documented study was 1906. Nobody knows what the optimal dose is and how often to give it, or when in the scenario to give it. Nobody will ever know those answers until someone goes away from the norm.

There are a few systems that have move to 0.5 q3-5 minutes, and i expect several more will move in different directions.

I actually expect AHA to go this route too.
 
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