Labor anelgesia

VentMonkey said:
I get increasing barriers, and educational standards, but is that literally all it takes? I wonder what the average age is for entry-level EMS providers across the pond?
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For what it's worth, providers at the EMT (or EMR) equivalent levels are permitted to administer nitrous and equivalents in many countries. we're talking about vocationally trained folks.



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EpiEMS said:
For what it's worth, providers at the EMT (or EMR) equivalent levels are permitted to administer nitrous and equivalents in many countries. we're talking about vocationally trained folks.
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Yep, my point exactly. Is it our culture on top of a limited educational barrier? I can't imagine other parts of the world don't have issues with substance abuse, providers with a less than professional approach, or both.

A Penthrox whistle would be ideal for most BLS providers, along with basic meds such as ASA, and IN Narcan for respiratory depressed opioid-suspected OD's. Again though, entry requirements, right?...
 
EpiEMS said:
For what it's worth, providers at the EMT (or EMR) equivalent levels are permitted to administer nitrous and equivalents in many countries. we're talking about vocationally trained folks.
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Eh, most paramedics is the US are vocationaly trained folks. ;)
Just sayin'.

I think the big reason it went away in the US was lack of equipment. I had heard that the company that made the mixer went out of business and nobody picked up the slack (or FDA approval) for EMS.
 
NomadicMedic said:
I think the big reason it went away in the US was lack of equipment. I had heard that the company that made the mixer went out of business and nobody picked up the slack (or FDA approval) for EMS.
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Right, which then leads to the "so why not Penthrox whistles?" question. Is Penthrox even FDA regulated, let alone approved?
 
VentMonkey said:
Right, which then leads to the "so why not Penthrox whistles?" question. Is Penthrox even FDA regulated, let alone approved?
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Withdrawn because of nephrotoxicity in larger doses. Apparently though, small doses have shown no ill effect. I also hear it's starting to fall out of favor down unda, being replaced with IN Fent.
 
Penthrox is awesome. Used it on a MCI once (again, overseas).
Works great and is also self limiting.
I think the topic has come up here before; it has gnarley side effects on the kidneys and liver in large quantities/doses... (like most medications).
 
NomadicMedic said:
Withdrawn because of nephrotoxicity in larger doses. Apparently though, small doses have shown no ill effect. I also hear it's starting to fall out of favor down unda, being replaced with IN Fent.
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Thanks, I learned something new here^^^.
SandpitMedic said:
Penthrox has gnarley side effects on the kidneys and liver in large quantities/doses... (like most medications).
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I'm unfamiliar with it, so what constitutes large or heavy doses for it?
 
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VentMonkey said:
I'm unfamiliar with it, so what constitutes large or heavy doses for it?
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I'm not too sure on the current science on that, but our protocols over there was a 3mL/dose (one whistle), not to exceed more than 6mL in any 24 hour period or 15mL in a week.

It is on a string you put around their wrist, they take puffs on the green whistle until they literally can't and they become flaccid (more or less). Then when they start to wake up you instruct them to take more puffs to desired effect. Self limiting, fast acting, great drug!

One whistle will last about 10-20 minutes.
 
My old agency used to carry nitrous then it became limited to ALS ski patrol and ILS special events teams. The reason it came off the truck was due to the inability to get parts for the regulators/mixing system.

Whenever we'd pick people up from our ALS ski patrol we'd always use it to get people out of their ski clothes and especially ski boots while we established IV access and started giving opiates.


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Remi said:
I don't know exactly why N2o fell out of favor in American EMS. I'm guessing it was a combination of the factors mentioned above, but mostly I imagine it's just logistics and possibly cost. It is probably cheaper to stock an EMS unit with vials of fentanyl than with the equipment to administer N2o, and it's definitely easier to store and account for the IV drugs. Plus, narcs have the obvious advantage of not wearing off immediately when you stop administering them.

Don't get me wrong - I think N2o would be great to have in the field, and anyone who thinks they might be able to get their agency to get it should try to do so.
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The number one reason is (possibly) misplaced accountability fears.

A very, very close number two is the FDA's stance on "adulterated gasses" makes the blenders a serious pain in the *** to obtain and carry around.

Worked one place that had it, and it was great. Maybe one day we can get it pre-mixed.
 
Aside from the cost I dont think im going to have much issue getting the medical director to go for it.

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Well look at that. No sooner than I start this, we get sent to IL to pick someone for a maternal transfer, early labor stages.....
 
VentMonkey said:
Thanks, I learned something new here^^^.

I'm unfamiliar with it, so what constitutes large or heavy doses for it?
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The nephrotoxicty reports come from its use as a general anesthetic agent. The concentration breathed to induce general anesthesia is far higher than the concentration needed for the analgesic effect.

The "dose" would be measured in exposure hours (we call them MAC-hours) to the anesthetic gas, whereas the pen would deliver an exponentially smaller amount of exposure, both in terms of concentration and duration.


I love the idea of penthrox. It is rapid-onset, short-acting, probably highly predictable in its effects. It's independent of renal or hepatic function, and is patient-administered in doses that are by design self-limiting. Im also guessing you won't meet too many patients with a methoxyflurane allergy.

And in a time of opiates run amok, it's nice to have an analgesic that still works on everyone, no matter their total daily oxycodone dose.

I would love to see it here.
 
Nova1300 said:
And in a time of opiates run amok, it's nice to have an analgesic that still works on everyone, no matter their total daily oxycodone dose.
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I gave a dude 400 mcg of fentanyl and 50 mg of ketamine the other day and it didn't touch him....

Made me [emoji848]


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Nova1300 said:
Im also guessing you won't meet too many patients with a methoxyflurane allergy.
.
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Not an allergy but a malignant hyperthermia trigger. It'd be pretty critical to flesh out a history before giving it.
 
Quick thread derail for the CRNA crowd:

How rare is MH? And is Dantrolene readily available in the pixxus in the event one is dealt this mysterious disorder?
 
From mhaus.org:

The exact incidence of MH is unknown. Epidemiologic studies reveal that MH complicates one in about 100,000 surgeries in adults and one in about 30,000 surgical procedures in children. The incidence varies depending on the concentration of MH families in a given geographic area. High incidence areas in the United States include Wisconsin, Nebraska, West Virginia and Michigan. However, the prevalence of genetic change that predisposes to MH is much higher. About one in 2,000 patients harbor a genetic change that makes them susceptible to MH.​

Most MH incidents occur in patients who have previous exposures to triggering agents. Events are also more common when the patient is exposed to more than one triggering agent. Also a large percentage of events are noted after the triggering agent has been discontinued (i.e. In PACU).

Every OR I've ever been in had a "MH cart" that had all the dantrolene, sterile water, bicarb, cold packs, etc in it.
 
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