Medical interventions on scene

[billycorgi]

Hello,

I am relatively new to the EMT scene in Alberta. I had a question regarding medications and on scene delivery. If a patient needs a medical intervention say nitro for chest pain or epi for anaphalaxis or salbutamol for SOB, would an EMT provide the medical intervention on scene along with vitals, AMPLE, and an IV or would you wait until you are in back of the ambulance like school teaches in scenarios? Any info would be great!

 

[TransportJockey]

Depends. Where I work with 30-90 minute transports, pretty much everything gets done en route to the facility unless its something that is immediate life threats like a chest dart or airway. If I was urban I'd start treatment on scene and continue en route


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[Anjel]

We have 3-5 minute transport times so everything is usually done on scene. Med pushed not so much, but IV, 12 lead, stuff like that. There are 4 of us in scene so while someone is doing the IV, one is doing a 12 lead, and the other getting meds ready.


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[billycorgi]

so there would be nothing wrong with doing vitals/IV/AMPLE along with a shot of nitro on scene with a cardiac chest pain as long as it is done within 10 mins on scene with a load and go

 

[hogdweeb]

in my area, it depends. We have nursing homes within 5 minutes of the hospital, amongst 95% of our calls in that same area. Have a little more time to stay and play, if we can afford it. We also have runs that are easy half an hour away. Thos we just load and go, everything we need to do can be done in that time. If it is anaphlyaxis, there is absolutely no reason to withhold epi so long as systolic BP is >100 and patient is in fact in anaphlyaxis.

 

[Medic Tim]

Hello,

I am relatively new to the EMT scene in Alberta. I had a question regarding medications and on scene delivery. If a patient needs a medical intervention say nitro for chest pain or epi for anaphalaxis or salbutamol for SOB, would an EMT provide the medical intervention on scene along with vitals, AMPLE, and an IV or would you wait until you are in back of the ambulance like school teaches in scenarios? Any info would be great!

Assessment and treatment of these pts usually starts on scene and then leads to the truck. For cardiac my partner gets a 12 and vitals while I do an assessment/ history. Will start Asa and nitro on scene and from there it depends how serious the pt is and how far we have to go.

Just because these pts may be labeled load and go.... Take it easy driving. It can be hard to do things in the back when you are being thrown around. It also adds a lot of unnessisary anxiety to the pt.

Smooth is fast.


Welcome to emtlife

 

[billycorgi]

Thanks Medic Tim!

I assume that an IV would be established on scene as well before the nitro is given regardless of what the systolic BP states? Or could you give the nitro without the IV as long as the systolic reading is above 100? Would it be better to wait to establish an IV in the ambulance or would your partner be all over that on scene as he or she is doiing vitals and ECG etc?

 

[Medic Tim]

Thanks Medic Tim!

I assume that an IV would be established on scene as well before the nitro is given regardless of what the systolic BP states? Or could you give the nitro without the IV as long as the systolic reading is above 100? Would it be better to wait to establish an IV in the ambulance or would your partner be all over that on scene as he or she is doiing vitals and ECG etc?

The cut off for nitro in AB is a sys of 90 and per policy I believe we are required to have IV access prior to its administration(though I am not sure)

As for who does the IV, It depends on my partner, the pt and what the scene is like.

After some time you will develop a rhythm or flow to your assessments and they will get easier.

 

[errey]

Thanks Medic Tim!

I assume that an IV would be established on scene as well before the nitro is given regardless of what the systolic BP states? Or could you give the nitro without the IV as long as the systolic reading is above 100? Would it be better to wait to establish an IV in the ambulance or would your partner be all over that on scene as he or she is doiing vitals and ECG etc?

Always get the IV done before nitro, you could possibly tank their pressure

 

[chaz90]

Always get the IV done before nitro, you could possibly tank their pressure

Always is a strong word. Thousands of people take NTG daily without "tanking their pressure." Just something to think about.

 

[EpiEMS]

Assessment and immediate life threats on scene. If it's not a "load-and-go," do as much on scene as need be, no?

 

[rmabrey]

I've yet to see a nitro tank anyones pressure. But when in doubt CYA

 

[Medic Tim]

to add to my previous post.
After ruling out RVI, If the pt has taken nitro before and they have a decent pressure....I am not to worried about getting the IV first.

people take nitro their own nitro all the time without checking their pressure.

 

[Mariemt]

Chest pain with no allergies to aspirin and if they aren't on any kind of blood thinners I'll give aspirin and maybe nitro depending on their pressure. Protocol says I have to check pressure first. I would give that on scene .
Vitals on scene as long as we are fast and can do it in our time window . I will out the leads on and get them sent ahead.
History as we go. Load blah blah blah.

 

[Mariemt]

I've yet to see a nitro tank anyones pressure. But when in doubt CYA

Yet is the key word. Be careful of the patient not admitting to Viagra use in front of his girlfriend etc.

 

[Mariemt]

Hello,

I am relatively new to the EMT scene in Alberta. I had a question regarding medications and on scene delivery. If a patient needs a medical intervention say nitro for chest pain or epi for anaphalaxis or salbutamol for SOB, would an EMT provide the medical intervention on scene along with vitals, AMPLE, and an IV or would you wait until you are in back of the ambulance like school teaches in scenarios? Any info would be great!

Our epi pens are in our jump bag and no I wouldn't wait to give that in the back. If they are needing it now, its time to give it now.
Aspirin, nitro , glucose etc I give on scene. Quicker the better.

If it is a load and go I will get the rest in the ambulance. Why wait to give something the patient needs while loading etc?

 

[broken stretcher]

short of an arrest, i do absolutely nothing in the house...
1) you can wait the 3 minutes it takes to load into the truck
2) have you seen the houses i go into when i work? you wouldn't wanna stay there either.
3) my truck is my sanctuary. i can set up everything how i want it where i want it. its a controlled environment (sometimes :rofl: )
4. the longer I'm in the house, the more likely something can go wrong.


get in, get out, go

 

[NomadicMedic]

Depending on how long it takes for the ambulance to get on scene. I'll do stuff in the house. Always the Priority One "if I don't do it now, they're gonna die" stuff or maybe some pain management and zofran if it'll make moving the patient more comfortable.

However, I also have been in my share of nasty houses and I'm not above having a relatively stable patient come outside and sit on the porch for treatment while I wait for the ambulance, so I don't get marinated in cigarette smoke or covered with roaches.

I also like to get a 12 lead early in any chest pain call, so I may elect to do that before we leave.

It all depends on my mood, the severity of the patient, how close I am to the hospital and how nasty the house is.

 

[Mariemt]

short of an arrest, i do absolutely nothing in the house...
1) you can wait the 3 minutes it takes to load into the truck
2) have you seen the houses i go into when i work? you wouldn't wanna stay there either.
3) my truck is my sanctuary. i can set up everything how i want it where i want it. its a controlled environment (sometimes :rofl: )
4. the longer I'm in the house, the more likely something can go wrong.


get in, get out, go

Um, I do a lot more than just CPR in the house. I can't make a patient having an asthma attack wait 3 minutes. I won't move the patient with a broken pelvis or hip/femur without splinting.
3 minutes is a long time for certain conditions.
A lot of calls, yeah I wait too, but I have had my share where I just couldn't make my patient wait. I put up with the smoke, the dog poop smell etc. I felt I had to treat in the house for their best interest.

 

[DesertMedic66]

There is no standard way. A lot of it depends on the call. The medics that I work with will get at least a set of vitals inside the house (12 lead if a CP call). If the patient doesn't need medication or treatments right away then we will load up inside of the ambulance and do everything there.

If the patient needs a treatment immediately then we do what ever we have to do inside the house.

Heck I've have 2 calls where we spent 45 minutes inside the ambulance with a patient and have them AMA.