abuan
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Happens pretty frequently here on Oahu especially in the rural areas.
MFI/RSI
- Thread starter starzolife
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DesertMedic66
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It is not in the CA paramedic scope (at least none of the proper medications aside from versed and Fentanyl are in the scope). The way around this is with flight crews and CCTs with a RN on board. The RN is able to give the medications and the paramedic is able to intubate.
Thanks for the quick answer. I'm having a hard time on my phone, but can you steer me towards an online Cali Scope?
DesertMedic66
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This was the only thing I could find right now:
http://www.emsa.ca.gov/media/default/word/ch4_emtp.doc
It looks like San Diego did a trial study in 1996 with RSI and from the trial they decided not to add in RSI to the paramedic protocols.
Thanks! It's a shame about the San Diego trial. From what I can see, it wasn't very well constructed.
DesertMedic66
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It's CA. The only things well constructed are our gun laws and vehicle emission laws
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For Paramedics, the answer is no, not outside a trial and there aren't any currently running RSI trials in California right now that I know of. For nurses, the answer is "it depends." RN/RN flight teams allow for the RN to do RSI and I've seen it also written in CCT-RN protocol. Technically, my job as an ED RN could have me perform the procedure but I'd have to be specifically credentialed for it. I'd be PICC certified before I would be allowed to intubate in my ED.
Looking at the Ca Paramedic scope and optional scope, it shows that some agencies are using "Drug Facilitated intubation", which as far as I know is RSI without paralytics.
Can anyone from the EMT life brain trust give me s good answer as to why? DFI is more dangerous, with higher failure and more likelihood of aspiration etc, so why are they allowing it over RSI?
Can anyone from the EMT life brain trust give me s good answer as to why? DFI is more dangerous, with higher failure and more likelihood of aspiration etc, so why are they allowing it over RSI?
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Because the people who make that decision don't know what they are dealing with.
Edit: I'm sure they have their reasons. Certainly there are very good arguments against prehospital RSI. But as you note, there are even stronger arguments against sedation-facilitated intubation.
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Our statewide protocols used to give an option for sedation only intubation for agencies not utilizing paralytics. I don't know for sure, but I believe it specified 0.3 mg/kg Etomidate. It's garbage, and I never used it. Our most recent protocol update seems to have eliminated that verbiage completely.
The urban service I rode with in school did not allow RSI, they only have Versed to facilitate intubation. The rural service I started with had RSI protocol and the majority of my intubations were RSI.
In my setting now, we have very open protocols. Most intubations still use our RSI protocol, but with proper ventilator settings, sedation and pain control we don't need to use long term paralytics as often. Having BiPAP available has reduced the need for emergent intubations as well.
In my setting now, we have very open protocols. Most intubations still use our RSI protocol, but with proper ventilator settings, sedation and pain control we don't need to use long term paralytics as often. Having BiPAP available has reduced the need for emergent intubations as well.
It isn't the best: up to 5mg Versed IV for sedation to facilitate endotracheal intubation before or after the procedure. Repeat up to 10 mg before calling for orders for more.
We have been using Ketamine more over the past few years and I have grown to like it. It is also a brochodilator which is great for certain respiratory cases.
Yeah 5mg isn't great at all! What's the name of the service? Trying to see the whole thing laid out if possible.
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