rhan101277
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I get this alot as well.
Moron CNA's
- Thread starter ilemtbwantn2bTXEMT-P
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I get this alot as well.
Sasha
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We just walk up and grab our chart. Never had a problem.
I also trust my partner enough to get my vitals while im going through paperwork and chart.
I also trust my partner enough to get my vitals while im going through paperwork and chart.
I usually didn't just walk up and 'grab' the chart; but if they didn't have paperwork ready for us I would offer to take the chart to the office and copy what we needed out of it while my partner would talk to the patient and the nurse/CNA. Surprising how much more help you get , and how much better you are treated when you offer to help: copy the chart, etc.
Other things we would do when we had down time would be go to the ECF's and offer to help them: take water pitchers with ice to patients at night; days, stop and say hi to all the patients. I had a partner who liked to play the piano: get lots of surprised looks from the staff; but when we came back for transports they would do everything they could to help us.
Another thing that we did was make a list of paperwork that we needed for each transport: either doc appts, dialysis or ED runs; and gave it to all the ECF's. That way they had exactly what we needed ready when we got there.
Other things we would do when we had down time would be go to the ECF's and offer to help them: take water pitchers with ice to patients at night; days, stop and say hi to all the patients. I had a partner who liked to play the piano: get lots of surprised looks from the staff; but when we came back for transports they would do everything they could to help us.
Another thing that we did was make a list of paperwork that we needed for each transport: either doc appts, dialysis or ED runs; and gave it to all the ECF's. That way they had exactly what we needed ready when we got there.
I give them 15 lpm via nasal cannula.
Sasha
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You know, because of the number of hospice calls my service does I've actually learned there are NCs that are designed to do this...
Sasha
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Yeah but not your run of the mill cannula and its humidified which i have never seen.pregospitally.
Yep, it would be, poor form to do this with a normal NC to say the least.
Sasha
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I dont think a normal cannula would tolerate it. When we tried to push 10lpm through a 6lpm percent lock it popped off the o2 tree im sure the same would happen exceedingthe flow rate for a cannula
Meursault
Organic Mechanic
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I may have... witnessed someone accidentally turn the regulator on a D tank to 20 LPM with a nasal cannula attached and on the patient. It didn't pop off in the short time between bumping the regulator dial and noticing the unexpectedly loud hissing sound. The patient found it uncomfortable, but she had other things on her mind.
I'm not entirely sure why our portable regulators even go to 25 LPM, as most of them on the BLS trucks don't have the attachments for CPAP.
There's also an interesting article I first saw here about using 15 LPM via NC during intubation to passively oxygenate the patient.
Sandog
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I think the moral of this story is to show professional courtesy. It is just impolite to call a fellow health care worker a moron. Karma has a strange way of reflecting your actions.
I assume you're referring to the "Levitan NO DESAT" method found here?
http://www.epmonthly.com/features/current-features/no-desat-/
The article advises using combined 15LPM NRB and 15+LPM NC oxygen administration for preoxygenation and continuing the NC administration throughout intubation. It even suggests that the combined NRB NC administration may sometimes be enough to serve as a bridging therapy and avoid a tube altogether.
I had assumed that a normal nasal cannula will take a 15LPM flow, but I've never tried it.
Brown does not think so to be honest, there may be a role for some of these new whiz bang synthetic clotting factors or haemoglobin in the future.
Permissive hypotension really only applies in uncontrolled bleeding and most of that is probably internal, we can control external bleeding fairly well with pressure and the combat application tourniquet
Permissive hypotension really only applies in uncontrolled bleeding and most of that is probably internal, we can control external bleeding fairly well with pressure and the combat application tourniquet
So, permissive hypotension is a good thing. However, I personally believe there should be a difference in permissive hypotension and permissive exsanguination.h34r:
Is there possibly a need for products like hetastarch in the prehospital setting?
Not really.
Several years ago I was at a trauma conference where they presented evidence that synthetic volume expanders cost more and had the same outcome.
They are demonstrated better suited to the military where it is better to carry a bunch of 250ml colloid solutions than litres of saline.
As demonstrated in the recent wars, massive transfusion is the solution to major hemorrhage.
In terms of "permissive exsanguination" the solution is simply to stop the bleeding.
Stands to reason pushing more water at higher pressure through a leaky hose would do what except make it leak more?
One of the major problems in hemorrhage is the lack of metabolite carrying capacity. Water doesn't do it.
Here is a brief clip on hetastarch:
Home › Drugs A to Z › H › He › Hetastarch Prescribing Information
Print | Save or Share Hetastarch
Dosage Form: injection
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6% Hetastarch
In 0.9% Sodium Chloride Injection Hetastarch Description
6% Hetastarch in 0.9% Sodium Chloride Injection (Hetastarch Injection) is a sterile, nonpyrogenic solution for intravenous administration.
The composition of each 100 mL is as follows:
Hetastarch 6 g
Sodium Chloride, USP 0.9 g
Water for Injection, USP qs
pH adjusted with Sodium Hydroxide, NF if necessary
Concentration of Electrolytes (mEq/L): Sodium 154, Chloride 154
pH: approximately 5.5 with negligible buffering capacity
Calculated Osmolarity: approximately 309 m0sM
Hetastarch is an artificial colloid derived from a waxy starch composed almost entirely of amylopectin. Hydroxyethyl ether groups are introduced into the glucose units of the starch, and the resultant material is hydrolyzed to yield a product with a molecular weight suitable for use as a plasma volume expander and erythrocyte sedimenting agent. Hetastarch is characterized by its molar substitution and also by its molecular weight. The molar substitution is approximately 0.75 which means Hetastarch has an average of approximately 75 hydroxyethyl groups for every 100 glucose units. The weight average molecular weight is approximately 600,000 with a range of 450,000 to 800,000 and with at least 80% of the polymers falling within the range of 20,000 to 2,500,000. Hydroxyethyl groups are attached by either linkage primarily at C-2 of the glucose unit and to a lesser extent at C-3 and C-6. The polymer resembles glycogen, and the polymerized D-glucose units are joined primarily by α-1,4 linkages with occasional α-1,6 branching linkages. The degree of branching is approximately 1:20 which means that there is an average of approximately one α-1,6 branch for every 20 glucose monomer units.
The chemical name for Hetastarch is hydroxyethyl starch.
The structural formula is as follows:
Amylopectin derivative in which R2 and R3 are H or CH2CH2OH and R6 is H, CH2CH2OH, or a branching point in the starch polymer connected through an α-1,6 link to additional D-glucopyranosyl units.
Hetastarch injection is a clear, pale yellow to amber solution. Exposure to prolonged adverse storage conditions may result in a change to a turbid deep brown or the formation of a crystalline precipitate. Do not use the solution if these conditions are evident.
The flexible plastic container is fabricated from a specially formulated polyvinylchloride. Solutions in contact with the plastic container may leach out certain chemical components from the plastic in very small amounts; however, biological testing was supportive of the safety of the plastic container materials. The container solution unit is a closed system and is not dependent upon entry of external air during administration. The container is overwrapped to provide protection from the physical environment and to provide an additional moisture barrier when necessary.
The closure system has two ports; the one for the administration set has a tamper evident plastic protector.
Hetastarch - Clinical Pharmacology
The plasma volume expansion produced by Hetastarch injection approximates that of 5% Albumin (Human). Intravenous infusion of Hetastarch injection results in expansion of plasma volume that decreases over the succeeding 24 to 36 hours. The degree of plasma volume expansion and improvement in hemodynamic state depend upon the patient's intravascular status.
Hetastarch molecules below 50,000 molecular weight are rapidly eliminated by renal excretion. A single dose of approximately 500 mL of Hetastarch injection (approximately 30 g) results in elimination in the urine of approximately 33% of the dose within 24 hours. This is a variable process but generally results in an intravascular Hetastarch concentration of less than 10% of the total dose injected by two weeks. A study of the biliary excretion of Hetastarch in 10 healthy males accounted for less than 1% of the dose over a 14 day period. The hydroxyethyl group is not cleaved by the body but remains intact and attached to glucose units when excreted. Significant quantities of glucose are not produced as hydroxyethylation prevents complete metabolism of the smaller polymers.
The addition of Hetastarch to whole blood increases the erythrocyte sedimentation rate. Therefore Hetastarch injection is used to improve the efficiency of granulocyte collection by centrifugal means.
In randomized, controlled, comparative studies of Hetastarch injection (n=92) and Albumin (n=85) in surgical patients, no patient in either treatment group had a bleeding complication and no significant difference was found in the amount of blood loss between the treatment groups.1-4
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Indications and Usage for Hetastarch
Hetastarch injection is indicated in the treatment of hypovolemia when plasma volume expansion is desired. It is not a substitute for blood or plasma.
The adjunctive use of Hetastarch injection in leukapheresis has also been shown to be safe and efficacious in improving the harvesting and increasing the yield of granulocytes by centrifugal means.
Contraindications
Hetastarch injection is contraindicated in patients with known hypersensitivity to hydroxyethyl starch or with bleeding disorders or with congestive heart failure where volume overload is a potential problem. Hetastarch injection should not be used in renal disease with oliguria or anuria not related to hypovolemia.
Patients with pre-existing coagulation or bleeding disorders should not be given Hetastarch injection.
Warnings
Life-threatening anaphylactic/anaphylactoid reactions have been rarely reported with Hetastarch injection; death has occurred, but a causal relationship has not been established. Patients who develop severe anaphylactic/anaphylactoid reactions may need continued supportive care until symptoms have resolved.
Hypersensitivity reactions can occur even after Hetastarch injection has been discontinued.
"Usage in Plasma Volume Expansion
Hetastarch injection has not been adequately evaluated to establish its safety in situations other than treatment of hypovolemia in elective surgery.
Large volumes of Hetastarch injection may transiently alter the coagulation mechanism due to hemodilution and a mild direct inhibitory action on Factor VIII. Administration of volumes of Hetastarch injection that are greater than 25% of the blood volume in less than 24 hours may cause significant hemodilution reflected by lower hematocrit and plasma protein values. Administration of packed red cells, platelets, or fresh frozen plasma should be considered if clinically indicated"
Futhermore
"Hematocrit may be decreased and plasma proteins diluted excessively by administration of large volumes of Hetastarch injection. Administration of packed red cells, platelets, and fresh frozen plasma should be considered if excessive dilution occurs."
http://www.drugs.com/pro/hetastarch.html
Sasha
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Oh it wasn't an instant pop off. It took a few minutes, but would continually pop off until we turned the flowrate down.
I think everybody can agree with that statement. And you obviously know substantially more about products like hetastarch than I do. But, along the lines of what Brown said, I can't help but think there can be a place for HBOC products in the future, or something like that. Not as a definitive solution but as a better means of support until the pt's reach definitive care.
No, sorry. Thought i copied only the part that I wanted and when I was trying to type in my comments i didn't notice the rest of the post ad I sent it off before previewing it because I was distracted.