"Outside the norm" paramedic drugs

NomadicMedic

NomadicMedic

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I'm curious if any ground medics are carrying drugs outside of the normal load out. For example, most of use have haldol, a benzo or two and benadryl for sedation. Anyone carrying Ziprasidone?

Antiemetics are usually Zofran and Phenergan. Anyone carry anything like Anzemet?

It seems like the standard ALS pain meds are Fentanyl, Morphine and Toradol. What do you have in your box? Butorphanol?

My guess if it's anyone, it'll be someone from Texas. :)
 
n7lxi said:
I'm curious if any ground medics are carrying drugs outside of the normal load out. For example, most of use have haldol, a benzo or two and benadryl for sedation. Anyone carrying Ziprasidone?
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Ok, you got me. Why are you carrying Geodon? Are you encountering schizos in acute violent outbursts often enough to require this? Are there off label uses you are carrying this for?

Do the risks outweigh the benefits? What if they are on oral geodon and you give some more IM...bad juju there.

What benefit is there to administering geodon over other agents?

n7lxi said:
Antiemetics are usually Zofran and Phenergan. Anyone carry anything like Anzemet?
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This one I was not familiar with but from what I read it is given about an hour before chemo treatments or two hours prior to surgery.

So why and what is the benefit of this drug on an ambulance?

n7lxi said:
It seems like the standard ALS pain meds are Fentanyl, Morphine and Toradol. What do you have in your box? Butorphanol?
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This one I know under the name Stadol.

Widely used in veterinarian medicine...
Highly abused in the nasal spray form
More effective in women and used during labor or in conjunction with some surgical anesthesia.

Again, same question...what is the benefit over the other meds and why carry this when it is limited in its actions?
 
I'm not currently carrying any of these, but know of services that do have the examples that I mentioned.

My last ALS service carried Anzemet instead of Zofran. Benefit? I don't believe there was any, aside from the fact that it was what the med control doc wanted.

Another service I know of did carry Geodon, it was on med control orders only, and they did run in an area where there were many unstable psych patients who had been placed in group type homes following the closure of a state run mental facility. I don't know if they still carry it.

I'm curious if anyone is currently running with these (or other) meds.
 
Olanzapine for behavioral/psychs
 
It can be. It reads, as standing orders, consider diazepam OR Midazolam OR Olanzapine. I still usually just go versed first line.
 
I wish we had zyprexa zidas(spelling?) . Works amazing sublingual. But I dont see being able to put it in someones mouth who is uncooperative.
 
Anjel1030 said:
I wish we had zyprexa zidas(spelling?) . Works amazing sublingual. But I dont see being able to put it in someones mouth who is uncooperative.
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Sit on them and plug their nose.

Works great for 3 year olds.

The only "outside the norm" drugs we have are on our critical care trucks, which I'm not allowed to play on.
 
I've read some a bit about ketamine, anyone carrying that on their rig, no one is in my areas.
 
Ketamine here. Well, not on the rigs yet. It just got in to our supply. :D
 
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I won't list CCT drugs because they really don't count.

Last service I was at had nitro infusions, famotidine and norepi. There's a service just west of here that supposedly carries hydromorphone.
 
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n7lxi said:
Antiemetics are usually Zofran and Phenergan. Anyone carry anything like Anzemet?
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We use Gravol (dimenhydronate) IM or IV here as our (only) antiemetic drug.
 
akflightmedic said:
This one I was not familiar with but from what I read it is given about an hour before chemo treatments or two hours prior to surgery.
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They are both anti-emetics, on the ambulance, stopping vomiting or relieving nausea is a good thing in my mind.

I like phenergan (promethazine) more than zofran because of the side effect profile. (which includes "mild sedation")

Use it secondary to narc administration, for motion sickness, or for a "sick" person.

Most people now like zofran because of "less" side effects, but I liken it to nyquil vs. dayquil. When you want to feel better and rest, especially if you are going to be chilling in the ER for a few hours, it is best to be a bit more relaxed.

It is also a first generation H1 blocker. So you do not need it an diphenhydramine seperately.

Really it is not a good idea if you have to drive, work, etc, though.

I keep phenergan in the house.

As for the rest, I would replace morphine with meperidine.

Outside the USit is routinely used as a medication to reduce labor pain by peripheral IV instead of needing regional anesthesia. (it does not reduce smooth muscle contraction like morphine)

Good stuff too.
 
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Veneficus said:
They are both anti-emetics, on the ambulance, stopping vomiting or relieving nausea is a good thing in my mind.

I like phenergan (promethazine) more than zofran because of the side effect profile. (which includes "mild sedation")

Use it secondary to narc administration, for motion sickness, or for a "sick" person.

Most people now like zofran because of "less" side effects, but I liken it to nyquil vs. dayquil. When you want to feel better and rest, especially if you are going to be chilling in the ER for a few hours, it is best to be a bit more relaxed.

It is also a first generation H1 blocker. So you do not need it an diphenhydramine seperately.

Really it is not a good idea if you have to drive, work, etc, though.

I keep phenergan in the house.

As for the rest, I would replace morphine with meperidine.

Outside the USit is routinely used as a medication to reduce labor pain by peripheral IV instead of needing regional anesthesia. (it does not reduce smooth muscle contraction like morphine)

Good stuff too.
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Was not aware of the "moderate sedation" qualities of phenergan. It's our only anti-emetic at the sports medicine job and has worked very well the one or two times the doc has given it in the last couple of years. Well enough that the player could play in a game an hour later, so I guess the sedation properties cannot be too significant?
 
Tigger said:
Was not aware of the "moderate sedation" qualities of phenergan. It's our only anti-emetic at the sports medicine job and has worked very well the one or two times the doc has given it in the last couple of years. Well enough that the player could play in a game an hour later, so I guess the sedation properties cannot be too significant?
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I frequently have patients PTFO after IV Phenergan. Definitely has some sedative properties.
 
Tigger said:
Was not aware of the "moderate sedation" qualities of phenergan. It's our only anti-emetic at the sports medicine job and has worked very well the one or two times the doc has given it in the last couple of years. Well enough that the player could play in a game an hour later, so I guess the sedation properties cannot be too significant?
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Don't know how much the doc gave, but every time I gave 12.5mg of Phenergan... everyone was loopy.
 
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How about beta blockers?

Some other "non standards"; My service currently carries 60mg of PO Prednisone, PO (liquid) Benadryl, 50mg of Labetelol and PO (liquid) Maalox.
 
usalsfyre said:
I won't list CCT drugs because they really don't count.

Last service I was at had nitro infusions, famotidine and norepi. There's a service just west of here that supposedly carries hydromorphone.
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Champion and Careflite, I reckon?

They carry nubain (not that exciting) on EPFD in lieu of morphine. We've got solu-medrol, terbutaline, vecuronium, mag and inotropium at my current service- a bit out of the box for the area. We also have bretyllium in our supply and protocols, but not on the trucks.

One service here doesn't even carry narcs or benzos on their MICU trucks.
 
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