Patient positioning

[gamma6]

Wow, that's pretty amazing. I use an NPA at least once every month on a fairly slow 911 car. I'm surprised that in your 8 years of working the road that you've never had a patient gag on the OPA you placed. Or did you just choose to use no adjunct at all then, even though you had already decided the patient's airway wasn't patent?



What was your point about hyperkalemia?

How would you "fix" an EtCO2 of 5 mmHg? ... of 100 mmHg?



Oh man, don't make me get out the soapbox! To those who choose not to use the KED or another similar device, can I tell your medical director and your operations manager about how you think that it's optional?? You can't just choose to rapid extricate patients because you are lazy and don't want to take the time to apply a short board or KED.

I'm not here to start a pissing match either, but Gamma, I would just be careful what you're getting yourself into. It seems like you are talking about things that you don't really know much about. When you say things like "end title" it gives people the idea that you really don't know what you're talking about, and they won't respect or listen to you.

ok not going to argue with you....because i choose not to use a K.E.D. and can get the pt out safely doesn't make me an idiot.....and yes you can talk to my boss about it. there are a thousand ways to do something, think outside the box.

end tidal, my bad.

a few things didn't come out the way i wanted to respond, my apologies. i'm not an idiot i swear.

 

[MrBrown]

...true o2 never hurts anyone but.....

There's a whole gammet of stuff coming out about reperfusion injury and hyperoxygenation, especially in patients with ischemic injury (heart, brain, bowel, anything really), is bad.

Nothing is magic about oxygen and it's often given to patients who do not require it, in concentrations far & above what is required.

if you do put a nrb on em i would start around 10 and go up from there

Why ten litres? Why not .... 6 or 8, again, there is nothing magic about oxygen and if the normal inspired volume is (from memory) about 5 litres who says that this huge amount of oxygen is not doing harm?

unless the pt is not breathing or is cyanotic, now you are dealing with resp. acidosis

I think what you have here is a false positive. Cyanosis and hypoxygenation go hand in hand, whereas respiratory acidosis and cyanosis do not. One is high PaCO2 and the other low PAO2.

*stops squishing Vent's toes

as far as a npa is concerned i don't use em and actually have never used one. most of the time the pt is out and i stick an opa in. why screw around with the npa...

What if you cannot use an OPA? NPA's do have their place.

How do you know they are "hyperventilating" as opposed to being tachypneic due to an underlying acidosis from sepsis or some metabolic issue like DKA or they have impending respiratory failure where their PaCO2 is rising and they must breathe fast to maintain an acceptable pH? Do you tell your DKA patients who may have a clinical definition of "hyperventilation" with a low PaCO2 but are still acidotic with a pH of 6.98 to "slow down"? Are you prepared to treat a patient with a pH of 6.5? That is a death situation and the body will fight to recover homeostasis and will continue that struggle until exhausted or interfered with rather than assisted or until assisted in its fight against death.

Basically what she said!

i have been through paramedic and have been on the street for 8 yrs.

Then why are you still practicing as a Basic? Sounds to me like you've got "just enough syndrome" and I see it a bit in my US EMS friends; they have "just enough" knowledge (because that's all they were taught) and end up with false positives or false negatives because they get two things mixed up (which we all do, not saying I'm fantastically awesome or anything) and go off on a tangent ....

...if the pt is gonna fight ya don't push the issue. if the pt needs it and will tolerate it great, do it.

So by your statement, I am a critical asthma patient, I can't speak more than one word a breath, my PACO2 is going through the roof and my respiratory centre is legging it out of town, I'm freaking out and don't want you to smother me with a nebuliser mask .... what, you're just gonna go "don't push it?"

 

[EMSLaw]

ok not going to argue with you....because i choose not to use a K.E.D. and can get the pt out safely doesn't make me an idiot.....and yes you can talk to my boss about it. there are a thousand ways to do something, think outside the box.

end tidal, my bad.

a few things didn't come out the way i wanted to respond, my apologies. i'm not an idiot i swear.

Like it or not, the KED is the standard of care. Yes, there are situations where the safety of the scene, or the injuries to the patient, require a rapid extrication. But when those circumstances don't exist, you should use the KED (or another "vest-type upper spinal immobilization device") or short board.

Why? Well, when you do a rapid takedown of the patient, and the patient ends up a quadraplegic, and you are hauled into court, the plaintiff is going to put an expert - probably an EMT instructor - on the stand. And that expert will be asked what the standard of care is for removing someone from a crashed motor vehicle. Then the expert replies that one should use a KED in that situation. Pan to the Doctor who says that had the KED been used, little Johnny would be walking and playing baseball in the bright sunshine today. Pan to the Jury, awarding lots and lots of money.

The KED is a pain. We all know it's a pain - especially when it's the middle of the night, and it's cold, and you want to go back to bed. But if the situation calls for it, it should be used. The extra ten minutes won't hurt as much as the potential consequences.

 

[MrBrown]

...Pan to the Jury, awarding lots and lots of money.

Ah I do like that notion, how much of it do I get?

 

[redcrossemt]

ok not going to argue with you....because i choose not to use a K.E.D. and can get the pt out safely doesn't make me an idiot.....and yes you can talk to my boss about it. there are a thousand ways to do something, think outside the box.

end tidal, my bad.

a few things didn't come out the way i wanted to respond, my apologies. i'm not an idiot i swear.

If you have been through paramedic, why aren't you a paramedic? Going through paramedic means nothing unless you can retain the knowledge, pass the test, and go through a few CEU's a year to keep your license. And even then, being a paramedic doesn't mean much... Nor does CCEMTP these days.

If you are not concerned about violating the accepted standard of care, please PM me with your organization and operations manager's contact information so him/her and I can talk. Imagine when the lawyers find out you bragged about getting the patient out safely without the KED!!!

Still waiting to hear how you are going to fix their EtCO2 and the comparison you were making about hyperkalemia and pH...?

 

[redcrossemt]

Pan to the Jury, awarding lots and lots of money.

Do the lawyers roam EMTlife looking for easy prey??

Defendant: Well, I never said I wouldn't use a KED.
Prosecutor: Actually, we have the conversation from EMTlife right here. Will you read it to the jury?

 

[redcrossemt]

There's a whole gammet of stuff coming out about reperfusion injury and hyperoxygenation, especially in patients with ischemic injury (heart, brain, bowel, anything really), is bad.

Why ten litres?

Sounds to me like you've got "just enough syndrome"

"don't push it?"

+1

10 liters because it gets you in the high flow area, dontcha know? And obviously we do that because they said "HIGH FLOW O2 for all sick patients" in MFR/EMT/P school.

J.E.S. - I like it. Very popular in medics nowadays. No one thinks they need to learn.

Why would you push it? If they're conscious and they're not breathing well enough, it's their fault.

 

[Brandon O]

Why ten litres? Why not .... 6 or 8, again, there is nothing magic about oxygen and if the normal inspired volume is (from memory) about 5 litres who says that this huge amount of oxygen is not doing harm?

Well... actually the rest of it's just getting wasted. You get what you breathe with the NRB.

I suspect that on issues like the KED, IF your protocols do not demand specific treatment or at least allow wriggle room -- Mass. protocols, for instance, are written loosely -- a ballsy EMS provider could sit in that courtroom and argue the clinical side based on the available evidence. I don't know who would pay for that trial, though. Maybe Bledsoe has some extra dough. And your employer might be done with you waaaay before a jury ever heard thing.

 

[EMSLaw]

Ah I do like that notion, how much of it do I get?

Get your NREMT-P, write a bunch of articles, become well known, and then prostitute yourself as an expert witness for a few thousand dollars a pop. Welcome to America, land of opportunity!

Do the lawyers roam EMTlife looking for easy prey??

Defendant: Well, I never said I wouldn't use a KED.
Prosecutor: Actually, we have the conversation from EMTlife right here. Will you read it to the jury?

I don't practice that kind of law, so I wouldn't know. The longer I'm a lawyer, the more kinds of practice I think I wouldn't be interested in. But personal injury, insurance defense (which are two sides of the same coin), matrimonial, and real estate are on the list at the moment.

But I wouldn't put it outside the realm of possibility.