Protocol question

BadCowboy0716

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If you could change one protocol in the book which one would it be and why? I'm looking a paper subject. I was thinking about writing about RSI because we currently don't do it here being as we run in the city and we are only 5-15 minutes from like 5 different hospitals.
 

NomadicMedic

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Which book are you talking about? All of us have very different protocols.

In my case, I'd like to have Lasix removed from our CHF protocols and CPAP added as a BLS skill for everyone.
 
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BadCowboy0716

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I mean our list of protocols on the truck. We have our BLS able to do Cpap here.
 

JPINFV

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I'd add a line to the intro stating that the protocol is a guide, but any intervention provided is done under the paramedic's own judgement.
 

usalsfyre

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Long Spine Boards are only to be used for extrication and movement and the patient immediately removed once on the stretcher.
 

Carlos Danger

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I would add Ketamine for sedation, intubation, and analgesia in certain cases.

I would also take spine boards out of the protocols completely.


Just one? IV nitro.

I hear a lot of paramedics say this and I always wonder why IV nitro would be better than SL?
 
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VFlutter

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I hear a lot of paramedics say this and I always wonder why IV nitro would be better than SL?

Unless they are planning on initiating a Tridil drip I do not really see much of an advantage.
 

Carlos Danger

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Unless they are planning on initiating a Tridil drip I do not really see much of an advantage.

As you know, setting up and titrating a drip is infinitely more time consuming and infinitely more of a hassle than popping SL's.

Yet I often hear paramedics say they want to include IV nitro in their protocols, and I always wonder why.
 

Medic Tim

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I would add Ketamine for sedation, intubation, and analgesia in certain cases.

I would also take spine boards out of the protocols completely.




I hear a lot of paramedics say this and I always wonder why IV nitro would be better than SL?

I have the choice of ketamine , morphine and fent for RSI, procedural sedation and analgesia. It is a great drug. I would not remove boards completely. They make for decent extrication and carrying device. I prefer the scoop versions.

I also have iv nitro for acs and Chf if the transport time is greater than 20 min or if I am in the clinic.
 

Scott33

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Yet I often hear paramedics say they want to include IV nitro in their protocols, and I always wonder why.

More a case of not having to break the seal on a CPAP mask for the CHF patient, and to provide a nice steady drip for both CHF and ACS patients for those of us not restricted to a max of 3 doses. Also requires no coaching in how to expose the frenulum of the tongue. Easily titrated with a short half life.
 

Carlos Danger

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I would not remove boards completely. They make for decent extrication and carrying device. I prefer the scoop versions.

I agree they can be handy, so I wouldn't take them off the ambulances, I would just remove the protocol requirement for their use.
 

Carlos Danger

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More a case of not having to break the seal on a CPAP mask for the CHF patient, and to provide a nice steady drip for both CHF and ACS patients for those of us not restricted to a max of 3 doses. Also requires no coaching in how to expose the frenulum of the tongue. Easily titrated with a short half life.

The CPAP think is a decent point, but even considering that, I think the time and hassle of setting up a drip and the time a titration cycle takes makes an infusion only worth it if you have a pretty long transport time.
 

Epi-do

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I can only pick one? I don't even know where I would start, since most of them are out dated and need to be updated.
 

phideux

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At the place I left recently, Get rid of the Mast Trousers. They were the best thing since sliced bread in the 70s, things have changed since then. :p
 

Handsome Robb

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RSI for medics that prove themselves proficient and competent. I know plenty of medics that have no business pushing paralytics.

Take nasotracheal intubation out. We carry the kits, are trained to do it but the ERPs here would blow a gasket if you brought a patient in with a nasal tube and QA/I wouldn't be far behind. If you don't want us doing it then don't give us the protocol, supplies and training to perform it...
 

MackTheKnife

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At the place I left recently, Get rid of the Mast Trousers. They were the best thing since sliced bread in the 70s, things have changed since then. :p

I've been out of the scene for awhile. What's wrong with MAST?
 

chaz90

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I've been out of the scene for awhile. What's wrong with MAST?

In short, they don't help and actually appear to hurt. Also, you'd end up screwing around on scene putting them on sick patients rather than transport to definitive care.
 

NomadicMedic

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Uhh, how long have you been out of the scene? It's been over 20 years since I've seen a PASG on a truck.
 
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