Reasons NOT to Switch to D10

I specifically spoke to our medical director about the switch to D10 from D50, after bring it up in medic class and my instructor knowing nothing of the new trend.

He cited several reasons, including recent shortages, availability for pediatric patients (No D50 for peds), less risk of tissue necrosis, and a simpler protocol that meets all patients rather than one adult and one ped, in addition to the known benefit of not spiking BGL.

Our current protocol is D10 250ml bag; 2mg/kg.
 
NPO said:
I specifically spoke to our medical director about the switch to D10 from D50, after bring it up in medic class and my instructor knowing nothing of the new trend.

He cited several reasons, including recent shortages, availability for pediatric patients (No D50 for peds), less risk of tissue necrosis, and a simpler protocol that meets all patients rather than one adult and one ped, in addition to the known benefit of not spiking BGL.

Our current protocol is D10 250ml bag; 2mg/kg.
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5ml/Kg ;)
 
I do not understand why we use measurents of volume in medication administration protocols. Clearly things come in different concentrations and the protocol should not have to account for all that.
 
Tigger said:
I do not understand why we use measurents of volume in medication administration protocols. Clearly things come in different concentrations and the protocol should not have to account for all that.
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Absolutely. Effective "units" of any medication aren't determined by their volume, so I don't see why a protocol should ever even mention it.
 
Fair enough. But for the most part, it doesn't seem to be the proper measurement. Our racemic epi is done in volume as well, which makes no sense.
 
If your company only buys 1 brand of medication and is only 1 concentration where is the issue?

Our protocols list the dose and volume for every single medication
 
DesertMedic66 said:
If your company only buys 1 brand of medication and is only 1 concentration where is the issue?

Our protocols list the dose and volume for every single medication
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Medication shortages happen. Sometimes it's practical to carry different concentrations of the same medication (we are doing this with Ketamine). Even my very large AMR operation struggles to keep the same concentrations on the ambulances (and we stock all the fire departments, making us the largest combined EMS service in Colorado).

It's also the technician mindset. Joe mouthbreather medic just knows that he needs to give Xml of medication, but he doesn't actually know how to calculate the actual amount of medication he is giving.
 
Tigger said:
Medication shortages happen. Sometimes it's practical to carry different concentrations of the same medication (we are doing this with Ketamine). Even my very large AMR operation struggles to keep the same concentrations on the ambulances (and we stock all the fire departments, making us the largest combined EMS service in Colorado).

It's also the technician mindset. Joe mouthbreather medic just knows that he needs to give Xml of medication, but he doesn't actually know how to calculate the actual amount of medication he is giving.
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One tan box, one purple box.
 
Tigger said:
Medication shortages happen. Sometimes it's practical to carry different concentrations of the same medication (we are doing this with Ketamine). Even my very large AMR operation struggles to keep the same concentrations on the ambulances (and we stock all the fire departments, making us the largest combined EMS service in Colorado).

It's also the technician mindset. Joe mouthbreather medic just knows that he needs to give Xml of medication, but he doesn't actually know how to calculate the actual amount of medication he is giving.
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Dosing by volume is entirely legitimate.

Obviously, one still needs to know the mg/kg dose, and adjustments need to be made for non-standard concentrations.

But assuming the concentration is usually the same, writing protocols based on a standard concentration makes perfect sense. It skips an entire med calc step where mistakes can be made.

It is actually the opposite of a technician mindset. It is efficient because concentrations don't vary that much, yet when they do, adjustments are made.
 
Remi said:
Dosing by volume is entirely legitimate.

Obviously, one still needs to know the mg/kg dose, and adjustments need to be made for non-standard concentrations.

But assuming the concentration is usually the same, writing protocols based on a standard concentration makes perfect sense. It skips an entire med calc step where mistakes can be made.

It is actually the opposite of a technician mindset. It is efficient because concentrations don't vary that much, yet when they do, adjustments are made.
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Which is simply not a luxury many agencies have. Mistakes can be made in calculation, and mistakes can be made when providers lapse into habit and assume that all medications are packaged the same. A good provider should not do that, just as a good provider should be able to do some simple med math calculations. It does not make sense to have a protocol for every medication concentration, as that is not a known quantity.
 
Tigger said:
Which is simply not a luxury many agencies have. Mistakes can be made in calculation, and mistakes can be made when providers lapse into habit and assume that all medications are packaged the same. A good provider should not do that, just as a good provider should be able to do some simple med math calculations. It does not make sense to have a protocol for every medication concentration, as that is not a known quantity.
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Are there really that many concentrations out there for the drugs that are commonly administered by paramedics?

Is a typical paramedic realistically going to encounter more than 1 or 2 concentrations of their most commonly administered drugs?

Call me a technician, I suppose.
 
Remi said:
Are there really that many concentrations out there for the drugs that are commonly administered by paramedics?

Is a typical paramedic realistically going to encounter more than 1 or 2 concentrations of their most commonly administered drugs?

Call me a technician, I suppose.
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I'm not calling you anything, just pointing out that there are many providers who have no idea what exactly they are giving when they push the plunger. I guess I don't see it as an unrealistic expectation to have to do simple math.

We have changed concentrations for mag (four times), vec, succs (I think), dextrose, versed, morphine, fentanyl, ketamine, and naloxone in the last eighteen months. This is not an ideal situation, but we have been able to maintain stock on the all ambulances in a cost effective manner. But since the protocols are not written as "administer Xml," we do not have to change anything, which I guess seems sensible to me.
 
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