Firechic
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I second Ridryder911's recommendation. We use the nasal atomizer with Versed administration for seizures. Works quicker than IV or IM.
RSI
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How does it work for NARCAN? Just curious, because I'm seriously starting to consider doing my ride time at the Philly squad that is known as the "Narcan Task Force" (Hack on the PD's Narcotic Task Force - they have shirts and everything)Originally posted by Firechic@Apr 2 2005, 02:07 AM
I second Ridryder911's recommendation. We use the nasal atomizer with Versed administration for seizures. Works quicker than IV or IM.
Jon
we do not carry RSI anymore....it was pulled a couple of years ago i think. we HAD etomitdate and sux (shortened form bc i can't spell it out :lol since then i've been on a couple of calls where the medic really really wanted it (head bleeds, major head trauma, and i forget what else) and several other calls where we were BLS managing the airway (highflow/NRB) and right after we got to the hospital the doc was telling the nurses to start drawing up RSI and then tubed them. we currently carry versed, valium, and MS but i don't know whether or not the medics are allowed to use them in an RSI fashion (i'm an EMT and i don't have a copy of our als protocols). the flight crews have RSI....
since then i've been on a couple of calls where the medic really really wanted it (head bleeds, major head trauma, and i forget what else) and several other calls where we were BLS managing the airway (highflow/NRB) and right after we got to the hospital the doc was telling the nurses to start drawing up RSI and then tubed them. we currently carry versed, valium, and MS but i don't know whether or not the medics are allowed to use them in an RSI fashion (i'm an EMT and i don't have a copy of our als protocols). the flight crews have RSI....I find it to be VERY helpful and use it when I feel I need to control the airway. We have protocols, but we do it under our "judgement" and so far it has worked out well. The docs we work with are great and treat the medics as part of the team, so they give us pretty much anything we want. We can get pretty liberal when it comes to our protocols due to the docs trusting us.
because Durham is small and the transport times short, we do not have RSI here, just ETI and NTI. NTI works pretty well for most patients here. We dont carry any paralytics here because of our medical director...I have no opinion.
On the drugs subject: ALL narcs are carried in eyeglass cases on our person. Our trucks kept getting broken into and now the hoods can just hold a knife to our throats instead of destroying the back of the truck....
On the drugs subject: ALL narcs are carried in eyeglass cases on our person. Our trucks kept getting broken into and now the hoods can just hold a knife to our throats instead of destroying the back of the truck....
In the few minutes that I have been a paramedic, I have needed RSI once (an EMT tried to stick an OPA in a patient's mouth who was suffering from a severe head injury).
I think anything that would ease the intubation of a patient would be beneficial, but in my experience I have been quite successful without breaking teeth.
I think anything that would ease the intubation of a patient would be beneficial, but in my experience I have been quite successful without breaking teeth.
Working in two different environments I have the opportunity to utilize two different protocols.
For the Fire/ EMS side, our conscious sedation protocol is as follows:
Etomidate 0.3 mg/ kg. for the non-head trauma patients that can be repeated x 1 in 60 seconds if the patient is still clenched along with Hurricane spray to blunt the gag reflex (since Etomidate does not) and Versed post intubation for sedation. For the head injured patients we go with 0.6 mg/ kg. right off the bat since we noted a markedly increased incidence of jaw clenching with the smaller doses.
On the aircraft: Our RSI protocol is as follows:
Sedate with 0.3 mg/ kg Etomidate
Paralyze with 1.5- 2.0 mg/ kg of Anectine (Succynlcholine)
Re-sedate with Versed within 5 minutes.
Maintain paralyzation with Norcuron if needed.
Our reasoning for using Etomidate first vs. Versed is that it is faster acting with less potential for side effects especially in the hemodynamically unstable patients. If they are hypotensive we just use the Etomidate for continuous sedation as opposed to the Versed.
For the Fire/ EMS side, our conscious sedation protocol is as follows:
Etomidate 0.3 mg/ kg. for the non-head trauma patients that can be repeated x 1 in 60 seconds if the patient is still clenched along with Hurricane spray to blunt the gag reflex (since Etomidate does not) and Versed post intubation for sedation. For the head injured patients we go with 0.6 mg/ kg. right off the bat since we noted a markedly increased incidence of jaw clenching with the smaller doses.
On the aircraft: Our RSI protocol is as follows:
Sedate with 0.3 mg/ kg Etomidate
Paralyze with 1.5- 2.0 mg/ kg of Anectine (Succynlcholine)
Re-sedate with Versed within 5 minutes.
Maintain paralyzation with Norcuron if needed.
Our reasoning for using Etomidate first vs. Versed is that it is faster acting with less potential for side effects especially in the hemodynamically unstable patients. If they are hypotensive we just use the Etomidate for continuous sedation as opposed to the Versed.
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I love it.
I just started my ride time in probably the most progressive of the PA counties.
Standing orders for 4mg of MS for cardiac and non-cardiac pain control.
Standing orders for 5mg of Midazolam (I think - not 100% sure of protocols yet) for "Facilitated Intubation" We can't carry RSI drugs on ground ambulances in PA, yet. Probably not ever, if Dr. Wang keeps on turning out good, well-backed studies.
Jon
I just started my ride time in probably the most progressive of the PA counties.
Standing orders for 4mg of MS for cardiac and non-cardiac pain control.
Standing orders for 5mg of Midazolam (I think - not 100% sure of protocols yet) for "Facilitated Intubation" We can't carry RSI drugs on ground ambulances in PA, yet. Probably not ever, if Dr. Wang keeps on turning out good, well-backed studies.
Jon
rescuecpt
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Um...no. [/b][/quote]
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Um...no. [/b][/quote]
We can, but we won't.
Jon
The ground system that I work with utilizes the standard Etomidate, Anectine, and Vec dosing. Versed only for continued sedation which IMHO is not needed if Vec is used. In the air we use Etomidate and Zemuron (my personal fav, quicker than Vec and doesn't last as long), Diprivan to keep them down if needed and not contraindicated. I hate Sux, too many patient presentations that its contraindicated in. Not a real Versed fan either, can't use it in most traumas or in the case of hemodynamic instability.
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Remember, though, that Vec won't put them to sleep, really, just paralyize the patient.
It is cruel to paralyize a pt. and have them awake, espicially if we are carriying on joking about the pt. being a stupid mother-****er for wrapping his corvette around a large tree with ETOH on board.
Jon
It is cruel to paralyize a pt. and have them awake, espicially if we are carriying on joking about the pt. being a stupid mother-****er for wrapping his corvette around a large tree with ETOH on board.
Jon
medicNsand
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RSI is good in rare circumstances, I feel. It's a mentality We All Know. Some Medics want to do things " 'cause they can" as opposed to the patient really " Needs It" complex. I have Succ's/etomidate/versed for my regiment. Been the most helpful in head injuries ( IE, with regards to penetrating obvious mortal GSW's) didn't fit criteria then, LOL,.......