Sedation/Anesthesia in the Field

[MrBrown]

Oh dear, sedation assisted intubation is dangerous and was banned in this part of the world coz it made mortality go through the roof

 

[Emtpbill]

Oh dear, sedation assisted intubation is dangerous and was banned in this part of the world coz it made mortality go through the roof

I hear you brown!!! About 7 years ago we got versed to put people down to tube em, about 3 years ago is when it was changed that 2 medics had to be treating. I'm sure stats had a play in the 2 medic thing. The only time I give it now is for seizures if Ativan isn't working. Versed that is.

 

[emtchick171]

I hear you brown!!! About 7 years ago we got versed to put people down to tube em, about 3 years ago is when it was changed that 2 medics had to be treating. I'm sure stats had a play in the 2 medic thing. The only time I give it now is for seizures if Ativan isn't working. Versed that is.

Wow...the 2 medic thing is an interesting fact. I know we don't do RSI just yet, but it is definitely being considered and will probably happen within the next couple/few months.

It is interesting to know that y'all give Ativan and Versed for seizures, our first line drug is always Valium. Actually, that is the only drug we carry on the truck to help with seizures.

 

[Boston.Tacmedic]

We use ketamine in low (10-20mg bolus) doses for analgesia and big (1.5mg/kg) doses for anaesthesia.

Now interestingly here you cannot give ketamine to somebody who has been given midaz but you can give midaz for post-ketamine sedation management.

I am not a fan of just pouring morphine into people hoping the pain goes away because the pain is likely to stay and thier blood pressure is the only thing thats going to go away.

After 20mg of morphine if it is having no effect then its time to try something else.

Oh and Oz you clean your own mess up, Brown is at his friends house in Box Hill making lunch. If memory serves MICA 5 is just round the corner.

I couldn't say it better myself , so I won't I agree 100%. Punishing the whole profession because of others poor training just holds us all back and needless endangers the PT. RSI works and works well.

My .02

 

[Smash]

I hear you brown!!! About 7 years ago we got versed to put people down to tube em, about 3 years ago is when it was changed that 2 medics had to be treating. I'm sure stats had a play in the 2 medic thing. The only time I give it now is for seizures if Ativan isn't working. Versed that is.

Whilst my preference is definitely for 2 medics to carry out a drug assisted intubation, I'm not sure that that is Mr Browns point.

Sedation alone is not a good method for enabling intubation, especially in the types of patients that RSI is traditionally used for (eg head injuries with trismus).

The idea of using sedation alone to enable intubation makes me feel queasy! Or worse, going nasal for a head injured patient...

I must say it's an interesting turn of phrase "to put people down". I put my dog down once...

 

[MrBrown]

Drug assisted intubation (ie midaz'ing people to facilitate tubing them) has been banned most places Brown knows of .... any service that is half arsed coming to the party is just wrong

 

[usalsfyre]

So while there is a definite use for medication only assisted intubation in the setting of predicted difficult airway, midazolam is NOT the agent of choice, as it has a very definite effect on respiratory drive, airway protective mechanisms and blood pressure. Etomidate and from what I understand ketamine are much better choices.

Versed-only facilitated intubation is asking for trouble.

 

[Emtpbill]

While I agree that most medics would love to have more medications to use to help intubate a patient, we can only use what is granted to us. If all that I am permitted to use is versed, then I will use it to the best of my abilities. The wheel of progress at times seems to fly, but other times gets beat out by a snail.

 

[emtchick171]

While I agree that most medics would love to have more medications to use to help intubate a patient, we can only use what is granted to us. If all that I am permitted to use is versed, then I will use it to the best of my abilities. The wheel of progress at times seems to fly, but other times gets beat out by a snail.

I couldn't have said it any better myself. That is part of our jobs...working with what we have & improvising to get the job done...no matter how good/bad it seems to be going.

 

[MrBrown]

That is part of our jobs...working with what we have & improvising to get the job done...no matter how good/bad it seems to be going.

So working with what you have and/or improvising includes clinically dangerous undertakings which have the significant potential to cause secondary brain injury?

Perhaps the reaosn nobody has RSI is because nobody trusts you (not you specifically) with it. With the kind of statements made on this forum by various people it is no suprise.

Man this stuff just makes Brown's blood boil.

 

[Emtpbill]

So working with what you have and/or improvising includes clinically dangerous undertakings which have the significant potential to cause secondary brain injury?

Perhaps the reaosn nobody has RSI is because nobody trusts you (not you specifically) with it. With the kind of statements made on this forum by various people it is no suprise.

Man this stuff just makes Brown's blood boil.

What I meant was that I can only use the skills I am proficient in, what I am given, and use my judgement on when to and when to not apply them.
just because another medic is not proficient has no bearing on the appropriateness of a certain modality being employed, correctly and competently, by me.

 

[emtchick171]

So working with what you have and/or improvising includes clinically dangerous undertakings which have the significant potential to cause secondary brain injury?

Perhaps the reaosn nobody has RSI is because nobody trusts you (not you specifically) with it. With the kind of statements made on this forum by various people it is no suprise.

Man this stuff just makes Brown's blood boil.

Maybe I should have been more specific with my post. Improvising is part of our jobs, we treat what we see we DO NOT diagnose. In everyday life we take chances (not just talking about on our jobs). Every decision we make has a consequence...whether it be good or bad. Sometimes, in certain situations you have to weigh out the good and the bad...and see which one is the best choice.

- - I am not going to do ANYTHING on the back of my truck to intentionally harm my PT more than they already are...nor am I going to do anything that is contraindicated!

 

[emtchick171]

What I meant was that I can only use the skills I am proficient in, what I am given, and use my judgement on when to and when to not apply them.
just because another medic is not proficient has no bearing on the appropriateness of a certain modality being employed, correctly and competently, by me.

I understood you, I believe you and I both confused Brown. Sorry for the confusion Brown, I should have been more clear.

 

[MrBrown]

What I meant was that I can only use the skills I am proficient in, what I am given, and use my judgement on when to and when to not apply them.
just because another medic is not proficient has no bearing on the appropriateness of a certain modality being employed, correctly and competently, by me.

Unfortunately it does because those who exhibit the most clinical risk (ie the least competent, educated, proficent whatever term you want to use) is who the system is set up for.

Maybe I should have been more specific with my post. Improvising is part of our jobs, we treat what we see we DO NOT diagnose. In everyday life we take chances (not just talking about on our jobs). Every decision we make has a consequence...whether it be good or bad. Sometimes, in certain situations you have to weigh out the good and the bad...and see which one is the best choice.

- - I am not going to do ANYTHING on the back of my truck to intentionally harm my PT more than they already are...nor am I going to do anything that is contraindicated!

Good to hear, if you need help ring up Brown and him n Oz will come for a blast in the blue car or big red helicopter

Unfortunately again, many a provider Brown has seen subscribe to the old ambo trick of "more is better" or somehow believe thier minimal education qualifies them to undertake risky clinical dexterities because "it helps"