the 100% directionless thread

[Handsome Robb]

Since we're talking about trauma anyone using TXA yet? Our flight service is, hopefully it's going to wander to ground along with ketamine for analgesia and procedural sedation.

 

[Wheel]

That's a trauma activation by state law here. MVA at >40 MPH.

State Trauma Criteria:
Mechanism:
MVA >40 MPH
Motorcycle accident >20 mph or ejection from the bike
Rollover >90*
Death in the same vehicle
Ejection from the vehicle
MVC vs. Pedestrian >6 MPH or run over at any speed
>20 inches of severe damage to vehicle
>11 inches of intrusion to passenger compartment on passenger side
Extrication time >20 minutes

Injury:
Flail chest
Acute paralysis
Two or more proximal long bone fractures
Burns >15% of TBSA or burns to face/airway
Penetrating chest, abdomen, head, neck or groin trauma
Amputation proximal to wrist or ankle

Physiologic:
SBP <90 mmHg
Respiratory rate <10 or >29 BPM
Revised Trauma Score <11
GCS <14

Our TC does green, yellow and red activation. Green being by mechanism, yellow can be certain mechanisms or injures and reds are critical trauma patients. Greens get an ER Physician, yellows get a ER Physician with the trauma surgeon or their PA doing a bedside consult within 30 minutes and a red gets a Trauma Surgeon with their team in the trauma bay.

Your guy would definitely get a CXR and labs here right after the primary survey. Depending on what he told the physician they might place a c-collar as well but if we've cleared it in the field they usually trust us if you've proven yourself competent. Pretty ridiculous they collared him right on your gurney.

Our trauma activation is similar, except we don't activate on mechanism alone. If there is a significant mechanism, then it has to be coupled with obvious injuries or physiologic signs in order for us to activate the trauma team.

 

[Anjel]

oh absolutely. I've learned all our trauma surgeons here want to know is mechanism of injury, last set of vitals and any assessment findings that aren't blatantly obvious. You will usually get yelled at if you fail to mention the rigid abdomen or unilaterally diminished lung sounds but point out the left BKA, for example lol







I always thought it would be cool to be a cop and a paramedic. I'd rather do that than be a firefighter/paramedic.

I should just move to Texas and work for Highland Park DPS.

Flint, MI does that. Well Genesse County really.

They are an Echo(?) unit, and drive to the scene and hop on board a private BLS unit and transport. Then when they aren't doing that, they drive around and do traffic stops.

 

[chaz90]

EMS abuse much?

 

[EMT x 626]

Just applied for a few job opening. Hope I get it!

 

[Carlos Danger]

Our flight service is, hopefully it's going to wander to ground along with ketamine for analgesia and procedural sedation.

I never had ketamine in transport, but I wish I did.

I've used it a fair amount in anesthesia, but mostly as an infusion with lidocaine in chronic pain patients already on lots of opioids, or to prevent hyperalgesia - but I used it a couple days ago for procedural sedation for the first time. I was placing a sciatic nerve block in a very uncooperative 8-year old girl, and it worked marvelously.

From now on I'll be much quicker to use it for blocks in kids and uncooperative adults. I also think next week I'm going to found some excuse to use it for induction a couple of times.

 

[NomadicMedic]

Ketamine is at the top of our medical directors "want to add to the protocols" list. From what I understand, the state medical director is interested in ketamine primarily as a bronchodilator in refractory asthmatic kids I was scratching my head, what about as an induction agent? What about as an analgesic? Sometimes statewide protocols are not the very best thing.

 

[Handsome Robb]

Ketamine is at the top of our medical directors "want to add to the protocols" list. From what I understand, the state medical director is interested in ketamine primarily as a bronchodilator in refractory asthmatic kids I was scratching my head, what about as an induction agent? What about as an analgesic? Sometimes statewide protocols are not the very best thing.

What about in as an induction agent in those severe asthmatic kids or adults that need a tube? Give him that idea! or burn patients even though the bronchodilation won't help much.

Wheel, we don't activate the trauma team our trauma center makes that call off our report. We can call "Trauma Pre-alerts" for GSWs to the torso, unresponsive patients with a unilaterally blown pupil and profound hypotension after a traumatic injury."

 

[NomadicMedic]

I put the bug in the ear of our guy on the protocol committee. He's well armed with research showing the benefit of K as an induction agent.

 

[Tigger]

The past month of work has just about run me over. Time for a break...in Jackson Hole!

 

[NomadicMedic]

I'm 100% fried. Between the job on the truck, I'm also on several committees at work. I'm the president of the Paramedic Association, I've got a couple of part-time things on the side; I do some consulting work, I've got an Internet radio station that takes up a good amount of time a I work on the FM license, and I am being courted by another EMS agency for an operations management position. I think I just need to take two weeks off, turn off the phone and sleep.

 

[DesertMedic66]

Well my company is deciding to pull Morphine and replace it with Fent. 100mcg standing order

 

[Anjel]

Well my company is deciding to pull Morphine and replace it with Fent. 100mcg standing order

Well that's dumb.

 

[Carlos Danger]

Well that's dumb.

I don't see why. Aside from a longer duration of action, which is really not an issue for EMS, I cannot think of one advantage that morphine has over fentanyl, but I can think of several that fentanyl has over morphine.

 

[Handsome Robb]

Well my company is deciding to pull Morphine and replace it with Fent. 100mcg standing order

100? That's it? :censored::censored::censored::censored: why don't you just give them an ice pack?

We max out at 300 mcg for adults or 3 mcg/kg for pedis on standing orders but can call for more. Morphine has no max, 2-5 mg for adults or 0.1mg/kg for pedis q15. I carry 600 mcg of fentanyl, 40 mg of morphine and 40 mg of midazolam. I always make sure I have enough narcotics on me to fulfill my standing orders. Always funny asking for a restock on narcs..."what'd you do with all of those!?"

I'm usually >150-200 mcg in most patients before you really start Gavin any sort of an effect on their pain. That's just my experience.

 

[TransportJockey]

I don't see why. Aside from a longer duration of action, which is really not an issue for EMS, I cannot think of one advantage that morphine has over fentanyl, but I can think of several that fentanyl has over morphine.

I think the only thing I see as dumb is if the 100mcg standing order is the max they can give without calling for more

 

[Carlos Danger]

100 mcg is a reasonable dose.

It shouldn't be a max dose, of course, but it's a good place to start and should work pretty well in a lot of cases.

 

[Anjel]

I read that as 100mcg being a max dose. Which is what I thought was dumb. Fentanyl is usually my analgesic of choice. We have both. 300mcg of Fent and 20mg of Morphine.

 

[DesertMedic66]

First dose for us is 50mcg followed by a second dose of 50mcg more on standing order. We can contact base for more.

If a FD gave the patient morphine PTA we can still give up to 100mcg on standing orders. It's not a huge improvement but it is a step back in the right direction.

We lost pedi ET a couple of years ago along with needle cric. Rumor has it those will be coming back in 2015. Our new medical director is very pro EMS.

 

[Anjel]

First dose for us is 50mcg followed by a second dose of 50mcg more on standing order. We can contact base for more.

If a FD gave the patient morphine PTA we can still give up to 100mcg on standing orders. It's not a huge improvement but it is a step back in the right direction.

We lost pedi ET a couple of years ago along with needle cric. Rumor has it those will be coming back in 2015. Our new medical director is very pro EMS.

Ah ok. Well that is better then. Still seems a bit limiting, but baby steps.