the 100% directionless thread

[triemal04]

Yep. Definitely time to implement a new, nationwide tax on Californians.

Anytime one leaves the state on a temporary basis, it's $500. Anytime one leaves the state on a permanent basis, it's $5000 per month. All proceeds shall be split between the city, county and state that has to put up with them.

Maybe that'll help contain the stupid a little better.

 

[NomadicMedic]

Evidently there was a cardiac arrest right near the start of a large Labor Day parade in Wilmington, and the news decided they should publish an article with a play by play of the events. It's interesting to read the description of this code from a layman perspective.

http://www.delawareonline.com/story...ency-delays-start--labor-day-parade/71836896/

After ROSC, I usually direct a rescuer to apply light chest compressions. Just, ya know, in case.
That's just odd.

 

[redundantbassist]

Evidently there was a cardiac arrest right near the start of a large Labor Day parade in Wilmington, and the news decided they should publish an article with a play by play of the events. It's interesting to read the description of this code from a layman perspective.

http://www.delawareonline.com/story...ency-delays-start--labor-day-parade/71836896/

And then the healing wizards came, and said their magic spell of "I'm clear, you're clear, we're all clear" and brought him back to life!

 

[SandpitMedic]

Ditto.
Be safe guys. Also, enjoy that holiday pay!

 

[DesertMedic66]

This is the biggest issue I have with this situation.

I don't necessarily have a huge problem with them wanting you to take up a suspected opioid OD, even despite them breathing well - I don't think there's any reason for it and I don't think it's a great practice, but whatev - however, the fact that they are forcing you to give such a large dose is simply stupid. It's not needed and it's potentially bad for the patient.

For an EMT who is dealing with a patient who is apneic or hypoxic from resp depression and they are in over their head and they need to do something and all they have is a metered-dose device of some type, then 2mg is fine. But for a paramedic who can easily divide the doses and is dealing with a patient who is already breathing adequately, it's asinine.

That, and having to take orders from an ED RN. I can't get past that one.

Welcome to my world. The only things we can titrate are CPAP, O2, and Fluid bolus. Everything else we have to call for orders fo . We have 2 different kinds of orders. The majority of our orders can be given by the MICN. However there are a few orders that have to be given directly from the ED doctor.

I generally had two formats for calling hospitals. One was simply a radio report that was similar to a report I'd give at bedside to the receiving staff. The other was what I'd use when asking for orders, for whatever reason. It was generally clear that I wasn't asking for, nor expecting, orders for care of that patient, when simply giving a radio report.

If you disagree with the MICN's order, should one be given, just make sure you clarify the order in such a way that you're trying to point out why you don't think it's a great idea to do at that time. "Confirm 2 mg Narcan for a spontaneously breathing patient that is protecting their own airway, satting 96% on room air with an EtCO2 of 38?" The MICN might not exactly "like" having to repeat an order, but the restated stuff might make them rethink the order. Also, if there's and adverse event of some sort afterward, you then can bring that up later in a run review... and it's on tape. Or you can request to speak to the Base Hospital Physician about the order. Be polite and professional and if the order won't be detrimental to the patient, you should be able to choose when to "do it" and at what rate. After all, 2 mg Narcan SLLLOOOWWWWWWWWWWW IVP will still result in 2 mg being administered just as a 2mg Narcan bolus does.

Just be very certain what your county's policy is when you are refusing an MICN order. Remember, if the MICN doesn't give the proper order and you carry it out, YOU are the one they'll hang because you're the ultimate safety device. As an RN, if I think a medical provider's med orders (for instance) are unsafe or appropriate for that patient, I have the responsibility to NOT do it and question it.

If it was a clearly harmful or dangerous order for the patient I would not complete the order, however in this case it would be very hard (IMO) to say that this was a dangerous or clearly harmful order.

I have 3 types of call ins. The information only call ins for AMAs, the standard call in where I am just transporting, and then seeking orders contact (I usually start that off with "I'm seeking orders for 50mcg of fent for ABD pain" and then state my case.

As for this call I did restate the order exactly how you stated it to which I was given the yes by the MICN (their reasoning was based solely off of the GCS and nothing to do with respiratory depression).

I slowly put my patient in the restraints and very slowly gave the 2mg Narcan while running the line wide open. By the time I was done giving it we were walking thru the back doors at the hospital.

 

[exodus]

Because narcan is indicated for respiratory depression. Not ALOC.

And my GoPro stood up fantastically to my snowmobile accident, helmet not so much.

But it is, only one indication of it is respiratory depression induced by opiods:

http://eilat.sci.brooklyn.cuny.edu/newnyc/DRUGS/Naloxone.htm

For the complete or partial reversal of CNS and respiratory depression induced by opioids:

Narcotic agonist
Morphine sulfate
Heroin
Hydromorphone (Dilaudid)
Methadone
Meperidine (Demerol)
Paregoric
Fentanyl citrate (Sublimaze)
Oxycodone (Percodan)
Codeine
Propoxyphene (Darvon)


Narcotic agonist and antagonist
Butorphanol tartrate (Stadol)
Pentazocine (Talwin)
Nalbuphine (Nubain)
Decreased level of consciousness
Coma of unknown origin
Circulatory support in refractory shock (investigational)

 

[CALEMT]

Well out of the 8 days I went available for at work (part time) hopefully I'll be able to pick up 3 or 4 shifts next week.

 

[Jim37F]

Ok computer literate people, I'm shopping for a new laptop, primary use Internet, Office, and some PC games. I was about to pick up a $400 laptop when the sales guy said the i3 core wouldn't do.....So what should I be looking for in terms of processor and all that should I be looking for?

 

[Flying]

Ok computer literate people, I'm shopping for a new laptop, primary use Internet, Office, and some PC games. I was about to pick up a $400 laptop when the sales guy said the i3 core wouldn't do.....So what should I be looking for in terms of processor and all that should I be looking for?

Games are the most intensive, which games or what kind?

 

[triemal04]

I slowly put my patient in the restraints and very slowly gave the 2mg Narcan while running the line wide open. By the time I was done giving it we were walking thru the back doors at the hospital.

This goes around a lot, so it's not just you by any stretch.

What's the half-life of narcan?

When giving narcan, what really matters, the dosage and route of adminstration or the rate of administration?

If you give 2mg over 5 minutes one day and 2mg over 5 seconds another, do you think there will be a difference in the patient's presentation 30 minutes later?

 

[CALEMT]

Ok computer literate people, I'm shopping for a new laptop, primary use Internet, Office, and some PC games. I was about to pick up a $400 laptop when the sales guy said the i3 core wouldn't do.....So what should I be looking for in terms of processor and all that should I be looking for?

Theses the option of building your computer. Im not at all tech savy, but from what I've heard from other people its like building an AR-15 (except someone else it putting together the computer) in the sense of you build it to meet your specifications.

 

[DesertMedic66]

This goes around a lot, so it's not just you by any stretch.

What's the half-life of narcan?

When giving narcan, what really matters, the dosage and route of adminstration or the rate of administration?

If you give 2mg over 5 minutes one day and 2mg over 5 seconds another, do you think there will be a difference in the patient's presentation 30 minutes later?

If I remember correctly the half-life is anywhere from 30-90 minutes.

The dose is what matters not the route (aside from the absorption).

In my experience if you slam Narcan the patient normally responds by vomiting and being aggressive. If it is given slower they seem to not have the issue of the vomiting or being aggressive (my experience with Narcan is very limited however. I have only given it 3 times)

As for the patient 30 minutes later, there shouldn't be a difference or at least none I can think of.

 

[teedubbyaw]

^ no matter what you say, he'll continue to pick apart what you say since apparently it's how he fulfills his satisfaction.

 

[Akulahawk]

If I remember correctly the half-life is anywhere from 30-90 minutes.

The dose is what matters not the route (aside from the absorption).

In my experience if you slam Narcan the patient normally responds by vomiting and being aggressive. If it is given slower they seem to not have the issue of the vomiting or being aggressive (my experience with Narcan is very limited however. I have only given it 3 times)

As for the patient 30 minutes later, there shouldn't be a difference or at least none I can think of.

The rate at which the patient receives the drug into circulation affects the patient's response. You just effectively said so. Different routes of administration result in different rates of uptake into circulation. If you're told 2mg IVP, you're not necessarily being told to slam it in. You can choose a much slower route, and therefore a much more gentle response by the patient. Yes, total dose does matter. However, slam that stuff in, and your fully-awake, well perfusing/breathing patient will likely still be very, very angry with you. Give it slowly and they'll still likely experience withdrawl symptoms, but the onset will be much less rapid and you'll still have a fully-awake, well perfusing/breathing patient.

Also, slam it and your angry patient could end up also wearing some silver bracelets, courtesy of law enforcement.

 

[triemal04]

As for the patient 30 minutes later, there shouldn't be a difference or at least none I can think of.

Correct.

Give it slowly and they'll still likely experience withdrawl symptoms, but the onset will be much less rapid and you'll still have a fully-awake, well perfusing/breathing patient.

Also, slam it and your angry patient could end up also wearing some silver bracelets, courtesy of law enforcement.

Also correct.

If the total dose is large enough to precipitate withdrawal, unless it's being given VERY slowly (like a drip given over hours and titrated to breathing status/level of consciousness) the patient is still going to go into withdrawals. It might be a somewhat slower onset and not something that has to be dealt with by the provider who pushed the med...but it's still going to happen. While doing what you did might make your life easier...do you see how it's still a problem?

 

[triemal04]

Hypothetical question for all the moderators. Purely hypothetical of course.

If someone was to admit that they were a troll and just trolling this forum...what would happen to them?

 

[teedubbyaw]

Hypothetical question for all the moderators. Purely hypothetical of course.

If someone was to admit that they were a troll and just trolling this forum...what would happen to them?

You mean, like, desertmedic, with the title under their name? Derp.

 

[DesertMedic66]

You mean, like, desertmedic, with the title under their name? Derp.

You caught me, I give up, I admit it. Now just have to wait for the mods to ban me.

 

[teedubbyaw]

I told him he can't troll a troll. Guess I'm getting reported.

 

[Chewy20]

Hypothetical question for all the moderators. Purely hypothetical of course.

If someone was to admit that they were a troll and just trolling this forum...what would happen to them?

hes been here long enough