the 100% directionless thread

[NomadicMedic]

I wouldn't know...is it?

not anywhere I’ve ever seen..

 

[E tank]

not anywhere I’ve ever seen..

doesn't surprise me I guess...it's effect is way more predictable than atropine and pretty forgiving in terms of over shooting the HR. It lasts longer too... wouldn't expect to make it to the field as I don't expect it to be really well known in EM. It should be, IMO because it lacks the downsides of pacing and PD epinephrine and goes directly to the problem like the one in this thread. But no one asked me...does make me wonder if more progressive overseas systems use it tho.....

 

[PotatoMedic]

doesn't surprise me I guess...it's effect is way more predictable than atropine and pretty forgiving in terms of over shooting the HR. It lasts longer too... wouldn't expect to make it to the field as I don't expect it to be really well known in EM. It should be, IMO because it lacks the downsides of pacing and PD epinephrine and goes directly to the problem like the one in this thread. But no one asked me...does make me wonder if more progressive overseas systems use it tho.....

Do you have any literature on it? I haven't been home to google anything about it yet. And since I no longer have school to keep me occupied maybe I can push this through my protocols. Also any idea the cost per unit?

 

[Carlos Danger]

Do you have any literature on it? I haven't been home to google anything about it yet. And since I no longer have school to keep me occupied maybe I can push this through my protocols. Also any idea the cost per unit?

I think it is much more expensive than atropine, but of course drug costs vary widely. But my guess is that's one of the main reasons why I've never seen it in EMS, or even outside anesthesia circles, really.

 

[E tank]

Do you have any literature on it? I haven't been home to google anything about it yet. And since I no longer have school to keep me occupied maybe I can push this through my protocols. Also any idea the cost per unit?

It's one of those things we do in anesthesia that hasn't made it out to the rest of the world like PDP's and ketamine at one time...It'd be an interesting discussion because it is a great way to raise the HR...use it for that purpose several times a week...but biases being what they are, I'd be surprised if you got a hearing....

 

[Carlos Danger]

Do you have any literature on it? I haven't been home to google anything about it yet. And since I no longer have school to keep me occupied maybe I can push this through my protocols. Also any idea the cost per unit?

The advantages that E tank named (more gentle and predictable; longer lasting) are significant, but are probably less important when the only time you are using an anticholinergic is to treat hemodynamically significant bradycardia and organophosphate toxicity. I have always assumed that the main reason glyco is used so much in anesthesia is that doesn't have the potential to cause the CNS effects that atropine does. This is important when you are routinely using it to counteract the cholinergic effect of NMB reversal agents in elective surgical cases, but again, probably much less of a worry when you are only using it for emergencies in the field.

I think probably, those who write EMS protocols usually aren't that familiar with glyco, and even if they are, the advantages over atropine are considered not worth the (presumably) higher price given the scenarios that anticholinergics are used for in EMS.

 

[NomadicMedic]

The advantages that E tank named (more gentle and predictable; longer lasting) are significant, but are probably less important when the only time you are using an anticholinergic is to treat hemodynamically significant bradycardia and organophosphate toxicity. I have always assumed that the main reason glyco is used so much in anesthesia is that doesn't have the potential to cause the CNS effects that atropine does. This is important when you are routinely using it to counteract the cholinergic effect of NMB reversal agents in elective surgical cases, but again, probably much less of a worry when you are only using it for emergencies in the field.

I think probably, those who write EMS protocols usually aren't that familiar with glyco, and even if they are, the advantages over atropine are considered not worth the (presumably) higher price given the scenarios that anticholinergics are used for in EMS.

And frankly, seldom used. In the last 10 years I’ve given atropine <5 times. And I was in busy systems that saw lots of sick patients.

 

[CALEMT]

Check my bank accounts. Hey I guess all those force days I can finally afford things for my truck.

 

[fm_emt]

Only $205 later, I took my PALS renewal today. They managed to stretch it out to be a 6 hour class. Still got the 2015 version. I haven't really looked at the 2020 changes yet.

Oh, I passed it.

 

[Peak]

I think it is much more expensive than atropine, but of course drug costs vary widely. But my guess is that's one of the main reasons why I've never seen it in EMS, or even outside anesthesia circles, really.

It comes in our RSI kits, not that we use it.

 

[OceanBossMan263]

I notice the paramedic books added a blurb about it now, but I'll just reemphasize that hyperemesis gravidarum is simply awful. The wife is dealing with it for the second time in as many pregnancies and is gearing up for home IV service of up to 2L or D5 in Ringers a day. And since they assign a nurse to do it and she feels too weirded out, I am not placing her IVs.

Any ladies here who have gone through it, I'm truly sorry. Same for husbands who've had to manage the household throughout.

I'm now trying to figure out the right combination of medic side jobs to pick up in addition to my 9-5 in order to cover household expenses with her out of work (physical therapist) while still maintaining some home time for her and our 1 year old. Hopefully I will pick up something that also contributes to my state pension. Lots of fire districts around here use per diem employees

 

[Carlos Danger]

Check my bank accounts. Hey I guess all those force days I can finally afford things for my truck.

 

[GMCmedic]

Picked out a welder. I think the first order of business is building an overland trailer for my hunting trips.

 

[DesertMedic66]

Well all of Southern California (10 or 11 counties) just hit 0% free ICU beds. PICU and NICU patients are being transferred to dedicated pediatric only facilities in order to overhaul those units into COVID ICUs. All of our local hospitals ED COVID units are full with patients being in there for 3+ days.

But for some reason the county refuses to start our new policy on paramedic refusals for 911 calls. All while one of our biggest hospitals in the region is about to go on strike.

Not looking forward to the next couple of weeks.

 

[DragonClaw]

I might make rent this month. Maybe.

One day I'll have some stability.

 

[Peak]

Well all of Southern California (10 or 11 counties) just hit 0% free ICU beds. PICU and NICU patients are being transferred to dedicated pediatric only facilities in order to overhaul those units into COVID ICUs. All of our local hospitals ED COVID units are full with patients being in there for 3+ days.

But for some reason the county refuses to start our new policy on paramedic refusals for 911 calls. All while one of our biggest hospitals in the region is about to go on strike.

Not looking forward to the next couple of weeks.

Are they still mandating that the EDs find hours into for homeless people before they will discharge them?

 

[DragonClaw]

I passed first semester paramedic school though. ☺

Phew buddy

 

[DesertMedic66]

Are they still mandating that the EDs find hours into for homeless people before they will discharge them?

Yes sir. Nothing has changed there. Some of the hospitals are also considering their C-Diff patients as “clean” patients.

 

[Jim37F]

Yes sir. Nothing has changed there. Some of the hospitals are also considering their C-Diff patients as “clean” patients.

 

[PotatoMedic]

Been doing the free paramedic refresher through prodigy. Actually pretty good. Think 5.5 hours of ce is enough for the day.