We went through it quite briefly in my basic course but yes we did talk about it. From what I gather on this forum though I went to a very well taught basic course and my teacher was really great teaching us many things "above the basic level" if we wanted to learn them. My medic course doesn't seem to be doing a great of a job so we'll see when it's all said and done.
What direction is BLS goin in your state?
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We went through it quite briefly in my basic course but yes we did talk about it. From what I gather on this forum though I went to a very well taught basic course and my teacher was really great teaching us many things "above the basic level" if we wanted to learn them. My medic course doesn't seem to be doing a great of a job so we'll see when it's all said and done.
NebraskanPrincess
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My service lets us Bs do nothing spectacular, which sucks when we're the two Bs on first call, but ah well 
Rural Nebraska:
As Bs, we are allowed to administer O2, but we interpret the pulse ox and don't provide it to every pt.
Blood Glucose Readings
Albuterol (with certification)
IV Monitoring (with cert) (our service doesn't allow initiation with B's - has to be a P)
ASA
Nitro Spray (if we administer those two, the Paramedic HAS to be en route as it's a non-BLS call)
Again, that's what our service does. Rural Squads who run only Bs and use us as their ALS service do BG reads, O2 Admin... and that's about it. I haven't run across one of 'em yet who've given ASA, Nitro, Epi-Pens, and they definitely don't carry albuterol.
Nebraska as a state does not allow EMTs to do advanced airways (I think - a fellow Corny may have to correct me), but we are allowed to do IVs with the appropriate training. There's talk about taking away IVs, though. And if we do have the advanced airways right now, those are soon to go, too.
Rural Nebraska:
As Bs, we are allowed to administer O2, but we interpret the pulse ox and don't provide it to every pt.
Blood Glucose Readings
Albuterol (with certification)
IV Monitoring (with cert) (our service doesn't allow initiation with B's - has to be a P)
ASA
Nitro Spray (if we administer those two, the Paramedic HAS to be en route as it's a non-BLS call)
Again, that's what our service does. Rural Squads who run only Bs and use us as their ALS service do BG reads, O2 Admin... and that's about it. I haven't run across one of 'em yet who've given ASA, Nitro, Epi-Pens, and they definitely don't carry albuterol.
Nebraska as a state does not allow EMTs to do advanced airways (I think - a fellow Corny may have to correct me), but we are allowed to do IVs with the appropriate training. There's talk about taking away IVs, though. And if we do have the advanced airways right now, those are soon to go, too.
the things we take for granted in my country emt b's can
administer nitro spra(under medi direction)
check gmr
administer epi-pen (medi direction)
iv set up
pulse oxi
activated charcoal
asprin
etc
you know i really cant understand the concept with some states where by emtb's are not allowed to take a glucose reading. If a patient can do it why cant an EMTb with basic medical/first aid knowledge stick a pt. hmmmm strange but i guess it is what it is
administer nitro spra(under medi direction)
check gmr
administer epi-pen (medi direction)
iv set up
pulse oxi
activated charcoal
asprin
etc
you know i really cant understand the concept with some states where by emtb's are not allowed to take a glucose reading. If a patient can do it why cant an EMTb with basic medical/first aid knowledge stick a pt. hmmmm strange but i guess it is what it is
Arkymedic
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Our basics pretty much are only allowed to drive. There are a few volunteer EMS services, but even as rural as Arkansas is, almost the entire state is covered with ALS.
I guess you haven't been around long enough to read one of my lengthy lectures on SpO2, SaO2 and the oxygen dissociation curve as well as all that V/Q mismatching stuff.
Now, do you understand the indications for a 10 L or a 15 L NRBM.
Do you know when a 4 or 6 L NC is providing the same FiO2 as a 2 L NC?
Why do EMT-Bs put some much time and effort into getting individual "certs" for albuterol, pulse ox, d-sticks or whatever when with just a few more hours they could be a Paramedic?
medic417
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But I don't want that resposibilty. I just want to do what I want to do without being accountable. We're only talking about skills a monkey could do after watching videos on U Tube. And we all know O2 benefits everyone.:unsure:
:blush:
BLSBoy
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Yikes!
Theres BLS providers that can administer Nitro?!:wacko:
I won't do nitro without a VII lead done. And I prefer to have an IV in place as well.
As for the advancement of the scope, I for one am excited to see our pts get better treatment, quicker, but I would like to see significantly more education before these skills are disseminated to the masses.
Theres BLS providers that can administer Nitro?!:wacko:
I won't do nitro without a VII lead done. And I prefer to have an IV in place as well.
As for the advancement of the scope, I for one am excited to see our pts get better treatment, quicker, but I would like to see significantly more education before these skills are disseminated to the masses.
Foxbat
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In PA, EMT-Bs can assist pt. with a prescibed nitro.
There are Paramedic schools that don't even teach about V/Q mismatch and the O2 disassociation curve. We are lucky to get new EMT-B's that realize maybe not all patients need 15LPM of O2. Much different ballgame in the U.S.
mikie
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The more 'progressive' BLS procedures I was permitted (which wasn't directly taught in my Basic class)...
Glucagon IM (the '2 vial' setup, not the 'readied' one in the red case))
Albuterol Neb. Treatments
Combitube
ASA (4 x 81mg)
Nitro (spray)
Glucometer
-all in the standing orders too (no MC needed for administration (not saying that it wasn't often consulted first though)).
Glucagon IM (the '2 vial' setup, not the 'readied' one in the red case))
Albuterol Neb. Treatments
Combitube
ASA (4 x 81mg)
Nitro (spray)
Glucometer
-all in the standing orders too (no MC needed for administration (not saying that it wasn't often consulted first though)).
daedalus
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Skills skills skills. Its all skills isn't it.
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If a PT really needs six in nasal I would just ump them up to 10 on an NRB
Arkymedic
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Why? What reasoning supports this? Why give them more O2 than they need? That is exactly why the comments made earlier about BLS tx's were made.
This is where a few basic principles of O2 delivery should be discussed.
These arguments of which is appropriate, 2L or 4L NC and 10 L or 15 L NRMB show a poor understanding about the O2 delivery system and the O2/ventilatory demands of the patient.
If the device provides less than the patient's peak inspiratory flow rate, room air will be entrained to dilute the O2. The values quoted by text books for approximate FiO2 for each device are make for an "average" minute volume under "average normal" conditions.
To deliver oxygen CORRECTLY, one must look at the minute volume (RR x tidal volume) of the patient, and understand how the chosen O2 device works. It is also problematic that EMS is taught in their text books that a NRBM is a "high-flow" device. It is only high flow in that it uses more O2 than a NC. A true high flow device must meet the total minute volume demands of a patient. The venturi mask is a high flow device even though it requires less O2 than a Simple or NRB mask.
I was recently asked why one might see a NC on a patient also wearing a NRBM. The provider of O2 is trying to meet the patient's minute volume requirement the best they can with the equipment they have.
BTW, in some hospitals (also hospice and comfort care facilities), we now have high flow nasal cannulas that can go up to 40 L/m. They also must be capable of providing humidity that is close to the norm for the human body. One of those little cool water pass-over bubbler's don't do that and actually don't humidify all that well for the flows suggested on a regular cannula.
So my message is, a NC of 6 L might be providing the equivalent of a 1 L NC (approx 24%) if the patient has a high minute volume.
This is why I rarely question a 6 L NC on a COPD patient, even if they are one of the 5% that may be a retainer, if they have an increased minute volume with their shortness of breath. I watch their WORK of breathing as well as the SpO2. Just like running, if they are working too hard and with too little O2 uptake coupled with bad lungs and/or cardiac function, they "hit the wall" so to speak.
When you adjust the flow of a NRBM on a patient with a high minute volume, you are adjusting in hopes to maintain FiO2 stability. When the SpO2 drops on a patient wearing a 10 L/m mask and the patient is breathing hard and rapid, by increasing the liter flow to 15 L, you may not be increasing the FiO2 but merely attempting to meet the patient's peak inspiratory flow requirements to even get some minimum consistent FiO2 out of that bag.
Ever wonder why some patients pull off face masks? If the person's minute volume requirement is 18 - 22 L/m and you are giving 15 l/m, regardless of whether the reservoir bag is full, that person is air hungry and that face mask might as well be a plastic bag over their face. The face mask is not a tight seal and outside air will be drawn in by the patient which dilutes the FiO2 and comes at a great energy cost. If the mask has a tight seal, as in CPAP, you had better be able to meet the patient's flow demands.
The person who best understands their O2 equipment/basic physiology and knows when to make adjustments based on that knowledge, NOT a cook book recipe, is the one most qualified to perform that "skill".
These arguments of which is appropriate, 2L or 4L NC and 10 L or 15 L NRMB show a poor understanding about the O2 delivery system and the O2/ventilatory demands of the patient.
If the device provides less than the patient's peak inspiratory flow rate, room air will be entrained to dilute the O2. The values quoted by text books for approximate FiO2 for each device are make for an "average" minute volume under "average normal" conditions.
To deliver oxygen CORRECTLY, one must look at the minute volume (RR x tidal volume) of the patient, and understand how the chosen O2 device works. It is also problematic that EMS is taught in their text books that a NRBM is a "high-flow" device. It is only high flow in that it uses more O2 than a NC. A true high flow device must meet the total minute volume demands of a patient. The venturi mask is a high flow device even though it requires less O2 than a Simple or NRB mask.
I was recently asked why one might see a NC on a patient also wearing a NRBM. The provider of O2 is trying to meet the patient's minute volume requirement the best they can with the equipment they have.
BTW, in some hospitals (also hospice and comfort care facilities), we now have high flow nasal cannulas that can go up to 40 L/m. They also must be capable of providing humidity that is close to the norm for the human body. One of those little cool water pass-over bubbler's don't do that and actually don't humidify all that well for the flows suggested on a regular cannula.
So my message is, a NC of 6 L might be providing the equivalent of a 1 L NC (approx 24%) if the patient has a high minute volume.
This is why I rarely question a 6 L NC on a COPD patient, even if they are one of the 5% that may be a retainer, if they have an increased minute volume with their shortness of breath. I watch their WORK of breathing as well as the SpO2. Just like running, if they are working too hard and with too little O2 uptake coupled with bad lungs and/or cardiac function, they "hit the wall" so to speak.
When you adjust the flow of a NRBM on a patient with a high minute volume, you are adjusting in hopes to maintain FiO2 stability. When the SpO2 drops on a patient wearing a 10 L/m mask and the patient is breathing hard and rapid, by increasing the liter flow to 15 L, you may not be increasing the FiO2 but merely attempting to meet the patient's peak inspiratory flow requirements to even get some minimum consistent FiO2 out of that bag.
Ever wonder why some patients pull off face masks? If the person's minute volume requirement is 18 - 22 L/m and you are giving 15 l/m, regardless of whether the reservoir bag is full, that person is air hungry and that face mask might as well be a plastic bag over their face. The face mask is not a tight seal and outside air will be drawn in by the patient which dilutes the FiO2 and comes at a great energy cost. If the mask has a tight seal, as in CPAP, you had better be able to meet the patient's flow demands.
The person who best understands their O2 equipment/basic physiology and knows when to make adjustments based on that knowledge, NOT a cook book recipe, is the one most qualified to perform that "skill".
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Please explain why you would want to call a physician for anything you listed above.
Shishkabob
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Some states and agencies have different protocols then the ones you're used to.
A140160
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Where I am, we've got:
-Assist with Nitro
-Oral Glucose
-Epi-pen
-Bronchodilator
-CPAP (with cert)
Probably some others too but I can't think of them right now
-Assist with Nitro
-Oral Glucose
-Epi-pen
-Bronchodilator
-CPAP (with cert)
Probably some others too but I can't think of them right now
I understand that. My question is why you would want to. The poster mentioned that it was not required but that they often do it anyway.
Not trying to start the whole nitro with or without an IV debate again but for those of you that say you are allowed to administer nitro what are your guidelines for it?
We carry nitro spray but are only able to "assist" administration to a patient that is already prescribed nitro and we only use ours if theirs is expired, and we must consult medical direction prior to giving just so they have a heads up if we do bottom out their pressure.
We carry nitro spray but are only able to "assist" administration to a patient that is already prescribed nitro and we only use ours if theirs is expired, and we must consult medical direction prior to giving just so they have a heads up if we do bottom out their pressure.
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Foxbat
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We can assist with prescribed nitro (one dose) only if pt. has chest pain or discomfort (unless it's pleuritic pain or pt. < 30 y. o.), has systolic BP>100, and has not taken ED meds in las 24/48 hrs. After one dose, MC is notified and second dose may be given if ordered and BP is >100.