Would you do it?

[Veneficus]

Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds

Why 100 systolic? Are there times when it is below that it would be ok to? Who picked that number?

The legendary Trendelenberg, might not have the effet you want. (or any at all)

Max dosage 3? I hope your transport time is less than 9-15 minutes.

 

[EMTWintz]

Why 100 systolic? Are there times when it is below that it would be ok to? Who picked that number?

The legendary Trendelenberg, might not have the effet you want. (or any at all)

Max dosage 3? I hope your transport time is less than 9-15 minutes.

100 is a number pulled outa someone's arse, Trendelenberg may not have the effect i want but what else am i gona do? As this is a BLS squad with ALS on their way.(which btw will take up to 10min.)

 

[Veneficus]

100 is a number pulled outa someone's arse,

There is some minimal thought behind it, but I would say you got the gist of it.

Trendelenberg may not have the effect i want but what else am i gona do?

quite true, maybe dance around waving a dead chicken? might have the same effect might actually work better by scaring patient and the sympathetic response could increase bp.

As this is a BLS squad with ALS on their way.(which btw will take up to 10min.)

Maybe you should alter the protocol for a few more unless the docs really like hearing your voice.

 

[enjoynz]

You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right?

Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine.

R/r 911

Sorry Rid, but it could also be said for a medic that gives adreniline to a LQTS patient in arrest...
which I know is part of their procedures in codes here in NZ.
I can't say for the States, but I guess it would be one of the drugs used.
Sometimes it's guess work for all skill levels....you do the best that you can at the time with the information you have at that time.
eg. Patient Medical History, Medic Alerts, etc.
People die every day because the medical profession doesn't have all the facts or answers.........even in hospitals.
I would have thought if there were that many deaths caused by an EMT-B giving cardiac patients Nitro,
the powers that be, would have taken that drug off their Code of practice years ago?

Enjoynz

 

[Veneficus]

Sorry Rid, but it could also be said for a medic that gives adreniline to a LQTS patient in arrest.
which I know is part of their procedures in codes here in NZ.
I can't say for the States, but I guess it would be one of the drugs used.

Not that RId needs me to answer for him, as he is quite smart, but since i am just hanging around...

In resuscitative medicine the guidlines for epi in an arrest is based on an unknown cause. Unfortunately many medics think these guidlines are the word of God and if there is a save, it was because of this. They lack in both critical thinking and medical knowledge.

In any arrest, if you put forth some effort in finding the cause, treating that cause is the best solution. If I suspected LQTS, as you have seen, mag is my candy of choice.

Epidemiology needs to be considered in all arrests of unknown origin, but no effort is paid to that in medic school or even at the hospital level sometimes.

Sometimes it's guess work for all skill levels....you do the best that you can at the time with the information you have at that time.
eg. Patient Medical History, Medic Alerts, etc.
People die every day because the medical profession doesn't have all the facts or answers.........even in hospitals.

But there can be good guesses and no effort at guessing. There is a lot of inconsistency and especially prehospital, even if you do make a guess, you may not have anything to tret with.

I would have thought if there were that many deaths caused by an EMT-B giving cardiac patients Nitro,
the powers that be, would have taken that drug off their Code of practice years ago?

This arguement is an endless loop. If you don't give the nitro you are doing nothing, if you give it, you might cause harm. Do you stand and watch somebody deteriorate or make an effort that might harm? We have debated for years, there are no answers.

 

[Foxbat]

What I also have never seen is a volly squad work in earnest to eliminate their own organization in order to establish professional EMS in the community

My department used to be an all-volunteer agency, but now we have paid staff 24/7.
Or do you mean we have to prohibit volunteers altogether - as a 3rd person, or to staff additional trucks in case of MCI/multiple calls? That, indeed, will probably not happen anytime soon.

 

[Foxbat]

Volunteer paramedics? As far as I know, no such thing. Correct me if I'm wrong

You are wrong. There are volunteer paramedics in my area.

 

[AJ Hidell]

My department used to be an all-volunteer agency, but now we have paid staff 24/7.
Or do you mean we have to prohibit volunteers altogether - as a 3rd person, or to staff additional trucks in case of MCI/multiple calls? That, indeed, will probably not happen anytime soon.

What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department. Just never seen it happen. I have, however, many times seen volunteers fighting the take over by a paid department because they don't want to lose their little hobby. After all, they spent lot of money on all those LEDs on their POVs. They don't want to have to take them off!

 

[fortsmithman]

What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department. Just never seen it happen. I have, however, many times seen volunteers fighting the take over by a paid department because they don't want to lose their little hobby. After all, they spent lot of money on all those LEDs on their POVs. They don't want to have to take them off!

Currently my service is paid on call. I would really like it if the town changed us from paid on call to full time and hired the current members because nearly all the members of my service would quit our regular jobs and go full time. Only 3 members of my service have lights on their POVs. I wouldn't because if one gets into an accident while responding with the POV emergency lights. The insurance carrier my decline the claim and the member would have to pay any damages out of their pockets.

 

[Foxbat]

What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department.

And how will our residents benefit if we all walk out?
Let us also look at our neighbors' department. Unlike us, they are all volunteer (except one administrative member). Yet they are ALS and staff their truck 24/7. How will their community benefit if they no longer exist?

 

[fortsmithman]

Having a paid full time service with a volunteer division. It could work use the volunteer division to hire full time members when openings come up that could work.

 

[Ridryder911]

And how will our residents benefit if we all walk out?
Let us also look at our neighbors' department. Unlike us, they are all volunteer (except one administrative member). Yet they are ALS and staff their truck 24/7. How will their community benefit if they no longer exist?

Simple, you have will control on the quality of care. You are saying each of those ALS members are graduates of a degree program? ....
Yeah, I didn't think so.

R/r 911

 

[Foxbat]

You are saying each of those ALS members are graduates of a degree program?

Is every career medic graduate of a degree program?