HarryM

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About HarryM

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    New Zealand

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    EMT
  1. Tranexamic acid

    We've just had a memo out from our clinical research team which has said that at the moment the evidence is against prehospital use of TXA, but that we will be taking part in trials ourselves and make a final decision from there. The rationale was that while studies did show TXA decreased mortality from trauma, the studies were conducted in countries that had much higher levels of trauma deaths than New Zealand. They applied the study results to NZ and found that as the rate of death from trauma was much lower here then TXA would have a lower efficacy and with a lower efficacy, the risks of pathological clotting are significantly increased which outweighs the possible benefits.
  2. C-Collar only immobilization

    That's awesome. Trust me, it will lead to a lot less work immobilising a lot of patients and also increase comfort for your patients!
  3. Pediatric respiratory care

    Also playing devil's advocate....does your system have nebulished brochodilators?
  4. Possibly may never give it. I've always had good relief with a properly done valsalva or spontaneous reversion. Our guidelines are to only give adenosine for SVT only if there is compromise or a hx of SVT responsive to Adenosine. It's specifically differentiated from A.Fib in our guidelines which is treated with Amiodarone. I'm not going to be the person to give Adenosine to someone in A.Fib and then have to explain it in an audit. I can use all the medical research in the world to prove a case that it was worth a try with a funky rhythym, but at the end of the day our guidelines are written by an intensivist and we follow them. We can go outside them provided we can prove we were correct. But as you say, you can't prove you were correct in a pre-hospital setting. If we revert the SVT with Adenosine we can leave the patient at home provided it's not their first SVT responsive to Adenosine.
  5. Hmmm I'm not sure on that one. We use adenosine ONLY for SVT. You have to be 100% certain it is SVT. Otherwise for all other compromised tachydysrythmia's it's an amiodarone infusion and/or electric cardioversion for significant compromise. I'd be pretty wary of making a guess with any cardiac drug, but adenosine can be pretty nasty so personally I'd err on the side of caution and not go down that line unless certain it was SVT or consulted with clinical and got their view on the rhythm.
  6. Another one here. Hopefully will see some of the most recent evidence based research being put into play!
  7. Tranexamic acid

    Being used in NZ pre-hospitally by our on-call Docs. If you feel it would be useful and they can locate you faster than you can get to hospital than you can request they come out. Hopefully it will be introduced for paramedics in the near future.
  8. ED Wait Times

    If we spend longer than 20min handing a patient over to ED we get a page saying "Time at hospital has been over 20min. Please clear ASAP or advise of length of delay."
  9. Belated Hi

    Thanks guys. I notice that some people include an introduction of how their service/country operates EMS but I'm sure you've heard about it from NZ and Australian members on here. But if anyone is interested then just let me know. It's definitely interesting to me to see the differences between countries (and even services in the case of USA).
  10. Belated Hi

    I honestly can't remember if I've posted in Meet & Greet before. I've already made a few posts in the various topics and so figured it was time to say hi. I'm currently a fulltime EMT in Auckland, New Zealand. I'm relatively new and started out as a volunteer about 4 years ago before going full time this year (and throwing in the corporate life). I'm studying part-time towards my Bachelor of Health Science majoring in Paramedicine and will have that by the end of 2014. It's been great to see how different services around the world operate both clinically and operationally. Hopefully I'll be a bit more active on here from now on.
  11. chest pain bad, nitrates good

    I personally feel (and I haven't actually done any research on this, it's just observations of both ambulance and hospital staff) that the treatment of chest pain has not had a whole lot of really good research done on it until very recently. Which is why there is still a widespread mindset of chestpain = nitrates. It's really only recently for example that we introduced a requirement whereby GTN can only be administered to a chestpain patient with a HR between 40-150. And pre-hospitally, we have only in the past couple of years started pushing the maxim of checking for right sided involvement on a 12-lead before giving GTN. We have for example stopped giving O2 to chest pain patients and now give amiodarone and adenosine so we have moved forward. But on the whole, we still manage the majority of chest pain patients with GTN, aspirin and morphine, and have done so for a number of years without really any changes. So maybe its time so research was done on whether this is still the golden standard of chest pain management?
  12. Monitors

    There's probably a 90% chance it's the same as you....unless you live in Wellington
  13. Monitors

    Sorry. Never even heard of it. We use LP 12's and Philips MRx's with helicopters having LP 15's.
  14. Intubation in 2012

    Protocol for RSI 1. IV Fentanyl (1mcg/kg) 2-3min before induction 2. It pt has shock then IV Ketamine (1.5mg/kg) and IV Suxamethonium (1..5mg/kg). If pt does not have shock then IV Midazolam (0.05mg/kg) and IV Suxamenthonium (1.5mg/kg) 3. Intubate and confirm tube placement with ETCO2 4. Give 10mg IV Vecuronium 5. Give ongoing sedation (1-3mg midazolam and 1-3mg morphine every 3-5min) Standard Intubation Follow steps 3-5 (only if pt not in cardiac arrest, otherwise just tube and ventilate then follow 3-5 if you get ROSC). Only a few select people are trained for RSI so they get a lot of practice. Only issue is that they often aren't around when you need them. Everyone else gets plenty of opportunities to tube as a general rule. Either on-road or at hospital if they want. Success rate is very high.
  15. Ketamine... PCA?

    For sedation our preferred drug is Midaz but if you need to basically do a quick takedown for a very unstable patient who is a threat to others or themselves we can basically IM them with K using 2mg/kg up to 200mg max. Very effective. Only time I've seen it done patient became GCS 3 and maintained own airway well. No signs of respiratory depression. The issue we were having with midaz was that in patients that very highly combative due to amphetamines, you could hit with them with huge amounts of midaz with nil sedative effects but high risk of respiratory depression when you did finally get enough in to calm them down. One of the main reasons they brought in the K procedure for sedation.