I love it when a plan comes together. The heart of the concept is minimizing cerebral oxygen demand while maintaining a sufficient cerebral perfusion pressure and flow for tissue oxygenation. Assuming an ICP of 20mmHg, it would take a MAP of 80mmHg to maintain a CPP of 60mmHg (I bet MAP guidelines for the management of TBI are suddenly making more sense). Some sedative/analgesic medications balance those considerations better than others. This brings in the concept of flow metabolic coupling (Propofol is particularly good at this as sedative agents go). Agent's with good flow metabolic coupling such as Propofol reduce cerebral oxygen demand in balance with the amount they reduce cerebral blood flow. Agents such as Morphine or Midazolam do a poor job balancing the two considerations and reduce cerebral blood flow relatively more than they reduce cerebral oxygen demand.
Hey, good research topic. our service does not do hypothermia because we are so far away from a STEMI/Cardiac center that there is a real possibility that the patient will begin the re-warming process before they get there.
The only thing we even remotely do is cold packs to the axilla, groin, small of the back and behind the neck. Any further and we feel that we run the risk of doing more harm than good.
Now if we have ROSC and put them in a helicopter from the scene, then we very often put cold packs in those places but thats only if the paramedic thinks of it.
So to make a long story short - we do not have a permissive hypothermia protocol/guideline - it's more of a paramedic remember guideline. Does that make sense?
By the way, you probably won't get much more of a response out of here, we have a very limited number of people who still post, heck I might be one of the single handful of people who come here and actively review the forum. YOu might have better luck on the facebook sites.
So am writing a research for college about inducing hypothermia after cardiac arrest by paramedics out of the hospital, So am trying to find the safest ways to start targeted temp. management earlier.
gonna be thankful if you shared thoughts and experiences.
So question, in your next service, if they practice lax infection control will you quit that service again? Not to be the negative nelly, but did you bring up your concerns to management and if you did where did it go?
I have a co-worker at my other service that believes that because he is in great health he won't get Covid regardless of whether he practices infection control or not. I care if he gets it but it's on him and not me.
if you practice good Infection control habits you should be ok, honestly, screw your partners, in the end, you have to go home to your family and if they don't then they don't.
I would not have quit, I would have brought it to managements attention and let them deal with it, because in the end, you are the one out of a job and they still are working.
But honestly, the choice was yours to make and I'm hoping you made the right decision and you have or had a job waiting for you before you quit.
I wish you nothing but the best. Sometimes we have to fall on our swords to make a point.
That would fall more under the definition of emotional support animal. You would have to consult your agency's SOP regarding what to do with those. The agency I just left generally won't take them because the hospitals won't. We could only take service animals as defined by the ADA.
BTW...a dementia patient should have a caretaker or family member who can answer those questions for you. Just be sure to stick to the same ADA allowable questions you would ask the patient.
Yes, as the others have said, you need to be more specific. Find out what your supervisor means, with examples. I am mainly 911 service but have worked entertainment, mostly concerts and festivals. Without more info it's hard to guess what your boss is talking about.