raptor

Thanks fiznat, I had seen the highbeam article. Just trying to decide whether I can cope with the RTs. I had for a long time simply believed they were inappropriate due to the afterload issues. Obviously still used out there.

Anyone got any material at all from their training etc. Found an old article from the '70s that supports their use, but has so many contras that you wonder what old dear with a dozen comorbidities would be eligible for a rotating tourniquet! The later research demonstrates clear afterload issues. I am wondering if Western Australia have a good guideline or not! Any help will be greatly appreciated!

Had a look at medline, not a lot there really. My own feeling is that plenty of people believed they made a difference. I guess like MAST suits. I'm just not sure I really see the logic! Western Australia use them. That's where I'm headed in November. Thanks so far!

I think too many prehospital practitioners see 'psych' as an annoyance. Altered mental status can also be from organic causes. How do you know what is going on until you assess every person thoroughly and equally? The ethics of paramedic practice is dear to my heart. What level of care and understanding should our own family members, the people we love dearly, receive? That should be the standard for all. Ambulance should always be the primary transport authority for all mentally ill people. I am confronted with the 'psych' hatred every day in my colleagues. I find it offensive, especially since I've cared for a lot of mental health pts in the nursing setting also. The police culture, philosophy, and praxis does not allow for police to be the most ethical response to mental health. Paramedics should actually be empowered to assess and arrange placement for pure mental health crisis, fast-track mental health clients in ED, arrange community care, or refer. Currently this segment is let down by every sector in health care. Paramedics should take the lead, by lobbying, and in practice. In Australia we have been evolving to allow sedation using either midazolam, haloperidol, or droperidol over the last decade. I think it's time to take it much further.

The best drug we have in our van is deisel! Transport is treatment. If none of the other stuff happens, for various reasons, then you still did what the patient wanted! Take them to hospital! Well done on that, you did it extremely quickly! Kudos!

I am wondering if anyone can help me with finding evidence, including anecdotal, to support or refute the logic of using rotating tourniquets in the treatment of acute pulmonary oedema. I am aware of a study from 1995 that discounts RTs due to increasing afterload. They also seem counter-intuitive as they lead to worsening of metabolic acidosis. There are many reasons why they shouldn't be used, such as distal thrombosis, infection of a limb, etc. Any assistance would be much appreciated! Thank you all in advance!

Hi guys, New to the list. Just leaving Metropolitan Ambulance Service, Melbourne (MAS) for Western Australia Ambulance Service (WAAS). I am still amazed at how different we can all be at times. MAS = Salbutamol 10mg initially, followed by 5mg top ups 5/60. If moderate to severe, or not responding after 10/60 salbutamol, then 500mcg ipratropium. If consciousness lost, then 0.3mg IM adrenaline (oops...you guys prefer epi) every 20/60 (NSW uses adrenaline 5/60, which would be better). Hydrocortisone 250mg IV and IV salbutamol for severe. Sedate to enable ETI in unconscious asthmatic. I think Tasmania use dexamethasone (ideal as it has a much faster onset than hydrocortisone). WAAS = Salbutamol 5mg, repeated as needed. No ipratropium. Adrenaline 0.5mg IM repeated once only after 10/60. No corticosteroids. No sedate to intubate. Cheers for now!