scratrat

Brainfart...that was supposed to read 25 mg. I don't know what happened...

That's if I want to do it under standing orders.

I can call and get orders for 50-100 mg.

Hey, I take what I can get. In New Jersey we could not administer ANY narcotic for any reason without the express permission of medical control. You can use "Communication failure protocols", which is exactly what it sounds like, but you must document out the butt and notify the supervisor, and basically it's more hassle then it's it worth.

The only time we can use pain medications under standing orders are for the following two:

Demerol 12.5mg only for lower back pain. Not real descriptive, but it's our discretion.

Morphine 2-4 mg for isolated single fractures, IE arm, or femur. This one doesn't necessarily say you can't use it with a femur fracture associated to an MVC, but I wouldn't. Again, it's our discretion.

Anytime we don't feel comfortable, we can med control. Or we can call for additional orders.

Freakin idiots...

That ought to learn ya to leave them alone.....

I guess, maybe, just maybe, they belong in the wild after all.

And who does mouth to mouth...ew.

I am friends with a few gay and lesbian individuals. I could care less what your orientation is. To me, it's your persona. The only distaste I have, is for people who are way overly flamboyant about their sexuality. I don't mean to sound crass, but I can't stand that. It's like saying "Please look at me!! I'm gay!!" I can't stand that. You don't need to act a certain way just because of your sexuality. That person seems to me, like someone who wants everyone to look at him/her.

First, Doczilla, thanks for that about the use of big words.... I snotted Sprite out my nose!!!

Second, to everyone else, thanks for all of your input..

First, we already versed, which I hate. I used it in New Jersey for 6 years because we didn't have RSI. It NEVER worked. All it did what sedate somewhat and crash their BP. I never ask for it and I'd just rather not give it.

This is still in the works, so I don't know all the details for sure. As far as I know, etomidate and possibly fentanyl are the only two maybe being added. Not sure about fentanyl though. Anyway, in New Jersey before I left, we did use RSI at one project which I took advantage of a few times. A couple of those times, the person was successfully sedated enough to intubate with etomidate alone. They never really educated fully though which was a shame. The couple times I did it, I used everything including paralytics. I was under the impression you had to complete the sequence, rather than stop at etomidate. Then if successful, give valium for prolonged sedation, and vecuronium once tube placement was already confirmed.

Lidocaine her, would be for premedicating only. We don't have topical lido. And we haven't discussed pediatric use of atropine yet. In New Jersey, we were not allowed to RSI anyone under the age of 18. Only the flight crews could do that, and they would premedicate with atropine.

That's what we used it for too. But I have already heard, as you mentioned, that you may increase ICP just with intubation alone. That's why I was curious if I would get an order for it without using RSI. I also began to wonder why, when we only had versed up north for intubation, we didn't premedicate with lidocaine? Especially since versed is crap, and rarely produces complete sedation, at least in my experience with it. I love etomidate, and yes, I'd love nothing more than a paralytic to go with it, but as they say, baby steps.

Ours is 100 mmHg for both lasix and NTG.

As a side note, our current dose is 1 mg/kg. Rumor has it they may lower that to a straight 40 mg across the boards, but nothing in stone yet. They are supposed to be updating our protocols in the next 1-2 months.

Rumor has it, from good sources, that we will be granted the permission to use Etomidate for intubating soon. Our medical director is not fond of RSI, so we won't be getting paralytics. But thats for another topic in and of itself. I do possess the knowledge of RSI from using it at other projects though.

My question is this, say I have a trauma that needs to be intubated, but needs pharmaceutical help. Since etomidate is the only drug added, it's all we can use. After the intubation, we would most likely use valium or versed, both of which we already carry. Moving on, let's say there's is a possibility of head injury, or for arguments sake, some other reason I'm concerned with increased ICP. Would it be appropriate to ask for lidocaine as a premedication, or is that something we would use only for complete RSI? Like with sux and whatnot? Just curious what everyone thinks.

I started as an EMT at a local rescue squad. We worked backwards for some stupid reason from 12-8 then 4-12 then 8-4. I worked with this guy who snored OBNOXIOUSLY. (Yes, worse than you Bob. Remember Mumbles from Lower?) Anyway, I used to go into the hall and wheel a spare stretcher over towards the phone. The police would call on a very loud line if we had a call. I overslept one morning and didn't hear the other crews, the chief, or anyone else come in. They straped me to the cot and wheeled me outside in 20 degree temperatures. After freezing my nipples off, I was rudely awakened to a passing siren from one of the ambulances. They laughed for hours about that.

I know it's gonna be a bad call when you sit the patient up and the skin color improves to cyanotic

HEY! I remember that call. Didn't we piss someone off along the way?

Are you referring to me perhaps?

No, my twin evil brother is who he is referring to...

That sure is a lot of freaking epi!!!

Good pictures too!

Keep your mouth shut. That's it.

If they ask a question, know the answer.

All preceptors are different. I had some fun ones, and I had some miserable ones. Until you figure out which one they are, keep your mouth shut. They're not all that bad...

And you people wonder why I don't have a MySpace account...and never will.

I also read in a paper from back home, that a local officer was arrested for DUI. He pleaded out and was somehow attempting to get his job back, saying it was a one time deal and blah blah. The judge looked at the pics on his MySpace account and refused to give him his job back because there were pics on there of the cop drinking.

Yes they do. Again, you are just 100% wrong.

Yes it is, until proven otherwise. Are you saying that it would be OK to let the pressure say high if it was a hemorrhage?

I normally don't sink to the level of name calling, but you are a tool and obviously not competent. You are a danger to your pts and thankfully have a doctor to watch over you.

That is probably one of the only things you have said that even comes close to being correct, +2 for you.

You're wasting your breath....

JPIN,

I am sorry you have waisted your time typing all of that "stuff". Wait until you are atleast a medic to argue with the big boys! I am a college student also, do I seem better now??

No. Not at all.

Scratrat,

???????????????The BP thing.............. Start over with the whole paramedic thing, infact go get a job more suitable for yourself, like in a barber shop or something!!!

You truely are a moron. And so is your base doctor if those are the orders he gave you. Stick to playing with hoses, and leave the life saving to the people who know what they are doing.

I had to go and reread the hx. I would transport this pt as a moderate priority. No light and sirens, but a full als work up. It doesn't sound as if she has a SAH going on. Her headache is no longer, she is not nauseated, she is concious, with no blurry vision, and from what I can see she isn't even on coumadin. Diastolic of 160 is very high, I would definately try to lower the BP. Sounds like she popped her top!

You should never be lowering the BP in the field. Maybe in conjuction with an MI, but never any other time. Especially not with an associated H/A, whether it cleared or not. A neurologist will rip you a new one if you do. Until you prove there is no bleed, you definately shouldn't be so damned aggresive on this one.

wow. Thats cheap.

My medic school in New Jersey was just over $10,000 including books and all other certifications like ACLS, PALS, PHTLS, and so. I think I got screwed on that deal!

He has a way with people. I don't know what you are talking about..

I just wanted to see how many pages we could get it up to

You're right, I shouldn't have to. However, documenting that someone walked to the truck, for example, would be to admit a violation of company policy- "nobody walks." Of course, management could really care less whether the patient walks or not, they know the kinds of idiots we deal with. They just don't want us documenting it, because that costs them money. So they invent a punishable offense around it for use if somebody really insists on being a problem for them.

If I don't play the game, I run the risk of being fired- and having to find employment at another private company with the same rules. Me personally, I'd rather keep my seniority than bounce from company to company until there aren't any left that I don't have a reputation at.

Although this may make your life more difficult, I'd say screw your employer and write what happened. If you go to court, guess who takes the blame? If you think for one minute that your employer will take the stand and say "we tell them to omit the fact that this person walked", then you are sadly mistaken.

And if they threathen to fire you, call medicare and report them for fruad. If medicare investigates and fines the company, you can get a portion of the proceeds. Granted, this probably makes life worse, but that company can't fire you for it, or risk being sued for wrongful termination, and they can't inform any further employers. It's against the law.

I know this probably has little to do with the original post but....

I had a dead guy we pronounced who was in his 30's. His wife did not think it was a problem that when she left for work, he was seen EATING morphine patches. Needless to say, by the time we got there, he was long dead. We calcuated he ingested over 3000 mg of morphine.

Another case was an oxycodone overdose. We gave Narcan 2 mg. After several minutes, we inubated since she was still not breathing. She eventually woke up a bit and began fighting. At first the ER was pissed because we tubed her. Then they realized that since it was long acting, they would require a large narcan drip. I forget how much she ingested, but it was an enormous amount. So they left her on the vent for 24 hours to let nature run it's course.

Boy what a heated topic

Almost as bad as my post...good greif!

I haven't noticed this thread till now, so I'll reply to the original poster.

I have had experiences where I have allowed a basic to administer NTG or ASA under my direction. If I'm doing something at the time, and I've already deemed that I would be giving it anyway, I will SOMETIMES allow them to do so. I have to know that EMT well, and trust that they will follow my directions to the t. There are others that I would never allow it. Is it wrong? Yes. I probably shouldn't do it, but I have.

However, I would never allow a basic to push ANY IV medication. Granted NTG and ASA can easily be screwed up I guess. But pushing a drug is a little more dangerous in my eyes. And before everyone screams at me, yes, I know what if... But like someone else said, it's fairly easy to figure out one NTG. And again, I would have to know that they can handle that. I have never and will never allow a basic to administer IV medications, I don't care if it's a caridac arrest. I personally believe there is a much larger margain of error in IV medications. I'm sure everyone will have their feelings on that.

You know all the bums by first and last name, SS#, where they hangout, what they drink, and all their ins. info.

A nosebleed call turns into a code that you work on the boardwalk in front of 50 + people. All of whom go "ahhh" when you crack ribs and when you defib.

And then get angry when Paramedic yells at them, so you end up calling for "ACPD to respond forthwith to location for an extremely hostile crowd" :roll:

You just don't go down certain streets without ACPD

You get caught f*cking up on DriveCam, and get yanked from driving, you become an EDP from all the charts you write.

You PAY people to take your Fri and Sat night shifts.

Ahh, Urban EMS......I wont miss you a bit!

Why? You think ACPD is going to help you? HA! Just like they "secure" a shooting scene, and 30 people (all bystanders) still walk in and out of the complex. (Liberty School House ring a bell?)

And don't blame us dude!!! There are some EMT's just as cocky with people! So there!