letsgonational

Perhaps you all completely mis understood. "an educated paramedic?" You're all full of it... First of all. Our cath lab DOES love us....they do perfer 4 sites (2 dual lumens)...if I have time to do it in the field, they dont have to waste time in the cath lab. Thus, this will decrease the door to open time.... We do proceed with NTG during morphine administration but dont give morphine unless they still have pain after three NTG (that was my fault in typing...misunderstanding). We all cautiously give NTG to right sided AMI. Our goal is to make them pain free and keep their pressure above 90. If I have someone with +V4R I'm going to cautiously give NTG and be in contact with command and the cardiologist who is already viewing the 12 lead EKG to see what they want us to do. We really dont go dumping fluid into the patient... Hope this helps clarify what I was typing out to you...

If I'm thinking that the pt is AMI, they're getting: O2/Vital signs 324 ASA PO Monitor/IV access NTG after IV access with bp checks q 3 minutes 12 lead EKG A total of three NTG (including home NTG) and then 4mg Morphine via IV. Morphine is repeated 1mg q 5 minutes. We transmit our 12 lead, notify the ER of a stat cath, and get them to the ER ASAP. We strive for 2 dual lumens or a total of 4 IV sites...cath lab loves us:-) 911 to open time is usually less than the 90 minute door to open time, except for long distance transports...gotta love rural EMS. Time is muscle, no need for a 12 lead before ASA and NTG if your pt is presenting with cardiac symptoms. I run as a single paramedic provider on a squad and I can get the entire list of things done in less than 10 minutes. Then we twiddle our thumbs and wait for the ambulance! Long story short. Never withold NTG if you think your pt is AMI. If you're thinking right sided AMI, call command after you obtain your 12 lead, hang saline, and get orders for NTG. Dont fluid overload them though...that just makes their heart work harder thus increasing ischemia and infarct.

We carry our keys on us as well as our narcs. I carry mine on a beaner; never lost them...just put the opening down then it wont come open and its easy to get them off easily. Some of the guys wear the flat key holder that slids on the belt. They wear it on the butt of their belts and put their keys in their back pocket. Cant even tell they're there. The other system I work for keeps them in the chiefs truck and they sign for them whenever they switch out. We have to call the chief when we want them replaced and they sit in a pouch in the top of the med bag (lock is combination and only the medics know it). There are risks you run into with a knox box system or leaving narcs locked in the top of a bag...we park at volunteer stations...numerous people are in and out and its really not that hard to steal them out of the bag....cut the bag! I prefer to carry them on my person and carry the key...I dont like the key being in the ambulance in the case of the knox system (anyone can get to it!). keep it on your body!!

I'm really glad you posted this. In Williamsport, PA we currently carry morphine and fentanyl. Our current is 4 of Morphine initially for anyone with pain (except for abdominal pain or severe trauma from MVA. Then most of us call command first). Morphine is repeated 1mg every 5 minutes; max dose of 12mg, decreased BP of 20mmHG, or ALOC. Most of us only use Morphine for cardiac or GI symptoms. Fentanyl is 1mcg/kg, usually used for extremity fx/pain. Fentanyl is repeated @ 15 minute intervals at .25mcg/kg to a max of 3mcg/kg, decreased BP of 20mmHg, or ALOC. As far as the quoted post, if you don't care about the big picture then why are you involved in EMS? The whole goal of EMS is to bring the ER to the pts home, workplace, MVA, etc...this means we're an extension of the emergency room. If you don't care about the "big picture" than I dont want you treating my family members. Your interventions set the tone for what happens to the patient in the emergency room. If you blow your patient off, than so does the ER staff. At least that's the way it is here. Paramedics here are highly regarded and if we do something, they know we did it for a reason. If you dont care about the big picture, get off the street. Its as simple as that.