gvandellen

I don't want this to be an argument. I just want to know if people read the insert with the Nitrolingual spray that says it can be given under or over the tongue and if it was an reasonable alternative for EMS. If it works the same then the protocols need to be updated to adjust for spray to be given on the tongue. Has anybody given it on the tongue or read the insert?

Spraying the drug on the tongue is still sublingual. Oral implies swallowing the drug.

This isn't a discussion on NTG though....This is a discussion on NTG Spray. I am not disputing the fact that the sublingual mucosa isn't the best route for NTG sublingual tabs gvien under the tongue or IV Nitro given IV or NTG Paste given on the skin. This post is about NTG spray given under or over the tongue. The company says it doesn't matter. If it doesn't matter then why do we fight with the patient to spray it under the tongue. I don't care how you give it!!! As Dust says spray it it their ear it's your patient but I have been told that the effects are the same either under or over the tongue. I don't care how....let the scientists figure it out. If it works then do it. I'm just trying to find out if anybody not stuck in the 80's and in a progressive EMS system has heard of this.

Do you have a degree in A&P Dust? Do you know the absorption rates of buccal vs sublingual tissue? Is it different? The same? Does it matter it 3 to 5 minutes between doses? Maybe you give the spray under the tongue because your director doesn't know the difference, maybe he doesn't care? Have you asked him? This isn't supposed to be a pissing match? You've been a medic for 35 years? So what? Medicine changes daily! I only link to that website as a general guideline but the product package insert states it as well. I'm just passing on information from the manufacture that I found based on information during my instruction. The great Dust doesn't know all or we'd all be attending your lectures for standing room only. The only thing you've confirmed is that what I learned was wrong by your statements not the ideal way. I've read them and you quote.. "The proper route of administration for Nitrolingual is -- and has always been -- sublingual. You can and will get some effect from spraying it on the palatine surface of the tongue, but that is not the ideal or recommended route." Says who? You? Your protocols? Your A&P teacher you had 35 years ago? What does the tongue have to do with it? Did I even say it would be absorbed by the tongue?

Just where is the nitro going to bounce off to??? I've never seen mist bounce? Ridryder buccal administration is a proper route for drugs. Nicotine gum is made like this. Chew and stick back in cheek every minute. Might be time to go back to school.

Wow, a bold statement to insult a 20 year medic that you don't even know...We have a fantastic medical director that even went to the state and asked for our medics to bypass contact medical command boxes because we can actually think as healthcare providers and to only contact them if a treatment isn't working. Can your system say the same? Our medics were taught this from the medical director with information also obtained from the AHA so apparently the patients are getting relief. Look at the package insert on the product Dust and it says... "...spray onto or under the tongue." and ..."preferably onto or under the tongue." See http://www.drugs.com/pro/nitrolingual.html Either way IS the proper route of administration... Buccal mucosa is just as absorbent and the only reason we put the Nitro tabs under the tongue is it stimulates saliva production to spread the Nitro around the mouth which the spray doesn't need.

I was reading Street Watch: Notes of a Paramedic the other day as usual he had me laughing my A$$ off about getting people to lift their tongue up to spray Nitrolingual however my mentor said that you just spray it in the mouth on the tongue. I hadn't thought about it since he just told me last week but I mentioned this on the blog and sure enough PC found it to be true. Has anyone else heard about this?

Old problem new hype....I'm 34 and I was drinking Robi DM when I was 18. Do the math. It's nothing new and most people don't OD on DM.

The only thing Fill in Forms are good for is when you need to write a PCR hours later and not as an official doc. They go in the shredder when the real PCR is done.

Hmmmm...One guy, one cup, and a freak on a toilet with wet hair? Just waiting for the website now :twisted:

This is why I love our planet... You think you heard it all and then something like this pops up. Human beings are great!!!

The call volume was high, I ran roughly 350 calls in 20 days. A lot of BS but we did have a lot of sick patients as well. There were a lot of patients that should have been treated on scene. 13 other students felt the same way. Why aren't we treating these patients quicker? I'm not bashing city style but I'm curious as to why it's gotten like this? Don't get me wrong my preceptor was smart and if I got hurt I'd want him. Good points by everyone though to think about. I just want the best for EMS and for the future students that do their time in Philly.

I spent 3 months in Philly doing ride time and now I work 911 in a suburb of the city that has as much crime, poverty, and call volume per capita as the city. The only difference is we treat patients before we leave the residence. Why? I never started a treatment for asthma on a city pt because we never brought in o2. My precepts said we work out of the truck in our environment. Now as a medic right outside the city I have to remind myself that I'm not in the city and we treat pt's before we transport them to a hospital? Is this burnout, laziness, or an overworked system for city EMS workers? My first few weeks in the suburbs I wanted to walk pt's out to the truck but my mentor had me actually treat a pt on scene. I have to be reprogrammed to treating a pt and I find that sad. I have had 3 CHF pt's and all had no resp distress on arrival to the hospital. 3 minutes to scene, 10 on, and 3 min transport vs 3 minutes to scene, walk pt to truck, increase SOB, start treatments, sit by charge RN trying to get a bed for a pt in distress. Aren't we sent to help pt's not transport? Why is city EMS so different? Does having a distressed pt help you get a bed quicker so you can clear your call? This isn't to attack city EMS, I understand your call volume, Philly even added more units to handle the call volume, I just want to know if you feel you are actually turning distressed pt's around vs just stabilizing them for entry to the ER.

Sort of sad, The MD gives a treatment, pt clears and they leave, paramedics give a treatment and we have to transport to be cleared. How many CHF patients treated at home by EMS are clear by the time they hit the ER stretcher?

How important are allergies to you as a pre-hospital provider? I ask this because as I was thinking that our DL only says that we are a organ donor? Would it benefit society to have allergies or certain information like diabetic printed on their DL? I don't want to get into a discussion on HIPPA and right of privacy on this and how the DMV would be involved and how it would need to be approved to get printed on a license. I've thought about that. I'll give you a quick scenario. PD pulls over someone because they are swerving from lane to lane. PD pulls the person over and they are compliant at first. They give their LIC but the officers gut feels like they are DUI because of the erratic driving? The person gets defensive and now the person is off to jail. Given that scenario do you think that PD having this information and them seeing that the person is diabetic they should then dispatch EMS to find the person BGL is 25? Would you look one more place for info on a patient? Examples if your not familiar: ICE on the cell phone directory...In Case of Emergency line The Bracelet/Necklace... Car Seats with info on the child on it.... I'm not talking Big Brother watching? Chip in the arm....just information that may kill them in the real world.

Let me add on one small thought to ponder. Who really calls us to the scene? Who uses 911? I have a family I love very much, I would kill any of you over them without even blinking. If I call 911 it's because I or my family has an emergency? They might die if I don't call. I can't do a direct Laryngoscopy on my son if he's choking as I don't have the tools. I don't care who they send as long as it saves my son. The risk to the patient is life vs maybe infected and dying 15 years later.

So Dust you disagree with the fact that most peoples perceptions of medicine and fears of disease isn't learned from the news. Take MRSA, did you once see see any news station in a report inform the public that there is Hospital acquired and Community acquired MRSA. Not once, because that doesn't sell papers. News is entertainment and thats the same source our patients get their medical knowledge. Be careful, don't sit on that toilet seat, because you could get AIDS was a media story. Our perceptions are created by what we see and hear, some take the news as gospel but some of us still need to find more factual information on what rates of transmission are for a intelligent discussion. This is a controversial subject. I don't intend on changing anyones views. I think we all have valid arguments. People only worry about a few things in life, money, family, and self being the top. This discussions covers them all and it pisses people off. Good. As long as no invalid info on statistics get posted but not corrected. To say that you don't want to continue a thread because you didn't like the way it started is childish. I'd never get through Saturday Night Live if I just had to watch the opening monologue to make my decision to keep watching. TIVO me and find the good stuff.

The public aka the patients opinion is based on FOX news driven hysteria however, fine you don't want an doctor for an elective procedure but in prehospital EMS it's hard enough to find good people. Some one just brought up a good point abut false positive result and that made me think the following for all that oppose the infected. I have been working 7 years now medicine. I spent my first few years as a hospital transporter, I've work 5 years in the ER and as an EMT, and now I'm an active 911 paramedic. I have been exposed 5 times in 7 years. I've been stuck, I've had a mouth full of blood spit in my face where you could see the blood running from my eyes from a patient that had a seizure in a hallway that was a known Hep C pt (the only time I took the drugs BTW). I've had IV tubing filled with blood from a patient I never even saw squirt into my face and eyes, I've been bit, and last year I had an IV fling blood in my eyes while placing an IV in an overdose and someone didn't quite have the arm held down. All unfortunate, but my point being, should I not work for 6 months each time I'm exposed for that slight risk that I may in fact infect someone else. If you have never had an exposure or aren't familiar with the process then here it is. Exposure, blood draw for baseline, (medication if wanted), 1 month blood draw, 3 month blood draw, 6 month blood draw. The last blood draw clears you. So at any point in this series I could infect someone because I myself don't know. Should I not be allow to work now? Should I be allowed to take disability for 6 months each time I get an exposure from helping a patient. Should my education be wasted when I am in great shape and perfectly capable of working? I know a LOT of people in the 6 month system right now and that would wipe out a lot of staff for maybes. If you get an exposure (and this is for people opposed) would you stop working? You may be a carrier now and not even realize it. Who's gonna pay the bill each time I have a really bad day? Should I not have sex with my wife because I could infect her? Exposures suck and I have been unlucky to get them but fortunately never to have gotten anything. If you have gotten exposed yet then good for you but it can happen. Again not directed at Ruff, If you are exposed should we write you off? BTW I really didn't mean a death sentence as in dying. HIV, HepB/C, TB all require big lifestyle changes from lots of meds to not being able to drink in certain stages. Lifestyle changes that people do not want to make when they are young and healthy.

My biggest beef with the whole argument isn't the specific diseases listed. HIV and HepB/C are all horrible diseases and anyone that contracts them is pretty much given a death sentence. The issue that we all are fighting about is the risk off US as health care workers infecting OUR patients. We know the risk the patient posses to us and we take universal precautions for this reason. Now let me make this point perfectly clear..... If the universal precautions we take are reasonable in our mind to protect US from THEM then why are they not good enough to protect THEM from US? Gloves, gowns, glasses, masks, and hand washing are our tools to protect ourselves from each other. So unless you walk into every patients house with an N95 mask every time you have a hint of a sniffle then that makes you a hypocrite and you potentially endanger my family the same as if you had HIV. If your against disease then be against it. Tell your employer that your sick and refuse to work. If they threaten to fire you for to many occasions then get a lawyer. There is not one health care worker is the US that hasn't worked at least one day with a cold because they felt they could get by. Not once does it pop into your head they you may harm a patient, do it expect it to be any different for someone that is a non symptomatic HIV worker? It's a job. Life is risky? So what? We all know that death can get us at anytime. The drinking and driving that didn't kill them in the MVC and damn we might expose them? Whatever!

Ruff, You talk about a risk in starting an IV? What Risk? Are you say that while he is starting a line he will pierce his own finger contaminating the needle and now in that same motion stick you with said tainted needle or a magical drop of blood drops onto the exposed area? If so then I also believe that you believe in the existence of aliens and right now they are plotting your capture. That is paranoid. Do an experiment for me....Put on a pair of 14mil EMS field gloves, take a lancet and stick your finger or poke it with a 16G IV, now try to get blood out of that glove. If it runs out of the glove then I might raise an eyebrow.

But see that is the problem. Rarely means that you have done it. Your first call of the day could be for a febrile 50 Y/O cancer patient. Your rarely could kill them. The problem is no employer will allow you to call out sick for every time you get a 24 hour cold. So it's sort of a catch-22. Do we risk not infecting our patient knowing we truly shouldn't be working? One cough could harm. I've had exposures to patients and unless it was a hollow needle stick I barely even thought of it the next day. The odds of an HIV positive EMT working a car accident even around all that glass and sharp metal wearing proper gear exposing the patient would be astronomical. I could think of a lot of other ways to harm my patient by my mistakes. HIV or HepB/C are not actively contagious diseases like TB due to it's route of infections so for an HCP to have one of those diseases would have effect on their ability to work. We sure find a lot of reason for people not to do our job. We aren't that special. Let's run down the list. Can't be depressed or bipolar? Medication apparently doesn't help people. Guess I don't need a drug box on calls. Can't have a missing limb? Prosthetics could never substitute for a real leg. It might snap off when I'm putting someone in the ambulance and drop them. Can't wear glasses of contacts? Might fall off or out and then they can't see. I certainly don't want people in the military with glasses. How can we trust that they have the right prescription and are seeing 20/20. I don't want someone like that as a partner in my squad. Certainly can't be overweight? They may not be able to get in a good position to put in an ET tube in a confined space. Can't be older then 50? Your just not as sharp as you used to be and your critical thinking skills could be hindered. Can't be female! Their compassion will get in the way and the are way to weak to lift a patient by themselves. Now we can't have any disease as well because there is a 1 in 1 BILLION chance we could infect a patient? EMS job ad - 18 to 35 year old male with clean bill of health, no glasses or contacts, all original limbs intact, must be athletic, BMI no greater than 16. Must have perfect immune system to avoid all viruses. Must retire by 50. All others need not apply.

Hmmm smoking...I quit 3 years ago...As a newly hired medic I just went on a call Saturday (My first shift) and my night mentor is a smoker. 1st patient....Resp Distress...First words out of my patients mouth were (Which one of you is a smoker?, that's what got me like this.). It's sad that the people sent to help them remind him of his mistakes. I've worked in health care for 6 years half of which I was a smoker. I feel bad for every patient now that ever smelled me in my first 3 years. I wish I knew then how unprofessional it really is as a health care worker. I don't care about your long term health or insurance discount as it's your life but when we walk into a home the last thing we should do is remind someone of their history just like we don't tell people they may die. The same reason why we don't use excessive cologne because we don't want to trigger an allergy attack. It's not a legal issue for employment but management can dictate (but there has to be a WRITTEN policy against it) to not be done on shift. If there is no policy then it's up to the individual but they should know better and if not they do now. :-)

Sorry, EMMA and Code3 are computer PCR programs

Assuming you only write your report after the call...not typing the whole report on the way to hospital ignoring your pt ((cough (some PhillyFD medics) cough))...How long does it take you to complete a CBR on say EMMA or Code3 for an average call?

How in the hell did I get a job??? I'm not taking out my tongue stud Dust!!!