ccmedoc

Totally agree with Ventmedic. If the ET is not available or otherwise able to be used, there are other options that are not as traumatic to the soft tissue. It is not idiot-proof, but is most often seen this way and used this way.. Ventmedic, do you have a preference of alternatives.? (King,LMA, etc...). Not for medics, but for BLS.. :wink:

My bad, thats Bakerma, not lonestar. Sorry 'bout that :oops: She is so very wrong.... :?

I think Lone Star should check his protocol book...May be in for a surprise!! :roll: I know this county well. :wink:

Is there a "routine" respiratory call??? :wink:

Boy, sure showed my arse on that one.. All I wanted to say was that I don't think that everybody that gets a c-collar needs to be backboarded. admittedly, the length of time on a backboard is an ED problem and not EMS in most cases. It hurt my feelings to be put with the firemonkey. I've seen the error of my ways, mostly anyway :wink: . This is one study that was done on the necessity of backboards.. obviously post-ems. I guess I will cave.. LBB- prehospital=good, inhospital=bad :oops: http://emj.bmj.com/cgi/reprint/18/1/51 The use of the spinal board after the pre-hospital phase of trauma management D Vickery Emerg. Med. J. 2001;18;51-54 doi:10.1136/emj.18.1.51

I agree with "selective immobilization" as opposed to mandatory immobilization regardless. Long back boards have been implicated in skin breakdown on bony prominences, such as the occiput. Long back boarding improperly can also exacerbate a previously occult injury that would not be as bad without the immobilization. sufficient padding and proper technique is necessary and I can say I haven't seen either more than I care to say. As for simply a c-collar, It may be prudent even without midline tenderness with questionable MOI due to a condition known as SCIWORA syndrome. This can pose a problem in both adults and children and may not even show on rad studies or films. Although the NEXUS criteria appears to be valid and good guidelines, they can be, as noted earlier rather cryptic. That being said, I do not believe that all individuals need to be backboarded simply due to MOI. I have read studies(Have to track them down) that indicate the average backboard time from initial placement through clearance in the ED as upwards of 70 minutes, more than enough time for skin breakdown to begin on healthy adults, let alone the elderly and child. I know this was an older study and have seen time drop dramatically around my neck of the woods, so if this is not the case in your area great!. A thorough assessment, good instincts, and experience do well in situations such as these. http://www.ijppediatricsindia.org/article....31;aulast=Kalra

I would like to respectfully ask why this statement..not a challenge, but for my own education As it is not our job to tell a patient what pain is or if they are feeling it or not, I believe that after a reasonable assessment, any pain should be controlled, or at least be addressed. Pain is what the patient says it is, right? If a frequent flyer keeps calling or a patient presents with an allergy to all analgesics and narcan, then it may be inappropriate to treat this patient with narcs. We are not in the business of telling people they do not hurt and, just as it is poor practice to give narcotics away at the drop of a hat, it is very problematic not to treat or undertreat this complaint of pain.. Drug addicts have pain too :wink:

A lot a that around here :shock: :? 8)

Although the bougie is a blind technique, oft times the laryngoscope is still used to displace some soft tissue and the tongue, so you can at least visualize the epiglottis. If the bougie is in the trachea, by withdrawing it slightly, you would feel a vibration, or "tracheal click". This is the end of the introducer against the tracheal rings. After the ET tube placement, confirmation should be made of course. An attempt at visualizing the tube placement is not unwarranted or ill advised..This is a slick unit, but can be cost prohibitive, or used to be until what is called the "blue bougie" has come out..this is disposable and relatively low cost. The arguments against use of this device in EMS systems is the deterioration of intubation skills of medics due to relying too heavily on the product and not attempting to visualize cords initially. I'm not sure I agree with this. -steve

Yeah, I think the original topic is done here, we should start one that asks..."will blindly following our protocols, even though there is compelling evidence to the contrary,protect us from litigation and a finding of negligence when we croak our patient??" I believe the answer to that humble question would be a resounding NO! CYA would be researching your treatments and insuring they are adequate and within the current standards of care instead of blindly following the other lemmings.. -steve

The wave of the future=Evidence Based Practice..Something EMS has evaded for decades in the states. Your just going to have to get used to it and institute change where needed. Sometimes this means not blindly following questionable treatment modalities..EBS, learn it, live it Doesn't everybody have New Unabridged Kanukistanian Dictionary in their repetoire????? -steve The cc means whatever you want it to mean, I'm flexible:lol:

No it was not missed, just discounted as babble..perhaps I should have said no one here qualified has condoned freelancing :wink: :roll:

No one here has condoned "freelancing". Only educating yourself and others on the changing views of medicine and standards of care, and questioning standards that appear to be outdated or of questionable safety..Maybe a clarification of your protocols should be in order as I doubt if you are able to deliver high flow, you would be denied starting with low flow oxygen. Especially with compelling evidence to the fact that high flow oxygen can and does have negetive effects on cardiac and systemic circulation, especially at critical times such as variant angina and vasospastic angina. How would you explain taking a patient with an episode of apparent angina and progressing this to infarct by the seemingly benign administration of oxygen. This would be inexcusable with the amount of research to becoming available describing the negative effects of empirical administration of high flow oxygen for chest pain without evidence of respiratory compromise. I doubt a firing would take place by asking for a clarification of the protocols you are under in the context of oxygen intox. or vasospasm/vasoconstriction related to overzealous administration.. You owe it to your patients and your practice to investigate this further. Your physicians responsible for the protocol development couldn't possibly hold it against you for this presentation..

I cant believe that this is still a discussion...Too much oxygen to the wrong person, ESPECIALLY cardiac patients, can be a very bad thing. I believe that local protocols need to be followed, but protocols are guidelines and most generally not to be held as a recipe treatment. At the time you begin delivering a drug or a treatment, YOU become the expert. By accepting the license to practice, ignorance ceases to be a defense..Protocols can be changed, and should be changed in lou of new compelling research to do so. delivering treatment because its the way we've always done it is the wrong reason..EMS has traditionally used empirical treatment strategies and these strategies must be and will be changed to meet new standards of care. these are my previous posts and I stand by them. It sounds like more than a few areas in the states could use additional research in their protocols and change them accordingly. Why is it so hard to believe that something as seemingly simple as oxygen administration could be so devastating?? The biggest problem I've seen in these posts in the unwillingness of some to take the initiative and do the necessary research and educate others in these matters.

Thank you and all I can say is please, PLEASE, people think outside the box and ask questions. If it doesnt seem correct, ask questions. If you need more studies on this subject dont hesitate to ask...."times they are a changin'"-Steve

Yeah, oxygen is considered a drug for a reason ----Anthony, you are correct in your assumptions--this article should do fine by you. --Steve

Here is one study that comes to mind---paradigm buster??? this will either clear it up or make more questions---both are great!! luv the learning!!! [web:8909a01252]http://www.rsm.ac.uk/media/downloads/j07-03oxygentherapy.pdf[/web:8909a01252] Steve

I see that there are both BLS and ALS (presumably) protocols present. As a Basic, I would say to never with-hold oxygen, but as a Medic you should have the freedom to decide whether your patient is in need of the high flow or not. To say that any person with a sat below 95% or so gets high flow oxygen is ludicrous and these decisions should be evaluated. The seemingly harmless overzealous administration of oxygen could be devestating in the wrong patient..be careful and be safe.. -steve

Well, decreased cardiac output would equal decreased tissue perfusion ie. brain, kidneys, heart, etc. A sat of 92% is not that bad unless there is accompanying respiratory problems, in which case, it possibly may be difficult to acheive this. Another factor is if the pt has a Hx of COPD and is chronically retaining CO2. There are many factors that affect oxygen saturation and oxygen delivery that are beyond the scope of this reply. Generally, classic angina and variant angina respond very well to around 40% FiO2, which would be nasal cannula at around 4lpm. With vasospastic angina, high FiO2 could exacerbate the problem and possibly introduce more problems..It is a long drawn out issue that could be discussed for hours. I believe you will find that most will say that high flow O2 is overkill and possibly harmful.. Peace, Steve

I agree with scaramedic and ,although it was not my intention to do so, I apologize for being drawn into comparison of RN to medic. My original intent was to illuminate the fact that the two professions augment each other as opposed to compete with each other and should be seen as two seperate and very different professions with very different intent of purpose. It is a shame that the disparity in pay amounts to a peice of paper known as a degree instead of proven skills, but so be it.. To make the money and function in the ED, nursing school should be your initial step in school, nothing less (CNA,LPN, etc). Good luck in both as they are both very noble and rewarding professions with growing opportunities for advancement in each of their prospective communities.. -Steve

Hey, this "advance your education and become an RN" is bull. I have been a ccmedic,flight medic, and am currently an RN in an innercity hospital E.D. with my MSN..I believe that the correct attitude should be change your way of thinking. I dont believe that nursing school, especially A.D.N. programs prepare an individual better for patient care, only differently. The National Registry is modeled loosly after the nursing curriculum and we do a suprising amount of "nursing" in the field. If taking orders from docs and charting is nursing, then I guess I missed the boat. Good paramedics are a rare breed and shouldn't be seen as anybody's "bitch". I was a medic before nursing school, and I believe that this made my nursing ed. very uneventful and somewhat boreing. The new medic curriculum prepares students much better than in the past, and that is the difference. In the past, medic may have been of suspicious quality, depending on location (6 month medic programs and no licensure exam), but recently the bar has been raised. As an MSN RN and a CCEMT-P, I believe it would be very difficult for a nurse to step into a medic job, but a much smoother transition to go medic to RN. Just my short opinion on a subject that could be and has been covered in volumes.. Respect each other and be safe!!

Yes, case by case is correct. The problem with high Fio2 is that the patient will experience some vasoconstriction eventually with decrease in cardiac output and oxygenation. Depending on the patients respiratory status and sat. It would be wise to use lower Fio2 initially to keep the sats obove 91% min. If there is no associated respiratory distress of decomp, NC is the best choice with the option to progress to higher flow. The last thing to do in the event of possible/probable MI is to compromise CO and oxygenation by a seemingly benign intervention such as oxygen delivery.. Be safe... Very good question with lots of research available on the effects of oxygen admin and intox..