okmedic

You will have to explain why you withhold romazicon in a pt with strong evidence to suspect a Benzo overdose with respiratory depression.

Hey guys!!! I've posted on a few threads now but I have yet to properly introduce myself. Obviously my name is Marcus which you could probably tell by my screen name. I am a Paramedic and work at a municipal 911 service in Oklahoma (non fire based) that probably serves about 10000 - 12000 people. I started my EMS journey back in 2002 and have done the fire service thing but found that I enjoy EMS a lot more. We average about 7 - 10 calls a shift (probably not a whole lot compared to most of you urban guys). Anyway see you around the forums!!! Later Gaters!!!

Yea, the patient was transferred to a different facility where they where suspecting possible bacterial meningitis, but the tap was negative.

First off, I'm not sure if this is the correct spot for this thread and if not I apologize in advance. So here is how it went down... Was called to a report of a 34 y/o male unresponsive at home. Pulled up to a single wide mobile home in the county and had family meet us at the truck. They told us they had been trying to wake him up all day (it was about 1500hrs at time of call). Report that last night he had been taking xanax and some prescription pain pills before he went to bed and they think he over did it. They reported that he had no significant history besides a recent back surgery (3months ago) and depression. They led us to the back bedroom where we found the patient laying supine in bed with cyanotic with deep snoring respirations. VS: Sinus Tach at 120, RR10, SPO2 61%, BP 119/70, pupils where pinpoint. Skin was dry and cyanotic in his nail beds and lips. I immediately had my partner insert an OPA and start bagging with supplemental o2. I started an IV and obtained a glucose check which was 126. At this point the bvm had brought his SPO2 to 95%. Per protocol I started with 2mg of Narcan IVP. After no response to that I gave him .5mg of Romazicon. And to my suprise........NOTHING!!! I thought for sure that the problem was a xanax OD. Frustrated I inserted an ETT and he took it like a champ, no gag at all. So we ran him in and at the ER they repeated with 2mg of Narcan and .5 of Romazicon with the same response...nothing. His tox screen came back positive for opiates and benzos, but everything thing was pretty much normal besides a white count that was elevated at 18.3. He also had a negative CT. The only thing I could think of is that his family hadn't seen him awake since he went to bed the night before around midnight and that he laid in bed for the approximate 15 or so hours hypoxic the entire time and had a hypoxic brain injury? Did I miss anything or is that just the way the cookie crumbles?? What do you think?

Everything that I have been told is that there isn't anywhere in OK that has a CCEMT-P program. I know a couple of services have an "in house" critical care cert. that they do and are able to bill for qualifying critical care transports (EMSTAT in particular), but I would not settle for anything less than a nationally recognized program. I have heard talks that EMSA is trying to bring a program to Oklahoma, but that is just hearsay. By the way, where service are you at?

Antidisestablishmentarianism

Here in Oklahoma we run quite a bit of diabetic calls, primarily hypoglycemia. This is probably because of the large native american population here. We also run quite a bit of the run of the mill respiratory/chest pain and mva's. Lot's of CHF'ers here it seems like.

Unfortunantly this is the society we live in today. The media doesn't want to report on the ROSC we get in the truck or about the 80 y/o granny the we help up her steps. People today want the "shock" factor in their news. I agree that it is news stories like these that give our already struggling profession a bad name, but like yourself I do not know of anything that can be done about it or do I see an end to the cycle in the future.

This sounds great, but does anyone actually carry 30mg of 1:1000 on their truck? I know we don't.

A set of vital signs would be a good start, is he still bleeding or is the bleeding controlled at the moment by the entrapment? A medical history would still be valuable in this situation, as well as medications and allergies. Definantly 2 large bore iv's but I wouldn't want to start any bolus over 250cc's until I know what his blood pressure is. What is the temperature outside? High flow 02, c-collar.

Funny as hell!! Keep 'em coming!

:pain10:

This would change the whole story... :geek:

My attention span wouldn't allow me to finish the video, I apologize.

Down with the sickness - Disturbed

I love Jon laJoie, he is funny as hell. You should look at the rest of his stuff. www.jonlajoie.com. I think his popularity will blow up in the next year.

Pretty Funny.

I actually lol'ed after reading that!!

Personally if I cannot ventilate because of a FBOA, and am unable to remove it I will more than likely be getting out a scalpel and a 6.0 tube.

I am assuming we are discussing cpr with the lay person right?

sorry about your luck

Yea, we have albuterol, atrovent, and solu-medrol at our disposal. The only problem is the copd pt's that don't call untill they are fairly locked up, the a&a treatment doesn't do much good if it can't reach the lower airway. Epi does a good job, but I would like an option that doesn't increase peripherial vascular resistance and increase myocardial oxygen demand in a patient that is already oxygen comprimised. Especially in patient with a cardiovascular history.

I have read about a few services having Terbutaline SQ in there respiratory protocols. I was just looking for an alternative to SQ epi for pts having brochiocontriction with a history of cardiovascular disease. Does anyone in the city have any experience with this? If so, what does your protocol say about it and personally do you think the med has it's place in the pre-hospital community.

Nothing like a few penis jokes to make my day lol.

I agree totally. Nice find.