PMedic850

<!--sizeo:12--><span style="font-size:12pt;line-height:100%"><!--/sizeo-->hi to all.

Here in Germany we use both, MSI and Fentanyl on our Emergency Physician Units. We actually only use MSI in myocardiac-infarction(hope I'm spelling right) due to its pre-load reduction.

Fentanyl is used in every other situations were pain-relief is needed. We use a initial dose of 0.2mg Fenta.

There is also now a big discussion about Ketanest here. Schould be used in cerebral-bleeding because it lowers cerebral pressure and the patient won't have breathing-depression (good for multiple trauma). The problem is that the dosage is hard to handle and patiant needs simmultain Midazolam to prevent him from nightmares.<!--sizec--></span><!--/sizec-->

I know it's been a few years, but in reviewing this post, I think by "Ketanest" you may have meant Ketamine. Is this being used in Germany?

Thanks and hope all is well!

I know it's been a few years, but in reviewing this post, I think by "Ketanest" you may have meant Ketamine. Is this being used in Germany?

Thanks and hope all is well!

Also, an update for all that helped by commenting a few years back... NYS approved Fentanyl for ground ambulance use on 06/11/2007 with online medical control orders only.

Yes, the PORTO2VENT CPAPos by Emergent rocks!

http://www.eresp.com/

Our agency has had these for over a year maybe 2 years & we love them.

Advantages:

-single adjustable knob & pressure gage on the front so you can see the pressure instead of having to guess by turning 3 different knobs.

-Since its a demand valve it runs on a jumbo D tank for +25-35 mins.

-Doesn't blow air in the patients eyes & face like other products and I think it's more comfortable for the pt (soft foam mask which makes a nice seal).

You can also click on the unit & see a demo.

[flash width=600 height=400:bc23eb1ee6]http://www.eresp.com/CPAPosSim.swf[/flash:bc23eb1ee6]

I arrive in a fly-car for a patient having chest pain. Mid 40's patient, very heavy accent. Doing my assessment & 12 lead, I hear the ambulance bringing the stretcher in. It's about 2am. I'm busy doing an IV, thinking about her 12 lead & meds, etc.

She asks a question (I thought she said, "are they bringing in the stretcher") & I replied "Yes"...She starts to yell & the FD starts to laugh.

I ask, why is everyone laughing & the patients yelling "Why would you say something like that!"(... in her heavy accent...).

The Fire Dept said, "She asked if she was going to die, and you said 'Yes' ".

That was my shining moment, by the time we got to the hospital, she was laughing

Robbie, your survey is flawed in its premise. The great majority of states do not have statewide protocols which affect every provider. Most leave treatment protocols to the domain of the local medical director. Therefore, except in those few retarded states that have a bureaucrat in the capitol dictating the treatment of every citizen of the state, the results of your survey have no real meaning. What exactly is it that you are attempting to show or prove?

We are looking at what states allow certain narcotics for pain management. If a state allows one agency (or region) to utilize the drug, then they have set a precedence for other agencies (or regions).

You are correct, most states leave it up to the individual agency's (or region's) medical director. I do realize that different states do operate very differently (ie: Texas DOH approves each agency's protocols/drug lists; Pennsylvania/NY have regions where the state DOH will dictate what protocols/drugs can be utilized; & Maine has statewide protocols dictated by the state DOH).

However, SOME states are heavily bureaucratic and do not allow certain drugs (i.e.: not allowing any agency (or regions) to use Fentanyl). We are just trying to show which states have allowed the use of certain drugs for pain management.

Does that make more sense?

Oklahoma, Iowa, Illinois, Kentucky, and Tennessee all have providers who allow Fentanyl administration on standing orders.

Just to make sure, are the standing orders for ground ALS units or flight units? The above map was based on ground ALS units.

Thanks for the feedback!

After quite a bit of research and help from our regional medical director this is what we came up with for Fentanyl use (as well as other narcotics used for prehospital pain management).

Any corrections or updates would be appreciated.

What an awesome tool! Our agency just switched from LifePak10's to the Philips MRX monitor w/12 lead & capnography (which rocks!). I monitor almost any patient with SOB or decreased LOC with the non-intubated oral/nasal canula. It's great to see any patient that are broncho-constricted and watch an obstructive waveform change to a normal waveform with treatments. It's the gold standard for intubated patients. It's funny to bring the patient into the ER, the nurses have NO clue what it is...they think your crazy or something.

Also, I think some states in the mid-west are measuring EtCO2 for cardiac arrest patients and anything less than 8mmHg they're ending the code.

I highly suggest getting to any Bob Page lecture, well worth any money being charged. He does "Capnography: Riding the waves" and his 12-Lead course is phenomenal!![/font:4c4fd3ea80]

I've herd the results have been very positive. I know that northfield labs is doing a study in our region, upstate NY. Here's a quick article on polyheme: www.amc.edu/polyheme

I am currently writing a free EMS Guidebook for Palm OS. I was going to add a list of commonly misspelled medical words but cannot find a list. If anyone has any words or a location for such a list I would appreciate a response or an email (mjb413@hotmail.com).

Thank you,

Mike Blew

Any chance you can post a link to your EMS guidebook? I have a Palm T3 & I'm always looking for good ems software.

Thanks!

To clarify, NYS has several different regions that control the pre-hospital protocols. However, I believe that anything related to narcotics have to be approved by the DOH (as they are state controlled).

Thanks TechMedic05 for the New Hampshire protocols.[/font:96ceab25bc]

Now I have not had my coffee yet this morning, could you explain the "diversion" issue? I'm not following you........................

Quote from the DEA's website: "Many problems associated with drug abuse are the result of legitimately-manufactured controlled substances being diverted from their lawful purpose into the illicit drug traffic. "

so diversion == stealing

Out of curiosity, what is the purpose of your research? Give us a little more info and we may be able to help you track down more info................

In our data collection, we have inclusion criteria for the use of Fentanyl; we [as an ALS agency] are planning on going through PCRs over a certain time period to determine if Fentanyl could have been used. We want to show that Fentanyl would be utilized and especially identify cases in which pain management was not utilized due to contraindications to Morphine (ie: hypotensive, hypersensitivity). Are patients being denied adequate pain management in the field?

In NY State, their primary concern is pre-hospital diversion (because it is the "#1 diverted drugs among anesthetists"). We have controlled substances & have had no instances of diversion in our region. However, recently the DOH released a statement at a regional protocol roll-out stating that they were giving us Morphine on standing orders because "we are not going to let our fear of diversion outweigh patient care"...If that was really true, then they need to get their story right.

So, I'm trying to determine what states approved Fentanyl for ground agencies. I would like to contact the respective regional or DOH EMS offices and seeing what obstacles they have overcome, try to collect data on instances of diversion in their state since implementation.

Thanks for the responses. A couple more questions:

1-How long has the state approved Fentanyl for ground ambulance use?

2-Links to regional protocols (or regional websites) would be great.

So far...I've been told the following states are approved for ground ambulance use:

-Maine

-Alaska

-Florida

-Pennsylvania (Approved for ground use in April)

-Texas

-Colorado

Thanks guys!

Can I get some replies as to what states use Fentanyl in the pre-hospital settings for pain management? I am conducting a study & have found several research papers on the pre-hospital use of fentanyl for pain management, but would always like more feedback.

Thanks![/font:0b93a70f03]

Personally, on every call where I start an IV, I use the Saline well / Lock and draw the labs through it. Then Hang a bag of NS @ KVO. I never use a micro drip set, always a Macro (unless it's for a piggy back med drip).

I guess I just figured if my patient decides to crap out on me, I'll won't have to bother breaking out a bag & drip set.

The hospitals we frequent all love the saline lock because they can disconnect it, gown-up the patient & then hook it back up without a bother. I went to one hospital in VT (that I rarely ever go to) & they wouldn't accept prehospital bloods, whatever...it's just more work for them.

I work for a commercial ambulance service and do a good amount of EMS and ALS transports. Finally our company came into the 21st century & we switched from the LifePack 10 to 12 Lead capable technology (Philips MRX).

Personally I love the Philips MRX, Large color screen (w/high contrast mode feature), the 12Lead view allows for continuous monitoring of all 12 leads in real time which is something none of the other monitors do. I love having EtCO2 monitoring & the NIBP is a nice feature if you're not moving. I've found across the board that unless you have a smooth ride, any NIBP won't function properly.

They fixed the small paper problem and have the normal/large size paper. The only downfall is that the leads don't snap back on the patient very easy, so instead of bruising the patient's chest, it's just easier to throw another electrode on. Also, the wires are not as thick as the LifePack12 but it gets the job done. I guess Philips came out with alligator clip leads which are a lot better.

I tried the zoll out, but found the screen to be too small and cluttered. The LifePack 12 is also nice, but the Philips has more functionality.

Hope this helps & I can't wait to hear everyone's comments!

-Robbie

robbie@maccue.net