9OrangeLetters

I use the part of my hand that's holding a thermometer. A tympanic probe might be +/- 5°C but that's far more accurate than "I think it feels hot". Maybe a good idea to get a general tenor of the patient's temperature by using the back of your hand, inside of your wrist or your fingers/palm, but I wouldn't go basing any patient treatments off of voodoo, no matter how you do that voodoo so well. There's a whole lot more of the clinical picture that we're leaving out here. I would expect hyperthermia to have associated reflex tachycardia, flushing, altered mental status, etc. I would also expect that hyperthermia that is the result of an infection to have my patient present with a "toxic" apperance, shivering at room temperature, general malaise, etc. With hypothermic patients, I would expect them to present with peripheral cyanosis, bradycardia, also altered, perhaps if they were septic a more noticable "toxic" apperance than relative hypothermia... There's more to this than "what part of your body are you using to check your patient's temperature"... I think if you're relying on subjective data for patient treatment or assessment, it's bad medicine.

We have 2 gms available for use if ordered by medical command. Here there is a combined Asthma/COPD "reactive airway" protocol, which allows the usual suspects of albuterol nebulizer and methylprenisolone IV, but the epi is specifically allocated to medical command authorizaion, and the mag is relegated to "potential medications ordered". It is worth noting that if I have somebody bad enough to require epi, I'm sure as hell going to put a call forward to a doctor to get wheels turning to prepare the ER for my arrival.

Wait, we're supposed to clean IV sites? I keed... Chloraprep all the way. I remember hearing somewhere (which means don't quote me on this) that the physical agitation of the skin was effective as well as the actual compound used... that's been rattling around my head for a while but I'm not sure if it's true or even where I got it. I probably heard it on a television commercial for soap for all I can remember... But I digress... I prefer the chlorapreps to alcohol. One, I think it works slightly better and I like the spongy thing, and two, there never seems to be ENOUGH alcohol on a prep to make me feel comfortable using it as a site prep. Alcohol is an effective sterilization agent on hard surfaces only when you light it on fire. And as it turns out, I was taught by Nancy Caroline that fire is bad for you. (for the forum purists who are most likely going to be all over me for this, OBVIOUSLY I'm being tongue in cheek)

Hi, I think this might be my first post (ah, memories to be created...) and how fitting of a topic, but RSI! I'm operating as a Paramedic in Pennsylvania, specifically Eastern. There is no RSI protocol here, per se, but a "sedation-assisted intubation" protocol, which allows for the use of Etomidate or Benzos. We're specifically prohibited from using fentanyl as an induction agent for intubation by protocol, and command physicians are prohbitied from ordering it. So no paralytics, no narcotics, only a hypnotic or a sedative. Talk about making us work from behind the 8-ball... next thing they're going to give us is a 3 stooges-esque hammer for RSI...