Johnboy

Go away?? And let you idiots give all these new people wrong information?? Nah, this is too fun.... In its investigation of herbal and chemical ingredients, the work of the pharma may be regarded as a precursor of the modern sciences of chemistry and pharmacology, prior to the formulation of the scientific method. My point is .... Dwayne is an idiot, and should have been fired for his inexperience and cockiness ... Mobey , you are going to have to to better then that! This site is a waist of time, and is filled with nothing but idiots that should spend their time and efforts on learning instead of waisting it on this bullshit site..... Get a life all!'

Really mobey? That's it?? Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs. The word derives from the Greek: φάρμακον (pharmakon), meaning "drug" Anything else?? Ruff, tuck your string in, and stop crying like bitch....

You ARE right. I DID make my point, a long time ago........

Your INEXPERIENCE, is your own worse enemy.... You need to learn more about pharmacy brother! We all make mistakes , the real man will admit them and LEARN from them.... My suspicions were absolutely correct! Learn this lesson from your prior boss!!! It would behove you....

As Dwayne should have learned before his dumb ass got fired, glucagon, is not such a bad thing.... Again, if you IO a patent prior to a trial of Glucagon, you are an IDIOT. Period, end of sentence!!!!!

You idiots on this site have blown me away, this isn't a site for learning. You people are idiots ! Plain and simple. I was on here for a week and am already done. You assholes simply amaze me. You all feed off of each others stupidity. Dwayne , as I said before - you deserved to be fired, why - because you are a strum job... Period...

I don't even know what to say- I am baffled at the ignorance

Dwayne- face the facts brother- and accept it. You were fired for doing this and for good reason. Someone other then myself also thought what you did was wrong- guess what, because it was dip shit. Who in there right mind would drill a diabetic that was hypoglycemic, prior to trying glucagon?? Oh wait- you , that's right!! Good luck, you are cool on this site , but I am quite sure you are black balled in the real world cowboy!!! Again- I would have fired you also cowboy!!! You are not only an idiot, buy a stubborn one at that...

I wouldn't Dwayne take care of my dying guinea pig......and, although I am not dwaynes boss, I would definitely buy his former boss a beer!! Cheers...

How so Ruff- this stuff takes place everyday....

Anyone else know of situations of Paramedics losing their jobs because of unjustified IO placement?? No names please, just situations. Thanks JB

Justin beiber, let me shed some light for ya....the IO should not even have been placed, unless the the useful hormone that we have in a siringe did not work!! Brain child you are buddy!!! Please do, go back to driving the ambulance, and better yet make it a transport company so you are not presented with critical patients Justin Beiber....

Yep D- it was from Medscape. A great website, you should read it more. You might learn something.... As a matter of fact reading articles like that one prior to your screw up might have changed things for the better for your pt, that you put an unnessesary hole in their leg and administered a potential toxic medication to... Maybe you should frequent this site less, and go job hunting . JB

Hypoglycemic symptoms are related to the brain and the sympathetic nervous system. Decreased levels of glucose lead to deficient cerebral glucose availability (ie, neuroglycopenia) that can manifest as confusion, difficulty with concentration, irritability, hallucinations, focal impairments (eg, hemiplegia), and eventually, coma and death. Stimulation of the sympatho-adrenal nervous system leads to sweating, palpitations, tremulousness, anxiety, and hunger. The adrenergic symptoms often precede the neuroglycopenic symptoms and, thus, provide an early warning system for the patient. Studies have shown that the primary stimulus for the release of catecholamines is the absolute level of plasma glucose. The rate of decrease of glucose is less important. Previous blood sugar levels can influence an individual's response to a particular level of blood sugar. However, one must appreciate that a patient with chronic hypoglycemia can have almost no symptoms. Hope this helps.. JB

Paramagic- I understand what you mean, however in this case, this diabetic with snoring respirations would not benefit from lidocaine, they are usually comatos, without the ability of feeling pain. I have been there numerous times with this type of pt. Neuroglycopenic symptoms include weakness, tiredness, or dizziness; inappropriate behavior (sometimes mistaken for inebriation), difficulty with concentration; confusion; blurred vision; and, in extreme cases, coma and death. Above--(coma, and death) JB-

If you thnk for one minute that Lidocaine is short lived in the elderly they you are dumber then I thought!!!

September 2006 Annals of Epidemiology Advantages of Nasal Adminstration Nasal administration of medications for systemic effect offers several advantages. The rich vascular plexus of the nasal cavity provides a direct route into the bloodstream for medications that easily cross mucous membranes. Due to direct absorption into the bloodstream, rate and extent of absorption and plasma concentration versus time profiles are relatively comparable to those obtained by intravenous administration. This method of drug administration is essentially painless, does not require sterile technique, intravenous catheters or other invasive devices, and is immediately and readily available to most patients. Due to the close proximity of olfactory nasal mucosa to the central nervous system, CSF drug concentrations may exceed plasma concentrations, making this an attractive method of rapidly achieving adequate CSF drug concentrations for centrally acting medications (i.e., benzodiazepines for seizures and possibly for sedation). 4,7,8 What else do you want proof You were WRONG in your treatment and exhibited POOR judgement. Again, kudos to your former boss!!! JB- Enjoy your day!!

Blood glucose control Recent data suggest that severe hyperglycemia is independently associated with poor outcome and reduced reperfusion in thrombolysis as well as extension of the infarcted territory.[45, 46, 47] Additionally, normoglycemic patients should not be given excessive glucose-containing intravenous fluids, as this may lead to hyperglycemia and may exacerbate ischemic cerebral injury. Blood sugar control should be tightly maintained with insulin therapy with the goal of establishing normoglycemia (90-140 mg/dL). Additionally, close monitoring of blood sugar level should continue throughout hospitalization to avoid hypoglycemia.[12] Ruff- I am talking about the situation at hand ,not your most recent post........I am quite aware what the indications are for lidocaine, and it is NOT through an IO of an unconscious pt for PAIN ..... Nice try .. If they said they felt pain then they were NOT unconscious, they were. RESPONSIVE TO PAINFUL STIMULI.... That is AVPU. ----- the P part, case you didn't know... Recent studies have demonstrated that blood pressure typically drops in the first 24 hours after acute stroke whether or not antihypertensives are administered. Further, studies reveal poorer outcomes in patients with lower pressures, and these poorer outcomes correlated with the degree of pressure decline.[49] However, other data suggest that blood pressure control, particularly when systolic or diastolic pressures are extreme and when thrombolytics are planned, can be an important treatment intervention. As a result, the control of hypertension in the setting of acute stroke is controversial.[20] Because a systolic blood pressure greater than 185 mm Hg or a diastolic pressure of greater than 110 mm Hg is a contraindication to thrombolytics, emergency blood pressure control is indicated in order to allow for thrombolytic administration. Because their BP was fine Dwayne , I could see why you placed the IO and gave them a medication that they didn't need ..( see above , unconsciousness, and Lidocaine) instead of giving them the medication that probably would have fixed the pathology (glucagon).....

un·con·scious (n-knshs) adj. 1. Lacking awareness and the capacity for sensory perception; not conscious. 2. Temporarily lacking consciousness. 3. Occurring in the absence of conscious awareness or thought: unconscious resentment; unconscious fears. 4. Without conscious control; involuntary or unintended: an unconscious Here ya go Ruff, In case you were not aware, Lidocaine is not indicated for unconscious persons. I have provided you with the definition of unconsciousness. I agree with you, Lidocaine IS, infact given to reduce pain. When your unconscious, guess what.... you feel no pain. Lidocaine.....Here is what you just gave an unconscious pt..... Adverse Reactions Systemic Adverse experiences following the administration of Lidocaine HCl are similar in nature to those observed with other amide local anesthetic agents. These adverse experiences are, in general, dose-related and may result from high plasma levels caused by excessive dosage, rapid absorption or inadvertent intravascular injection, or may result from a hypersensitivity, idiosyncrasy or diminished tolerance on the part of the patient. Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported: Central Nervous System CNS manifestations are excitatory and/or depressant and may be characterized by lightheadedness, nervousness, apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double vision, vomiting, sensations of heat, cold or numbness, twitching, tremors, convulsions, unconsciousness, respiratory depression and arrest. The excitatory manifestations may be very brief or may not occur at all, in which case the first manifestation of toxicity may be drowsiness merging into unconsciousness and respiratory arrest. Drowsiness following the administration of Lidocaine HCl is usually an early sign of a high blood level of the drug and may occur as a consequence of rapid absorption. Cardiovascular System Cardiovascular manifestations are usually depressant and are characterized by bradycardia, hypotension, and cardiovascular collapse, which may lead to cardiac arrest. Allergic Allergic reactions are characterized by cutaneous lesions, urticaria, edema or anaphylactoid reactions. Allergic reactions may occur as a result of sensitivity either to local anesthetic agents or to the methylparaben used as a preservative in the multiple dose vials. Allergic reactions as a result of sensitivity to Lidocaine HCl are extremely rare and, if they occur, should be managed by conventional means. The detection of sensitivity by skin testing is of doubtful value. Neurologic The incidences of adverse reactions associated with the use of local anesthetics may be related to the total dose of local anesthetic administered and are also dependent upon the particular drug used, the route of administration and the physical status of the patient. In a prospective review of 10,440 patients who received Lidocaine HCl for spinal anesthesia, the incidences of adverse reactions were reported to be about 3% each for positional headaches, hypotension and backache; 2% for shivering; and less than 1% each for peripheral nerve symptoms, nausea, respiratory inadequacy and double vision. Many of these observations may be related to local anesthetic techniques, with or without a contribution from the local anesthetic. DO NO HARM, Fluids are indicated in stroke pts, IF THEY ARE HYPOTENSIVE !!!! Do I have to explain why Ruff?? Probably, but I'm not. You can do your research. I am not waisting my time on this any longer. I have done plenty of IOs , WHEN THEY ARE WARRANTED!!!! You two deserve each other!!!

D. You gave Lidocaine to an UNCONSCIOUS pt. That is NOT indicated. This right here proves my beliefs about your judgements. That is for concious people. What don't you understand? You or nobody else on this site knew if she had addequate glycogen stores. YOU or nobody else did not know if it would have worked. It might have. I am glad you were fired , you deserved to be. You know everything, right? Your boss is a saint. What you did , you did outside the box alright, so outside, it was stupid. You need to read more about Lidocaine buddy. I am finished waisting my time with you. You were wrong in placing the IO prior to Glucagon, and you were wrong in giving a bolus of Lidocaine to an unconscious person... Again, what don't you understand? JB

Again, ass clown, you were terminated for this wonderous action that you saved the day with..OBVIOUSLY you were right all along!! I am pretty sure it happend for good reason, yea- your former boss had a brain!! Kudos to your former boss buddy, tell him I said thanks, he did that town a favor. Do yourself a favor, put the gun away and get the books back out jackass..

If you people can't find a procedure that has been going on since 2008, then you all need some help.. The problem Here is we have a person here that can't face the fact that he was wrong. Hopefully you are not around myself or my loved ones....maybe someone should buy you a holster so you can wear that EZ io gun all day long...people like you are the reason why procedures like RSI are not available to educated paramedics...

D- back to the matter- you were apparently fired over this, and now a complete stranger agrees with the outcome. Wake up.... It is this attitude, that gets paramedics in hot water and you are living proof.....

EMT Anne, continue your research, it is the standard now, and the onset is much faster then IM. In Dwayne's defense, I will assume that wherever you are, you are not using Glucagon in your protocols IN. Still, This pt deserved to have a trial of Glucagon IM, or IN prior to your IO insertion, you had NO IDEA wether or not she had addequate glycogen stores, and it deserved attention.. BGL of 27 with a response to an antihypoglycemic agent is again diagnostic (Whipple, look it up) You have fixed her, and we all know that you would have,however now, she has a big needle in her leg. You pushed lidocaine in an older, lighter pt. Probably 40 or at the most 50 kgs, and the dose you probably used was 40 mgs. Lidocaine, a proarrhythmic, (generally considered now in modern literature) was pushed in an unresponsive pt. (NOT NEEDED, and dangerous), and now she can look forward to the possibility of osteomyelitis. Good job. Good for you for thinking outside of the box, but this was a diagnosis of exclusion, you should have excluded it in your DDx in the field, with the intention of "do no harm" This was cowboy medicine. I believe you did not get fired because of your rx, but because of your cowboy attitude, and not knowing how to take a bit of advise from people that possibly could have done something less invasive while producing the same results, while alleviating dangerous sequelae. I would have fired you also..... JB- And fixnat, I never said to sit and wait...

Also, you said that you did not want to wait for the Glucagon to work before alerting the stroke team. That treatment would have given you your answer as to alert them or not. There are two things that medics only do once in their career, 1) calling an MI alert, when the st segments are raised by a LBBB, and 2) Calling a stroke alert before correcting the BGL.......Don't take it personally, it is just constructive critisism.