mo_medic

Let me just start by saying it's not me that wants to treat htn with sl nitro. So we were doing pharmacology in critical care class this week and we had a couple of guys with significant experience sitting in for ceu's. When I say significant experience, I mean critical care guys that have been medics for quite some time, have worked flight here in the US and currently do contract stuff in the big desert for the government both air and ground ambulance. So at some point late in the day one of my regular classmates made what I consider a profoundly stupid statement about wishing her medical director would allow medics to treat htn with sl nitro. She's been a medic for 2 years and I just couldn't believe she would want to treat it with sl nitro. I was always taught in medic school (the same school she went to) that could make things worse and cause rebound htn. Well long story short ... that spurred a very long discussion about treating or not treating htn in the field with nitro. Including these critical care guys who just weren't getting why you wouldn't do this. What were you guys taught in medic and or critical care class? Also, does anyone know if maybe this was an acceptable treatment years ago?

We do not have cpap where i work now, however at my previous department our protocol for using cpap was respiratory distress of any etiology as long as the patient had spontaneous respirations. More or less that was it, but we had special t adapters so we could also run a nubulizer treatment through the cpap. I had used it numerous times on pneumonia patients with some success. BP just had to be over 90 systolic. I actually had a pneumonia patient today (double pneumonia actually) from a local nursing home that had coarse diminished sounds with some wheezing, low initial spo2 but jumped up to 98-99 on nrb. Before i gave the bronchodilator i spoke to our med control doc for the day and he also had me give solu-medrol. Has anyone heard about giving a steroid for pneumonia before?

mmmm ... sounds like a deal

Well I live in the St. Louis area, but I my current dept is a little more than an hour north of there. Thank goodness for 48 hours shifts.

I've been a medic for 4+ years. Frequented ems forums (this site and others) when I was a new medic but haven't been online for quite some time. I worked 3 1/2 years at a busy and troubled inner city FD as a single role paramedic (no fire suppression) and now i work at a rural hospital based ambulance district. Our closest level 1 is over an hour away by ground with good road conditions, no traffic, and the EMT driving the rig hard. I consider myself an experienced and knowledgeable paramedic but also am grounded an know the limitations of our profession and the training we receive. I am confident in my abilities, but because of my experiences I stay humble in knowing that I don't know it all. Between long distance transfers of critical patients (when flying is not an option) and working in the ED around the nurses, I have come to realized just how little medical knowledge paramedics have. I like being "in the know" so i've enrolled in a semester long critical care program that starts in January. I'm sure i'll have questions that come up (and yes of course i'll ask the instructors my questions but I like to hear from multiple sources too) so i'd love to hear from any critical care guys/gals or flight medics out there that might have any suggestions for me. Also, i'm pretty sure I want to start focusing on becoming a flight medic. We have 3 air ems services in the area and i've started applying with them.