akroeze

I'll be there. Not like anyone from here would even care.

Wow, somebody has low self-esteem!

I'll be there (with the caveat that new job may change that)

Just something to think about but it sounds like they are setting you up to take all the blame if something goes wrong. Without proper policies they can wash their hands of you.

That HAS to be a joke

Well in Australia is it not common practice to essentially squeeze the chest to aid in getting air out?

Am I to assume that the opportunity has passed to put my name in? What qualifications were they looking for?

Hard to tell. I'd be very hesitant to decompress an asthma pt. If they didn't need it, now they WILL need a chest tube

That is a common fallacy that actually isn't true. Just because a patient has been decompressed does not mean they get a chest tube.

My thinking is that if they have a tension pneumo I'd rather treat assuming it than assume not and they get worse.

Ok so for some reason my brain went to status asthmaticus today and the treatment of it. Let's play doom and gloom and go for the worst case scenario, a patient who is to the point that you have absolutely silent chest. How would you determine if this patient needed a decompression for tension pneumo? Their vitals are already going to be out of whack and I don't want to be waiting for tracheal deviation to show up. Could an argument be made for performing bilat decompression on this patient to rule out bilat pneumo?

That's a weird lido protocol. ALCS says that if you use any antidisrhythmic during a code resus you need to back it up with a maintenance infusion at ROSC. Aren't you guys following ACLS protocol in every other way?

Yes and no to the following ACLS. We use the same drugs but have different doses for some reason. During an arrest we would push Lidocaine 1.5mg/kg q3-5min x 2.

Also as you see we only have the bare minimum of ACLS drugs.

The preloaded jets we've got of lido come in 100mg. 6 of those should be plenty to do the initial loading and then set up a drip that will last till you get to most hospitals, no? You only need a few mg/min... assuming you use 100 for the loading that means you've still got enough for more than two hours at even the highest drip rate.

That's a very good point that I was thinking about last night after I made my post. I decided I could take a burretrol, dump a pre-load in, dilut it with an equal amount of saline so now it is 10mg/mL and then just infuse away with easy numbers. I had never considered it before and quite honestly have never heard of it happening around here. But now I think it is something I would bring up in future cases with the doc.

On a side note how well does the IV Dramamine work for n/v?

I really don't have anything to compare to as it is the only IV anti-emetic I have ever given however I can say from personal experience that it takes about 10min before the patient gets relief and it makes a fair amount of them quite drowsy. Not sure if that is any help. I have yet to have someone under the full effects of gravol vomit (knock on wood).

Ok, I do not agree with having a supervisor overseeing my refusals. I always try and talk pt's into going to the ED, if they need to.

On that note. The last service I worked did have a slightly different refusal policy. Any refusal we did, we had to call a supervisor or dispatch on the radio. We would them switch over to an extra tac channel we had and we would give them a refusal report over the radio.

This was not asking for permission to refuse that pt and the supervisor never talked to the pt. All this was for was to have a recorded record of the report for liability reasons. The only reason we would call a supervisor is so they could acknowledge hearing the report clearly.

I had no problem with that system, as it did CYA. If a question came up, they could pull the tape on it.

Paperwork accomplishes that.

Just wondering if you guys managed to get your pics uploaded somewhere?

^^ You give lido but don't have the means to do a maintenance infusion? What form do you get the drug in?

By protocol the only time I give Lidocaine is during an arrest or 3mins pre-intubation with suspected increased ICP. In my protocols I can patch for stable V-tach and on direction of physician I give 1.5mg/kg over 2 minutes. If no response in 5 minutes I give 0.75mg/kg over two minutes.

Where I did my preceptorship we only carried 6 pre-loads of Lidocaine so not really enough to do any kind of drip with (even if the doc wanted one).

What about cardizem, procanimide, magnesium, zofran, promethazine, and a few others I'm sure I forgot haha? You dont have or don't drip any of those?

Don't carry any of those. As an ALS provider I carry:

Adenosine (well, the service I did preceptorship didn't carry it but most do)

Amiodarone (optional)

ASA

Atropine

Dextrose 50%

Dimenhydrinate

Diphenhydramine

Dopamine (premixed)

Epinephrine (1:10,000 and 1:1000)

Fentanyl (optional)

Furosemide (optional)

Glucagon

Glucose Paste

Midazolam (optional)

Morphine

Naloxone

Nitro Spray

Salbutamol nebs and MDI (That's right CB... I said SALBUTAMOL)

Sodium Bicarbonate

Xylometazoline (or phenylephrine) spray

Pretty limited list.

Here is something that Ottawa put out for their service:

Well there is a supplement to Mosby written by my ACP instructor (Rob Theriault) that covers mostly medical-legal issues in relation to Canadian laws. I think it is called "The Canadian Paramedic" or something like that.

Since many paramedics nowadays have degrees anyway so it may help a large percentage.

But that isn't by virtue of them being a Paramedic. The Paramedic part of your education counts for nothing at all in the realm of university is all my point is. Yeah if you have a university degree on top of it then you will be given those allowances just like everyone else with a degree.

Hello,

That is crazy. What is wrong with using a reference card. Your preceptor may be comfortable with the medications that

your protocols have. I am sure if a odd medication needed to be run the preceptor would have to bust out a calculator.

D

We only carry two things that can be given in drip form:

Dopamine (by protocol)

Epinephrine (have to talk to the doc.... even then it would be soooo rare to do)

I suppose we could also do a Versed drip but I really doubt it unless there is a very long transport with a status seizure.

No lido for mixing for a drip, no amio.

There are places where you can do a BScN program in less time based on previous university education. The University of Western Ontario has one that is 19 months full time for people who already have at least two years of university (but usually a degree). I believe that U of T has a similar program.

True but unfortunately they won't recognize college credit for anything so Paramedic doesn't help at all.

My preceptor didn't allow charts, didn't allow calculators and frowned if calculations were done on paper. To him you should be able to do it in your head.

but if you take RN program instead of Paramedic,and you complete the program, you are eligible to challenge Paramedic exams. Funny how that works.

Allowing to challenge != equivalency

Enjoy your diverticulitis! :wink:

Way to ruin it Dust, I'm going to the movies tonight and now I'm going to worry while I eat my popcorn and not enjoy the movie!

In fact, you now owe me the theatre admission for ruining my movie!

hmmmmmm, no response since last night ? The internets must have been down all night. Come-on, who is going to be the first to be adult enough to say OK, maybe I was wrong about that, I cant turn my back on my coworkers ? Therefore, I cant let the baby die either.

I choose not to enter this discussion with you as you are attmepting to bully your opinion on me and completely unwilling to accept that someone may think other than you.

I had a patient inform me that Dimenhydrinate (marketed under brand names Dramamine, Gravol, and Vertirosan) an antiemetic.

Well apperantly it made him nauseated and puke .... talk about having to turn away and have ones partner step in because your laughing so hard your eyes water.

I don't know why this is so funny. Some people DO have an adverse reaction to Gravol. My moter for one.

Honestly I don't know what I'd do in that situation. I would have to be in it before I knew.

Kind of a cop out I know but it is what it is.

You could throw in so many variables it is hard to say.

That was how I interpreted the situation. Nobody asked what you would do in your current sytstem, under your current protocols, against all established policies and guidelines. It was asked if you would do so, given direct medical control, in a system where such is allowed, even if not in written protocol. Nobody's asking you to play cowboy. Just asking if you'd do it, given the urgency of the situation, and all the support of your MD.

I would do it if it could be said that it would be an accepted thing that any (not literally any, but majority) normal medic in my situation would do.

That's an interesting point Dust.

You have a patient who is obvious traumatic death whom you deem is not a candidate for resuscitation. You have another patient trapped under them and alive but critical. The only way for patient two to be removed from the wreckage is to amputate above the knee the leg of patient one. Amputation isn't in your 'scope'. Do you do it?

Anyone?

I think it could possibly happen in Ontario. For example I bet my preceptor would get permission if he were speaking to his medical director on the patch phone but that is only because they have a long standing professional relationship.

So I think a lot would depend on how well the medic knows the doc. I as a new ACP wouldn't get such an order, a long standing ACP who is well known might.

That's an interesting point Dust.

You have a patient who is obvious traumatic death whom you deem is not a candidate for resuscitation. You have another patient trapped under them and alive but critical. The only way for patient two to be removed from the wreckage is to amputate above the knee the leg of patient one. Amputation isn't in your 'scope'. Do you do it?