cntrymedic

I work for St. Johns Health Systems in Missouri and they are by far one of the more advanced in their protocols and training regarding RSI. Even our EMTs are encouraged to attend advanced airway classes, the powers that be think this makes an RSI go more smoothly and i'm inclined to agree. In the RSI kit we keep in our narc box there is a card with a dose chart for the use of the different RSI agents. Let's face it, it's hard to remember a protocol when you don't use it much or if you are new to using it...so the powers that be established that we need a cheat sheet to help things going smoothly in the event of an RSI. The RSI card in our kit is laminated. Our protocol reads as follows (we keep a binder in our ambulance with protocols in it so we can 'cheat' as needed): Indications: 1. A critical need for airway control exists, such as: a. persons with impending respiratory failure. b. combative patients with compromised airway. c. patients with depressed LOC. GCS less than or equal to 8. d. patient with hypoxia refractory to oxygen. e. multiple trauma patients who require an airway. 2. Any time risk of potential/actual airway compromise is suspected. Relative Contraindications: Benefit of airway control must be weighed against risk. 1. Hypersensitivity to drugs. Absolute Contraindications: 1. Patients in whom cricothyrotomy would be difficult or impossible. 2. Massive neck trauma/swelling. 3. Patients who would be impossible to intubate or ventilate after paralysis. 4. Acute epiglotitis 5. Upper airway obstruction. Procedure: 1. Assemble necessary equipment and personnel. (suction unit and catheter, BVM w/ correct mask, appropriate size ET tube, working laryngoscope, appropriate drugs drawn up in syringes, pulse ox, ETCO2 monitor, cardiac monitor, cricothyrotomy kit, and alternate airways). (Failed airways include OPA, NPA, combitube, LMA, cric kit, etc.). 2. Position patient properly. 3. Assure at least one secure well running IV line. 4. Pulse ox and monitor attached 5. Assign specific duties (bagging the pt, application of cricoid pressure, pushing of meds, etc.) 6. Allow pt to breath 100% O2 for 4-5 min if possible, or ventilate the pt with BVM at 100% for 1-2 min or 4 vital capacity breaths. 7. Premedicate patient as indicated: a. lidocaine 1.5 mg/kg in pts with head injury or increased ICP. b. atropine 0.5mg for bradycardic pts c. atropine 0.02mg for pediatrics (min 0.1mg) d. etomidate 0.3mg/kg for sedation e. succinycholine 1-1.5mg/kg adult and 2.0mg/kg peds f. vecuronium 0.1mg/kg (no med control is needed if used for primary paralytic, succs must be contraindicated) 8. Perform intubation and confirm placement while monitoring spo2, cardiac rate and rhythm. 9. Cricoid pressure should be maintained from time of sedation until ETT is secured to prevent aspiration. 10. Versed 0.1mg may be used for continued sedation, and may be repeated once. 11. Vecuronium 0.1mg/kg may be used for continued paralization. Make sure the pt is also sedated. (watch the heart rate) *Med control is required. When utilizing RSI, even with adequate sedation, the patient may still be aware of the situation. Please inform the patient of any procedure you will be performing, just as you would with an awake and aware patient. In the event that the patient cannot be intubated after paralysis is achieved: 1. Place an OPA, NPA, combitube, or other airway. 2. Assist ventilations with BVM. 3. If unable to ventilate patient place Quick Trach. I hope this helps. If you have any questions about our protocol I'd be more than happy to try to answer them for you. Down here we are big believers in RSI and Capnometry and before i came to work here i had no clue about how it all worked....now, well, i'm a believer. i hope your search for a new protocol for your service is fruitful. Cntrymedic

ok, by now i'm sure ya'll know my opinion on the "ant issue" but just one more thing and i'll climb back down off of my soap box.....i believe we all learned this in medic school, the first rule is primum non nocere as long as we keep this pearl in mind we can never go wrong by first doing no harm. am i right? like i said, the pt's problem was resolved with all of the pt's dignity intact and without further harm....once again, WAY TO GO UG! i have no idea who Doc is but any time i see a post that makes as much sense as the one he/she (no pun intended) left i say thank you for using your head and making sense of an otherwise ignorant situation. vs...buddy, you know i love ya but you get a mind set like i do and when you do you are as tenacious as a pit bull and don't let go till you are the one who is right. seems to be we could both learn a lot by being proven wrong more often...lol...but nobody likes to be wrong and it would be easier if others wouldn't rub it in. sorry if i did that to ya man. hope you'll be back in chat soon to say hey. Dawn

i found another shirt that says simply "Official Sh*t Magnet" in big letters...lol.

favorite t-shirt i've seen online (i don't own it) says "ETOH QD & PRN" i love it!!!

ok....here's the thing....how many of us have actually seen this case??? none of us! i think it was handled quite well and praise uglymedic for thinking of the treatment he did. what we have to keep in mind is this...the pt was relieved of the problem successfully without detriment. Paramedics:1....Ants:0 If i ever see another case like this i'll try the same technique, it worked once, it should work again! lol way to go ugly...the shemale lives to fool another man, another day!!! lmao. as for vs...i just have one question. HAVE YOU EVER HAD TO TREAT A PT WITH THIS PARTICULAR PROBLEM? i mean, come on, honestly...wouldn't you have gone with your gut on this one? Walk a mile in uglymedic's shoes and then come back and b*tch about it. "Risk may cause failure but success cannot come without it"

ok...ak said it was something about a fire truck hitting a bridge or something...i'll go to the library this week and make a copy of the story and paraphrase it for everyone so we can discuss the idiots in my home town! LMAO!

ok...so i'm a loser...i live here and i never got to see the article...i'm just now seeing this in the forums. um...someone enlighten me as to what this article was about, otherwise i gotta pay five dollars to get the archives from the paper cause i'm not a subscriber...lol.

i've got a couple of good ones for ya...makes me giggle thinking about them. me and a good friend work together at the same service and have been through medic class together, etc...but it seems like she is always the one this stuff happens to! she woke up one morning a few weeks ago after falling asleep on the couch in the living room of our quarters with an ear full of surgi-lube! talk about hillarious...she said that she couldn't hardly get it out and that q-tips just went in and kept going!!! lmao...she also said that when she walked into the caffeteria the medic who had done the prank ended up spitting his breakfast across the room cause she had such a funny look on her face. same medic who did the lube in the ear thing is notorious for putting surgi-lube or defib gel into boots if you take them off and leave them where he can get to them...then he'll have us paged and you have no choice once your feet are in the boots but to wear them...no biggy, it's water soluble so it eventually dries up. and we all know to bring extra shoes with us to work! if you are looking for a no-mess way of doing this prank try gummy worms in the boots....no mess, no wet, still funny as hell! this medic is an older fella...we commonly refer to as father time or old man river....he walks around the quarters in the winter time when we are up in the wee hours in a red union suit that has the hatch over the butt!!!! lmao. we love him. the girl i went to medic class with got caught half asleep one morning by old man river washing the ambulance with the front windows down....teehee...she has yet to live that one down! ok...last one! since my friend is often the brunt of the pranks at work she devised a way to get even and look innocent!!! believe it or not! when she does her truck checks in the mornings and washes/cleans the ambulance, she will "accidentally" armourall the bench seat in the back of the rig! lmao...many times she has held a straight face and innocently said "i don't know why it's so slick" while the red-facec medic says something obscene about the previous shift's crew and how he's going to get back at them! i still don't think the medics she works with have caught on, even though she will take corners a little faster than most of us! lmao

I'm Danderfluff of Willowbottom and my elven name is Alatariel Calmcacil 8) Sounds sweet doesn't it.