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tac57

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  1. Toronto has given out kits containing a couple sterile syringes, 2 amps of naloxone and an instruction card to addicts, their family members and other at risk groups for a while now. Although in Canada needle exchange programs are very common, so this is in some ways just the next step in harm reduction.
  2. "Yeah but AEDS don't cause a cardiac arrest patient to come up swinging when you take away their arrest." Done properly, naloxone should just restore resp drive. Give 0.4 mg im (for bls) at a time. You can always give them more. For the public, why not make a naloxone auto-injector that comes in a 2 pack, each dose giving 0.4 mg. If one pen doesn't do it then give the other.
  3. deCORticate goes to the core. Look at the positioning and you'll see what i mean.
  4. That nasty krokodil stuff has been seen in canada now... And codeine (tylenol #1 w/ 8mg of codeine) is otc up here...
  5. The other option to mitigate SOME of the upper gi risks associated w NSAID use is to take a proton pump inhibitor. E.g. losec/prilosec. OTC in the us, rx in canada. Go to a doc though before you start ppi therapy for this indication. This obviously does not eliminate the risk entirely and safe use of NSAID's involves several factors.
  6. That resp rate >28 = ventilate. No really this is what they teach to all first responders (EMT-B's in canada) and AFAIK primary care paramedics. It is taught that one should coach someone's respirations down w a BVM if rr > 28 resps/min. I don't need to get into the issues w this, but suffice it to say it should be adequate minute volume we care about at the BLS level. If the MV is OK, then give oxygen if indicated and monitor the pt. Hyperventilation can be pathologic/detrimental or be a normal compensatory response that you don't want to get rid of w/o being able to manage the pt to an als level. Think DKA or other causes of metabolic acidosis. @MariB: these are still issues w the BLS and ALS standards in Ontario. These standards govern both paramedics and for the BLS standards all FR agencies (MFR in Canada=EMT-B in the US). Although when they don't require an IV pump to run dopamine on Ontario land ALS there is an issue...
  7. Withr regards to the epi, if he is from Canada autoinjectors are OTC. Amps of epi require an rx to obtain from the pharmacy, but it is VERY easy to get (similar to ABx. rx for travellers diarrhea). As for OTC meds, there is a lot of medication that can be purchased w/o an Rx here if you ask at the pharmacy counter. http://napra.ca/pages/Schedules/Search.aspx Select search drug schedules and select schedule II. In Canada meds are divided into schedules, with only schedule one requiring an rx. Schedule II can be purchased otc but you must ask at the pharmacy. Some of this stuff probably shouldn't be sold OTC in any form! Examples: Lidocaine 1% w/o epi-parentral Lidocaine 2% w/o epi-parentral Bupivicaine Lidocaine topical preparations Tetracaine ophthalmic preparations (can cause serious harm if used inappropriately) Dimenhydrinate-parentral Diphenhydramine-parentral Nitro spray (cheap, around $20-24) Epinephrine autoinjectors (no ampules/vials) Glucagon (also cheap in canada, ~$50) Tylenol #1 (325 mg acetaminophen and 8 mg of codeine) activated charcoal For some reason, levophed (norepinephrine) is OTC (yet you can't buy amps of epi 1:1000 or salbutamol otc??). Any of you critical care guys know why they would even consider selling heparin OTC? Seems like a recipe for disaster...
  8. I remember a similar topic on another forum and I thought it would be interesting to discuss it here. So: If you had to pick only 5 meds to stock a drug bag for use in an austere environment what would they be and WHY? Be specific. For example, don't say antibiotic, say what specific drug you would take and your rationale. I will give you a freebie: since i live in Canada where it is not considered a drug, 0.9% Nacl will not be considered a drug for the purposes of this topic (but other fluids will be). Multiple dosage forms of the same drug also count as that one drug. Also feel free to mention what administration equipment you would like to have along with you (no restrictions here). So what would be YOUR top 5 medications to take with you? I'll start it off: 1. Epi 1:1000 - can use to tx anaphylaxis or asthma exacerbation refractory to salbutamol. 2. Either naproxen or ibuprofen. Not sure which one i'd take. For minor injuries. 3. Gravol (dimenhydrinate) injection - it is an antihistamine (salt of diphenhydramine). In theory you might be able to use it for allergies as well as n/v if there was no other option. 4. Ketamine - can be used for analgesia, sedation or general anesthesia depending on dose. Pts keep their airway reflexes intact. 5. A broad spectrum ABx for PO and IV/IM use, likely a fluroquinilone such as levofloxacin or ciprofloxacin. A cephalosporin such as cephalexin would be useful for Abx. prophylaxis for wounds. I'm not sure what would be more critical - the cipro will provide coverage for most types of commmon RTI, UTI and bacterial gastroenteritis issues. I would also add a few litres of saline and iv start gear. Again, in canada, crystalloid iv solutions are otc and not legally considered drugs.
  9. That oxygen is harmless and is a cure-all That pulse oximetry is evil and should not be used when giving oxygen because you just throw on an NRB@15. That BLS providers cannot give medication, but can only "assist" That you do ABC instead on CAB for your primary in an unresponsive pt. That a 1 day HCP cpr class means everyone is a BVM jedi that will never fail or have a difficult bag mask ventilation pt. And due to this failure of ventilation never occuring, that BLS providers can't safely drop in a king-LT in an apenic GCS 3 pt. And that king-LT's should only be used in a code. That training BLS providers on what vital signs ACTUALLY tell them is taboo and evil... Physiology and pathophysiology education is evil... Oh wait, sadly these are still issues w bls in Ontario.
  10. "It is a different concept I mentioned. It is a type of spin that very small objects such as electrons have" E.g. quantum spin states. Were you teaching MRI theory?
  11. Sorry I kind of mistated my question. My bad. What I meant when I said why do people get hung up on age and consent I was referring to the laws themselves. Obviously providers need to follow the laws. It seems strange that legally in the us you could force a person under 18 to receive treatment or on the flipside not be able to treat them due to age. One of the fundamental principles of biomedical ethics is autonomy and it seems as if blanket laws like these violate this principle. In canada there is no age of consent - if the pt can make an informed decision then you must honor it (ethics consult and the courts are available if needed) One example is vaccines - a pt should be able to receive a vaccine even if the parents are the wierd antivax types as long as the pt consents and makes an informed decision. In canada this usually isn't an issue. For example, oral contraceptives are available through high school public health nurses for a small fee or free from a doc if you have a drug plan. Age is no issue since the provider makes the capacity decision. Besides if a child presented on their own to the provider for care they are seeking medical help on their own accord which demonstrates a form of capacity in of itself.
  12. What is the big hangup with age and consent in the usa medic forums? If a person can understand the tx, the benefits, risks, alternatives and consequences of not getting it then age is no factor. If the pt can provide informed consent then there is no issue, just document. Now the approach for a 12 y/o will be different than one for a 15 or 16 y/o but the idea is the same. Btw where i live any person of any age can go get health services at the local public health dept, including reproductive healthcare such as oc's or other contraceptive methods, pregnancy tests, counselling and plan B emerg contraception
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