Jump to content

Scaramedic

Members
 View Profile  See their activity

  • Posts

    1,428

  • Joined

  • Last visited

 Content Type 

Posts posted by Scaramedic

    nsmedic393 - this one is for you

    in General EMS Discussion

    Posted

    A good BP means nothing if in the process you cause the patient's hemocrit to plummet.

    Hemocrit, schemocrit oxygen is way overrated anyhow! :lol:

    Peace,

    Marty

    :thumbleft:

    P.S. before anybody goes crazy on me, I am kidding. Jeez, get a sense of humor! :wink:

    P.S.S. Would someone from the Great White North start a thread explaining what a PCP is. I can't really add anything except smart ass replies to this thread. Sorry, once again ignorant American here. :lol:

    Noloxone...should EMT-I's be able to administer?

    in General EMS Discussion

    Posted

    I agree with you Hammer the incidence of complications with Narcan are almost nil if it is administered properly. My experience with Narcan (I hate typing out Naloxone) is bringing the pt up to a point just below verbal works the best, no fighting, no N/V and more importantly you can actually get them to a hospital. Which brings up a point that has not been discussed, the half life of Narcan vs the half life of opiates.

    Narcan's half life is shorter than opiates, so another danger of bringing your pt. to fully awake is a majority of them will refuse transport. This creates a situation where they may slip back into resp. depression, depending of course on the purity of the opiate they were using. That is where an old school trick comes into play. Forgive me if this is not done any more, I have been off the streets for five years. If someone refused transport we would also give them IM Narcan on top of the IV dose. The idea being that it would stretch the antagonist effect out long enough for the Opiate (who am my kidding, the Heroin) to be used up in their system. So Lithium that might be why your instructors were pushing you to think about other routes.

    So who should be allowed to administer Narcan? I do not believe Basics should be using Narcan, sorry guys I love Basics but this drug is not for you. If administered properly it is safe, but I am a worse case scenario kind of guy. Being administered incorrectly is what concerns me, Para's can deal with the screw up Basics can't. I do not consider running code 3 to the hospital a proper intervention for a bad dosing of Narcan. I do not have much experience working with Intermediates, I have only worked in dual Medic systems or Medic/Basic systems, so I do not know much about the Intermediate level. So as far as Intermediates and Narcan go, I will withhold my judgment. PCP's, I am going to claim being a stupid American on that one, I have no clue what a PCP is, maybe someone can explain that one to me somebody. :-#

    So that's my .02 on this issue, I do love the discussion though.

    Peace,

    Marty

    :thumbleft:

    DUMBEST THING EVER HEARD ON THE RADIO/SCANNER

    in Funny Stuff

    Posted

    Heard this one morning (about 0400):

    Unit: "3xx"

    Dispatch: "3xx go ahead"

    Unit: "We're checking on a possible man down in a white SUV at *location*, we'll advise"

    Dispatch: "10-4"

    Unit: "3xx"

    Dispatch: "3xx go ahead"

    Unit: "We're 10-8 (in service), it was just 6xx (supervisor)"

    Our supervisors drive MARKED white Expeditions, the crew found one of them sleeping in their truck. :lol:

    Let me guess it was either Curtis or Jim?

    DUMBEST THING EVER HEARD ON THE RADIO/SCANNER

    in Funny Stuff

    Posted

    On the PD radio on night.

    Dispatch: Do you have a description of the suspect?

    Officer: "5'6" Black hair, brown eyes, you know your typical Mexican, good luck finding him they all look alike."

    :shock:

    Needless to say that ended in a write up and a cultural sensitvity class for every fricking service in the county.

    Peace,

    Marty

    :thumbleft:

    Jump bag for new emtiv

    in Equiqment and Apparatus

    Posted

    Amen rid. To raise money for an effort to storm Washington and smack people around, im going to be selling the official ridryder 911 "dilution is not the solution" bumper sticker. Any takers?

    I am assuming you mean Washington D.C. other wise I am going to gather up the boys with the torches and pitchforks and meet you all at the border.

    You'll never take our apples alive!!!

    Peace,

    Marty

    :thumbleft:

    Noloxone...should EMT-I's be able to administer?

    in General EMS Discussion

    Posted

    They are both, they are the side effects of opiate withdrawal which you can induce by administering Narcan. Remember the mechanism of action for Narcan, it blocks the receptor sites for opiates, thereby creating withdrawal like symptoms. If you push too much Narcan you can put the patient into a very fast pseudo withdrawal, and yes that can be life threatening.

    Peace,

    Marty

    :thumbleft:

    Nope. Sorry your wrong.

    On the first point i will concede that it could be considered an issue of semantics. However, opiod withdrawal is not life threatening. alcohol yes, Barbs yes, heroin no.

    Long term withdrawal is not life threatening, but acute withdrawal secondary to a high dose of Narcan is. You are instantly throwing someone into withdrawal, the body reacts violently. Look at the list, I consider arrythmias/tachycardias and seizures life threatening. This is why I believe it should be a Paramedic based intervention only.

    Peace,

    Marty

    :thumbleft:

    Noloxone...should EMT-I's be able to administer?

    in General EMS Discussion

    Posted

    Please correct me if I am wrong ( a rare, but nevertheless possible occurence) but the S & S you listed above are not actually side effects of Narcan but symptoms of opiate withdrawal. An unpleasant but not life threatening condition.

    They are both, they are the side effects of opiate withdrawal which you can induce by administering Narcan. Remember the mechanism of action for Narcan, it blocks the receptor sites for opiates, thereby creating withdrawal like symptoms. If you push too much Narcan you can put the patient into a very fast pseudo withdrawal, and yes that can be life threatening.

    Peace,

    Marty

    :thumbleft:

    Are They Dumbing Down Emergency Medicine?

    in General EMS Discussion

    Posted

    I have noticed a trend recently that concerns me greatly, the dumbing down of emergency medicine. I say emergency medicine because it is not just for EMS, it is for everyone M.D.'s, RN's, Para's, Basic's, etc.

    On this site we have several discussions concerning this issue going on right now. Just reference the thread "New CPR standards." In this thread a study is cited that concludes that EMS and ED personnel should not intubate arrest patients. The study says that BLS procedures are the intervention of choice when it comes to ventilating certain arrest patients. Also several other threads reference the Basic course being simplified over the years.

    The most glaring example of dumbing down I have seen is ACLS. I recently renewed my ACLS and was shocked to see the changes that have taken place. To give you a reference point, when I took my first ACLS course you had to know at a minimum the basic EKG rhythms, and strips were part of the test. The test itself was not hard but did require a bit of actual thought. We also had to base our joule settings on the patient's weight, yes a little math was involved, and we had to know such things as drip rates for various medications.

    Fast forward to 2006, I am sitting in class with about 40 RN's, 2 M.D.'s, 2 Paramedics and 1 X-ray tech. In this room only about 5 people could read an EKG. But according to the new ACLS standards that's OK, because EKG interpretation is not part of the new standard. All you have to know is this, is the rhythm too fast, too slow and is it regular? There are some strips in the book for review but they are not part of the test anymore. And, if the test is too hard for you, you can use the handy dandy cards that are included with the book. The test is a little on the easy side too, here's an example...

    A 42 yo male presents to your Emergency Department he is pale, diaphoretic and and is complaining of generalized weakness. His B/P is 88/45, PR 34, RR 28, the EKG shows a sinus bradycardia. After IV, monitor and oxygen your first pharmacological intervention should be..

    A. Purina Dog Chow

    B. Haloperidol

    C. Atropine <---------This is the answer

    D. Two ASA, discharge patient and have him call his Doctor in the morning.

    OK, so that was an extreme example but I hope you get my point. No more EKG's, no more memorization of medications, drips and dosages, and simple tests. And to top it off, you can not fail the course, they will help you pass it with remediation.

    I love the fact that on this website the push is towards higher education standards for EMS personnel. I think that the higher educated someone is the better care provider they become. The problem is, even though we are talking amongst ourselves about higher education it seems like the trend amongst many groups is going in the opposite direction.

    So that is my question is this, are they dumbing down Emergency Medicine?

    Peace,

    Marty

    :thumbleft:

    New CPR standards

    in General EMS Discussion

    Posted

    I still question the science behind his conclusions, there are several studies that show it is not necessarily the ventilation's that are the problem but the high flow 02. Here is an abstract of one of those studies..

    Normoxic ventilation after cardiac arrest reduces oxidation of brain lipids and improves neurological outcome.

    Liu Y, Rosenthal RE, Haywood Y, Miljkovic-Lolic M, Vanderhoek JY, Fiskum G.

    Department of Biochemistry and Molecular Biology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

    BACKGROUND AND PURPOSE: Increasing evidence that oxidative stress contributes to delayed neuronal death after global cerebral ischemia has led to reconsideration of the prolonged use of 100% ventilatory O2 following resuscitation from cardiac arrest. This study determined the temporal course of oxidation of brain fatty acyl groups in a clinically relevant canine model of cardiac arrest and resuscitation and tested the hypothesis that postischemic ventilation with 21% inspired O2, rather than 100% O2, results in reduced levels of oxidized brain lipids and decreased neurological impairment. METHODS: Neurological deficit scoring and high performance liquid chromatography measurement of fatty acyl lipid oxidation were used in an established canine model using 10 minutes of cardiac arrest followed by resuscitation with different ventilatory oxygenation protocols and restoration of spontaneous circulation for 30 minutes to 24 hours. RESULTS: Significant increases in frontal cortex lipid oxidation occurred after 10 minutes of cardiac arrest alone with no reperfusion and after reperfusion for 30 minutes, 2 hours, and 24 hours (relative total 235-nm absorbing peak areas=7.1+/-0.7 SE, 17.3+/-2.7, 14.2+/-3.2, 16.1+/-1.0, and 14.0+/-0.8, respectively; n=4, P<0.05). The predominant oxidized lipids were identified by gas chromatography/mass spectrometry as 13- and 9-hydroxyoctadecadienoic acids (13- and 9-HODE). Animals ventilated on 21% to 30% O2 versus 100% O2 for the first hour after resuscitation exhibited significantly lower levels of total and specific oxidized lipids in the frontal cortex (1.7+/-0.1 versus 3.12+/-0.78 microg 13-HODE/g wet wt cortex., n=4 to 6, P<0.05) and lower neurological deficit scores (45.1+/-3.6 versus 58.3+/-3.8, n=9, P<0.05). CONCLUSIONS: With a clinically relevant canine model of 10 minutes of cardiac arrest, resuscitation with 21% versus 100% inspired O2 resulted in lower levels of oxidized brain lipids and improved neurological outcome measured after 24 hours of reperfusion. This study casts further doubt on the appropriateness of present guidelines that recommend the indiscriminate use of 100% ventilatory O2 for undefined periods during and after resuscitation from cardiac arrest.

    PMID: 9707212 [PubMed - indexed for MEDLINE]

    I stand behind my statements, 37 is a damn high ventilation rate, in my experience I do not see someone ventilating at a rate that high for long. Also as I stated intubation secures the airway and an NRB, NPA or OPA does not. Dr Ewy also states that it will be a hard sell to stop Paramedics from intubating. That statement is false, it would be easy to get Para's to stop intubating, convince their Medical Director that intubation is unnecessary and they will not have a choice. Now that is going to be a hard sell.

    Peace,

    Marty

    :thumbleft:

    New CPR standards

    in General EMS Discussion

    Posted

    Another important factor is that we and others have shown that physicians and paramedics are so excited during a cardiac arrest that they overventilate-an average of 37 ventilations/minute. It is very difficult to get these individuals to ventilate less, unless you do not have them ventilate at all.

    I am going to have to call bulls*^t on this statistic. 37 ventilation's per minute, that works out to 1 ventilation every 1 1/2 seconds. Just try to ventilate that fast with your average BVM, if you squeeze properly and wait for re-inflation it takes about 1 1/2 seconds minimum. Are you trying to tell me they are non-stop bagging these patients? I have seen studies that say we were not bagging enough, now were bagging to much. Make up your minds please, this is getting really old.

    And what department are they using for their study? Dr's and Para's are so excited they don't know what they are doing, Please! We used vents, is my vent getting too excited, is it pumping out at 37bpm? I'm scared to see the Dr's and Para's quoted in this study, please remind not to travel to Tuscon.

    The kicker to me on this article is no intubation. According to Gordon A. Ewy, MD intubation is only for ventilating the pt. I intubate to ventilate and to secure the airway. If I only have an OPA/NPA in place and the pt vomits they are going to aspirate vomit into their lungs. Like Rid I don't have a sheepskin on the wall but even I know vomitus in the lungs is bad.

    This seems like really bad medicine. I agree with Rid, it sounds like someone is trying to sell something, something that smells like crap. :pottytrain4:

    Peace,

    Marty

    :thumbleft:

    Difficulties with Paramedics as EMT's

    in General EMS Discussion

    Posted

    Did being an EMT help be a medic? From my experience as an EMT, I will never forget:

    1. The siren has three modes. Slow, fast, and real fast.

    2. You have to screw the regulator on real tight or else it goes PSSSSSHHHH very loud.

    3. You have to push the button on the side of the radio mic or else no one can hear you.

    4. People are heavier than they look.

    5. BLEEDING is BAD. Put PRESSURE on the BLEEDING to make it stop.

    6. When in doubt, call the medics.

    7. BROKEN BONES are also BAD. Keep them from MOVING to prevent the person from being in PAIN.

    8. The NRB goes on the FACE.

    9. Push fifteen times on the chest, THEN put in two breaths. Repeat until the medics get there.

    10. Put the AED pads on FIRST, then turn the machine ON.

    This is just to respond to all of the "Medics were EMT's.... and BLS before ALS" stuff on here. I had to learn to tie my shoes at somepoint before I could even become and EMT, too, but no one seems to harp on that much. You know what's even more important to be a good medic than being a good EMT? Anatomy and Physiology, Pathophysiology, and Pharmacology. They are infinitely more important to the successful treatment of a patient than BLS skills. Yep, you heard me. Good CPR will keep a patient viable, and it is very important to do correctly, and if you can do it well, you will be the vital part of a chain that can save someone's life, but you know what? It won't stop an asthmatic from going into respiratory arrest. It won't reverse a narcotics overdose, it won't stop and anaphylactic reaction from progressing or keep a rapidly slowing down heart from coding.

    To add a few from way back when....

    1. MAST trousers are indicated for hypovolemic shock.

    2. The purple box is what the Paramedic gives to make the pt's heart go real fast.

    3. The Paramedic gives the shot with a really long needle that he sticks in the chest.

    4. You must change the siren every 30 seconds or it will hypnotize you and you will die!!!

    and my personal favorite, I swear I am not making this up......

    5. If you feel the need to wear gloves there's a box under the bench somewhere.

    Peace,

    Marty

    :thumbleft:

×
×
  • Create New...