hertzvanrental

In the UK we have the following options: Paracetamol Ibuprofen The above can be given together or independently Entonox Tramadol (depends where you work) Nalbuphine (now withdrawn I believe) Morphine up to 20mg for adults , paeds are age/weight related. Oramorph (oral morphine) Ketamine/midazolam (flight paramedics and CCPs) There is also talk of intranasal diamorph in the future. I'd like to see Fentanyl added personally. Decent analgesia is underused and for what reason? There is no justifable reason to withold proper analgesia. I know it only shows a very minute proprotion of paramedics but the US Paramedic reality shows I've seen rarely show any medics giving pain meds. Pain is something we can treat and a lot of our patients are in pain so we should be treating them. As for the abdo pain BS, any decent DR worth their salt should be able to daignose the problem irrespective of prehospital analgesia. Also forgot to mention Lidocaine with EZ-IO, also Lido for suturing for Paramedic practitioners and ECPs.

Sorry to hijack. A UK perpesective. My service is the only ambo service in the UK to use the EZ-IO (there are a few HEMS dotted around that also use it) most others use FAST, BIG and traditional methods (although paeds only for those that use the latter). We've been using it for a few years now. We can use it on anyone, adult/paeds, cons or unco. We use lido 20-40mg adults and 0.5mg/kg on paeds. We can push every IV drug/fluid through it (except heparin and tenectaplase) if we need to. I've used it several times and found it to be an excellent addition to our arsenal of skills. A lot of the time it is used in arrest situations but personally I have also used it in severe hypotension where the patient has been shut down. Also in paeds burns, 2 yr old burns to head neck, back & chest, unable to get IV so popped in an IO, lido then morphine, worked a treat. The child was too busy screaming with the burn pain to think about the IO. We also had a young patient who had a femoral haematoma that popped and was bleeding out, she had 3 IO's in! Great bit of kit! Having said that, if I can get an IV I'll get an IV. As for the valium question, do you guys not use rectal diazepam? Unless the patient was status then I'd probably have to resort to the brown route (LOL). There are also veins in the feet or ankles that we use on seizure patients.

What! Never heard of glucagon being lethal with extended transport times. Crikey what do they teach you? Give the patient IM glucagon and follow it up with oral sugars and carbs. It's rare that some one wont wake after glucagen. Please don't tell me you rush around like a headless chicken initiating transport becuase your patient is unconscious due to hypoglycemia. Do you not wait for the meds (whether it be glucagon or IV D50/glucose 10%) to take effect first before coming up with a differential diagnosis. Don't you treat these patients at home?

I've got many IVs in patients with their pressure as low as 60 or 70 systolic thank you. The last two being anaphylaxis patients again both of these were last week! As for waiting till your pressure is lower than 90, I didn't say that I wouldn't have fluids up and running, it's that they would be at KVO rate. I think it's you that needs to read up on prehospital fluid resuscitation as it can cause more harm than good. Try looking at the references which seem to come from North America. If I can get an IV I will but I wont piss around making several attempts to get one when time is of the essence. I'll have two attempts then go for the IO. if a kid has bacterial menningitis I'll go IO so that I can get my glucose, benzylpenicillin, diazepam and fluids in as needed while someone is poking around looking for a suitable IV site. The parents/ED Docs will and have thank/ed me for it later. HMMM getting a IV in the saphenous on an 18month old with septacemia, I'd love to see that.

totally agree, sorry for going off topic.

Too scared! Try telling that to top consultant paediatric DRs. Don't get me wrong, I would far prefer to get an IV in a kid than have to go IO but I bet I can get my EZ-IO in far quicker than some one pissing around, wasting precious time digging for a vein on a shut down kid. And if a medic is too scared to start an IV in a kid then do you really think they are gonna have the balls to go IO, I doubt it. (TBH they shouldn't be a medic at all) http://www.ich.ucl.ac.uk/clinical_informat...uideline_00049/ And if you are bleeding to death internally, unless your systolic pressure is less than 90, you wont be getting fluids off me. I'll rapidly be transporting you to the room of bright lights and shiny steel aka the OR and you'll thank me for it later. What you wouldn't thank me for is filling you full of fluid and making the bleeding worse. Going back to EJVC in trauma, I was taught to turn the head and tilt the head down, surely if you are applying a c-collar you are suspecting a c-spine injury turning the head is the last thing you should be doing. As for flow rate IO I've never had a problem pushing fluids or meds, it's just like pushing them through a 16g in the AC. If it's slightly off target that might explain why some people feel it slightly harder. Again I've never had any problems, I've done enough of them. As

In fact in seriously unwell kids the I.O route is the prefered choice. Such as meningococcal septacemia etc.

You can't use the EJV for major trauma with a c-collar applied. If I have some one screaming in agony I can use the EZ-IO and give em morphine. If you f*ck up a EJV then that's your lot, shouldn't be going for another go or on the other side. I.O is pretty much a guaranteed success. I've never missed.

I think our lot would prefer us to steer clear of the EJV unless for cardiac arrest. I.O is much more preferable. If I cant get a line & glucagen doesn't work then I opt for ez-io every time.

On the EZ-IO needles there are markers so it may not be possible to use on a 300lb porker, why not go for a vein in the foot? Or worst case EJV. If the I.O needle is sited properly and flushed after use then there should be no problem with regards to infection, I've never had any problems.

Smart car. We have been single responding for years in the UK. At first it was to get ALS care to the patients side quickly. You know, get the best medics on them, giving the patients quality care before a truck arrived. Now all they are used as are clock stoppers. Our lot couldn't give a toss whether it was a paramedic or a garbage man driving it so long as it had a defib on board and stopped that wonderful clock in under 8 minutes!

I find this an interesting topic. Here in the UK as you know we have EMT and Paramedic. EMTs give glucose gel & I.M glugagen, Paramedics have I.V glucose as well. Now when I was an EMT and working with another EMT or if I was working solo on a response car my only options were glucagen if a/w was compromised. The vast majority of diabetic hypos that I attended all stayed at home after glucagen and some oral sugars & carbs. Never had any problems. Obviously I.V glucose is preferable and that is what I give now. Nearly all our hypos are treated and left at home (IV taken out of course) again never had any problems. Someone made a comment about not getting an IV, giving glucagen and then having another look for an IV coz they may have better luck, this is because glucagon is an inatrope therefore raising BP= good veins (sometimes anyway). Our guidelines state that it's a clinical decision as to whether a paramedic chooses to give glucagen or IV glucose. Like I said before I go for IV every time. Rectal, errrr yuck! I will be getting my EZ-IO out before ever considering administering via the brown route! Sticky, sugary ass, fuck that!

I've decided to write or attempt to write my own blog, :shock: 8) http://streetmedic-coocoocachoo.blogspot.com/ Happy reading, only just got started.

Do you guys do in line nebulisation? If a patient is in respiratory arrest or close to it, we set up an in line neb using BVM, catheter mount, t-piece and neb acorn. Can be connected up to tube, LMA(para) or face mask(EMT). Back to back nebs and sub cut epi. It works. Obviously no good in cardiac arrest.

Sort of, no-one answered.

What about a patient who is on beta blockers who is suffering anaphylaxis and is unresponsive to epi? Glucagen may work in this situation.

What about a patient who is on beta blockers who is suffering anaphylaxis and is unresponsive to epi? Glucagen may work in this situation.

Take up surfing and some outdoor stuff, I love the west country. Or are you too old for all that pondlife!

We use portex in the field. In hospital It was an more robust autoclavable version which I found easier inserting to the side of the mouth and giving it a twist which worked every time compared to holding it like a pen and inserting it in line with the roof of the mouth. Also used proseal and found that easier with it's introducer, I was working with one of the consultants who was to do with it's development.

I'm just wondering, if there was three of them, one in the drivers seat and two in the back then why would they think it's a signal to get going? Surely the crew in the back would notice if the driver was in the front or not! Or is that just too easy?

As previousley stated it is used widely in the UK and has been for a number of years. All paramedics are trained in it's use and a lot of EMTs can use them. When moving a patient to the truck then hanging the BVM might be asking for trouble if not tied in well. But once on the truck we pop the patient on the ventilator and our hands are free. Have to watch out for pressures though. If manually ventilating then careful bagging is what is required. Wouldn't want to use one on a Asthmatic resp arrest though. Having said that I haven't done many on the road, usually get the tube or use a boogie if difficult tube. Last time I used an LMA was on a person who set fire to themselves. It provided a great airway. When I was in the OR doing my trainig I inserted about 70 compared to 31 tubes because over here anaesthetists are opting for LMAs as most people are fasted and most procedures are short in duration.

I knew that muppet was on here, he hasn't posted for a long time! I know SWAST is a decent service. I also know that pondlife is keen to see us develop, that's why I put that little dig in about mobimed. As for dodgy, who you been talkin to!

you may say that but they use crappy FRED aeds and have mobimed, like pondlife stated if we are to start using adenosine then the mobimed system will be useless.

Cultures! With bacterial meningitis there isn't usually time time to do cultures. If clinically suspected it's AB first then do the investigations (that's in hospital over here as well). As for the 30 year old with a Hx of a cough for 2 months (as quoted by LOGOS), I don't know anyone in their right mind who would treat this with AB. For a start I wouldn't even suspect MS and if he did have it and it was the bacterial form he wouldn't have lasted 2 months!

No need for thrombolytic therapy in urban areas! What are you talking about. We can deliver this type of treatment quicker than the hospital even in the parking lot of the hospital. In fact we are encouraged to initiate therapy asap. Once the ED Doc has assessed the patient and then pissed around making a decision on whether they will be treated in the ED or referred to CCU, we would have thrombolysed the patient and maybe even aborted the MI, saving valuable myocardium and still done it quicker than the hospital. As for AB therapy, we are not talking giving it to every child with a fever or who is febrile. It's about recognizing the seriously child. Bacterial infection is one of the first things I want to rule out when dealing with a sick kid. I'll assess ABC in the home, high flow O2 tympanic temperature, blood glucose, cap refill. I'll stick a line in if necessary. ANY sign of a non blanching purpuric rash or petechiae ( also remembering the in the mouth and conjuvtivae) in an acutely unwell child then I won't hesitate to give Benzylpen. The earlier it's given the better. I've seen the rash of MS develop in front of my eyes, starting with one tiny spot on the abdo and within a space of 15 minutes all over. This got AB therapy from us and is alive and well today. The ED DRs praised us for recognizing and treating MS and says her speedy recovery was partly due to our early treatment. And there are lots of similar stories in the UK. http://www.meningitis.org/health-professio...lance-personnel