1EMT-P

What are you going to do if the patient is hypoglycemic? Are you going to give D50 in that ankle vein? What are you going to do is the patient suddenly develops Paroxsymal Supraventricular Tachycardia and needs Adenosine? Are you going to give that in the ankle vein? What id you patient codes? Are you going to push your ACLS medications in that ankle vein? Paramedics need to be comfortable with starting EJ's & Adult IO's in the field & if your not comfortable performing these procedures then you need to talk to your EMS agency & make arrangements to practice.

According to the Regional EMS Council of New York City (REMSCO) ALS Protocols you are supposed to do the following for a seizure patient. 1. BLS 2. Cardiac Monitoring 3. Start an IV/Saline Lock 4. Administer 25 gm of 50% Dextrose IV. 5. Administer Lorazepam 2 mg IV or IM if IV access is not available. What I told you was not wrong, it was correct... I would highly suggest that you review your protocols and that you follow them. If you go outside of your protocols and something happens a good lawyer will say that you were practicing medicine without a license!

1. ABC's - BVM Assist with high flow 02 + Nasal Airway 2. Established IV of NS 3. Placed Pt on Monitor 4. Administered # 4 81 MG Chewable ASA 5. Contacted Medical Command

Asysin2leads, Why are your medics starting IV's in ankle veins? Why not start an EJ or an IO? What if you need to give Adenosine or D50 to the patient? PS: you'll feel better :!:

I have started IV's in seizing patients and I have watched other medics start IV's in seizing patients, so don't tell me that it is impossible to start an IV in a seizing patient. I hope your not skipping IV's just because they are difficult!

For those of you who are interested there was an article in the August 1, 2003 edition of American Family Physician that covers the management of seizures. In the article they mention that Lorazepam is the preferred first line drug of choice in treating seizures because of it's anticonvulsant action and the fact that it is long acting. They also mention the fact that hypoglycemia may bring on status epilepticus and that the condition is quickly reversible when treated with 50 ML of 50% glucose. They also state that glucose should be given immediately if hypoglycemia is suspected.

Asysin2leads & Ace844 are you guys new medics? Because you sure do sound like it. There are an estimated 15 million diabetics in the United States and EMS personnel are frequently called to provide emergency medical assistance to these patients due to problems related to their diabetes. The most common emergencies include: diabetic ketoacidosis ( high blood sugar ) and hypoglycemia ( low blood sugar ). Both of these conditions if left untreated can be life threatening. S/S of Diabetic Ketoacidosis: Warm, dry skin; nausea & vomiting, tachycardia, Kussmaul's respirations ( deep & rapid breathing ), polydipsia, polyphagia, polyuria & fruity odor on the breath. S/S of Hypoglycemia: Cool, clammy skin, slurred speech sometimes confused with CVA, headache, weakness, agitation, aggressive or abnormal behavior, dilated pupils, seizures, decreased level of consciousness & coma. The treatment objectives include: 1. Maintain ABC's ( 02 & NPA work wonders ). 2. Establish if the patient is hypoglycemic. 3. Normalize the patient's blood glucose level & 4. Provide supportive care. Status epilepticus is defined as a continuous seizures lasting 30 minutes or more and this is considered a true medical emergency. Please note that Diazepam ( Valium ) & Lorazepam ( Ativan ) are considered the drugs of choice when treating a seizure in the field. Midazolam ( Versed ) is a benzodiazepine; tranquilizer & amnesic medication used to reduce anxiety, provide short term CNS depressant action & induce amnesia. Indications Include: 1. Premedication for intubation or synchronized cardioversion. 2. Chemical Restraint. Contraindications Include: Shock, severe hypotension, narcotic overdose, use of other CNS depressants or hypersensitivity. Side Effects Include: 1. Respiratory depression , 2. Headache, 3. Amnesia, 4. Hypotension, 5. Cough & 6. Nausea & Vomiting. Before you reach for that Versed or any other drug for that matter know what the drug does, know how the drug works, know the right dose and the drugs indications and contraindications :!:

I have friends who have AAS Degrees in EMS and I have friends who have BS and MS Degrees in other areas and they are all EMT-P's and they all get paid the same. Can someone please explain to me exactly how an AAS Degree is going to benefit someone with a Bachelors or Masters Degree? The bottom line is that it is not! Before you guys go pushing for an AAS Degree, stop and think about the Rural and Volunteer EMT's in the US!

I think an Associates Degree is a waste of time when you take into consideration that we are certified, not licensed and that we receive such low pay.

You may be on to something there about ned treatments, but what about Sub Q Brethine?

I believe that RSI has it's place in the field, but I do not believe that every EMS system should be doing RSI. I believe that Patient Assisted Intubation is a much better choice in some areas.

It doesn't make sense to give this patient Versed, if all they need is Glucose. Why not give them O2 and D50 first then if they don't respond give them Ativan or Valium. Remember treat the whole patient, not just the signs and symptoms .

We only have to call in for a handful of drugs like Dopamine, Morphine & Valium.

I would give D50 first, then I would recheck the patients blood sugar if the patients BS was still low I would give an additional dose of D50. If the patient did not respond then I would give 5-10 Mg's of Valium IV. If I didn't have IV access then I would consider giving 1 mg of Glucagon IM & 5-10 Mg's of Valium PR.

I am interested in seeing and taking your test just to see what you think Paramedics should know.

I use to carry a Thomas Aeromedical Transport pack equipped with everything to do BLS, plus 2 Bags of 500 ML NS with tubing, plus 24 g, 22, g, 20 g, 18 g, 16 g & 14 g x2, start kits plus medications Albuterol x 3, ASA x 1, Benadryl x 1, Brethine x 3, Epi 1:1000 x 3, D50 x 1, Narcanx 1, Nitro x 1, Phenergan x 2, Thiamine x 1, Toradol x 1. My Medical Director also let me carry Demerol 50 mg x 1, MS 2 mg x 2 & Valium 10 mg x 1. I only carry a pocket mask & something to control bleeding with now because of the liability.

The LMA does have some advantages over the CBT in that it comes in various sizes and can be used on Adults & Peds. The last time that I checked the CBT only came in two sizes, so it has limited use in the field. The big problem with the LMA is the cost, they are very expensive. Hopefully the cost will come down and we will see them used more in the field.

We currently do not use the LMA... Our EMT's are allowed to use the CBT & our Medics are allowed to use both the CBT & ETT. An LMA would be useful in patients that are difficult to intubate or in patients who are too small for the CBT. They also would be useful for rural providers who do not intubate very often.

I would highly recommend that you talk to your GP and/or Neurologist about changing your diet, I would also recommend that you talk to them about trying a preventative medication such as Inderal. You might want to talk to your GP about trying some anti-inflammatory medications. I know that some people have had good success with taking Aspirin with 10 to 20 mgs of Reglan. You could also try taking Aleve with Reglan or try taking Excedrin Migraine which is ASA, Tylenol & Caffeine along with either Dramamine or Reglan. I am not sure what they have in Canada, but you could also try using any of the abortive anti-migraine medications. You also might want to talk to your Neuro about having either a CT Scan and possibly an MRA. Good Luck,

What do you think is the best outdoor emergency care training program? Personally I like the National Ski Patrol's Outdoor Emergency Care.

Our Medical Director would ride with us on a regular basis when I was an EMT and Medic Student. He would allow us to go outside of protocol if he was on scene. We were allowed to get medications, place the patient on the monitor and set up lines etc., If we were medic students he would allow us to perform ALS procedures under his direct supervision. He was really cool, he was a former medic so he was always willing to allow us to try new things.

I have used both, I like PADS the best.

A lot of clinics, hospitals, medical offices and nursing homes are using AED's in place of ACLS these days in my area. All of the Dialysis Clinics in my area just recently replaced their Cardiac Monitor/Defib machines with AED's. The hospital also replaced most of their Cardiac Monitor/Defib machines in their clinics and on the med-surg floor with AED's. The only areas with full crash carts are the Cardiac Cath Lab, Critical Care, ED, OR & the Recovery Room. Are AED's replacing ACLS training & full Crash Carts where you live and/or work?

I think that they need to make some changes to the ACLS curriculum. There really isn't any motivation for experienced providers to sit through class. I have a friend who is an RN and she told me that most of the nurses that she works with in the recovery room and surgery do not take ACLS. They attend an in-service and read the material, but do not take ACLS.

I my opinion the Instructors role is to provide the students with the current/updated information and the students role is to read the material, perform the skills to the best of their abilities and take the test.