1EMT-P

I have to agree with AZCEP on this one. The University of Pittsburgh did a study that involved 42 EMS agencies over an 18 month period. There were 1,941 cases, with more than 30% requiring multiple intubation attempts. They concluded that pre-hospital providers often require multiple attempts to intubate. They recommended limiting pre-hospital intubation to 3 attempts.

Wang HE. Yealy DM. "How Many Attempts Are Required to Accomplish Out-of-Hospital Endotracheal Intubation?" Academic Emergency Medicine. 2006;13:372-377

I think it is great that Zofran has gone generic, maybe now more services will be willing to add it to their list of approved medications. So do you think it will replace Phenergan?

What's in your drug bag or box?

Lopressor- 5mg via IV over 5 minutes. May repeat after 5 minutes to a maximum dose of 15mg.

I usually use the blue commercial ones.

If you feel that you can manage the patient safely without doing invasive procedures like starting an IV or pushing D50, then I think you should, but I would not go out and buy supplies and use them at work due to the medico-legal issues.

What kind of IV tourniquets do you use?

If you want to discuss nursing or nursing wages please start another thread. This thread is about EMT-Basics performing select ALS skills.

I think you did the right thing in this case, especially if the patient had already expressed his wishes.

Did any of you happen to see the University of Pittsburgh Study on EMT-Basics performing limited ALS during cardiac arrests?

The researchers developed a three hour training module to train EMT-Basics in the use of both LMAs & EZ-IO. Following the training they divided the EMT's into teams of two & conducted simulated V-Fib cardiac arrests. According to the study they found that EMT-Basics were able to insert an LMA 78% of the time with a mean of two attempts and that they were able to insert an IO using the EZ-IO 94% of the time on the first attempt. They concluded that EMT-Basics were moderately successful in performing ALS interventions during cardiac arrest.

Gyette Fx.Rittenberger JC.Platt T.Suffoletto B.Hostler D.Wang HE "Feasibility of basic emergency medical technicians to perform selected advanced life support interventions." Prehospital Emergency Care.2006,10(4):518-521

It is hard to comment without having additional information. If you could provide us with some additional details it would be very helpful.

There are several options when treating patients with Asthma & COPD... The AeroChamber is a good one if your using MDI's. It was designed to boost the delivery of medication into the lungs... Another good option is the PARI Nebulizers, they have been show to be very effective & reliable.

I had an older Pulmonologist tell me that the newer medications are not really any better than the older ones that they are just more expensive... He still uses Albuterol, Alupent (Metaproterenol), Brethine, Dexamethasone & Theophylline.

I asked about that & apparently the patient's Allergist put her on the Protonix because he felt that she had both Asthma & Gerd..

Tniuqs, Please re-read the post... I did not say that I gave epinephrine to the patient... I did however give a list of treatment options, including epinephrine...

I have treated several patients who have had asthma & been on beta blockers. If the patient does not respond to oxygen therapy & nebulized Albuterol then I add Ipratropium bromide, if they still do not respond then I usually move on to

Epinephrine 1:1,000 0.3mg IM/SC & Fluids.

FYI: There are quite a few relative contraindications to beta blockers, including Asthma, Bradycardia with a heart rate less than 60 beats per minute, CHF, COPD, emphysema, hypotension 2nd or 3rd degree heart block & immunotherapy just to name a few.

OzMedic, This thread is not about bronchospams in patient's on beta blockers... It is about the use of DuoNeb in the field...

... If you would like to discuss the issue of bronchospasms in patient's on beta blockers please start a new post!

OzMedic, Don't go getting your shorts in a bunch :!: The fact of the matter is that you made a statement about backboards without providing any documentation to support your statement. I have only seen one study on vacuum devices and it showed that the vacuum device provided somewhat better immobilization of the torso with less movement, but it also showed that the rigid backboard with headblocks provided somewhat better immobilization of the head.

Some states do not require the NREMT-P. You might want to contact the State Offices of EMS in Florida, Illinois, Maine, Massachusetts, New York, North Carolina & Utah to see if they would accept your training.

Kevkei, Ipratropium Bromide is not indicated in the treatment of acute bronchospams, it is however indicated in the treatment of COPD, Chronic Bronchitis & Emphysema. Studies have shown that patient's with bronchospasms related to COPD, Chronic Bronchitis & Emphysema have shown significant improvement in pulmonary function following the administration of Ipratropium Bromide.

OzMedic, I have to respectively disagree with you when you say that people should not be transported on backboards... Have you ever taken care of an injuried skiier with bi-lateral femur fractures & a fractured pelvis on a ski slope?

Also vomiting is not an issue if you manage the airway & pre-medicate your patients with an anti-emetic like Phenergan!

Are any of you currently using DuoNeb (Ipratropium Bromide/Albuterol Sulfate) in the field for the treatment of Asthma/COPD/Shortness of Breath?

This is why we should never allow bean counters or politicians to make health care decisions.

Doc, Pericardiocentesis is an invasive procedure that is generally done under the guidance of ultrasound to minimize complications & risks. Since it is not within my scope of practice & I am not trained to do the procedure & do not have the recommended equipment I would not do the procedure.

Possible Causes of PEA:

P= Pulmonary Embolism

A= Acidosis

T= Tension Pneumothorax

C= Cardiac Tamponade

H= Hyperkalemia

(4) Hypokalemia

Hypoxia

Hypovolemia

M= Myocardial Infraction

D= Drugs ( Herbs, Illicits & Rx )

S= shivering

I would not have done the procedure, instead I would have started ACLS & transported the patient to the ED.

As I understand it, Fentanyl is very lipid soluble & has a much faster onset than Morphine Sulfate does. It also causes less respiratory depression & histamine release than other narcotic pain medications.