1EMT-P

I have no idea why she took the patient off of the NRB. Was the patient fighting the NRB? What was the patients vital signs?

I suggest that you check out the Richmond Ambulance Authority, they are one of the leading EMS systems in the country. Good Luck!

In the future we may see more providers administering & assisting with IN Narcan in the field.

FYI: An EMT-Basic by definition is an EMT who has training in [b]basic life support, including automated external defibrillation, use of definitive airway adjunct, and assisting with certain medications. AAOS Ninth Edition.

I have experienced problems in the past with newer EMT's who didn't know how to assist or do certain procedures, but those problems were corrected with better communication, planning and practice.

It sounds like she has a serious condition that needs to be addressed ASAP. Has she been evaluated by an Ophthalmologist and a Neurologist?

Dust just because someone is an EMT doesn't make him or her a loser :!: I know EMT's with college degrees in Athletic Training/Sports Medicine, Health Sciences and Nursing.

It all comes down to your assessment and the patients condition. You could treat the patient with IM or SQ Epi., plus Solu Medrol & Tagament. You could also give the patient Albuterol if needed.

Do any of you carry either Nubain and/or Stadol?

I like IN Narcan, but you have to be careful when you give it that you don't wake up an aggressive patient.

A very wise Paramedic once told me that Paramedics save lives and good EMT's save Paramedics.

What age is too young for a medic & what age is too old for a medic? Should there be age limits?

What medications do they use in Canada for PAI/RSI? What's your Medical Director's reason for not allowing sux?

RSI is a great tool to have if you have a good airway training program, good facilities & a good medical director, but it's not for everyone.

If you have a low call volume, RSI is probably not the way to go, but PAI is an alternative like the CBT or LMA.

I agree there does appear to be QRS's until the mid point & there also appears to be P's.

I have not used it in the field, but I have used most of the other medications. I urge you to check out the Richmond Ambulance Authority in Richmond, VA they were one of the first services to use it in the field & their Medical Director is considered to be an expert on it's use in the pre-hospital setting.

It's hard to say without having addition information, I would be interested to see what her lab studies looked like... I would also be interested in seeing her EKG... Has she been ill recently? Has she had an Echo? What about a 24 hour cardiac event monitor?

I have worked in rural areas before that were 30 - 60 minutes away and the nearest hospital was a small critical access hospital without Cardiopulmonary, CT, OB or Surgical Services. The next closest facility was a 90 plus bed facility which was over 50 miles away.

I don't think that I would do it, because it would be going outside of our scope of practice, not to mention the fact that there are ethical & legal implications to consider...

As a former PALS Instructor, I can honestly say that I don't like either course... I am in favor of having a Comprehensive Life Support Program that includes both Adult ALS & Pediatric ALS.

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.