1EMT-P

I haven't heard anything about a shortage, but I've noticed that a lot of services are going to Ativan and/or Versed as alternatives.

I've been involved in a number of incidents & I can tell you from experience that I did not find them that helpful... I've found that taking time away, breathing, reflecting & talking with my co-workers & friends was more helpful...

I can't believe that we are having this discussion, a patient c/o of chest pain should receive an immediate assessment along with cardiac monitoring, oxygen, aspirin unless contraindicated, a 12 lead ECG, IV access, labs should be drawn if you are allowed to do so & a pre-hospital checklist/screening should be completed. You might also want to consider giving nitro & pain medication like morphine prn as tolerated!

There are legal issues with using medical devices in ways other than they were intended, so I would discourage attempting to intubate in this fashion... Intubation may end up going the way of MAST, we might end up using alternative airways instead!

I would like some additional information about this patient, including his Signs, Symptoms, Allergies, Medications, Past Medical History, Last Intake & Events prior to the arrest. I would also like to know his vital signs & what treatments he has received. Instead of starting Dopamine, I would probably give this patient a 500 ML fluid bolus of LR or NS first & treat any hypovolemia before I started Dopamine, I would also consider giving him a trial bolus of Lidocaine 1 mg/kg. Lidocaine supressess ventricular ectopy, increases the ventricular fibrillation threshold, it also reduces the velocity of electrical impulse through the hearts conduction system. Lidocaine can be used in Wide Complex Tachycardia of an uncertain origin. If the heart rate was 150 or greater then I would consider cardioversion.

I would encourage you to contact the NY State Office of Emergency Medical Services to find out more about certification & reciprocity for those certified outside of NY. Good Luck!

I am not sure what KY is going with regard to the NREMT, what I can tell you is that I have been involved in EMS for over 19 years & I have been certified in three different states & every state has their own certification process. To be perfectly honest with you, I am not a big fan of the NREMT. I feel that EMS needs to improve educational standards & that they need to move toward a real national licensure exam, similar to what the LPN/LVN's & RN's have.

I have used the following medications for prehospital sedation: 1. Valium + Morphine (Patient Assisted Intubation), 2. Valium + Nubain, 3. Versed + Morphine, 4. Versed alone.

As Paramedics we have a legal & moral obligation to assess & treat our patients... If a patient has pain, then we must assess & address it... As long as you document your history, physical & treatment & follow your protocols you should be fine...

IV Ventolin may play a role in the treatment of these patients where it is approved, but what about using Sub Q Brethine?

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

I'm glad that they are adding additional skills to your scope of practice, hopefully they are also adding additional education to go along with your those skills!

I have to agree with Dustdevil, it appears to be 60 cycle interference.... 60 cycle interference was common back in the day when we used LP 5's.

I think the IO would be the best choice... If you did an EJ you would have to reposition the patient's head & neck & this in itself could pose a problem not to mention the fact that you would need to be able to apply a Cervical Collar given your patients MOI.

I don't see age as an issue as long as the person is willing to learn & to take on the responsibility. When I was a young medic, I was fortunate to have two very good mentors who took the time to mentor & teach me. I think that the best thing that a new medic can do is to find a good mentor & learn as much as they possibly can!

I would suggest that you consider looking at ADC, especially if costs is a consideration. I have used both the ADC Cardiology & the ADC Professional & I believe they are as good as the more expensive brands.

I can understand placing an NPA & applying a NRBM, but nasally intubating & applying a NRBM over the tube... :roll: .

Cardizem & Verapamil are both calcium channel blockers. Verapamil is the older of the two drugs & yes it can be used for atrial fib., but please keep in mind that Verapamil is no longer considered a first line drug for the treatment of atrial fib.

Calcium Chloride is usually administered as follows: Adults 2-4 MG/KG of 10% solution IV repeated every 10 minutes as needed. Pediatrics 5-7 MG/KG of 10% solution IV.

How many of you are allowed to access patient's central lines & ports in the field? I was talking with some friends of mine and they told me that they are not allowed to access patient's central lines and/or ports in the field.

Personally I don't like to use narcotics for kidney stone pain. I like to use IM or IV Toradol with Phenergan.

If the patient is alert & oriented & stable then YES they can request to be transported to XYZ hospital, but if the patient is in Police Custody or if they are altered or if they are a minor of if they are unstable then no you do not have to honor their request.

Most EMS agencies have Standard Operating Procedures and Protocols in place that deal with issues like this, I would urge you to ask your employer for a copy of your SOP's and review them, If your agency does not have SOP's then I would start looking for a new job ASAP...

GOOD LUCK,

1EMT-P

I was always taught that you should use Saline Locks for stable medical patients & patients at risk for APE or CHF & that you should use IV fluids for trauma patients or for patients at risk of becoming unstable.

Do any of you use the Littman Lightweight II SE Stethoscope in the field?

If I were you, I would document everything that happened and then I would contact the EMS Agencies Director and/or Medical Director in writing outlining your concerns. If the EMS Agencies Director and/or Medical Director do not respond in a timely fashion then I would contact your State EMS Office.

I would encourage you to do the following 1. Find a good mentor who can give you advice and help you. 2. Review your A&P & then draw & label the veins. 3. Take a deep breath before start your IV's. & 4. Try feeling & looking at the veins before you start your IV's. GOOD LUCK!