p3medic

Our BLS crews, and ALS for that matter have the option for narcan IN. We are currently discussing utilizing the IN route for Midaz as well. I like the idea of no needle. We have used narcan via the IN route for some time now with great results.

Your not going to effectively monitor vitals in a patient that is thrashing wildly on the cot, face down. Do you think your pulse oximetry probe or etCO2 is going to stay in place? Perhaps some electrodes, you'll see the tachycardia and artifact until he brady's down and dies on you. You decide to transport someone face down on a cot, in restraints and they die, you will be owned. There is enough literature warning cops, and hopefully EMS professionals of the very real danger of transporting patients in restraints while prone. Take a fat patient and lie them on their stomach and see how well they breathe. Now roll around and fight with them, raise their temp, hr, bp and mvo2. Now place them prone. See what I mean? Bad idea, and completely different than lying supine on a board. I have been in this situation, not heard about or read about, but running the call. The patient fought and fought with the cops until he didn't, and at that point it was all done. He had immediate resuscitation and stayed very dead. Sure, the drugs and agitation added to it, but I would bet his chances were better if he were not face down. I carry a cuff key on me at all times. If the cops cuff them, they come, and under no circumstances will they be transported in the prone position. Off my soapbox.

Handcuffs, chemical, and transition to soft restraints if possible. They may end up face down during the process, but as soon as they are cuffed, they are rolled over.

See post above. Face down on the stomach does cause harm, it is well documented. Look up positional asphyxia. I have unfortunately seen it first hand, its no joke. Never restrain someone face down, ever.

I had a similar call about 13 years ago, except the patient went into cardiac arrest and stayed that way. Never restrain someone face down. Once they are in restraints, roll them over.

Agitated, combative, handcuffed, face down on stretcher. Hmmm....do we roll him over before or after he arrests?

As you have probably figured out, the use of CPAP in an unresponsive patient is usually frowned upon.

We also use a refridgerator in the ambulance, the Engel 17. We keep our fluids at 4C.

Yes. What are you looking for?

Anyone in the US know of a ground based 911 system utilizing Plavix in their STEMI patients? Any factual info would be much appreciated.

I've been to court quite a bit for work, its not a big deal. As others have stated, refer to your report, don't make up answers to questions you don't have an answer for, and don't elaborate. Answer the quetstion and thats it. Remember, you are not on trial (I hope) so relax. The DA uses EMS testimony to help them paint a picture, bring the scene to life so to speak, its usually not the lynch pin to the whole case. Expect to spend less than 30 minutes on stand. The prosecuting attorney will speak to you first, usually start by having you explain to the court what your job is, the training required, you years of experience, etc...He/She may show you pictures from the accident asking if you can describe the scene, remember aspects of the call, statements made by decedent or defendant. Just remember, they aren't looking to prosecute you, so stay calm. Good luck.

I believe another class is starting this month, or perhaps August.

Yeah, he titled the thread crush/compartment syndrome. The TQ isn't helpful in the latter, but could be in the former.

Tourniquet.

Hyperventilating to blow off CO2 in an effort to buffer the acidosis eventually results in the tiring of the muscles involved in breathing, and eventual respiratory failure. Not saying thats what is going on in this particular case, but the lack of deep, rapid respiration in a hypoglycemic patient is very worisome, and probably needs prompt airway management unless a easily reversed cause is identified (opiate ingestion).

Good luck kid, but when you find out God is just like the Easter Bunny and Santa, don't say I didn't warn you. Just kidding, best of luck.

I don't check it stem to stern daily. I do check the controlled drugs, the monitor, suction and portable o2. Drugs other than narcs get checked monthly, and are restocked as needed. I carry my own bag, so I don't check the jump kits on the truck, at all.

If the city would only buy them a few more fire trucks this would never happen!

No offense to any FF/EMT's, but if a patient requires airway management, even BVM ventilation, then I need to be doing it, not them. Airway management is the most important "skill" we bring to a patient, and letting a FF half ass it while I wait for them to cut a patient out of a wreck is, in my opinion, doing the patient a disservice.

A 2" needle in an adult is the bare minimum, I'd suggest finding a 3" catheter.

I'm all for letting fire cut someone out of a car, but I've found myself providing care inside a wreck while fire is doing just that on enough occasions that I will happily wear it.

Love the shirt, but what a stupid hat!

Hell no, you wouldn't have to live in the projects and you could play bagpipes with our Regimental Pipes and Drums, they'd love to have you.

I can set you up in a triple decker in Southie, you'll fit right in!