Your aggressiveness

[Asysin2leads]

Yes. But, in addition, most providers halt CPR during a procedure that they're not good enough at in adults, nevermind kids. So they take too long, and as we should already know, no CPR = no chance.

CBEMT, do me a favor, explain to me how those FDNY EMT's in that other thread who drove off with out allowing ALS to enter didn't do EXACTLY what you are suggesting. Now, as I said before I am not exactly sure of the facts of that case, but basically, if you were in the back, and they said "Oh, those ALS providers will halt CPR on a procedure they're not good enough at in adults, let alone kids, and as we already know, no CPR = no chance," you would be in complete agreement with them.

Explain to me how that is the right thing to do. Please. I'm all ears.

[CBEMT]

That was choking. There's a difference. They should've been given a chance to clear the airway. Please don't insult me by assuming my actions in such a situation. You can stuff that attitude.

[sevenball]

It's all about intelligent, educated, critical thinking. Something you don't get out of a 13-week Kalifornia patch factory, or a 10-month Floridia medic mill. While it is tempting to say that this capability eventually comes with experience, the truth is that it doesn't always. In fact, I'd venture to guess that less than half of the medics in this country every become competent at it, regardless of experience.

Amen brother!!!!! I've been beating that drum forever. Microwave medics can be dangerous. Aggressive medics are a double edged sword. Finding your groove is key. Above all do no harm. Be a pt. advocate, not a skills whore.

[air.stump]

Sevenball wrote:

Amen brother!!!!! I've been beating that drum forever. Microwave medics can be dangerous. Aggressive medics are a double edged sword. Finding your groove is key. Above all do no harm. Be a pt. advocate, not a skills whore.

Couldn't have said it better.

[Flasurfbum]

It's all about intelligent, educated, critical thinking. Something you don't get out of a 13-week Kalifornia patch factory, or a 10-month Floridia medic mill. While it is tempting to say that this capability eventually comes with experience, the truth is that it doesn't always. In fact, I'd venture to guess that less than half of the medics in this country every become competent at it, regardless of experience.

Sorry Dust, but I kind of resemble that remark. My school is 12 months long, and I feel that we DONT get the kind of experience, and training that we would with a longer, more in depth course. I have tried to mitigate that with coming here to pick y'alls brains, pick my preceptors brain, and get as many clinical hours as I can to see as much as I can.

Some of us can only do as well as the system will allow us....

[Asysin2leads]

That was choking. There's a difference. They should've been given a chance to clear the airway. Please don't insult me by assuming my actions in such a situation. You can stuff that attitude.

Yeah, it was choking, but the fact that the pathology is an airway obstruction may not be readily apparent. I'm just pointing out that this is a case where the current emphasis on "load and go" was not the right thing to do.

Just as there are cases where providers taking too long to secure an airway led to adverse patient outcomes, I believe there are many cases where provider uneasiness or unwillingness to perform aggressive maneuvers led to poor outcomes.

[fishman]

Just thinkin. Remember, I think even BLS class shows that BVM is great for Peds. Most kids that get good resp, and hopefully the problem identified/fixed, bounce right back. Still, nothing wrong with preparing equip just in case.

If the Pt NEEDS it, do it, sometimes "less is more"

[fireflymedic]

Nothing wrong with being aggresive - you need to be decisive and sure of yourself when in difficult situations. That being said, you better know your limits ! If you aren't comfortable with it, you better have a back up or don't do it !

As far as the pedi situation, the trend is definitely drifting away from intubation. As dust and others have said, it's getting lower and lower on the list which makes me curious as to why more and more services are pushing for aggresive airway protocols (ie RSI). Yes, there is a time and place for it, but I'm seeing more and more that are simply doing things because they can. My service has very progressive protocols especially for a ground based service, probably the most aggressive in the state. However, we better be able to justify what we did and why. We are constantly reminded that the least invasive treatment that provides the most benefit to your patient is best. I don't believe it could be said any better. Just because you have the toys doesn't mean you have to play with them.