Be a kind medic

[tniuqs]

RSI without paralytics. most protocols i've seen up here have *sedate, *attempt, *paralyze if required, *attempt, for the flow chart.

Ah could it be that your topside medical director is not giving you all the tools you need to do your job or is he/she have a background as a G.P. ? that said, my personel preferance remains use only as much drug(s) as needed, but not having the "Hammer" is reactive Paramedicine not proactive and can really complicate the RSS senario when your at upper limits of versed and narcs .... IMHO.

Hopefully that will be corrected when new provincial protocols are finally approved.

One issue not discussed is that of major burns where eletrolye shifts are likely and SUX is a relative contraindication.

cheers

[Timmy]

Good Lord!! :shock: :pottytrain5:

[tniuqs]

Good Lord!! :shock: :pottytrain5:

Ok explain that comment boy wonder ... I don't speak OZ remember?

and are the paparazzi still after your every move ? te he.

[fireflymedic]

Squint - you have varying options for paralysis besides sux - our alternative is Roc which I don't have an issue with except the average down time is 20-30 min. As CB so well stated, I'm not a fan of snowing patients to get the tube. I'd rather do it right and be done with it rather than snowing them, attempt, have them gag, puke, and have to deal with possible aspiration. That's exactly what we are trying to avoid, so why promote a procedure which encourages it? RSS really has no place in EMS - I see it as an all or nothing. If we are going to have RSI, have it, but have the proper training and controls in place or don't have it at all for those idiots that refuse to function at the level required IMHO. In reality though, outside of CCT or services that run high trauma - how many RSI's do you get that you TRULY need? Even within that realm I don't see very many so I'm really not convinced it's something that everybody needs to "run out and get"....just food for thought.

And here's another thing we haven't discussed - what if you don't get that tube with RSS? You bump or irritate the chords enough for a spasm, well you're either waiting and praying OR you have to move to a cric. Neither of which is a great option. Definitely things to think about here people and discuss within your services.

[tniuqs]

Squint - you have varying options for paralysis besides sux - our alternative is Roc which I don't have an issue with except the average down time is 20-30 min. As CB so well stated, I'm not a fan of snowing patients to get the tube. I'd rather do it right and be done with it rather than snowing them, attempt, have them gag, puke, and have to deal with possible aspiration. That's exactly what we are trying to avoid, so why promote a procedure which encourages it? RSS really has no place in EMS - I see it as an all or nothing. If we are going to have RSI, have it, but have the proper training and controls in place or don't have it at all for those idiots that refuse to function at the level required IMHO. In reality though, outside of CCT or services that run high trauma - how many RSI's do you get that you TRULY need? Even within that realm I don't see very many so I'm really not convinced it's something that everybody needs to "run out and get"....just food for thought.

And here's another thing we haven't discussed - what if you don't get that tube with RSS? You bump or irritate the chords enough for a spasm, well you're either waiting and praying OR you have to move to a cric. Neither of which is a great option. Definitely things to think about here people and discuss within your services.

I do not disagree with what you are saying, but my world is not Black and White ... its all GRAY.

Oh I so fear incoming from dust with those racest remarks lol.

I would not say that outright that RSS or Facilitated Intubation has no place in EMS at all nor quite so profoundly but solid background in ICU sways me a bit that said.... "WE" meaning Freak and myself our enviroment(s) are quite different, ie tubing an in patient thats in renal failure and PH is no longer compatable with life, (npo for 2 days) on interfacility transport with the MD not available for an hour to get to ER, this is the life as we know it.

Having the latitude to use Guidelines and not strictly Protocol, I know from this thread have gone the other route as well, just Paralytics alone ....but this could be (my hope) an education issue not pocketing the narcs situation.

[chbare]

With Sux and burns, I suspect we are concerned about hyperkalemia? This is not usually a concern immediatly following the burn. After the first 48 or so hours it could be a problem however. I have used Roc as an alternative with good results. More recently used it on a hyperkalemic patient in acute renal failure, among many other problems.

One thing to always file away is the possibility of severe allergic reactions to NDNMB's. Especially now that roc seems to be drug of the year in the USA. Now that sugammedex is on the up and up, who knows what will happen with the NDNMB market.

Take care,

chbare.

[Dustdevil]

I think the title of this thread misses the mark completely.

This isn't about being kind. This is about being intelligent, well educated, and professionally competent.

The medic in the original story was none of the above.

[tniuqs]

Here' s the best point of this thread, a proffessional exchange of ideas, not a slag contest !

cheers

[Timmy]

Ok explain that comment boy wonder ... I don't speak OZ remember?

I’ve only been trained to use OPs, NPs and LMAs so I’m way out my depth talking about this as RSI/ETT will not be taught till I’m way older and have way more experience and education.

I think common sense is severely lacking in this scenario. I’m not quiet sure what the patient is presenting with to warrant RSI but there are some no brainer things to follow. I haven’t been trained in RSI and only know as much as I’ve read in my spare time but administering a paralytic without a sedative (if I’ve got that right) just doesn’t make sense.

Anywho, I agree with what’s been said already. If I was the patient I would sue.

and are the paparazzi still after your every move ? te he.

Indeed, I beat them away with a stick.

[badmedicine]

A lot of this boils down to giving medics tools without education. I use to work for a service that as long as you had a card you could get on a truck and do anything with in our protocols. It was assumed you knew what you were doing. The service I work for now has a senior medic program. You need to have passed a test on things like RSI, Retrograde airway, ect. and then be checked off by another senior medic or training personnel before you can do these procedures.