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I agree with flightmedic. As long as ET is considered the definitive airway, I will always attempt it first and foremost. We have protocols for our ALS fire depts to use king airways in cardiac arrests as their first line airway, but only during cardiac arrest. Meanwhile, our MICU units (just another fancy name for ALS dual paramedic units in Texas) carry kings but consdier them secondary if ET is unable to be obtained. The main problem I've been seeing (and other veterans too) is the tendancy for new medics to skip harder to master skills like ET and IV (compared to IO drills) especially EJ's in favor of these 'easier' skills. Then these medics go years without masatering the essentials and when they're leads and the shit hits the fan they and their newbie have a very small tool box. I've been in this biz 19+years and I don't allow any medic I FTO to skip an EJ or an ET attempt, ever. Even if it ends up FPO, they're still getting that attempt under they're belt before I allow them to try secondary adjuncts. All the fancy tools and such in the world will never take the place of a seasoned medic with an ET tube or an IV cath. with a critical pt. They're all tools and they have they're place and they all need to be mastered.

Great post Asys, its hard to think or somethimes say outloud, but the fetus really is a secondary consideration with this case. Maternal well being = fetus well being period. Utilizing what medications most ALS unit have, starting Mg++ and benzos are your best route right now. Although I do suspect that most ALS units dont carry enough Mg++ to effectively cease her seizure activity. I also would quickly take the RSI path, hypoxia will be detrimental to both. My personal thoughts on community ED vs women/infants center is mixed, if I could successfully secure airway and begin ventilation, was well as decrease seizure activity I would continue to tertiary care. I think what a community hospital ED would give you would be access to airway management (if needed) and an expanded pharmacy to treat seizure activity, but would they be able to perform an emergent c-section if needed and what about neonatal resusciatation? Very difficult questions, I am glad this case has give opportunity for so much thought. J, I agree the best treatment for this patient would be delivery.

28 weeks is the beginning of the third trimester, and while its past the cusp of extra-utero survivability, but still young enough that some development normally still occurs, such as formation of pulmonary surfactant and the like. Teratogenic means literally, giving birth to a monstrosity, and in parlance means it can cause birth defects, such as the children born to mothers who took thalidomide being born with no arms, and babies born to mothers who came in contact with finasteride being born without genitals. At 28 weeks there's not any chance of not developing limbs or genitalia, but I imagine a teratogen could still cause you some problems in utero. From this article I found it says that after the embryonic stage at 9 weeks, "Teratogens taken during this period can result in improper organ functioning, delayed growth, but seldom result in birth defects" I fully agree that if push comes to shove we need to focus on the mother's survival, but I'm still wondering if diverting to the ER round the bend couldn't provide us with better options. I doubt it. From my better understanding of how teratogens affect development, I think the risk is fairly low to the fetus at this stage, so I'd probably start the mag as soon as the seizure started, and if it was still going on after 5 minutes or drop some diazepam and cross my fingers. Here's a link to the article I got my information from, though I should warn you that there are some pictures of birth defects that might give you the willies: http://wikis.lib.ncs...pment_in_Humans I've dealt with one full blown eclampsia case in my career and it was a doozy. The venous pressure was so high it shot the IV catheter out and the blood spray looked like something from Saving Private Ryan, and no you wiseasses, it wasn't in an artery. We did the mag and benzo routine, we were able to control the seizures and get to a specialty hospital, but I never found out how the case turned out.

Welcome, never stop learning. I am an EMT B and have been in EMS for over 25 years.

Welcome Mr. Swint, Jump into the discussions and enjoy!

Based on the above question, I'd say it really comes down to the medic's experience running the call. I would not allow an inexperienced medic to attempt one of their first RSI's on this patient if I were their FTO. No arrogance intended, but I have top notch intubation skills (years of practice) and even I'd been hesitant to intubate this patient unless it were absolutely necessary. However, if you're going to protect the airway, if she's that critical, it's best to go all the way and get it right the first time. Secondary airway adjundants (even with NG tubes) increase aspiration risk when they're removed and they will be once you hit the ER. If diazepam doesn't stop her seizures and her bp keeps raising (whether or not your service can effectively treat it) her neurological functions need to protected, thereby hopefully protecting the fetus. Any medication cross over to the fetus is secondary at this point because they're dying and in the box our options are limited. This is kitchen sink time; you save the mother life/quailty as best as you can and hope to hell saving her saves her baby.

Wait a minute, I thought I was married to the greatest woman on the planet....you mean all this time I've been living a lie? Sob... Oh, the humanity. Sob.. Oh, and welcome to the forums. Sob.. Gonna go hide my head in a bucket and hit it with a hammer for a while. Okay, I'm better now...after a half dozen raps with the hammer i realized that I'm married to the greatest woman in the UNIVERSE!!!! So there too!!

Jason, Welcome, you will find some of the greatest info on these boards. Joined EMS when I turned 60. Was involved in so much other stuff earlier, just never had the time. I still wonder why I waited so long and put the other stuff aside. I have alwys been interested in EMS but never persued it. One day I was on my way home and the sign in front of the ambulance company caught my eye, so I asked myself, Why not?? I am an EMT-B in Medford NY and I am sorry I didn't do this earlier. I work with different age groups, and get to learn a hell of a lot. Keep Learning and kep an open mind! JMHO..

Welcome.

Three Words: Mobile Health Services. Expand the role of EMS to MHS that enables the paramedic to provide treatments in the home and reduce needless trips to te ER.

Herbie, I'm not saying paramedics shouldn't be able to. Like others have said, most of it is basic stuff. The thing that would make me concerned is giving out medical advice. As Dwayne said, there are so many differences in the training that paramedics receive from state to state, county to county. You guys are awesome at knowing everything there is to know about resuscitation drugs (hell, you guys could probably teach me a few things). Counseling people about medications can be on a slippery slope to practicing medicine. Do I think paramedics are capable of it? Absolutely. Do I think that with the huge variation in training it is a good idea? I'm not too sure about that.