AZCEP

Asys, the trouble is this individual hasn't responded to anything in the last few days. Deaf ears is one thing, but I do believe that it appears we have run the troll out of here.

Get in good with the IRB? Hopefully your medical control physician would be willing to help with gathering the data. Audit of PCR's for the last 2-3 years, looking for specific complaints and treatments. When you do something that works, keep copies of the documentation so when it happens again you can compare the two. Just suggestions, but not outside the realm of possibility.

This is actually a pretty common tactic of researchers. They will discover that there is a lack of evidence in support of, or a lack of evidence against a particular item, then expand on it to say that because of the lack, the opposite must hold true. A bit of a fallacy. On occasion, you will find that the authors will mention that the lack of conflicting evidence does not mean that something has been proven good or bad.

"It is the skill, the technique, the awareness of pitfalls, and the capability to handle complications that makes the difference, not the person in possession of the skill." If more providers took this profession more seriously, and understood the quote above, maybe we wouldn't have quite so many people telling us that our abilities need to be limited.

I will hold to my opinion of success depending on the situation. Critical trauma with short transport times, BLS should be able to manage just fine. Critical medical that lacks definitive care prehospital, BLS can manage reasonably well. The longer transport times and the sicker patients tend to do better when ALS is utilized. I will also admit that I am not familiar with the systems that were discussed, but I noticed that they were focused in the eastern US and Europe. Interesting reading, but I don't think system changing decisions can be made just yet.

It would appear that our friend from Mass. has decided he is no longer able to carry himself into unwinnable confrontations without the evidence that he was searching for. I could care less, but I really wanted to make sure that he understood my description of this medication's actions. I guess I will just have to go on about my business knowing that I helped to make the City safer for those that want true knowledge.

Wow PRPG, you seem to have lost your feeling of kumbyyah. To answer the question, ALS level texts are written at anywhere from 9-11th grade level. Even worse, the subject matter has been denigrated to the point it sometimes feels like it was conceived by the same people that brought you "Steamboat Willy". The students are another matter altogether. Let someone else start that thread.

The quoted abstract is good reason to consider protocols to be guidelines rather than hard and fast regulations on how things must be done. You have got to enjoy the fact that to evaluate the situation, the researchers chose to study chest pain.

I thought that the FDA had relaxed study entry regulations for potentially life saving treatments? This makes pretty good sense.

Remove all unnecessary personnel from the area, as quickly as possible. Sounds like an inhalational agent, so everyone moves upwind, and gets oxygen Better notify the receiving facilities to prepare for decontamination possibilities. Unlikely to need much, if this is inhalational, but have to be ready with the soap and scrub brushes

We don't necessarily need physicians to advance our craft. We do, however, need more providers that are willing to take the steps to advance it ourselves.

Somewhere in the general guidelines it does say that BLS providers can perform some of these treatments, but since whit72 has apparently fallen off the planet, we will continue without him.

Honestly, I don't know enough about the Canadian system to intelligently discuss it.

I could be wrong, but I think the reports you mention are from battlefield injuries. Situations where cleaning the site, applying direct pressure, and carefully bandaging will end up getting you killed. Placing a tourniquet is much faster, and therefore safer for the providers. Of course, this is the military, so we might see some of these ideas in the future.

I'm all for increasing the scope of practice, but not under the current educational system. Hopefully, those providers that feel drug administration is not a big deal will understand it a little better. Unfortunately, the original poster has yet to comment on why he thinks we are only holding basics back by not allowing them to use this drug.

Whit, Have you even stopped to read any of the volumes of information that we have provided for you? Do you honestly not know what a standing order is? You used the Brady paramedic text. I remember seeing this discussed in the chapter on medical/legal issues. Go look it up. We will wait for you. Ace, Please, for the love of all that is holy. Limit yourself to one high-quality reference embedding in your posts. This particular individual isn't taking the hint anyway. The rest of us can follow the links. Thanks.

Whit, I am all for educating the uninitiated, but the information that you have given seems to be from a handout provided for family members of newly diagnosed diabetics. Let's go on a little journey to see how this "simple" drug works, shall we? The patient's body burns up the available sugar, and because the brain needs a constant supply of sugar, the patient quickly loses cognitive function, personality changes, control of voluntary muscles becomes more difficult, and ultimately the patient loses consciousness. Now, assuming this individual is well-nourished, the body would have released glucagon from where? That's right! From the pancreatic alpha cells. The glucagon then moves to the liver and signals the breakdown of stored GLYCOGEN through the process of glycogenolysis. Now, at the same time, the brain is sending signals to the remainder of the endocrine system to do what? That's right again! Release hormones to increase perfusion to the brain of what little bit of sugar is still available. Which hormones would that be? Why the sympathomimetics from the adrenal medulla. Our friends epinephrine and norepinephrine. Now it would be nice if these two agents could pick and choose where they want to work, but unfortunately they can't. So, widespread vasoconstriction, increased cardiac output, smooth muscle relaxation, pupillary dilation, and emesis to empty the stomach. All because the body realizes that it needs to find food, kill it, and eat it. So, now we have released the little amount of GLYCOGEN , and the body is preparing for a fight. In the event the patient is malnourished, guess what will happen. Right again! Absolutely nothing on the level of consciousness front. The adrenal response will still happen, but due to the lack of available GLYCOGEN they will remain unresponsive. The BLS provider is poorly prepared to evaluate the consequences of administering this drug. In the event of any of the other causes of altered mental status, glucagon can, and will, make a bad situation worse. Stroke patients will be the most drastically affected, due to the sudden sympathomimetic deluge that the brain is ill prepared for. Patients in shock from other causes, are already in hyperdynamic states, as such, they are already using their stored GLYCOGEN for fuel. A patient in a cardiogenic shock state, will not appreciate the sympathetic release on the damaged myocardium. Is that enough for now, or would you like me to explain how Glucagon will also work to activate the cAMP in body cells in the event of a beta blocker toxicity? Too much bad/not enough good. Very bad idea.

Read the response and you will have both of your answers.

A trained chimp can administer an IM injection. That doesn't mean he should. The problem with allowing BLS providers to expand their scope with the current levels of education that are provided is quite simply, there is not enough time to allow for a good understanding of how the drug(s) are going to affect the patient. Glucagon has a wide range of effects. The least of which is increasing the blood sugar. Too many things can go horribly wrong when using it, and the beneficial aspects aren't enough to tip the risk/benefit scale in it's favor.

The point seemed to be that a few select individuals need to look into the effects that the medications that they propose to use more closely. I will not be drawn into "bashing" any one group, because every level is guilty on occasion.

This type of discussion really disappoints the public when we tell them we really don't deal with that much blood and guts. Recently transported a mid-30s female that was mauled by dog(s). Don't really know how many attacked her, never saw them, didn't care too much. When we pulled on scene, this lady was lying on a red sleeping bag, and blended into it nicely. This was the first time I had seen a patient that had blood coming out of every section of the body. Head--yep Neck--sure thing Face--just a couple Chest/abdomen--yes, and...yes Lower extremities--who layed out the ground beef? Upper extremities--were you preparing pulled pork sandwiches? Back--I don't know how they did it, but right between the shoulder blades 5-6 punctures More blood came out when we started the IV and ran in a little fluid(<100 mL). We emptied two rigs supply of trauma dressings covering this mess.

The hospitals will have to suck it up. The 10 P1s get sent to the Level I and II centers, an even split if possible, if not more to the Level I. First accessed P1 goes in first arriving unit with a walking wounded. I'd continue this until the P1s are gone. Then P2s with a walking wounded, leaving the remainder of the P2s to the transport units left. I am glad this is being managed on the internet instead of standing on the highway. Much easier to concentrate over a Starbuck's Frappacino(sp?)

More of everything! Notify all area hospitals of size of the incident Keep your own head, while everyone around you is losing theirs. Turn over command to the first white helmet that shows up.

Surgical airways: The home version

Just a suggestion, have someone change the default settings on your LP12 so you can see more than one lead at a time. It is quite simple to do, and is well explained in the operation manual. This simple modification makes life so much easier for everyone involved. Also, if you tweak the calibration to diagnostic, and out of monitor mode, you will be able to use the ECG's that you obtain more effectively.