tcripp

Especially when they are girls and getting close to puberty.

RSI is in our protocols - paramedics push the drugs and intermediates can do the intubation. Drugs include lidocaine, atropine, fentanyl, etomidate, succinylcholine, vecuronium and versed.

My sarcasm is usually followed by a smiley. Not sure which smiley for sincerity. I was, am, being sincere. But, I will explain why I thanked you for the statement. I have been working with EMTs who do have many years of experience who, on occasion, do as Ash did above by just doing what they think instead of conferring with the lead medic. What happened to a team approach? Why not ask your medic if he's not already thought about that or, maybe just maybe, blood sugar was at the bottom of his list of Hs and Ts. The other day, we had a patient that had crapped out on us...hyperthermia. My ILS partner was starting an IV and I pulled the catheter that I wanted used. Low and behold, my partner grabbed a larger catheter and decided to use that instead completely disregarding my approach to the treatment plan. Not a huge ordeal with the exception that I'm the one who is ultimately responsible for the patient and will have to explain if anything goes wrong. A simple "are you sure this is what you want" would have been more appropriate, in my opinion.

Thank you.

My responses are imbedded in your quote, in bold/red.

Not a chance. I'd do experience before school again in a heart beat.

Any chance you called the receiving nurse back for follow-up? Find out what exactly had happened?

I didn't respond to your initial question because I'm in a decent position where working for me is an option. (Married, 2nd income in the family, living below my means type of deal.) So I don't think I would be a fair representation. However, would I give up my shift if it were my sole income? I'd like to think that I would, but I can't say for sure. But, I do not necessarily like "seniority rules" at all. Why is it that the guy who's been with the service for 15 years barely skating by (performance wise) should get preferential treatment over the newbie who is desperately trying to make ends meet? Ultimately, they are both trying to feed their family. Now what I know I would absolutely do is take a pay cut across the board. A simple straight percentage across the board would be the fairest way to approach the situation for all concerned...in my opinion.

Brian, absolutely not in the least lttle bit. I'd like to understand why you guys do it one way and we might do it another. 98% of the reason I "sit on a forum" is to learn new things. It gives me a good starting point for research. The reason this thread started? My ILS partner made a comment that she "always" cleans with alcohol and then iodine unless there is a known allergy. She couldn't tell me why, just that was they way she was taught. For a simple IV start, I use alcohol unless the person is darker skinned and then I use the betadine to help me see the veins. (It's quite a neat trick if you've never tried that before.) For our blood draws, I use betadine but its not usually preceded by alcohol unless I need to make sure the skin was clean first. So, I'll continue my research if you'll let me know why you do the betadine first.

Just to clarify...iodine and then alcohol?

You think a 24 hour shift is incredible? Some of us work 48 hour shifts. I work a 48 hour shift and I love it.

Gotta love the CDC: Guidelines for the Prevention of Intravascular Catheter-Related Infections - http://www.cdc.gov/h...elines-2011.pdf Excerpt: Skin Preparation 1. Prepare clean skin with an antiseptic (70% alcohol, tincture of iodine, or alcoholic chlorhexidine gluconate solution) before peripheral venous catheter insertion [82]. Category IB 2. Prepare clean skin with a >0.5% chlorhexidine preparation with alcohol before central venous catheter and peripheral arterial catheter insertion and during dressing changes. If there is a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70% alcohol can be used as alternatives [82, 83]. Category IA 3. No comparison has been made between using chlorhexidine preparations with alcohol and povidone-iodine in alcohol to prepare clean skin. Unresolved issue. 4. No recommendation can be made for the safety or efficacy of chlorhexidine in infants aged <2 months. Unresolved issue 5. Antiseptics should be allowed to dry according to the manufacturer's recommendation prior to placing the catheter [82, 83]. Category IB

http://www.purduepharma.com/PI/NonPrescription/A6910B13.pdf No specific time frame identified.

While not my original question, your statement encouraged me to do some research...so I'm learning today which is never a bad thing. Since I was under the impression that chloraprep was used for things such as blood cultures and not for simple IV or even SC/IM injections, I had to do a little reading. Based on this site, http://www.chloraprep.com/, it reads that a chloraprep (which containes a 2% Chlorhexidine Gluconate/70% Isopropyl Alcohol formulation) "requires two minutes to begin antimicrobial activity". So, for every IV that you start, you wait two minutes? If so, can I assume you are cleaning the site prior to applying the constricting band?

When you clean your IV site, what is your method for cleaning? Alcohol alone, betadine alone or both alcohol then betadine?

For our service, we don't have glucagon at all. Aside from price, the fact that we probably would have used it maybe once in the past year AND the fact we are about 20 minutes from a local facility...it's not effective if your patient has already used up their glycogen stores which is what would happen in your patients with insulin pumps that have gone screwy. We have IOs, but (as I've mentioned before) is not to be used for D50 unless we truly believe it is life or death and with that we must call for orders. (It's one of the few things that are a clear black and white in our guidelines.)

Only time I have used it was for esophageal choking. And, it did help to some degree.

Welcome and, before I forget about it, Happy National Public Safety Telecommunicators Week (aka 'Dispatchers')

Don't let age be a huge factor in your decision. Some of the better medics (IMHO) coming out of school are a little gray around the temple. They have good life experiences behind them.

You have definitely asked a question that is a huge controversy, at least in my neck of the woods. But, my recommendation follows pretty much what Chris has stated. If you are in no hurry and can spend some time in the field, then I would do that. Not only will it make you a better paramedic in the end, it will also help you to get a job. As to getting your AEMT, I actually think it might benefit you although I got my intermediate 1 year prior to getting my paramedic and only used that level 2-3 times. That being said, it was 2-3 times more than had I not. Not to mention, I would not have passed up taking the national registry which made going through the skills testing at a paramedic level less traumatic. I also recommend you get as many of the pre-reqs done up front. You will find the program to be a little to easier to understand/comprehend. (I had my Math/English completed, but struggled with doing pharm/A&P as co-reqs). As to how long to stay at the basic/intermediate level...only you can determine that one. I spent 2 years as an ECA before moving to Basic. Spent 2 years before becoming an Intermediate. So, by the time I graduated the program, I had 6 years under my belt. Now, I've been a paramedic for 1 year but I have 7 years of service. I think it's fantastic that you are looking at what will make you a better medic and less at how soon you can get a paying job. It's good you are in a position to make that decision. Good luck on whatever you decide.

No Zantac here...just diphenhydramine (in addition to epi, albuterol and solumedrol). Since the Benadryl seems to be a standard in these parts, I'm curious to know what are you hoping to gain by going with this drug? Are you looking at adding it to the Benadryl...or instead of?

And we only have the Zofran. I wish we still carried the Phenergan and had the option. Especially for the patient who is allergic to one of the two...and we are on a long haul (1.5 hour drive).

Glucagon is used by several services in my area with IN as an accepted route. It's rate of absorption is equal to or faster than that of IM not to mention, why stick the patient one more time if you don't have to. Now, I do not have the data to back it up other than the fact that I can find, online, other services who do administer it that way. But...to your question posed (as quoted above). I'd like to answer your question with a question. Why isn't IN administration a standard everywhere? There are just some medical directors who aren't comfortable with this particular item and since we require their "okey dokey" to practice, we do what they want. That holds to many other treatments as well. My service does not have IN as an option and that includes Versed to help sedate a combative patient. Regardless, if I can't get an IV for Valium (...um, needle near a comabtive patient), then my next alternative is Versed IM (yet another needle near a combative patient). Just because it's not accepted EVERYWHERE doesn't mean it is necessarily a bad thing. ***Ugly, thanks for starting this thread. I started to yesterday and then got distracted by bright, shiney things.

I appreciate what you are saying and want to clarify that I don't think that EMT-Basic's should be pushing this med. They don't have IV skills so IV meds should not be a part of their sill set. However, with that being said, EMT-Intermediates or the new national registry Advanced EMTs, already have the capability of pushing a number of meds in a number of routes. What I am trying to ascertain is this. Are there other services out there who currently allow this particular position to push this particular drug? Thanks to one of our posters, Utah has some very aggressive protocols (http://health.utah.gov/ems/emsc/ems_provider_reference.pdf) that could scare you where Zofran can be delivered by a lower level. (Also, I firmly believe that instead of allowing lower levels to do skills "just because there aren't enough upper level" is not the right way. We should be figuring out how to get more upper level...)