hertzvanrental

If the patient is ill enough to require an IO chances are they usually don't have 4-5 minutes spare. Especially if they are conscious and in agony. They want their morphine now not 5 minutes later. We got EZ-IO in 2005 with lido but had lido removed last year so won't know about leaving it for 5 minutes. I thought it would be quicker onset. When I suture or use a digital nerve block I find lido works very quickly

Here in the UK (in my service, formerly Sussex, now SECAMB) we got EZ-IO on every vehicle. We also had lidocaine 1%. Recently it was removed because it was found to make very little difference. I have to admit that I agree. I have used the EZ-IO in conscious pts and even in some unconscious pts their leg will raise up when pushing fluids or meds despite lidocaine.

There aren't many patients that really benefit from prehospital iv fluid. Trauma for a Start, particularly penetrating trauma. The first clot is the best so why risk blowing it of with Salty water! IV TXA, pelvic binder and traction splints for femoral fractures and get them into surgery. Also think about how permissive hypotension may benefit certain too. DKA, do you really want to fill patients up quick? No. I'm not saying IV fluid doesn't have its place just not in the excess that it's currently used. Here in the UK we've eased right off. However my last patient today had some Ns, morphine, ondansetron for their acute pancreatitis!

Difficult really but I tend to agree with ER Doc. We don't know what her BP runs at normally and some patients with known HTN won't/don't tolerate a "normal" BP. Can we predict how much of a drop in pressure there would be post iv beta blockers? And as stated before she was mildy symptomatic. I'm in no way saying the OP was wrong in their treatment, it sounds like they did a great job with the pt, just saying that it's a tricky call to make. And as ER Doc stated there didn't seem a huge urgency to treat there and then. I can't remember but did she have chest pain? If so then that may warrant iv beta blockers in the field. Out of interest do any of you guys out there perform fundoscopy in the field? Anyone checking for papilloedema? As it's part of my scope of practice then I would be checking for optic disc swelling etc etc.

You risk an uncontrollable and potentially rapid decrease in BP by giving sublingual nitrates. With the potential for disastrous consequences. That is why hypertensive crisis is best treated in hospital. I'm only talking of symptom relief if required. You're not going to prevent end organ failure on a 5 minute ride to the ER. Morphine actually blunts vasoconstriction. Sub arachnoid bleeds and head injuries receive morphine with caution. And I'm not talking about loading someone up with 10-20mg, I'm talking 2mg-4mg to give some relief. A small dose like that is highly unlikely to be detrimental to the patient's BP

Iv paracetamol (or morphine titrated to effect) and Ondansetron for symptom relief. Monitor and transport. Avoid nitro, dangerous and outdated practice with regards to managing HTN in the field. You've got no control. What is the rationale for treating HTN in the field?

We have it here in the UK. My service was one of the first. Used it quite a bit. We obviously use it in Trauma but is also now indicated for post partum haemorrhage (we've had syntometrine removed and are not getting misoprostol), internal bleeding etc. In fact used it 2 nights ago. Eastern European guy was beaten by 6 guys and left for dead. Had lost about 600ml on the floor from a mouth injury. Had to suction him, apply constant direct pressure en route to the ER/AE. BP was down. Treated with fluid and 1g IV TXA.

Have a camera on a tablet so a Dr can interview the patient! WTF! Train staff appropriately and have alternative pathways so patients can be referred on if required. No good trying educate the public, the great unwashed are too stupid or can't be bothered to even listen.

The first paramedics are trained in England - British heart Foundation The first paramedics are trained in England A traumatic episode at a patient's home leads to a new training course for paramedics in England. In 1965 we helped Dr Frank Pantridge to launch the world's first ambulance-based resuscitation service in Belfast. Four years later Brighton-based cardiologist Professor Douglas Chamberlain was inspired to build on Pantridge's work after a catastrophic consultation in a patient's home: 'As I examined the patient's chest he apparently died. I started vigorous chest compressions and commanded his wife to dial 999. After what seemed a very long time I heard the two tone of the ambulance. The driver came in and I said, "Where's the defibrillator?" He said, "We don't have it. We have to report back to the Medical Officer of Health who will decide whether to send the coronary ambulance."' After another wait, the right vehicle actually arrived. The defibrillator was brought upstairs, plugged in and turned on, 'and there was a great explosion,' remembers Chamberlain. 'Clearly water had got into it. I later learned that where it was kept had a leaky roof. It was quite a major bang, a lot of smoke. It was an awful thing; it haunts me still.' The day after watching his patient die in such awful circumstances, Chamberlain told the Medical Officer of Health he wanted to shake up the system and train ambulance staff to do what Pantridge was doing in Belfast. 'And so we took the first six people from Brighton ambulance station in the first week of July 1970, and I very quickly had a six-month course mapped out. So by the end of 1970 we had six trained men - we didn't call them paramedics then. I went on giving that course for 26 years, every six months.' Such schemes multiplied through the 1970s and 80s, maturing into a national training scheme. Image: Professor Douglas Chamberlain The first paramedics are trained in England - British heart Foundation - 50th anniversar

The POP video was great. What a great bunch of doctors. I know it was about US prehospital care but it's a shame they didn't get together with likes of Professor Douglas Chamberlain who was a cardiologist in Brighton, UK. He had a similar idea in the late 60's but due to politics couldn't the programme up and running til the early 70's. He's our honorary medical advisor still. Had the privilege of being taught thrombolysis etc by him. Wonderful man as I'm sure his American counterparts are

Ridiculous and unprofessional! However obviously not a stroke then! O2 in a stroke, was she hypoxia then???? Highly doubt it................. Ridiculous and unprofessional! However obviously not a stroke then! O2 in a stroke, was she hypoxia then???? Highly doubt it.................

All the above Can he straight leg raise? Urinalysis etc etc Altered neurology (Inc the left leg), reflexes Full family hx re: cancers etc CVA tenderness Hx of recent trauma, exercise

Hi here's a list from the UK of what our services are using: Activated charcoal Atropine Adrenaline Amiodorone Aspirin Benzylpenicilln Buccastem Chlorphenamine Cyclizine Diazemuls Dicobalt edetate. Entonox Furosemide Glyceryltrinitrate Glucagon Glugogel Glucose 5% Glucose 10% Heparin Hydrocortisone Influenza Vaccine Ipratropium Metoclopramide Midazolam Morphine Sulphate Nalbuphine hydrochloride Naloxone hydrochloride Obidoxime Ondensatron Oramorph Oxygen Pandemrix Paracetamol po & iv Prednisolone Prochlorperazine Salbutamol Sodium chloride Sodium lactate Sodium thiosulphate Stesolid Syntometrine Tenecteplase / Reteplase Tramadol Tranexamic acid Paramedic practitioner/Emergency Care Practitioner list: Aciclover Amethocaine Amoxicillin Benoxinate Cefalexin Cetirizine Chlorphenamine maleate tablets 2mg/5ml Chlorphenamine maleate tablets 4mg Chlorphenicol 1% eye ointment 4g tube Ciprofloxacin Clarithromycin Co-amoxiclav 125/31 suspension Co-amoxiclav 250/62 suspension Co-amoxiclav 375mg tablets Co-codamol 8/500mg tablet Co-codamol 30/500mg tablet Codeine phosphate Dexamethasone Diazepam 2mg tablet Diazepam (IV sedation) Diclofenac Suppository Diclofenac IV Domperidone Doxycycline Erythromycin antibiotic 250mg Flucloxacillin antibiotic 250mg capsules Flucloxacillin antibiotic syrup 125mg/5ml Flucloxacillin antibiotic syrup 250mg/5ml Fluroescein 1% eye drops minims Fucithalmic Ibuprofen suspension 100mg/5ml Ibuprofen tablets 200mg Instillagel Lidnocaine (pre-filled syringe) Levonorgestrel Lidnocaine Hydrochloride Locorten-Vioform Loperamide Metoclopramide Metronidazole 200mg tablet Metronidazole 400mg tablet Morphine Sulphate (IM) Naproxen Nitrofurantoin Nystatin Oxybuprocaine 0.4% eye drops minims Paracetamol tablets 500mg Prochlorperazine Phenoxymethylpenicillin Prednisolone Prochlorperazine injection Revaxis Tetanus/Diphtheria Tramadol Trimethroprim. CCP: IV Co-amoxiclav (open fractures) ephidrine IN diamorph Calcium chloride Diazepam for conscious sedstion Flumazenil Ketamine Mag sulphate Midazolam Sodium bicarbonate. HEMS: RSI drugs octiplex (for warfarinised head injuries) O -ve blood Hope this helps

but in this situation where is an "area" that it shouldn't have been? Over here, sure the traffic cops want the road open ASAP, they also appreciate that the patient will always and does come first.

Forgive me if this has already been posted (I could'nt find it). But what is wrong with some of the cops on your side of the pond? http://news.sky.com/story/1207268/cop-slaps-cuffs-on-firefighter-at-crash-site https://www.youtube.com/watch?v=5OVCbadSqQg