Nitro with a right sided MI

[DwayneEMTP]

I am all about knowing as much as you can, it definantly makes a medic more confident in his treatment.

Sorry man, I got distracted. The whole "infectious disease in EMS" thread is getting on my nerves... :wink:

But I agree with you here. The more you know, the more cloudy everything gets...for a while...then it opens up whole new vistas of ideas! Pretty cool!

So do you get the same preceptor for a set amount of time?

Yeah. We have a minimum of 500 hours preceptorship, 300 in the hospital. Our preceptorship is broke up into four phases of 125 hrs each. They should all be preceptored by a different medic. I've had 7 or 8 now as some left for other states, a couple left to teach, etc.

I know a lot of times in class our patients "die" when we do improper treatments, but I can't image that it happens every single time in the real world. I don't think it helps things, but it doesn't always "kill" them. Of course in class our scenarios are a lot of times based on the patient being on the verge of dying anyways

That's one of the beefs I had with school actually. Pts are near dead and then we make 'em hunky dory, or they are fine and we kill them. I've found the influence we have mostly, not always, is usually baby steps in the right direction. I give nitro, lasix to my pulmonary edema, apply CPAP and somewhere near the hospital he gets a little better...know what I mean?

I can't really see much in ems that is x leads to y leads to z, and so on and so forth, all I see is a bunch of grey area.

Yeah! Giving fluid to hypovolemia is good! Unless we raise the BP above 90 systolic and blow their new clots, which is bad. So we keep it lower, and don't perfuse the brain with ICP-Way bad! So we raise it a little to perfuse the damaged brain-Good! But we dilute the clotting factor and they stroke...way, way, bad.

Is that what you were thinking of? I now find that I love the physiology puzzle...but it scared that pants off of me in the beginning!!!

I like your ideas, and the way you think. Thanks for sharing your thoughts with me.

I have to hit the sack...off to work early tomorrow...I'll look back during the day if I can, if not then in the evening...

Have a great day!

Dwayne

[Ridryder 911]

Dwayne, it sounds like you have the makings of a great thinking Paramedic. It reminds me of myself during my education (and continuous) process, I analyze things to death. Of course I was challenged by my professors to do such. I believe this is why I still enjoy the challenge of medicine still today...

Don't feel bad, you have the typical syndrome of receiving overwhelming information. As one of my Paramedic Professors used to say..."If it feels like we are force feeding your brain with information through an NG tube, then we are doing our job well"... . As someone mentioned the light bulb does come on.. sometimes in the most unexpected times and places.

I believe in the House of God methods.. if no IV then create one. I am not too proud of establish an IJ on a conscious patient or if need be an EZ I/O (p.s. 1 mg into a liter presents a good analgesic effect of the process and pressure infusion). Remember, I was a burn nurse and nothing is sacred. I've even started them in dorsal penile veins.. hey a vein is a vein, when everything is burnt.. Yeah, thank goodness for I/O's!

The point of the original post was it not so much bad care, as it was inappropriate care. The medic (from what was posted) apparently is not abreast of good thorough cardiac care. As well, it speaks poorly on their system to pair up newbies together... God help them & the patient.

R/r 911

[chbare]

Good points. This is yet another concern I have regarding all of the EMT training I have completed. The scenarios and situations are canned to the point that you literally have to follow one path to the letter or your patient dies. I understand that giving a novice a set of standards and guidelines to base care around can help with learning; however, at some point we need to take into consideration reality. I find there are three patient types:

1) Patients that will do poorly regardless of your interventions.

2) Patients that will do well regardless of your interventions.

3) Patients that can go either way.

Take care,

chbare.

[fireboz184]

where I work, if a patient has had nitro before, we can give it without a IV established if the BP is 100 or higher, which was not the case, also, we do not give ntg for pt with right sided MI's. we do have IO's for adults here, is this an option? if you take the time to do a diagnostic test, you should probably base your treatment on your results. [/font:25a4a95211]

[Dustdevil]

if you take the time to do a diagnostic test, you should probably base your treatment on your results. [/font:1c9d172e93]

That's a good point that it takes a new practitioner a long time to actually realise. We ask so many questions and do so many tests during our diagnostic exams. But with that knowledge comes responsibility. You can't just ask a bunch of SAMPLE AEIOUTIPS DCAPBTLS questions out of your cookbook and then not be assimilating that information into a competent plan. You have to UNDERSTAND the implications of your findings and adjust your plan accordingly. If you go performing monkey skills on your patient because you think your protocols allow it, and then chart physical findings that clearly contraindicate your treatment, you're not going to keep your job for very long. We see this happening almost everyday here on EMT City, so you know it is a huge problem on the streets.

I also agree that I probably would have gone with an IO on this patient before I shot for a jugular or central line. Less risky and a lot more expedient.

[DwayneEMTP]

Ok, again my apologies for the above post that was supposed to be a PM. :oops:

I think I've got it figured out. I went into the "quote" function to cut it out and paste it into the PM, but decided to edit it first, and THEN cut it into a PM, Lost my focus and got both brain cells concentrating on different things, forgot that I never actually cut it out and moved it....and wallah!

See, simple! :?

Sorry all for littering up the thread. I'll try and pay better attention in the future.

Dwayne

[small-T-medic]

If I understand correctly, then Medicgirl84 is BLS qualified. If I'm wrong about this then please forgive me. And before I continue, Medicgirl84, please don't take offence to the following. It's purely a statement and a rule I live by, especially coming from a training environment.

I try never to listen to the comments that are given by an individual of a lower qualification about an individual of a higher qualification. In South Africa, this would be construed as "spreading unfounded illusions about the probity of an individual registered with the HPCSA (eventhough no information leading to the possible knowledge of the medic in question may have been provided)" in which case, that individual would then also be investigated. What Medicgirl84 did here, did not start off as wrong, but, in my humble opinion, has been taken to the level of "wrongness". I agree with coming to the forum to post the topic, and thereby getting the opinion of other individuals of equal qualifications, but from what I can tell, this is continuing on to bad mouthing of said individual.

I understand your frustrations regarding your partner, Medicgirl84, but in my opinion again, if you felt that this medic is not performing up to a standard that has been predetermined, then it is your obligation to express your concerns to a higher authority (which, as far as I can tell has been done), and provide eyewitness accounts to any further questions that may be directed to you. Not "bad mouth" your partners 3 attempts at the IV (we all have our bad calls), etc.

[ozzieambo]

We do things a lot different here in the land down under. Just from your description you pt sound classic cardiac to me. For us straight on to high flow oxygen minimum 6ltr probably 15ltr on non rebreather mask based on colour of pt. All chest pain/suspected AMI get asprin (ASA) Nitro only if Bp higher than 100. morphine 2.5mg (can be given IM if no IV access) if not then IN Fentanyl or methoxyflurane (penthrax) for pain relief. By the sound of this pt we would of passed a code 3 (pt report to hospital) and rapid transport.

Sounds like you need to cover your arse everyday at work. Keep track of things that go wrong and report if needed. Who cares if you are meant to be the junior officer we are talking about peoples lives here....

[john_boston]

There is this new fangled (yes I said fangled) drug called ASA. Funny enough it is actually the BEST medication that most can give prehospital for these kinds of patients. ASA actually reduces mortality, nitro (regardless of patient) and analgesics do not.

ASA and oxygen with a proper history and monitoring are fine.

Hilarious. I don't know how the OP could work with such a medic. It's amazing some of them can pass certification.

[Riaan]

Hi all, I am from South Africa and a E.C.P - A (Paramedic) and R.M.I. when given Nitro can kill pt. I work in rural era and the closest cardiac center is 3 and half hour drive and flight time a hour plus. When you have a cardiac pt we have set protocols as how to treat, the fact that you were 45min away from hosp does not change the fact that as a medic you treat to the best of your ability and when in doubt you ask! I was not on scene but as a paramedic in a province with almost no paramedic's you do your basic's and make a diagnosis on your findings and treat accordingly.

I would have started as the medic from down under with high concentration of O2 which funny enough is the BEST treatment and I am not sure how your qulifications work but even if you are not allowed to place I.V.'s he as a paramedic have a number of different sites for IV placement surely. emtgirl84, I have noted that when one asks a lot of questions (why ?, ) the medics we work with are careful and stays updated! Yes I know that not all medics including paramedics like lower qualified personnel telling us but you will see a change in your partner just same advice. Please understand it is only my opinion but I think that because we work with people that does not stay current or attend updates which there skills get tested and they have to pass the exams the above mentioned will keep on happening.