Eydawn Posted April 10, 2008 Posted April 10, 2008 So sue me I didn't see the "no air support" blurb. Lol... So why not? Just outta curiosity... is it a terrain thing? I'd be trying some warm compresses to the muscular areas that are painful. Stick hot packs down w/ tape with a layer of gauze between their bare skin and the hot pack. Got any sedatives that might help calm her? Wendy CO EMT-B
spenac Posted April 10, 2008 Author Posted April 10, 2008 So sue me I didn't see the "no air support" blurb. Lol... So why not? Just outta curiosity... is it a terrain thing? I'd be trying some warm compresses to the muscular areas that are painful. Stick hot packs down w/ tape with a layer of gauze between their bare skin and the hot pack. Got any sedatives that might help calm her? Wendy CO EMT-B No air because there is no air in my area, but that is changing. A fixed wing is opening this month about a 40 minute flight to our airport, then a helicopter is supposed to be put about an hour flight away from us, but not available yet. This is what I deal with. Patient can't stay still enough for the warm packs to stay in place. List of drugs available is on page 1 one. Patient screams "Don't let me die".
Eydawn Posted April 10, 2008 Posted April 10, 2008 That's what the TAPE is for.... duct tape if you must... Let's give her some tylenol and some benadryl? That's about all I can think to do, to be honest... because I'm not a paramedic and don't know all the ramifications of all the meds you've got. Something in my head is jouncing around wondering if sodium bicarb might have some positive effect... let me go JFGI and I'll get back to you on that one. But start with the acetaminophen, and benadryl just in case there is some allergic component and it's not presenting as one might expect. Wendy CO EMT-B
Ecnalubma08 Posted April 10, 2008 Posted April 10, 2008 I like Dawn's idea of "taping the hot packs on." Calcium Gluconate is sometimes used to relieve muscle cramping...hmmm. I did notice that you had that on your rig so...
Eydawn Posted April 10, 2008 Posted April 10, 2008 Per an article on emedicine.com: "Calcium gluconate is no longer recommended for widow spider envenomation." http://www.emedicine.com/EMERG/topic546.htm "In the treatment of black widow spider envenomations, antihistamines are used before antivenom administration to reduce acute adverse reactions to the antivenom." Well, the benadryl is a good idea then... also seeing support for use of benzo's.... ativan, anyone? Hm. Still wondering about the sodium bicarb. Something's telling me that the calcium channels that have been dumped have something to do with sodium bicarb being a good thing. Neutralizing increased pH and halting the nerve firing, reducing muscle cramping? Still having trouble finding resources. Wendy CO EMT-B
Eydawn Posted April 10, 2008 Posted April 10, 2008 Found what I was looking for. Benzos can be more effective in treating the pain caused by muscle cramping secondary to envenomation, and are preferred over muscle relaxants or opioids. So I'd definitely get some Versed on board. Also, these kind of enevenomations can lead to rhabdomyelosis... which is countered by administration of sodium bicarbonate. So since your transport time is so long... I might be considering that. I knew there was something in there... Wendy CO EMT-B
AZCEP Posted April 10, 2008 Posted April 10, 2008 Calcium gluconate can be considered if a gel form is available to place on the site. IV/IA use has fallen out of favor however. I'd consider using as much Benadryl as possible to see if we could calm her down. Adding in the BZD and maybe some fentanyl/morphine as well. Sodium bicarbonate is not going to be terribly helpful at this stage, although contacting poison control might be. Aside from the sinus tachycardia, is there any abnormalities noted on the ECG? P wave flattening, T wave hyperacuity, ST depression/elevation, QRS widening/voltage changes?
Mateo_1387 Posted April 11, 2008 Posted April 11, 2008 I would say use valium. It is a great benzo that will cause muscle relaxation and some calming effects.
ccmedoc Posted April 11, 2008 Posted April 11, 2008 I have not read the entire thread so if I am off base here...sorry I did see this though and .. Also, these kind of enevenomations can lead to rhabdomyolysis... which is countered by administration of sodium bicarbonate. So since your transport time is so long... I might be considering that. I knew there was something in there... Wendy CO EMT-B The administration of Bicarb in crush injuries with extended extrication would be in respect to the lactic acidosis from the resultant anaerobic metabolism from the hypoxic muscle. Not the rhabdomyolysis. Envenomations also have the possibility of creating a compartment syndrome, which is similar to crush in that it creates a lactic acidosis from the same mechanism. The rhabdomyolysis will most likely be treated with dialysis once to the hospital. ARF, Hyperkalemia, hypocalcemia, and marked hypovolemia will most likely present with this patient. Probably not within a couple of hours though. I would expect to maybe see ecg changes throughout transport, though. Fluid resuscitation may be required with long transport to the hospital. The bicarb is usually only administered in crush injuries with some kind of extrication. Bicarb administration without labs and a blood pH.... this would be close to malpractice.. Calcium chloride in judicious amounts for the hyperkalemic effects on the cardiac muscle, fluid resuscitation, and possibly diuretics to diurese your patient may be advised if your transport would be hours..get the urinal ready, if you cant foley the patient.. This would potentially be a VERY difficult patient to manage in a small hospital, let alone in the back of an ambulance. Just my experience.
AZCEP Posted April 11, 2008 Posted April 11, 2008 The rhabdomyolysis will most likely be treated with dialysis once to the hospital. ARF, Hyperkalemia, hypocalcemia, and marked hypovolemia will most likely present with this patient. Probably not within a couple of hours though. I would expect to maybe see ecg changes throughout transport, though. This would be a good indication to use the sodium bicarbonate as Wendy noted. Once ECG changes are witnessed, start treating the associated hyperkalemia that is probably the cause. However, without any progression toward this, I'd hold the bicarb/calcium for the time being.
Recommended Posts