Do you give benzo's to a hypoglycemic seizure?

[1EMT-P]

What are you going to do if the patient is hypoglycemic? Are you going to give D50 in that ankle vein?

What are you going to do is the patient suddenly develops Paroxsymal Supraventricular Tachycardia and needs Adenosine? Are you going to give that in the ankle vein?

What id you patient codes? Are you going to push your ACLS medications in that ankle vein?

Paramedics need to be comfortable with starting EJ's & Adult IO's in the field & if your not comfortable performing these procedures then you need to talk to your EMS agency & make arrangements to practice.

[Ridryder 911]

Actually yes, a ankle vein is better than none, apparently you have never worked around geriatric or burn patients. I have started IV's on thumb veins, chest wall, adult scalp, even penile veins.. & yes I would do that before an sternal I/O on an conscious adult.. I have started sternal on unresponsive patients or < LOC (there is a reason there nicknamed bed of nails), EJ yes, maybe.. I do know if I was in the ER & you brought a patient with a sternal I/O & there was peripheral veins, I definitely would have a discussion with your medical director or higher.

Maybe you can understand a vein is a vein.. you try to avoid distal foot veins in diabetics secondary for circulatory purposes..D50W can be diluted down.. & pushed slower but can be administered.

Ridryder 911

[kemt217]

My bad Budda, meant glucose gel not glucagon. Thanks for pointing it out.

[Asysin2leads]

>1. BLS

>2. Cardiac Monitoring

>3. Start an IV/Saline Lock

>4. Administer 25 gm of 50% Dextrose IV.

>5. Administer Lorazepam 2 mg IV or IM if IV access is not available.

>What I told you was not wrong, it was correct... I would highly suggest >that you review your protocols and that you follow them. If you go >outside of your protocols and something happens a good lawyer will say >that you were practicing medicine without a license!

Look, I don't what exactly you were smoking, when you looke up the NYC REMSCO protocols, but the REAL ones are here:

http://www.nycremsco.org/images/articlesserver/als-513.pdf

You nicely admitted the big ORS between Lorazepam, Diazepam, and Midazolam, and kinda just glossed over the part about IF IV ACCESS IS UNAVAILABLE. I know this because I had to write it from memory during paramedic class for an exam. So let me ask you, why do you feel the need to lie and misconstrue information to make your point? Do you do that on your ACR's as well? Try and hold yourself to a higher ethical standard from now on.

[buddha]

So let me get this straight - in NYC you just blindly give D50 to a seizure patient without obtaining a blood glucose??? Kinda risky, isn't it? I always believed NYC was off in their own little world...

Incidentally, NYS Public Health Law gives each of the 18 Regional Medical Advisory Committees authority to promulgate their own ALS protocols. This is why there is such a garden variety across the Empire State. In our region, there is an active seizure protocol which must be followed and which centers on breaking the seizure with 5 mg valium. Once the seizure is broken, the presenting problem becomes altered mental status. The first thing required in the AMS protocol is a BG determination, and if less than 80 mg/dL, thiamine 100 mg and bolus D50.

I do know how to follow protocols, 1EMTP, but just cuz NYC does it does not make it right. My doc would ream my ass for putting an EJ in this patient. And also, our region does not allow IO access in patients over age 6 - nor anywhere other than tibial.

[THE_DITCH_DOCTOR]

Ah, nice to see that some people in EMS still check common sense at the door in their balls out rush for the most "advanced" treatment possible.

[kevkei]

I agree that treating patients blindly or black and white gets you (and EMS) nowhere. It's the coma coctail all over again. That's why they are called guidelines, you have to adapt to each individual patient.

And another thing, protocols aren't always correct- hence adaptation. If you do something outside of your protocols, you should do well as long as you meet the standard of care, you use your head, critical thinking and common sense and you have supporting arguments and a train of thought for why you did what you did. (It's called thinking outside of the box.)

[THE_DITCH_DOCTOR]

And another thing, protocols aren't always correct- hence adaptation. If you do something outside of your protocols, you should do well as long as you meet the standard of care, you use your head, critical thinking and common sense and you have supporting arguments and a train of thought for why you did what you did. (It's called thinking outside of the box.)

That's assuming a couple of things:

1. You can defend your argument in some semblance of an organized, logical and educated manner. Many can't.

2. Your medical director is not an egomaniacal prick who thinks you have an ego problem, compounded by a serious lack of education because you are (in his mind) one step above a guy who asks "Would you like fries with that?". Many are.

3. Your patient has a good outcome because of, in spite of, or irregardless of the care you provided. Many don't.

[kevkei]

That's assuming a couple of things:

1. You can defend your argument in some semblance of an organized, logical and educated manner. Many can't.

2. Your medical director is not an egomaniacal prick who thinks you have an ego problem, compounded by a serious lack of education because you are (in his mind) one step above a guy who asks "Would you like fries with that?". Many are.

3. Your patient has a good outcome because of, in spite of, or irregardless of the care you provided. Many don't.

This is true, and is why not just anyone can do it.

OMG, do you have the same medical director that I do?

[THE_DITCH_DOCTOR]

No, not the same medical director....at least not for most of my career. The one I spent the most time working under actually treated most of us (read as those who could back up our reasoning and have an intelligent conversation) with a great deal of respect and he would have the ass of anyone who didn't respect "HIS" medics (and he called ALL of us that- from FR's up to EMT-P's). He was not a man you wanted to cross, but he got more pissed if you didn't stand up for yourself during audit and review than if you fought tooth and nail about something you felt was right. That's where I learned the debate technique I utilize on here.