Be a kind medic

[fireflymedic]

Recently I was quite disturbed when on a scene with another crew who cared for a patient prior to my arrival. I found the pt intubated, paralyzed, but not sedated or any pain meds given. I'm finding this to be a disturbing trend among those who RSI that they are not considering the comfort of their patient. I cannot think of a single reason why one would not do the courtesy of at least mildly sedating a patient who has been paralyzed. The comment made by the other medic was "he's down far enough he won't know". I beg to differ as someone who has experienced RSI without sedation and was a VERY unpleasant experience. It was terrifying to be unable to breathe and feel the intubation attempts, despite fact I knew what was going on - imagine if you didn't have that knowledge... You may think your patient is down far enough, but some may still have some awareness and remember hearing is the last thing to go and I've had more than one patient tell me something I've said as I'm sure many have. I know the topic of RSI has been hashed here extensively, but I thought this reminder important. So please everyone, be a kind medic to your patients. They will thank you for it.

I'll get off my soapbox now.

[Ridryder 911]

One of the many reasons RSI has a black eye in EMS. Poor undereducated medics not fully knowing or understanding a medical procedure. I guess whenever an EMS and a few Paramedics get their arse sued for emotional distress, then maybe we will learn the difference. Doubtful, they will probably ban it ... unfortunate for us that understand and the patient that need it.

So many assume Versed has total amnesic qualities which is false. Not all patients that receive Versed forget, as well many co-relate paralyzed and sedation as the same thing, when it is NOT!

R/r 911

[Dustdevil]

The comment made by the other medic was "he's down far enough he won't know".

WTF!?!?!? Do your protocols allow him to make that choice? Most RSI protocols I have seen don't give you that option.

I'm certainly no proponent of cookbook protocols. However, this is a shining example of exactly why they must exist in so many systems.

Plan A would be to only allow intelligent and thoroughly educated professionals to practise in your system, under constant medical QC review. However, when that is not happening, Plan B is unfortunately to have strict, cookbook monkey protocols, and assure that there is no deviation without proven medical justification. This, "I don't think he needs it" nonsense is the same thing as a resignation, as far as I am concerned.

[tniuqs]

Recently I was quite disturbed when on a scene with another crew who cared for a patient prior to my arrival. I found the pt intubated, paralyzed, but not sedated or any pain meds given. I'm finding this to be a disturbing trend among those who RSI that they are not considering the comfort of their patient. I cannot think of a single reason why one would not do the courtesy of at least mildly sedating a patient who has been paralyzed. The comment made by the other medic was "he's down far enough he won't know". I beg to differ as someone who has experienced RSI without sedation and was a VERY unpleasant experience. It was terrifying to be unable to breathe and feel the intubation attempts, despite fact I knew what was going on - imagine if you didn't have that knowledge... You may think your patient is down far enough, but some may still have some awareness and remember hearing is the last thing to go and I've had more than one patient tell me something I've said as I'm sure many have. I know the topic of RSI has been hashed here extensively, but I thought this reminder important. So please everyone, be a kind medic to your patients. They will thank you for it.

I'll get off my soapbox now.

Well get back up on that soapbox !

This is reportable in any freaking system, either that or the patient was a cadaver ... OMG that is so not Paramedicine it is cruel bottom line.

[fireflymedic]

Dust - oh trust me, they got an earful from me later on. As I stated, this was not a pt of mine - it was an intercept pt and once in our hands was nicely sedated courtesy of fentanyl and versed. I'd be interested in talking with this patient later on to see what was remembered and what wasn't just to prove a point !

[sirduke]

Worked a trauma call about a year ago, young kid, about 15, at the local death track, tried to jump too high on his dirtbike and broke both femurs.

We called in a air evac unit, prepared our patient for transfer. He was CAOX3, stable, talking to us, and had received 2 mg morphine. Not complaining of pain at the moment.

When the air med crew arrived, they decided to intubate him, and prepared for RSI. Medic #1 pushed the paralytics and immediately medic #2 shoves in the laryngoscope. Kid starts to projectile vomit, aspirates, goes from pink to blue.

End results, kid dies a day later from aspiration pneumonia.

RSI in the hands of the wrong people is not a good thing.

Medic #2 no longer works with that service, but not sure if they are still practicing.

[fireflymedic]

Gotta give the drugs time to work - if ya don't then the effect isn't achieved. Average time of onset is 60-90 seconds. Make sure they don't have reflexes anymore before you go shoving crap in. Sirduke - I'm amazed with two broken femurs he wasn't complaining of pain. Must have been running on adrenaline high and not feeling it yet. Agreed with you that certain things in the wrong hands can be a deadly combo. That goes for anyone.

[sirduke]

Hell, I was amazed too. He was a small kid for his age, and the 2 o morphine hit him pretty hard, but he was still talking to us.

I hate that damn dirt bike track, we've had 3 fatalities there in the last 2 years, and God only knows how many mangled kids. Frigging parents keep pushing them to hard.

But yes, the medic didn't give the meds time to work and thats what cause the problem.

[ERDoc]

I agree with Dust, WTF???? Since when do paralytics get them "down far enough?" Paralytics do not provide any sedation. In a just world this medic should have to see what it's like to be paralyzed and tubed without sedation. Part of RSI is sedation. Once you have them tubed, keep them sedated enough and you won't have to use any more paralytics. It sounds to me like this medic is the kind of guy that gets off on saying, "Yeah, I get to paralyze people to save their lives." I wonder if he was one of the 12 from Naples, FL, lol.

As for the helicopter crew, again, WTF????? I hope these parents took that medic for everything he had. I know we do not have the whole story, but why are they intubating a pt with femur fxs? It sounds to me like those morons are 100% responsible for that 15 year old's death.

[JakeEMTP]

I guess sedation wasn't in the cookbook recipe.

RSI is a great tool if used correctly. Freakin morons should not be aloud near another pt. until serious remediation has been completed. :evil: