Pain relief and EMS

[Camulos]

Wish we had Nitrous Oxide. but oh well. its on the approved drug list for the state.

I wouldn't be too keen for it. I often find it more of a hinderance than a help. It is big and bulky and I anecdotally don't find the efficacy particularly good. In fact we are currently in the process of phasing it out of service. There are also certain clinical conditions that preclude its use - particularly in trauma. Actually there's a good question!!!

Outline when you would not give entonox and also state the reasons why.

Stay safe,

Curse :evil:

[rock_shoes]

I wouldn't be too keen for it. I often find it more of a hinderance than a help. It is big and bulky and I anecdotally don't find the efficacy particularly good. In fact we are currently in the process of phasing it out of service. There are also certain clinical conditions that preclude its use - particularly in trauma. Actually there's a good question!!!

Outline when you would not give entonox and also state the reasons why.

Stay safe,

Curse :evil:

We use two pneumonics in our service. DIVINE for contraindications and SADMC for cautions. DIVINE stands for Decompression(complications with nitrogen narcosis as nitrous oxide is N2O2), Inhalation(people with inhalation injuries need as much O2 as possible because the nature of their injuries has already compromised the bodies ability to perform gas exchange), Ventilation (you must be able to ventilate the space to prevent the gas from affecting the provider), Inability to comply (entonox is self administered so the patient must be able to comply with directions, Nitro in the last 5 minutes (N2O2 has a mild vasodialatory effect on it's own which will have an additive effect to that of Nitro), Embolus (primarily concerned about a PE). N2O2 is heavier than air so it will collect in dead spaces. This also precludes it from use in conjunction with any chest wall trauma.

Cautions using SADMC are: Shock (N2O2 has a mild vasodialatory effect. Not really a help with a patient in shock. Shock also affects a patients ability to comply). Abdominal distention (vasodialatory effect, N2O2's propensity to collect in dead spaces). Depressant substances (N2O2 is a CNS depressant which means it could have a greater effect on someone who is already CNS depressed). Maxillo-Facial injuries (Affects a patients ability to use the delivery device. N2O2 collecting in dead spaces). COPD patients (These patients already have a compromised respiratory system).

[Camulos]

We use two pneumonics in our service. DIVINE for contraindications and SADMC for cautions. DIVINE stands for Decompression(complications with nitrogen narcosis as nitrous oxide is N2O2), Inhalation(people with inhalation injuries need as much O2 as possible because the nature of their injuries has already compromised the bodies ability to perform gas exchange), Ventilation (you must be able to ventilate the space to prevent the gas from affecting the provider), Inability to comply (entonox is self administered so the patient must be able to comply with directions, Nitro in the last 5 minutes (N2O2 has a mild vasodialatory effect on it's own which will have an additive effect to that of Nitro), Embolus (primarily concerned about a PE). N2O2 is heavier than air so it will collect in dead spaces. This also precludes it from use in conjunction with any chest wall trauma.

Cautions using SADMC are: Shock (N2O2 has a mild vasodialatory effect. Not really a help with a patient in shock. Shock also affects a patients ability to comply). Abdominal distention (vasodialatory effect, N2O2's propensity to collect in dead spaces). Depressant substances (N2O2 is a CNS depressant which means it could have a greater effect on someone who is already CNS depressed). Maxillo-Facial injuries (Affects a patients ability to use the delivery device. N2O2 collecting in dead spaces). COPD patients (These patients already have a compromised respiratory system).

GREAT answer!!!!

Pneumonics are your friend.

Another one I have heard apply to entonox in order to remember some common CI's is CHUNDER

C - Chest injuries (usually also think abdo here for the same reason)

H - Head injuries / Heat (pertaining to fire)

U - Unconscioussness / Under zero degrees celcius

N - Nutters (psych pts - politically incorrect I know, but it's not MY pneumonic)

D - Diving (within previous 48 hrs)

E - Early age (Too young to self administer)

R - Refuses

And should be used with caution in pt's vomiting - hence CHUNDER

Stay safe,

Curse :evil:

[Just Plain Ruff]

I wanted to clarify some things on our narc list

morphine we can give up to 10mg's for pain without orders

Fentanyl - up to 100mcg before we call for orders

nitro, aspirin, toradol, versed, valium and every other medication we can give without calling in for orders.

RSI needs no orders just justification of why you did it in the run report.

I have found that sux is a great drug for pain, my pain from listening to the patient scream, just give it to em, intubate em and they won't be screaming anymore.

Make sure you give versed and some pain relief before you paralyze them.

The last two sentences above are said with sarcasm dripping

[Camulos]

I have found that sux is a great drug for pain, my pain from listening to the patient scream, just give it to em, intubate em and they won't be screaming anymore.

Make sure you give versed and some pain relief before you paralyze them.

The last two sentences above are said with sarcasm dripping

Hilarious :wink:

And no need for the discalimer. I'm sure we have all felt like that at some stage. After all who needs physical restraints when you have sux!!!!

Stay safe,

Curse :evil:

[tniuqs]

The last two sentences above are said with sarcasm dripping

Very Harsh

Ok so have you ever thought of using Blow Darts :shock:

http://en.wikipedia.org/wiki/Curari

[Just Plain Ruff]

Very Harsh

Ok so have you ever thought of using Blow Darts :shock:

http://en.wikipedia.org/wiki/Curari

I only use darts for the ones I cannot catch.

did I tell anyone that I raise my own poison dart frogs?

[tniuqs]

did I tell anyone that I raise my own poison dart frogs?

Thanks but I will pass on the offer for dinner of Frogs Legs :shock:

cheers and now back to regular sheduled programing.

[Quakefire]

In Saskatchewan (another crazy Canadian province) At the PCP (BLS) level we got nothing, The ICP/EMT-A (ILS) have entonox and the ACP has morphine

[rock_shoes]

In Saskatchewan (another crazy Canadian province) At the PCP (BLS) level we got nothing, The ICP/EMT-A (ILS) have entonox and the ACP has morphine

It sounds like you guys are calling what the rest of us know as PCP, ICP (With the exception of Alta. where EMT is used. Confused yet?). Do people doing a current PCP program license as ICP's following school?