How do you manage medication drips

[Ridryder 911]

Unless it is standard of practice where you are, then there is no certification on the line.

Actually, it is. Read the drug insert. If it describes it should or has to be per pump (i.e. Levophed, NTG) then you as a practitioner should had known and then you willingly administered the improper way. I know, as I have testified against an EMS that transported a medication that should had been per pump only.

Their defense was, they did not have one. The court & jury, stated that if that was the case they should had declined the transport or made other arangements. Do you take a NICU without a transport incubator or if the patient is on PEEP/Vent ... BVM them?

Doesn’t sound like you ever did it in NY, otherwise you’d know that 911 medic’s don’t carry IV pumps of any kind…

(IV drip sets yes, pumps no)

It’s all titrate to effect (within dose limits mcg/k/min).

-ntg

Ignorance does not make State standards correct. Weight/volume and toxicity does not equal in good patient care. Bolusing medications that were intentionally prescribed as a IV drip can land you & your medical director for review. I don't care how long, etc. Tell me when you see the immediate effects of Dopamine in the field and I will tell you probably have overdosed them. As EMS matures and is assumed to be responsible health care providers, part of the risks is we will be scrutinized by litigation cases that will point our faults.

Part of the problem of Paramedicine is we fail to teach and educate pharmokenetics properly. The only reason ..."desired effects" was ever taught was because most assume that Paramedics were too stupid to understand other dynamic parameters. Let's not reenforce their theory.

R/r 911

Edited April 14, 2009 by Ridryder 911

[scott33]

Doesn’t sound like you ever did it in NY, otherwise you’d know that 911 medic’s don’t carry IV pumps of any kind…

(IV drip sets yes, pumps no)

It’s all titrate to effect (within dose limits mcg/k/min).

Although it is poor practice, there is little need for 911 to rely on pumps in NYC, given their proximity to the abundance of healthcare facilities which pebble the area. There are plenty of IFT medics who do use pumps in the NYC area however. Transcare, NSLIJ, and Lifestar are just three companies I know of who use them.

IVPB Mag and Amio, may not cause a huge issue with just "running it in" using the volume over time formula, but the potential will always be there to cause a bigger problem than you started with.

I would much rather see the likes of Dopa on a pump, but as already pointed out, that would involve education.

Edited April 14, 2009 by scott33

[medic_texas]

Rid knows what's up. If it is your "standard of care" to infuse medications without a pump, then your standard sucks and YOUR CERT IS ON THE LINE every time you infuse a medication. Read your drug inserts because I'm willing to bet every one of them tell you to use a pump. Lidocaine, nitro, levophed, dopamine, cordarone, etc.

I've seen medics bring a patient in, 2 separate incidents, where they were infusing dopamine without a pump. The second time the bag was EMPTY.. it somehow was wide open, either by the idiot medic or by accident, either way it's going to court. I'm just happy my name is nowhere on the charting because it's going to be ugly. I know you don't want that to be you. Being a 911 medic or a transfer medic does not make you immune to lawsuits, see above story.

[scott33]

I've seen medics bring a patient in, 2 separate incidents, where they were infusing dopamine without a pump.

It is worrying but it does go on, and sadly quite legally.

Some medications should just always be on a pump, and Dopamine is a prime example. As for "titrating to effect", it is going to be quicker on a pump as you just plug in your new rate instead of messing about with a clamp or dial-a-flow. There is also the advantage of being able to document more accurate amounts of medication given, and over how long. You can set it to give the patient X amount of medication and no more, which takes care of arriving with an empty bag and red face.

What's next - Insulin drips without a pump?

[akroeze]

Ok so what do I do when I encounter a post-arrest patient who need dopamine but I don't have a pump because it isn't standard here? Do I refuse the dopamine and lose my liscence because I didn't do the minimum care expected of me?

[medic_texas]

Ok so what do I do when I encounter a post-arrest patient who need dopamine but I don't have a pump because it isn't standard here? Do I refuse the dopamine and lose my liscence because I didn't do the minimum care expected of me?

You should talk to your director and medical director about having pumps to accurately infuse your medications because that is the suggestion by the drug companies.

The first thing that will be done when you get your patient to the hospital is drips changed and set up to infuse accurately. Why is this standard of care in the hospital but not in EMS?

Like I said, if such a disaster happens, it will fall on you - the hanger of medication without a pump

But do what you guys want.

[FireMedic65]

You should talk to your director and medical director about having pumps to accurately infuse your medications because that is the suggestion by the drug companies.

The first thing that will be done when you get your patient to the hospital is drips changed and set up to infuse accurately. Why is this standard of care in the hospital but not in EMS?

Like I said, if such a disaster happens, it will fall on you - the hanger of medication without a pump

But do what you guys want.

The powers that be at such places don't want to spend the money one them. It has been suggested and brought up many times where I work, and it is always shot down because of cost. Pretty sad if you ask me.

[crotchitymedic1986]

This discussion is typical about what is wrong with EMS, everyone wants to bitch about the problem, but when it comes time to roll up your sleeves and do some work, everyone walks away. You do not have to buy brand-new, state of the art, triple chamber pumps to regulate what we need to regulate in EMS. There are many reputable companies that deal it refurbished pumps with a warranty. I have found several on the internet in the $400-1000.00 range. Maybe you can only buy one a quarter, or two annually, but you can afford to buy what you need. Maybe you can do a fundraiser, maybe you can talk your local hospital into donating some old ones, when they buy new ones (or sell them to you cheap).

I get tired of hearing the "we cant afford it" bullshit. You didnt budget for $5.00 a gallon diesel, but you managed somehow (because you were forced to). I promise you that if you would get your ass off myspace and facebook for 30 minutes, you could figure out a way to start buying some pumps for your service.

Sosayeththecrotch

[Ridryder 911]

This discussion is typical about what is wrong with EMS, everyone wants to bitch about the problem, but when it comes time to roll up your sleeves and do some work, everyone walks away. You do not have to buy brand-new, state of the art, triple chamber pumps to regulate what we need to regulate in EMS. There are many reputable companies that deal it refurbished pumps with a warranty. I have found several on the internet in the $400-1000.00 range. Maybe you can only buy one a quarter, or two annually, but you can afford to buy what you need. Maybe you can do a fundraiser, maybe you can talk your local hospital into donating some old ones, when they buy new ones (or sell them to you cheap).

I get tired of hearing the "we cant afford it" bullshit. You didnt budget for $5.00 a gallon diesel, but you managed somehow (because you were forced to). I promise you that if you would get your ass off myspace and facebook for 30 minutes, you could figure out a way to start buying some pumps for your service.

Sosayeththecrotch

So very true. As well, part of the problem is majority of EMS administrators are not properly educated in business nor the effects of the American way of payment .... Medicare.

Dependent upon the State you are located but Medicare has a special section for those that have to transport drips that require special education up and beyond the general NHTSA Paramedic curriculum (i.e. Lidocaine and Dopamine are the only two discussed) then a Speciality Care Transport charge can be added. Of course one should have the proper education and evidence to back this but the fee usually is increased and can actually off-set the equipment within a short period of time. Even known to be profitable.

R/r 911

[FireMedic65]

This discussion is typical about what is wrong with EMS, everyone wants to bitch about the problem, but when it comes time to roll up your sleeves and do some work, everyone walks away. You do not have to buy brand-new, state of the art, triple chamber pumps to regulate what we need to regulate in EMS. There are many reputable companies that deal it refurbished pumps with a warranty. I have found several on the internet in the $400-1000.00 range. Maybe you can only buy one a quarter, or two annually, but you can afford to buy what you need. Maybe you can do a fundraiser, maybe you can talk your local hospital into donating some old ones, when they buy new ones (or sell them to you cheap).

I get tired of hearing the "we cant afford it" bullshit. You didnt budget for $5.00 a gallon diesel, but you managed somehow (because you were forced to). I promise you that if you would get your ass off myspace and facebook for 30 minutes, you could figure out a way to start buying some pumps for your service.

Sosayeththecrotch

Very true! The problem is, these people who bitch about the cost... we know they can afford it, they just don't want to spend the money on something that "isn't required". The moment the word came out, about activated charcoal being no longer a 'required' item to have, it was pulled and won't be stocked again. Just goes to show, if they don't NEED it, they won't get it. Sad huh?