Etomindate

[mobey]

We do 5mg Versed and a dose of Fentanyl (3.5 mcg/kg) in the absence of paralytics.

[akroeze]

We do 5mg Versed and a dose of Fentanyl (3.5 mcg/kg) in the absence of paralytics.

Holy crap, that's a lot of Fentanyl. Any 'up to' on it?

[mobey]

Holy crap, that's a lot of Fentanyl. Any 'up to' on it?

200mcg is the max dose.

Like I say the high dose is just for intubation, usual dose for pain control is 1-3mcg/kg

[akroeze]

200mcg is the max dose.

Like I say the high dose is just for intubation, usual dose for pain control is 1-3mcg/kg

Are your protocols online somewhere?

[chbare]

Hehe, ever watch a cardiac surgery? Pretty strange watching somebody receive 1 mg or more of fentanyl for induction.

Take care,

chbare.

[mobey]

Ok I realize this is hardly "evidence" of what I am saying, but this is a direct cut & paste from the protocol. Unfortunatly it is a secure site I pulled it from so I cannot give a direct link. (I think ya'll know I am trustworthy though)

fentanyl Sublimaze®

Opioid Analgesic

1 - 5 mcg/Kg RSI if Hypotensive and 3 - 5

mcg/kg if normotensive / pain control is 1

mcg/kg or 25 - 50 mcg per dose prn use

Max 200 mcg per dose

[CTXMEDIC]

Ah, either not intubate them or wait till they become unresponsive enough to intubate.

Dude, i think i pissed myself...ROFLMFAO!

Patient: "Sir, your monitor says Im in V-Tach"

Medic: "Yes sir, youre correct."

Patient: "Are you going to shock me back into a perfusing rhythm?"

Medic: "No sir, I cant."

Patient: "WTF you mean, cant?"

Medic: "Im not allowed to shock you until you pass out and become pulseless"

Patient:

Medic: :wink:

Patient: "Well i feel my throat closing up and i can barely breathe"

Medic: "Sir, barely breathing means you can still breathe"

Patient: "Cant you put a tube in me to help me breathe"

Medic: "No, sir. Tell me when your throat is completley closed and you stop breathing, THEN i can try to put this tube down your closed airway" "Oh, and dont fight me sir or ill have to sedate you"

Patient: :shock:

[fiznat]

Dude, i think i pissed myself...

Heh it is a bit misleading to compare intubation to cardioversion, but I agree our protocol does sound a bit ridiculous on it's face. Then again, I can understand the reluctance of physicians to approve prehospital RSI on a large scale. The potential for abuse, misuse, and damage to the patient are pretty high, and the research isn't exactly supporting EMS intubation these days.

It isn't like we sit there and do nothing for these patients. My medical control is fairly progressive in every other aspect, with standing orders for a wide array of treatments that I know a lot of other services have to call and ask for. Our docs are the type that if they start seeing research that definitively supports prehospital RSI and they feel they can upkeep the program, then we will have it. Until that day, though....

[CTXMEDIC]

i know man, im just bustin yer bawlz

i think the whole 'dont let medics intubate' argument is a buncha crapola, ive seen FAR more docs and med students miss a tube than i have medics. i saw a guy a few weeks ago going on and on about this video laryngascope they got. glidescope i think it is. he let a first year try to get the tube and the kid couldnt get it. of course im in the corner goin :roll:

so this doc is like trying to tell everyone how great this multi-thousand dollar gadget is, and on and on he goes. well after the student tried twice and FAILED, the good doc takes over and FAILS as well. he ended up using a good old MAC blade....we just snickered and walked out...

[VentMedic]

i know man, im just bustin yer bawlz

i think the whole 'dont let medics intubate' argument is a buncha crapola, ive seen FAR more docs and med students miss a tube than i have medics. i saw a guy a few weeks ago going on and on about this video laryngascope they got. glidescope i think it is. he let a first year try to get the tube and the kid couldnt get it. of course im in the corner goin :roll:

so this doc is like trying to tell everyone how great this multi-thousand dollar gadget is, and on and on he goes. well after the student tried twice and FAILED, the good doc takes over and FAILS as well. he ended up using a good old MAC blade....we just snickered and walked out...

How many people were laughing at you when you were learning to intubate? Regardless of what their title is, any new skill needs some practice. What is unfortunate is some med students never get the opportunity to hold a laryngoscope or practice on an intubation head before going live. They are tossed in cold and expected to sink or swim. The same with new equipment. I don't always agree with this but there is a lot of ground to cover in 3 years of residency. Laughing at anyone in a teaching environment just shows your immaturity and insecurity about your own level of training.

Doctors aren't always the ones that are expected to intubate. A Paramedic, however, is expected to be proficient at this skill. It is when those that don't take it seriously or don't get the opportunity to maintain their skills that it comes into question.