New Skills for Sask EMT's

[Quakefire]

Yeah there have been questions about the training modules the college has approved, even though we have completed ours we have been advised to avoid using the king while the college makes up its mind.

Arctickat any other insights into whats comming down the pipe for the PCP's and ACP's in Sask?

[Siffaliss]

Howdy.

Acording to the new Sask Health Protocols Sask EMT(PCP) practicioners are now able to use Entonox, King LT's, CPAP, and 12-lead ECG's. There is also the possibility of expanding our Nitro protocols with med control.

Seems like a move in a good direction, especially for rural BLS services.

So what are you saying? That the EMT's have been trained on where the stickers go for 12 leads or how to fully interpret them? And are 15 leads right around the corner?

And it's kind of silly to give someone nitro without having an IV in place first, rural or anywhere.

[Quakefire]

While we are trained to interpret 3-lead ECG's we are not allowed to interpret ECG's, aparently I cant tell a NSR from Vfib but thats besides the point. The new skill will allow us to capture a 12-lead ecg, not diagnose/interpret it

[Siffaliss]

While we are trained to interpret 3-lead ECG's we are not allowed to interpret ECG's, aparently I cant tell a NSR from Vfib but thats besides the point. The new skill will allow us to capture a 12-lead ecg, not diagnose/interpret it

Yeah, we're not talking about NSR and fib.

Point is, you should still not be giving nitro without being able to start and maintain an IV. You should not be giving nitro without being able to obtain and interpret 12/15 leads. Why do something just because you can? That gets practitioners and patients into trouble ...

[Quakefire]

We can only give Nitro where a patient has their own prescription or with direct medical control, Chances are if we are giving nitro the patient has their own to self medicate with any way. I agree we should have a line in place first in case that access is required very quickly. With the 12-leads it will give the hospital an idea of any changes over that last few miniutes (or up to half an hour from some places in our service area) and allows for preparation of proper treatment

[Siffaliss]

We can only give Nitro where a patient has their own prescription or with direct medical control, Chances are if we are giving nitro the patient has their own to self medicate with any way. I agree we should have a line in place first in case that access is required very quickly. With the 12-leads it will give the hospital an idea of any changes over that last few miniutes (or up to half an hour from some places in our service area) and allows for preparation of proper treatment

Ok that's a little more clear. In Alberta if protocols dictate, an EMT can administer nitro however a line first has to be in place. As a rural EMT on BLS cars I never did feel terribly comfortable with that, so never did give it when opportunity presented itself. Good thing too, because as I recall several of those patients did have RVI (as we found out later by transferring them to the city for further treatment). As a paramedic student in an urban ALS service, I get to see a lot more cardiac patients, probably due to the sheer volume of calls we do compared to what I was doing while rural. So I guess I'm fortunate in the way that I've just seen more reasons why and why not to give it. It's a scary drug that nitro ...

[tniuqs]

CPAP: Thats very interesting so what flavor machine and what are the protocols (as in pre set levels ?) orientation hours, are you just approved or are there any on the trucks already ?

And do you have flow diverters with your BVM and adjustable PEEP gauges any DAR filters for suspected infectious disease ?

Tis the season ....

This EMT/EMTI/PCP thing about NTG and the gospel according to; Must have 12 lead can anyone present studies on frequency of adverse effects frequency with RVI ?

cheers

[mobey]

This EMT/EMTI/PCP thing about NTG and the gospel according to; Must have 12 lead can anyone present studies on frequency of adverse effects frequency with RVI ?

That is really something I have always wondered as well.

I know..... I should know this already.... but I am a busy guy.

The reality is, although I have always taken this RVI/Nitro induced hypotension VERY seriously, I have never seen it.

Being from Sask, I have sprayed many a Nitro with no line or 12 lead, and never had a dramatic drop in BP. I am not saying it does not happen.... or that it is not common. I am just saying anecdotally, I have never seen it.

I will someday look up a study on this topic, but since I.V. is in my scope here in Ab, I don't really concern myself as much as I used to (unless it is a inferior STEMI).

[tniuqs]

Hah just wait till your running NTG drips.

IN the "old" days we did it all the time with a 4 lead,ONLY honestly I can not recall killing anyone, although I do know of an RN/REMT-P did about 6 years ago, oddly now practicing somewhere else than AB I think NWT ?

just saying ..... omg there is another patch I need to make

[Siffaliss]

but since I.V. is in my scope here in Ab, I don't really concern myself as much as I used to (unless it is a inferior STEMI).

Uh huh ... and how can you properly diagnose an RVI in the field without a 12/15 lead?

An EMT can go and obtain a 12 or 15 lead all they want ... they cannot however base any treatment they provide on those findings as interpreting those ECG's are not in scope.