CHF - no more Lasix?

[armymedic571]

We in PA have had the same shift away from Lasix as most. We still carry, but must call Command for its use.

Here is a ling to our CHF protocol:

http://www.dsf.health.state.pa.us/health/lib/health/ems/pa_protocols_-_master_-_effective_11-01-08.pdf

Actually, I think that will give you call of the protocols, but there they are.

We too, have advocated for the use of nitrates and CPAP. If you dont have CPAP, get it. It is one of the best non-invasive techiques you will ever do.

NTG seems to be the key. So much so, we have started to give NTG drips.

I am under the opinion that Lasix has its place in our bag O' tricks, but I can unstand why it was taken away in a manner of speaking.

I think the underlying issue here is education, assessment and history.

1) Our providers are not proprerly educated.

2) Because of this, they do not complete adequate assessments.

3) And, they fail to do thorough Patient Histories.

Why is this important. Many of our patients have multiple problems, some have multiple problems with the same parts of their bodies. In this case the lungs. How many patient have you had, that had CHF, COPD, and were currently treated for pneumonia. Great, so now they are having shortness of breath, what is the underlying cause? The only thing that will tell us (besides the pt's white count and BNP) is:

Education, Assessment, and history.

You cannot fault the system. We as providers did this to ourselves. The only thing we can do now is keep our standards high, and show the medical community that we can think on our feet, and make appropriate decisions in the field.

[JTpaintball70]

There's a rumor that the urban areas of the state might lose it, but they want to keep it for a lot of the really rural areas that we have. With a transport time of well over an hour you can actually see a little benefit from Lasix.

[armymedic571]

There's a rumor that the urban areas of the state might lose it, but they want to keep it for a lot of the really rural areas that we have. With a transport time of well over an hour you can actually see a little benefit from Lasix.

Don't forget the foley....

[JTpaintball70]

Don't forget the foley....

Some of those rural medics are actually allowed to do them.

[armymedic571]

Some of those rural medics are actually allowed to do them.

As it should be. It is part of the national curriculum as is OG/NG tubes and central lines.....

[JakeEMTP]

Don't forget the foley....

Ha! My wife who is an OR nurse always wondered how we could administer Lasix w/o a foley in place! Although we had to demonstrate our ability to place a foley annually, we didn't even have them on the ambulance.

[JTpaintball70]

As it should be. It is part of the national curriculum as is OG/NG tubes and central lines.....

National curriculum yes, but NM has always thumbed it's nose at anything national. I would like to see NG/OG and Foles on all rigs not just some.

[chbare]

Actually, we are starting to see major benefits to using ACE inhibitors. If you guys have time and interest, you should look at what has come out regarding ACEI's.

Take care,

chbare.

[JakeEMTP]

Actually, we are starting to see major benefits to using ACE inhibitors. If you guys have time and interest, you should look at what has come out regarding ACEI's.

Take care,

chbare.

Thanks Bro! That will give me something to do tomorrow after I recert in ITLS.

[Kiwiology]

I think the underlying issue here is education, assessment and history.

1) Our providers are not proprerly educated.

2) Because of this, they do not complete adequate assessments.

3) And, they fail to do thorough Patient Histories.

I think that's very true and there are better treatments out there than frusemide, eg CPAP