ERDoc Posted September 5, 2011 Posted September 5, 2011 Really, Really ? So you are advocating giving a treatment based on your assessment skills when the equipment says you should not, and then you get upset when newbie morons who cant assess without equipment overrules your orders ? Seems like I read a similar thread where you argued the exact opposite just a few days ago. Why the flip-flop ? In case you forgot, I am discussing the thread where I advocated giving D50 (1/2 amp) to an unconscious diabetic patient with a normal glucose reading. You are a waste of time but I'll respond anyways. Let's look at the indications for both albuterol and D50. According to micromedex, the indications for albuterol include cough, which is what I was treating. There is no equipment needed to test for a cough so no one is relying on equipment to make a clinical decision. The indications for D50 include hypoglycemia. Nowhere does it say if you think they are hypoglycemic. I am using albuterol for an indicated purpose. My issue is with others who are supposed to be carrying out those orders not doing so. You are not using the D50 for an indicated use. You weren't right, you were lucky. There is a huge difference. Knowledge with work forever, luck runs out eventually. Even a broken clock is right twice a day. Again, your lack of experience is obvious. When you can figure out how a pacer/AICD/magnet work, come back and talk to us. Until then, stop spreading you stupidity and incompetence. Most of us can see right through you but there are new providers here who are still learning and I would hate for them to make a mistake because they thought you had a clue. Asys, I understand what you are getting at. At the places I've worked, including during residency, anesthesia was never very helpful. In 8 years, I've had to ask them to get 2 airways I couldn't. The first was a trauma as a resident where there was blood just pouring out the trachea. I wasn't about to screw around as a new second year resident. The anesthesiologist was able to get it with some difficulty. After things were done, I asked what she did. Her response, "I couldn't see a damn thing, so I just stuck it where the blood was coming from." The other was as an attending. I had an easy airway and could see everything but for whatever reason I couldn't get the tube past the cords. I called anesthesia and he tells me he got in. I take a look and the balloon is sitting above the cords. Long story short, I end up traching the guy, which I was getting ready to do 20 minutes earlier. The level 1 trauma center I work at now, we don't even have anesthesia come to traumas. If EM can't get the tube, surgery gets the trach. At the smaller hospital I work at, there is no anesthesiologist in house after hours so you have to wait for them to come in from home. There are almost no tools that anesthesia has to offer that we don't have already. They are great at getting any airway, no matter how difficult in the controlled setting of an OR where they have had time to assess and make a decision about the airway. In a crash/uncontrolled setting where you don't have a choice and haven't had a chance to do a full assessment, I'd argue that EM and possibly EMS in some instances are the experts and should not rely on someone to bail them out. We (EM and EMS) are the masters of resuscitation and that includes controlling the worst of the crash airways.
Richard B the EMT Posted September 5, 2011 Posted September 5, 2011 For the record... STATE OF NEW YORK DEPARTMENT OF HEALTH Corning Tower The Governor Nelson A. Rockefeller Empire State Plaza Albany, New York 12237 Antonia C. Novello, M.D., M.P.H., Dr.P.H. Dennis P. Whalen Commissioner Executive Deputy Commissioner March 24, 2005 Re.: NYS EMT/AEMT BLS Albuterol Protocol This updated protocol reflects a change in the concentration/dose of Albuterol to be administered. The original version had a typo in the concentration listing Albuterol at 0.83%. This updated version of the protocol lists the correct concentration of Albuterol as 0.083%. Please remove the old protocol from your protocol manual and replace it with this updated version. If you have any questions please feel free to call our Education Unit at (518) 402-0996, ext. 1, 4. NYS EMT – B Basic Life Support Protocols (updated 3/2005) SC – 4 Page 1 Note: This protocol is for patients between one and sixty-five years of age, who are experiencing an exacerbation of their previously diagnosed asthma. Note: Request Advanced Life Support if available. Do not delay transport to the appropriate hospital. Note: If patient exhibits signs of imminent respiratory failure, refer to the Adult or Pediatric Respiratory Arrest Protocol. Note: For patients with a history of Angina, Myocardial Infarction, Arrhythmia or Congestive Heart Failure, medical control MUST be contacted prior to administration of Albuterol! Nebulized Albuterol I. Perform initial assessment. II. Assure that the patient’s airway is open and that the breathing and circulation are adequate. III. Administer high concentration oxygen. IV. Place the patient in the Fowler’s or Semi Fowler’s position. V. Do not allow physical activity or exertion. VI. Assess vital signs, ability to speak in complete sentences, accessory muscle use, wheezing, patient’s assessment of breathing difficulties and through the use of a peak flow meter, Borg Scale, or other method. VII. Begin transportation. Nebulized Albuterol, continued NYS EMT – B Basic Life Support Protocols (updated 3/2005) SC – 4 Page 2 VIII. Administer Abluterol Sulfate 0.083%, one (1) unit dose in a nebulizer at a flow rate of 4 – 6 LPM. DO NOT delay transport to complete medication! IX. Re-assess vital signs, ability to speak in complete sentences, accessory muscle use, wheezing, patient’s assessment of breathing difficulties and through the use of a peak flow meter, Borg Scale, or other method. X. If patient’s symptoms persist, a second administration of nebulized Albuterol may be administered. A maximum of two (2) total doses may be given. XI. Ongoing assessment. Obtain and record the patient’s vital signs enroute as often as the situation indicates. XII. Record all patient care information, including the patient’s medical history and all treatment provided on a Prehospital Care Report (PCR).
Eydawn Posted September 6, 2011 Posted September 6, 2011 ASYS! You're back!!!! We missed you! Speaking as an asthmatic, yeah, if I'm severely screwed the MDI isn't going to do much for me, but it may buy me some time. At the very least, it's a psychological intervention that will quell the "panic response" that feeds the monster... If you can establish that an albuterol MDI is what the patient normally uses, I wouldn't administer it myself but I wouldn't prevent the patient from taking it from the person offering it (after verifying that it was in fact albuterol and not expired). My big question: why would you folks administer an expired epi pen, but not use someone else's MDI? What if it's not really anaphylaxis, but something like a niacin flush? Nobody ever died because of an albuterol administration (MDI form, at least... let's not think IV or continuous neb on altered mental status), but people sure as heck have died from epi pen administration. I may or may not have played the "oh look at what got dropped over there, it must be yours, yeah, you keep that now" game with someone in fairly good status, with an inhaler that expired within the month... is it risky? Sure. How risky? Fairly low, based on my assessment. Wendy CO EMT-B
Just Plain Ruff Posted September 6, 2011 Posted September 6, 2011 http://www.jppt.org/...JPPTv8n1ms7.pdf Seeing as this thread is morphing into treating asthma, can you explain the actions of mag sulfate, especially in the paediatric population. I will bet after chbare's query, that someone is madly using Google to explain (exactly how oxygen shut's down the respiratory drive in acute, severe respiratory distress) I have always wondered why EMS has jumped onto this mag sulfate band wagon with such vigour, as in most ER (that I have worked) we rarely used mag sulfate. Studies and because of the multiple pharmacological interventions of beta agonist and anticholinergics plus mag sulf, its very difficult to make any real conclusions, although I have heard from a few paramedics that swear that suddenly, after 15 minutes post administration of the triple treatment their patient rapidly improved ? cheers I don't know but my wife is an example of having a respiratory issue with mag. She was admitted into the hospital last thursday with contractions. She's 2 months early. They start her on Mag Sulfate in her hospital room and her pulse ox drops dramatically while on the mag. I wasn't there so I don't know how that happened but it was a significant enough drop that the nurse refused the doctors orders to restart the mag. They put her on PRocardia for the contractions and they let up significantly but not without the procardia side effects to my wifes body. So can someone tell me why the mag dropped her Oxy sats? I can't remember and my books are of no help because they are all on the way to Eydawns house via the USPS who I hope gets them delivered before they go into shut down mode.
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