Home care paramedicine, why not like this?

[Kiwiology]

Peptidoglycan is nowhere as brain-box melting as liposaccharide

And bro, I was taking the piss, we've been through this before

[DwayneEMTP]

I don't know those things. The only antibiotic that I feel relatively confident giving without advice is PCN for tooth pain. Most times the issues go through a higher level of care and/or is a condition that I'm confident that I recognize as identical/near identical to one that has been previously diagnosed by a higher level of care.

In my experience this is the way that most antibiotics are delivered. One or two patients that require direction, and then another 10-300 pick up the same bug and can be treated likewise with a relatively high level of confidence.

Despite the tools at our disposal, I've always really felt like a poser prescribing antibiotics. It's never really made my willy hard as it seems to for some medics, so I have no issues seeking guidance when I believe it's necessary.

[Eydawn]

Pardon my thread tangent for a mo' folks....

Kiwi- stop pissing in every single thread you post in wouldja? It mucks up the folks who are actually trying to follow what is going on.

You are a funny fellow, but howsabout you go a few posts where you don't have to return to explain you were once again "taking the piss" hm?

Lots of love,

Wendy

Now, as to antibiotic selection... what kind of oversight have you remote guys had? What kind of antibiotic specific education? Or are you just the "hands" giving it out with direction/approval from the "brain" doc overseeing you? Just curious...

Wendy

CO EMT-B

[DwayneEMTP]

...Now, as to antibiotic selection... what kind of oversight have you remote guys had? What kind of antibiotic specific education? Or are you just the "hands" giving it out with direction/approval from the "brain" doc overseeing you? Just curious...

Wendy

CO EMT-B

You know, this is a good question, but it's kind of like asking, "How good are nurses at intubating?" Know what I mean? Most I know have the theory, but little if any application, others I'm confident would make me look like a monkey humping a football by comparison. If you think that American EMS is all over the board, remote medicine is much worse. And for most of us, worse still in the fact that we rarely practice any significant skills.

Most of the remote medics that I know, myself included, are complete douches. They had a buddy get them a job, started out dumb and then were placed in a position where there is almost no oversight allowing them to become dumber still though all the while looking in the mirror day after day praising themselves as a rock star. It's really easy to be a legend without an audience to provide feedback.

But, as at home on the street, there are the rare, inspiring exceptions. Mongo Medic, our new member is one of those. Friggin' knows everything off the top of his head, treats every patient with love and kindness...I hate his guts. Though in the years that I've been doing this now, I've met several hundred medics, I doubt that I have more than a dozen examples of the exceptions. Many fall somewhere on in the gray between douche and inspiration, but I'd have to say that douche is the dominant category.

For me, I think I had about 8hrs concerning antibiotics several years ago, and then about 5hrs at my last gigs...but I don't really understand them very well. I can hand them out all day if I want...I just don't want to. So I nearly always consult with someone before prescribing them, unless as I mentioned before, say, PCN for toothaches. Why am I comfortable with that? Because I've treated about a gazillion of them, and the first half a gazillion the medcon doc prescribed PCN.

Man, here they give amoxicillin for EVERYTHING. Had a guy in with a lac to his leg, healing pretty well, no sign of infection, cut with a rusty machete. I recommended a tetanus shot. "No, that only works if it's still bleeding. I'll give him some amoxicillin." (And before anyone gets started!! No, I didn't make them do it my way...there is only so much change that you an make so fast in many of these environments without alienating yourself to the point of impotency.)

Just sayin'...

[DFIB]

I don't know those things. The only antibiotic that I feel relatively confident giving without advice is PCN for tooth pain. Most times the issues go through a higher level of care and/or is a condition that I'm confident that I recognize as identical/near identical to one that has been previously diagnosed by a higher level of care.

You are a smart man for seeking guidance as far as antibiotics are concerned although in your line of work I would have thought you used lots of bactrim, vibramycin, multi generation cefalosporin, metronidazol, and such.

It's never really made my willy hard as it seems to for some medics, so I have no issues seeking guidance when I believe it's necessary.

Only if you chase them with viagra

[mikemedic999]

ECPs use amoxicillin and erythromycin here as far as i am aware....

[Kiwiology]

Antibiotics are necessary but they are the most wrongly prescribed medicine on the planet hence why we now have these abx resistant super infections that turn you to soup or some shit

Sure it might make some trailer trash medic get hard that he can "prescribe" an antibiotic because "it makes him a doctor" but he's an idiot

I know a little about antibiotics and when to give them and what for and how they work and such and I keep a supply of relevant texts handy for guidance because I know I know only a little

[MongoMedic2]

Antibiotics are necessary but they are the most wrongly prescribed medicine on the planet hence why we now have these abx resistant super infections that turn you to soup or some shit

Sure it might make some trailer trash medic get hard that he can "prescribe" an antibiotic because "it makes him a doctor" but he's an idiot

I know a little about antibiotics and when to give them and what for and how they work and such and I keep a supply of relevant texts handy for guidance because I know I know only a little

Kiwi I think that we have found something that we agree on as far antibiotics being used wrongly, however I think that starts in the Doctors office. Now my disclaimer: I am not a doctor, nor do I claim to know more than a doctor, with that being said.....I am not sure what it is like in NZ, but in the US if a patient wants an antibiotic and the Doctor disagrees, then the patient just goes to the next Doctor until they get what they want. So what happens is business gets in the way of good medical decisions. They don't want to loose their patients, because that hits them in the pocket book in private practice.

One of my biggest hang-ups doing these RM gigs is when an antibiotic is given for the "because I can" with no other medically nec. explanation available. I often try to explain this to my Mongolian Doctors, if you give a medication be sure to document your findings in your chart that would suggest the need for the medication. This is especially true for antibiotics.

My concerns come from two angles, first and foremost the patient care. I don't want a patient to receive a medication (i.e. antibiotics) for something that will resolve itself with OTC's in a few days, or that needs to take its course. Well a distant second is that supplies are a continous problem here where I am at, and that presents its own problems.

I also have a short coming when it comes to what anibiotic to give for what, that is why before I do I consult a PDR or hell even the internet. That way I have some basis for my decision. Now I will say this I have been lucky enough to have done this job with some pretty good guidlines, that says if you see this give this and expect that (call it cookie cutter medicine if you will).

However, I still try to look up information so that I can educate myself maybe on a particular case. Maybe the next time I encounter such a case I can pull that out of the memory bank, the next time I encounter a similar case.

MongoMedic

[MongoMedic2]

Now, as to antibiotic selection... what kind of oversight have you remote guys had? What kind of antibiotic specific education? Or are you just the "hands" giving it out with direction/approval from the "brain" doc overseeing you? Just curious... Wendy CO EMT-B

Wendy,

I have had it to where I have had guidlelines/protocols to go by. If you see this, give them that.....if this test says that, give them this (cookie cutter medicine). I have also had access to Medical Direction via phone. What I have tried to do is come up with some kind of plan with about two or three options for the Doc to choose from or sometimes I will say this is what I think it is, how about I give them drug xyz. The Doc will either say yeah or nay and give me their recommendation. Most often if they have dealt with certain Medics enough, then they will pretty much go with what you say, unless you are just off your rocker.

From my understanding, most Remote Medic jobs work pretty much the same.

MongoMedic

[systemet]

Let me start by saying that I know very little about the proper use of antibiotics, and they're also an area where my pharmacology is very poor (along with cancer chemotherapeutics!). So I'm not sure I can contribute a lot here, but:

* Bear in mind, in a lot of countries, antibiotics are available without prescription and are being widely used for self-medication for minor illnesses, many of which are viral, of insufficient severity to warrant antibiotic therapy, or being treated with an inappropriate agent for too short a period of time.

This doesn't make it right to compound the problem by giving them out inappropriately, but it does put it in perspective a little, I think.

* The development of antibiotic resistant microorganisms is definitely bad, but I wonder how much of this is occurring in animal populations? A lot of industrial meat production occurs under very unsanitary conditions and requires routine use of antibiotics in feed. How much of the developing antibiotic resistance is due to this.

Honest question.

Oh, and Dwayne, you're not a douche, but this was funny, and probably applies well beyond the remote medicine environment:

Most of the remote medics that I know, myself included, are complete douches. They had a buddy get them a job, started out dumb and then were placed in a position where there is almost no oversight allowing them to become dumber still though all the while looking in the mirror day after day praising themselves as a rock star. It's really easy to be a legend without an audience to provide feedback.

edit: spelling

Edited March 5, 2012 by systemet