Pain managment techniques within the EMT-B and paramedic scope of practice

[Kiwiology]

What would you do for an out of hospital cardiac arrest if you did not have it ? Just saying

Intubation for cardiac arrest is no longer recommended

Nobody in cardiac arrest ever died from not having an endotracheal tube shoved down their gob

[mikeymedic1984]

????????????? I agree that you cant kill a dead person with any act that you do after they are in arrest, but you have a much better chance of rescuscitation if their lungs are not full of puke, and the heart is actually getting a little oxygen.

[systemet]

If you need ETCO2 to tell if your patient is not being ventilated properly, then I agree, you should not be doing vent calls.

Really?

Having capnography is going to let you know that the tube has been displaced quicker than anything else. It's going to give you some indication of developing bronchospasm. If you have a pre-transport ABG, it may allow you to estimate the PaCO2 somewhat reliably. It may warn you of a cuff leak or mucus plugging.

How do you suggest assessing the adequacy of ventilation without it?

[Asysin2leads]

I agree with systernet. Without ETCO2, the signs of a displaced tube come on right about when it becomes to be too late. ETCO2 and 12 leads aren't for the dysfunctions that are obvious, they are for the dysfunctions that are not readily apparent. Anyone can tell you what's happening with a 65 year old chain smoking obese male who is pale, cool, and diaphoretic and clutching his heart, but the 43 year old woman who "just doesn't feel right" is the one that we can use 12 lead diagnostically for. Its the same with ETCO2, if the person is turning blue, yeah, we know what's happening, but what about the beginning of tachycardia? We can use ETCO2 to help rule out causes.

[Happiness]

So since we were talking about pain meds and then to something else. The words You are a pt advocate have been mentioned. RWN as far as I can see you did what you had to do. We all want our pts to feel no pain but that is not always possible. But as for you older guys come on just because a 19 yr old newbies says to a nurse I think she needs more meds dosn't mean she is going to get them, and we all know that.

As you all know I live on a rock and we have to fly out our phycs. I did one today and because the nurse didn't feel compfortable giving the pt another 2 mg of adivan IV, this pt almost didnt get out. Actually the ALS crew were on the verge of refusing him. I am told by my dispatcher, make sure your pt is snowed, but the drs say they need to rousable by voice. I do talk to the nurses and the Drs about this stuff but if they dont want to they dont. But to my defense I do have the ablity to say I am not taking this pt because the flight crew will refuse him. Now in these cases they (the hospital staff) should have to go on a plane and have a pt flip out in front of them so they understand the dangers that these call can create.

My pt was in his 30's, about 6ft 4, and about 220 lbs. He is a non compliant perenoide schitzophrenic, that has been also an IV drug user in the past. He took himself to the hospital because he is hearing voices from the TV telling him to very violently kill his mother and then kill himself. Now really alot of read flags in this. This is what he had in a 2 hr time period. 2 mg of adivan and 5 mg of haldol IM, then an hr later they started an adivan regement a total of 6 mgs and 50 mg of gravol while I was there. This pt was still able to open his eyes and communicate. When he did become fussy on the stretcher I was able to settle him down and asked him simply to just go back to sleep. I seriously wanted one more dose of adivan but I didnt get my wish and this pt was almost returned, if he freaks in the plane the possiblity of an extra 4 people being killed is a big possiblity. I have been doing these types of medivacs for 15 years and I being a pt advocate have not been heard but I keep on trying, so RWN now you know you can ask but be aware you may not be heard and you will just have to carry on. In this you have to pick your battles.

[Kiwiology]

but you have a much better chance of rescuscitation if their lungs are not full of puke, and the heart is actually getting a little oxygen.

There is absolutely no evidence that is true, there is evidence that it is not; in fact such a notion even defies the basic laws of physiology.

Just because you practice some voodoo ritual that refuses to die of attempting to shove a tube down somebodies gob does not mean it is going to do any good and there is plenty of evidence showing it in fact does harm.

The leading cause of cardiac arrest is dysrhythmia; the leading cause of dysrhythmia is myocardial infarction. Ventilating somebody does not mean the inspired oxygen is going to reach the heart on a cellular level. There is evidence that supra physiologic amounts of oxygen actually do significant harm. Ischaemia is not hypoxia and oxygenation is not ventilation.

No evidence has ever been presented that intubation has ever been beneficial in improving rates of neurologically intact survival in a cardiac arrest patient; it is tradition wrapped up in lure and nothing more; charlatanism if you will; it probably does more psychological benefit to the person trying to intubate ("Because I did everything I could to make sure his heart got oxygen!") than the patient receiving it.

It never had any evidence, so any intervention without evidence should be dismissed without evidence.

[ERDoc]

It never had any evidence, so any intervention without evidence should be dismissed without evidence.

Careful there Kiwi, lack of evidence is not evidence of absence.

[Kiwiology]

Careful there Kiwi, lack of evidence is not evidence of absence.

You are correct and I agree with you however no evidence that endotracheal intubation in cardiac arrest improves rates of survival to neurogenically intact discharge has ever been presented.

Intervention without evidence should be dismissed without evidence.

My interest away from fixing up super crook and heaps nunngered people is the role of diet and nutrition in the prevention and reversal of chronic disease; if I came into your Emergenemedicinotology department and started telling patients to eat plant based food for it will reverse their coronary artery disease and that they will never require any more stents, bypasses or GTN after having a carrot wax again you'd be on my case that I was practising charlatanism and that I must present some evidence that it works or stop purporting said charlatanism so I'd have whip out the published medical evidence supporting my claims.

There is no no evidence that endotracheal intubation in cardiac arrest improves rates of survival to neurogenically intact discharge it is therefore an intervention without evidence and should be dismissed without evidence.

The same can be said for the current traditional standard of spinal immobilisation; there is no evidence it is of benefit and should therefore be dismissed citing lack of evidence

Edited April 8, 2012 by Kiwiology

[ERDoc]

My interest away from fixing up super crook and heaps nunngered people is the role of diet and nutrition in the prevention and reversal of chronic disease; if I came into your Emergenemedicinotology department and started telling patients to eat plant based food for it will reverse their coronary artery disease and that they will never require any more stents, bypasses or GTN after having a carrot wax again you'd be on my case that I was practising charlatanism and that I must present some evidence that it works or stop purporting said charlatanism so I'd have whip out the published medical evidence supporting my claims.

If you ever do that I will be forced to hurt you badly. Get rid of obesity, stupidity, and alcohol and you take away about 90% of my business.

[Arctickat]

There is no no evidence that endotracheal intubation in cardiac arrest improves rates of survival to neurogenically intact discharge it is therefore an intervention without evidence and should be dismissed without evidence

Ahhh, but there is evidence that endotracheal intubation is beneficial.(Class IIb) according to AHA.