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Posted

"I think Nitro should be banned from EMT level administration"

I am just curious, Why?

Because we do not have the luxury of an ECG. If the patient is having a Right Sided Ventricular Infarction and we administer Nitro we will drop the preload due to the vasodilation. This can induce severe hypotension resulting in immediate hypoperfusion. In essence we could contribute to the patients ultimate demise.

Here is a link that explains it in detail.

http://www.emsworld.com/article/10321209/recognition-and-treatment-of-right-ventricular-myocardial-infarction?page=2

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Posted

The harborview crowd has always thought of themselves as better than the rest of us mere mortal beings when it come to cardiac resuscitation numbers.

They have always posted numbers that are double the rest of the country.

I've always said that there are questions on how they come up with there numbers and what types of patients are being included in their data. If you only include cardiac arrest that are witnessed and have immediate CPR & defibrillation, the numbers will be better anywhere.

To openly state they don't follow AHA guidelines is just plain foolish , I can imagine a lawyer seeing that and waiting for the next non survivor to file a lawsuit.

If you read any of the published data (including the annual countywide report) what's used for the "50%" resucitation rate is the Utstein Criteria. It is a very selective criteria, based off the people who allready have the highest chance of a successful rescucitation. It's also a criteria set that ensures that every system would have worked that particular code; different places will have different thresholds for starting/withholding CPR, but pretty much everyone would start one on someone who meets the Utstein Criteria. So there may be some...selective <cough> PR <cough> data reporting going on, but it does make it easier for an accurate comparison between systems.

Of course, at this point the King County system isn't alone in pushing 50% using Utstein; it's happening in lots of places. If you look at the annual report (it's online) they're also posting a 20% survival rate (that's survival to discharge neurologically intact) for ALL non-traumatic cardiac arrests. THAT is an impressive number, but my guess is that anyone who get's close to 50% with Utstein will be getting closer and closer to that as well.

Forgot to mention that many places are taking part in, or have taken part in studies that disregard AHA reccomendations. Which are only reccomendations; like NFPA and fire departments, you aren't required to follow them.

If you look at the ROC studies, including the one that's ongoing looking at lidocaine vs amiodarone vs placebo...that's not following AHA guidleines. Yet 12 (I think; can't remember and am to lazy to check) different regions and who knows how many different services are doing so.

Or the CCR studies that were done awhile back...completely different than AHA guidelines, and never had a problem.

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