mobey Posted December 2, 2013 Posted December 2, 2013 Sedation and or analgesia can go IM. Not saying I would have done it in this case.... Just food for thought.
Kiwiology Posted December 2, 2013 Posted December 2, 2013 Yeah I thought about that, we have IN/IM fentanyl and midazolam plus IM and oral ketamine. Not sure I'd go down the IM route to be honest given that in the patient who is very compromised absorption is likely to be prolonged. Could always get an EJ or IO but again, if the patient is peri-arrest then the balance of risk vs benefit is in favour of just cardioverting him anyway without it, it sounds barbaric no two ways about it but I am sure he'd rather be alive and have a bit of a sore chest.
paramedicmike Posted December 2, 2013 Posted December 2, 2013 Sedation and or analgesia can go IM. Not saying I would have done it in this case.... Just food for thought. It can also go IN. More food for thought.
perimeter Posted December 3, 2013 Author Posted December 3, 2013 Just to clarify are you a paramedic student? Or are you a paramedic? Have you taken ACLS yet? Answers to these will help frame answers from here on out. What was your impression of this guy? Was he sick? Or not sick? Stable? Not stable? You decided not to cardiovert him. Why? What was your thinking? My impression was that he was sick. I decided not to cardiovert because in my mind he was "stable" for his condition and I'd rather hold on to what I had (awake, good BP) and wait until I had extra help in the ER in case the cardioversion went south and he converted to a less stable rhythm.
Just Plain Ruff Posted December 3, 2013 Posted December 3, 2013 My impression was that he was sick. I decided not to cardiovert because in my mind he was "stable" for his condition and I'd rather hold on to what I had (awake, good BP) and wait until I had extra help in the ER in case the cardioversion went south and he converted to a less stable rhythm. With a 7 minute drive and your assessment of his being sick but not sick enough to cardiovert, the decision to hold off till you arrived at the ER was I believe a sound one. Had you had a longer drive to the ED then I might have gone a different route. 1
scubanurse Posted December 3, 2013 Posted December 3, 2013 Agreed. If he was alert and mentating well enough to converse with you during transport, monitoring and diesel seem like a good idea.
HellsBells Posted December 6, 2013 Posted December 6, 2013 (edited) You don't have an option for IO access? Edited December 6, 2013 by HellsBells
island emt Posted December 7, 2013 Posted December 7, 2013 only one asa ?? standard is 325 mg po per AHA. Why did you not have IV access? With that pressure he should have plenty of choices . Did you start low & small or jump right on a big bore @ AC? I'd much rather have a good flowing 22 or 20 in the hand or wrist than blowing big bore in the AC's. Have to ask as I see this regularly with new medics. what did the veins in his feet look like? or didn't you look? We're not picking on you here, just triyng to figure out the why of the pt and call. and the care provider involved .
paramedicmike Posted December 7, 2013 Posted December 7, 2013 You don't have an option for IO access? Have you ever started an IO on a conscious patient?
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