Viagra/Nitro Situation?

[Lithium]

Actually, Dust devil is right.

MedicMal (and any others wishing more information about the practice of paramedicine in Ontario), this is EXACTLY the reason why the Ministry of Health changed the title of the provincial exam from EMCA (emergency medical care assistant) to AEMCA (Advanced EMCA). The AEMCA exam now includes scenario questions regarding the use of medication administration and defibrillation, and the ministry was smart enough to figure out that yes, this changes everything.

As BLS providers, you're allowed to perform advanced life support skills, hence your symptom relief and defibrillation program. Even though these are thought of as BLS drugs, they certainly are not. As you advance yourself in your profession, you'll come to realize why things are set up the way they are. Ever wonder why ACPs are allowed to give first time nitro, or administer Epinephrine EITHER SC or IM and you're not? Symptom relief has only been around for 10 years now, and defibrillation about 15. The medical directors of the various base hospitals are still getting comfortable with letting PCPs giving these meds.

Defibrillation in and of itself is still a controlled act, and since you're not technically licensed to practice the same way as your ACP or CCP counterparts are, this is why your defib algorithms are the way they are. Basically, you put on the pads and press analyze and let the machine do the thinking. ACPs and CCPs interpret the rhythm and choose how they want to proceed.

peace

[kevkei]

I just got into a debate w/ several members of my squad about this issue. As an EMT-B are we allowed to administer nitro to a patient using Viagra? What exactly are the harmful effects of doing this?

The short answer is that they both act by similar mechanism, and combining them together makes things much worse. They both cause vascular smooth muscle relaxation by affecting calcium channels. Imagine it as being giving a patient 10 sublingual nitro's all at once.

[kevkei]

Ever wonder why ACPs are allowed to give first time nitro, or administer Epinephrine EITHER SC or IM and you're not?

Yes, because we are prescribing that treatment to the patient, not their Physician.

[hfdff422]

Dust-

Upon further ponderance of the discussion, you are correct. "BLS" skills are based on treating signs, but these medications are administered to treat symptoms therefore you are 100% correct that it is no longer in the "BLS" realm wether or not our hospital ED lists it under "BLS" provider standing orders.

And as for brain surgery, it really does not look that hard. Do they have depth guards on those little saws?

[Dustdevil]

Thank you, Sir. I know it is easy to jump to the conclusion that I am merely trying to belittle EMT's, or to claim they should not be practising at this level, but that is not my intention at all. All I am trying to do is make EMT's understand that, regardless of their certification level, they ARE practising Advanced Life Support, and to give that practise the respect and consideration it deserves. There is a real danger in the attitude that the ALS skills they are given are "just basic stuff." It results in what we commonly see here, which is people giving drugs with next to NO understanding of the pharmacology and physiology involved. If we can make those basics respect the level of care they are giving, it will go a long way towards making their practise safer and more professional. If you want to truly be a professional, that is crucial.

[calebshelton]

In Missouri were not allowed to give nitro to any pt who has taken any ED drugs in the last 48 hours. The pt will have severe hypotension. That's why we can't give those two meds together.

[CBEMT]

Umm, thanks.

Not sure why we needed to dig up a 4 year old thread.......

[mobey]

Umm, thanks.

Not sure why we needed to dig up a 4 year old thread.......

How else would we find out how they do it in Missouri?

I am quite sure the poster did not look at the date, this is pretty easy to do with the related topics at the bottom of the page.

[JPINFV]

Umm, thanks.

Not sure why we needed to dig up a 4 year old thread.......

I think a part of the problem is the "related" threads that show up on the bottom of a thread. More than once I've caught myself looking at them and thinking, "Gee... I remember that thread from a while ago, who bumped it" only to see that there is no bump (or spoon).

[EMT City Administrator]

It is better to add to old threads with relevant information than to start a new one.

It is OK to to do so.