Neb.EMT Posted April 27, 2006 Posted April 27, 2006 VS for starters, as has been discussed before, Canadian education requires more from you as a whole than the US system. As far as the Romazicon. I knew what was coming to me when I posted in the first place. If I can learn the pharmodynamics and pharmokinetics of other potentially dangerous drugs what makes it so impossible I learn this one as well? In all reality that concerned whether or not I can adm. it. It would just be nice to have avail. to me should the need arise.
nsmedic393 Posted April 27, 2006 Posted April 27, 2006 Its pretty friggin rare that someone dies form a Benzo OD. Usual tx at the hospital is no monitor them until they wake up, its rare that the hospitals would use romazicon. Like VS said, for opoids and benzos the best possible pre-hospital care is airway management and supporting respirations if needed. People in general (not just you neb) need to get away form the mentality that there is a vial or a syringe or a shot or spray to fix everything. Probably annother thing to mention aside from skill level is the level and quality of evidence to support a protocol for romazicon. Around here if you want a new drug you better have some evidence in the form of studies to show that you need it. I don't know if you are familiar with levels of evidence but narcan is currently listed as a class 2B which means "There is fair evidence to support procedure or treatment " and the evidence has been obtained by Evidence obtained from a well designed cohort or case-control study, usually from more than one center or research group or evidence obtained from a well designed controlled trail but without randomization or Dramatic results from uncontrolled experiments. Romazicon is listed as a 3/D "There is evidence to support that the procedure or treatment should not be used" and the evidence was obtained by Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees. Soundl like there isn't enough evidence that anyone should be giving Romazicon prehospitally, let alone I's. Looks to me like there isn't enough evidence that anybody should be giving Romazicon pre-hospitally, let alone emt-Is.
Ridryder 911 Posted April 27, 2006 Posted April 27, 2006 These posts amaze me !.. At the time of writing this it is 10 think they should and 11 agree they should not. 1 Undecided. Now, if you agree to administer it at least be able to give a rationale why ?.. Just, like other posts, many have an opinion but, cannot back it up.. Does this not at least may you wonder ? Hmm.. maybe this is ONE of the problems of EMS ? R/r 911
Nate Posted April 27, 2006 Posted April 27, 2006 These posts amaze me !.. At the time of writing this it is 10 think they should and 11 agree they should not. 1 Undecided. Now, if you agree to administer it at least be able to give a rationale why ?.. Just, like other posts, many have an opinion but, cannot back it up.. Does this not at least may you wonder ? Hmm.. maybe this is ONE of the problems of EMS ? R/r 911 I agree.
Lithium Posted April 27, 2006 Posted April 27, 2006 Better idea ... let's get the narcotics off the streets, then we'll no longer have the need for narcan Oh my bad ...preventive medicine thinking here, and this seems to be poor in EMS ... :roll:
firemedic78 Posted April 28, 2006 Author Posted April 28, 2006 quite a bit of response on this one... ok, first off let me clarify my question. I did not mean for everyone to assume that EMT-i's should have full autonomy to push naloxone, or for every unconscious/unresponsive patient that you come across. I fully understand/respect the anatomy and physiology aspect of concern with pushing drugs. And i am aware that detailed drug affects/effects down to a cellular level are not taught at most emt-b or emt-i levels. It was touched on in my intermediate class, but i in no way think i understand the full A&P of pharmacology! (just to set the record straight) The comments about side effects...we can stumble on any patient with tachycardia, arrhythmia's, seizures, nausea, hypotensive, etc. We are taught how to manage these patients to our certification level already. So pushing a few mgs of narcan to ease our job (see Titrated to effect) should be allowable under a paramedic order or medical control authority. There can be arguments either way on this one. On one side of the group you will have those who would rather just load-n-go and bag these patients. Then you will have the others who would rather bring them a little off the opiate and possible not have to bag patient all the way to the hospital...possibly risking a side effect such as tachycardia or hypotension, etc. so i suppose it's all a matter of preference as to what you would rather deal with. (or protocols of course) thanks for all the responses...
nsmedic393 Posted April 28, 2006 Posted April 28, 2006 The comments about side effects...we can stumble on any patient with tachycardia, arrhythmia's, seizures, nausea, hypotensive, etc. We are taught how to manage these patients to our certification level already. There is a big difference between coming across a patient with a arrhythmia and causing that said same arrhythmia. If the first instance you are either called by 911 or the patient develops it during a transfer and you have to play with the cards you are dealt regardless of your cirtification level. Now if you give a drug that causes an arrhythmia and you aren't properly equipped to deal with it than you have made everything much much worse havn't you?
PRPGfirerescuetech Posted April 28, 2006 Posted April 28, 2006 Ok. Time for a PRPG rant. As BLS providers we are trained to a certain level. We can do certain procedures within our scope, all of which do not have potentially harmful adverse effects on a patient (for the most part). The reason we dont do advanced procedures, is simply because we dont have the tools to fix the potential side effects. Medicine is simple. We are here to make sick people less sick, fix problems, and go home safe. To allow undereducated BLS providers ANY procedure that could cause potential side effects is a massive problem. Why? Because we dont have the tools to fix the issues. Look at the adverse effects of this medication. ADVERSE EFFECTS: · Opiate reversal can cause vomiting, sweating, tachycardia and hypertension. In patients with cardiac disease more serious effects such as VT, VF and pulmonary oedema may occasionally occur · Rapid reversal of the opiate overdose may lead to combative behaviour in the patient Appropriate treatment of these potential side effects require the ability to... Cardiac monitoring (arrhythmias), IV access (all), manual defibrillation (the lethal arrhythmias), intubation (for when you shock them to asystole), ventilations (who wants to bag, compress, and push meds?) further advanced airways (for when tube placement, just isnt happenin') Also requires the following meds. Lasix, versed, epinephrine, atrophine, lidocane, dopamine, adenocard, cardazem, and much....much...more. I know i missed a few procedures, its 8am and i got thumped last night....let this infraction go....thanks. Moving on...in order to appropriately allow basics to administer medications, you need to allow them to administer and perform these said meds and skills. With allowing them these skills, there are others that need to be allowed. You want narcan? This comes with it. You want these procedures too? Go to medic school. With every action, there is a appropriate reaction. We have to be able to accomidate for as many possibilities post medication administration, as we can. Why? Because this, and this only is in the best interest of good and prudent emergency patient care. We are here for the patients. Look at the bigger picture, and you will understand my point. If you still disagree with me, your an idiot. Another example of how education will continue to be the root of all EMS evils.
vs-eh? Posted April 28, 2006 Posted April 28, 2006 The comments about side effects...we can stumble on any patient with tachycardia, arrhythmia's, seizures, nausea, hypotensive, etc. We are taught how to manage these patients to our certification level already. So pushing a few mgs of narcan to ease our job (see Titrated to effect) should be allowable under a paramedic order or medical control authority. There can be arguments either way on this one. On one side of the group you will have those who would rather just load-n-go and bag these patients. Then you will have the others who would rather bring them a little off the opiate and possible not have to bag patient all the way to the hospital...possibly risking a side effect such as tachycardia or hypotension, etc. Sorry man, but ya still don't get it do you. Ummm load and go and bag? No, it's called intubating and a nice drive to the hospital where in a controlled environment this patient can be titrated off the opioid (assuming that is all they are on). Do you not agree that this is easy and safer for you, your partner, and your patient? Instead you give the narcan and risk all the things mentioned. Again for iatrogenic opioid OD or perhaps an accidental paed OD you might do things differently. Generally speaking though, the safer route will always be intubate and drive to the hospital. The first time you get cranked in the face, spit on, bitten, etc...You may revamp your treament strategy. You make it seem that you are practicing better medicine or are some how more competent by giving the narcan? That's how I read it. Hyper, not hypotension...And where are these 14 people (now majority) pleading their case for narcan admin at this education level? We are all waiting for your statements... I thought so...
Scaramedic Posted April 28, 2006 Posted April 28, 2006 Vs whats up, you got rid of Eddie Murphy for John Colbert!!! I like Colbert but Eddie is still da man! Ooops, back on topic... Yeah I agree with what ya'all said mmmkay, drugs are bad! Peace, Marty :thumbleft:
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