JPINFV Posted May 4, 2006 Posted May 4, 2006 Ahhh, I get what you're saying. I think I'll just have to agree to disagree. Even though there's many factors which affect a drugs affinity for receptors, I don't think the serum concentration of what it's competing against is really an influence. Mainly due to the fact that the narcan is not competing against the morphine in a one on one situation. All the narcan is doing is looking for a receptor to bind to. If anything, I would think the other factors you mentioned would be more of an influence (bioavalability, temperature, pH, paCO2 etc ... ) peace Is the morphine not just looking for a receptor to bind to too? At its core, chemical reactions and receptor binding is a random process. For a reaction, the two molecules have to make contact (random), with enough energy (Just because the total energy might be enough doesn't mean that each molecule has enough energy) with the right orientation (random) to cause a reaction. Similarly, a molecule binding to a receptor has to make contact (random) and has to hit in the right orientation (again random) to bind. A higher concentration makes it more likely that the conditions needed to bind to the receptor are met.
hammerpcp Posted May 4, 2006 Posted May 4, 2006 Well, the convo veered off towards BLS providers rather than EMT-I's (which I have no idea about) and that is what I was referring to. Ontario BLS providers to be precise. As far as American ambulance personnel go, are any of you really "educated" rather then trained? :wink:
JPINFV Posted May 4, 2006 Posted May 4, 2006 ^ I thought the EMT-B course was more of an orientation to EMS then actual training... /sarcasm, but only slightly
Lithium Posted May 4, 2006 Posted May 4, 2006 Yes, but if I understand KevKei, he's implying that the concentration of morphine in the patient with 20 mg would cause the more rapid descent in concentration of narcan. I personally just don't see it that way ... to me, its more of a hit and miss. Narcan is a competitive antagonist, not noncompetitive. The scenario I see in my mind is that its not like two boxers dueling it out in the ring (narcan vs. morphine) and one comes out the champion. It's more like 2 horny male teenagers trying to race to the door of the girl they both want a date with (door = receptor). Basically, whoever gets their first gets lucky :wink: peace
JPINFV Posted May 4, 2006 Posted May 4, 2006 Going off of your analogy, it would be more like a whore house. Multiple girls (many receptors), multiple boys (Lets say boyA for narcan and boyB for morphine). Who ever doesn't get a girl gets randomly thown out over time. Also, over time, a boy will leave the room (vacate the receptor), but is still free to compete for reentry into the room (i.e. not eliminated just because he got a girl) All other things being equal, if you have more boyB (morphine) then boyA (narcan), then more boyB will find a room. Sure boyA will get some, but boyB will get more. Since there is more boyA out in the cold then there would be if there was a lower concentration of boyB, boyA is kicked out more often. Of course, in this situation, boyA is a prude and doesn't actually interact with the girl. He just keeps boyB from getting some.
medic001918 Posted May 4, 2006 Posted May 4, 2006 On the paramedic level we are educated far more so than the EMT or Intermediate level. The EMT course (in my area) is all of 120 hours or so, along with the pre req EMT-B course which is 120 hours amounts to only 240 hours or so. That's hardly enough to justify pushing medications. This especially holds true when as a paramedic we've spent at minimum two semesters on A&P alone. Add to that the paramedic level courses that review the A&P and more importantly pathophysiology and pharamacology and you have someone that just might take something significant from their education. Shane NREMT-P
kevkei Posted May 4, 2006 Posted May 4, 2006 Yes, but if I understand KevKei, he's implying that the concentration of morphine in the patient with 20 mg would cause the more rapid descent in concentration of narcan. I personally just don't see it that way ... to me, its more of a hit and miss. Narcan is a competitive antagonist, not noncompetitive. The scenario I see in my mind is that its not like two boxers dueling it out in the ring (narcan vs. morphine) and one comes out the champion. It's more like 2 horny male teenagers trying to race to the door of the girl they both want a date with (door = receptor). Basically, whoever gets their first gets lucky :wink: peace Lithium, my point is that there are factors to affinity more than natural affinity and physiological conditions. Affinity is also affected by drug concentration when you have competing agonist/antagonist. Take your exampleof 2 horny males, male 'A' (narcan) and male 'B' (morphine). All things being equal, male 'A' and 'B' racing to the door. If male 'A' (narcan) is bigger and faster, but also better looking, he might win compared to male 'B' who is smaller and slower. But what if male 'B' brings along a bunch of friends that help remove male 'A' from the girl just as they got started? Male 'A' isn't beaten up or removed from the house, and once in a while he might sneak in and remove male 'B' and bind with the receptor (to bad he can't stimulate it because he has no efficacy :shock: ) but then 'B's friends come along and 'competatively' remove 'A'. Eventually, male 'A' loses interest and leaves the scene unless he calls for back-up himself. In summary, male 'A' has a higher affinity than male 'B'. Male 'B' happens to have more friends which eventually help him have higher affinity to the girl. Here's a hint, when you have a chronic user that has had many EMS transports to hospital "Usually he starts to breathe after 0.4 mg IV but today it took 4 mg to get an increased respiratory rate." If a patient has S&S indicative of a narcotic toxidrome triad (miosis, altered LOC and bradypnea/apnea), I would think that receptor occupancy is darn near 100% regardless of how much they took. If a chronic user will normally get to this point with 20 mg of MS, what happens if they take 40 mg? Nothing! It will however change how much narcan it will take to effect your desired response.
hammerpcp Posted May 4, 2006 Posted May 4, 2006 Is that enough to qualify you to give all the medications and do all the invasive procedures you do as a paramedic?
Dustdevil Posted May 4, 2006 Posted May 4, 2006 Is that enough to qualify you to give all the medications and do all the invasive procedures you do as a paramedic? No. But it's getting close. It's still the best we've got. :?
medic001918 Posted May 4, 2006 Posted May 4, 2006 Is that enough to qualify you to give all the medications and do all the invasive procedures you do as a paramedic? Would I like to see more education? And a longer curriculum? Yes, I would. But like Dust said, this is the best we've got and it's the system in place. So if you're questioning if as a paramedic I'm educated enough to perform the procedures and administer medications, then how could you begin to think an Intermediate would be qualified to do so? I'm all for making the paramedic program a bachelor's level program. I see no drawbacks to the concept, and only positives. The paramedic program that I completed was an associate degree level program, which is better than some of the certificate programs that exist. Shane NREMT-P
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