RSI

[medic03]

just curious what you guys and gals that RSI use in the field. I carry mivacron, etomidate & pancuronium and ativan/morphine for additional sedation if needed. I have access to Rocuronium, but I don't carry that on my body, I gotta go into the drug cabinet on the rig, so it's easier to use the first 2 drugs listed.

[PArescueEMT]

when I worked on a CCT unit, we used Vec, and Versed. worked like a charm. Especially on the burn vics

[medic03]

I love versed. I use to use it at another place I worked and it worked like a charm. probably my most fav drug. Don't carry it here, got almost everything else but versed.

[Jon]

Originally posted by medic03@Feb 1 2005, 01:14 AM
just curious what you guys and gals that RSI use in the field. I carry mivacron, etomidate & pancuronium and ativan/morphine for additional sedation if needed. I have access to Rocuronium, but I don't carry that on my body, I gotta go into the drug cabinet on the rig, so it's easier to use the first 2 drugs listed.
you carry your narcs and other pharm. on your person?


Jon

[MMiz]

Originally posted by MedicStudentJon+Feb 1 2005, 09:45 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Feb 1 2005, 09:45 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medic03@Feb 1 2005, 01:14 AM
just curious what you guys and gals that RSI use in the field. I carry mivacron, etomidate & pancuronium and ativan/morphine for additional sedation if needed. I have access to Rocuronium, but I don't carry that on my body, I gotta go into the drug cabinet on the rig, so it's easier to use the first 2 drugs listed.
you carry your narcs and other pharm. on your person?


Jon [/b][/quote]
My county keeps all drugs in a drug box locked in the rig, but I heard of some that have medics keep the drugs in pouches they carry. I don't see that happening, but I guess "to each their own".

[medic03]

Originally posted by MedicStudentJon+Feb 1 2005, 09:45 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Feb 1 2005, 09:45 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medic03@Feb 1 2005, 01:14 AM
just curious what you guys and gals that RSI use in the field. I carry mivacron, etomidate & pancuronium and ativan/morphine for additional sedation if needed. I have access to Rocuronium, but I don't carry that on my body, I gotta go into the drug cabinet on the rig, so it's easier to use the first 2 drugs listed.
you carry your narcs and other pharm. on your person?


Jon [/b][/quote]
yep, all narcs go in my shirt pocket (the pack is the size of an altoid case) and I have an RSI kit in my BDU pants. THe narcs are signed out to us in the beginning of the shift and we sign them back in at the end. I would never put them in my truck or my tech bag because we are always jumping from one truck to another or switching off equipment from the 3 helicopters, so I prefer to keep my stuff on me. It's my ass on the line if I lose them, so I like to know they re always on me. The RSI kits are not accounted for, so those we toss around. as long as there is one with the airway bag, that's fine.

[Firechic]

Vecuronium & Versed & Ativan - love them!!

[Chimpie]

Some depts started having the medics carry the drugs on them cause their rigs were getting broken into while they were out attending to a patient or grabbing a bite to eat.

[rescuecpt]

We don't carry regular drugs with us, but once we open the safe with the narcs, they're in a fanny pack that we have to wear until we do our inventory update and re-lock the remaining inventory in the safe.

[medic03]

nobody asked you Erika, so sit down and be quiet :P

[rescuecpt]

Originally posted by medic03@Feb 3 2005, 01:53 AM
nobody asked you Erika, so sit down and be quiet :P
:P

You're still mad that when I hit you in high school you started crying in the middle of the Commons and everyone saw you cry like a little girly man.

[medic03]

I hate you..... sniff.

[Margaritaville]

We are taking a serious look at RSI. Does everyone like it? Has it proven to be a useful enough tool to justify the training and costs?

[medic03]

hells yeah!

[PArescueEMT]

Originally posted by medic03@Feb 4 2005, 12:04 PM
I hate you..... sniff.
don't forget that we can gang up on her...

[Jon]

Originally posted by rescuecpt@Feb 2 2005, 09:33 PM
We don't carry regular drugs with us, but once we open the safe with the narcs, they're in a fanny pack that we have to wear until we do our inventory update and re-lock the remaining inventory in the safe.
i've done a little research, and sevral local areomedical services have both medic and nurse carry the narcs on their person, usually a fanny-pack arrangement. sevral medics carry versed and sux, too...just prefrence...

Jon

[Merck]

You guys are making me jealous. RSI has been a long standing argument for us. To date, we haven't been licensed to use it it in the field (save for the airevac qualified folks). Sadly, we usually just overdose people on midaz and possibly morphine if we need to knock them down. Interestingly enough, while this seems a little basic, I haven't found a lot of good research on the efficacy of prehospital RSI and what I have found doesn't seem to really support it. Do you guys have specific scenarios or protocols, or does it just fall to sound judgement and experience.

Phew. That's a lot of typing......where's me beer, eh?

Merck

[Ridryder911]

Currently writing new policy for ground truck. A a flight nurse/paramedic, we carry Entomidate,Fentyl, Pavulon, Suchs., Fentyl, Diprivan & the old usual Ativan (w/nasal atomizer if needed, M.S.) etc

Be safe,

Ridryder 911

[Jon]

Originally posted by Ridryder911@Mar 30 2005, 07:47 AM
Ativan (w/nasal atomizer if needed
How does that work for you folks - I've seen the ads in JEMS, but never seen it in person.

Jon

[Ridryder911]

had a seizing patient w/head bleed, clamped down , ... you know the type. sprayed & in about < 10 seconds seizure stopped. Love it ! researh shows, just as fast as IV route. I really recommend it.

Be safe,
]
Ridryder 911

[Firechic]

I second Ridryder911's recommendation. We use the nasal atomizer with Versed administration for seizures. Works quicker than IV or IM.
:)

[Jon]

Originally posted by Firechic@Apr 2 2005, 02:07 AM
I second Ridryder911's recommendation. We use the nasal atomizer with Versed administration for seizures. Works quicker than IV or IM.
:)
How does it work for NARCAN? Just curious, because I'm seriously starting to consider doing my ride time at the Philly squad that is known as the "Narcan Task Force" (Hack on the PD's Narcotic Task Force - they have shirts and everything)

Jon

[AJemt]

we do not carry RSI anymore....it was pulled a couple of years ago i think. we HAD etomitdate and sux (shortened form bc i can't spell it out :lol:) since then i've been on a couple of calls where the medic really really wanted it (head bleeds, major head trauma, and i forget what else) and several other calls where we were BLS managing the airway (highflow/NRB) and right after we got to the hospital the doc was telling the nurses to start drawing up RSI and then tubed them. we currently carry versed, valium, and MS but i don't know whether or not the medics are allowed to use them in an RSI fashion (i'm an EMT and i don't have a copy of our als protocols). the flight crews have RSI....

[medic03]

Originally posted by Merck@Mar 30 2005, 03:35 AM
...... I haven't found a lot of good research on the efficacy of prehospital RSI and what I have found doesn't seem to really support it. Do you guys have specific scenarios or protocols, or does it just fall to sound judgement and experience.......
I find it to be VERY helpful and use it when I feel I need to control the airway. We have protocols, but we do it under our "judgement" and so far it has worked out well. The docs we work with are great and treat the medics as part of the team, so they give us pretty much anything we want. We can get pretty liberal when it comes to our protocols due to the docs trusting us.

[rescuejew]

because Durham is small and the transport times short, we do not have RSI here, just ETI and NTI. NTI works pretty well for most patients here. We dont carry any paralytics here because of our medical director...I have no opinion.

On the drugs subject: ALL narcs are carried in eyeglass cases on our person. Our trucks kept getting broken into and now the hoods can just hold a knife to our throats instead of destroying the back of the truck....

[ECC]

In the few minutes that I have been a paramedic, I have needed RSI once (an EMT tried to stick an OPA in a patient's mouth who was suffering from a severe head injury).

I think anything that would ease the intubation of a patient would be beneficial, but in my experience I have been quite successful without breaking teeth. :D

[Doctor B]

Working in two different environments I have the opportunity to utilize two different protocols.

For the Fire/ EMS side, our conscious sedation protocol is as follows:

Etomidate 0.3 mg/ kg. for the non-head trauma patients that can be repeated x 1 in 60 seconds if the patient is still clenched along with Hurricane spray to blunt the gag reflex (since Etomidate does not) and Versed post intubation for sedation. For the head injured patients we go with 0.6 mg/ kg. right off the bat since we noted a markedly increased incidence of jaw clenching with the smaller doses.

On the aircraft: Our RSI protocol is as follows:

Sedate with 0.3 mg/ kg Etomidate
Paralyze with 1.5- 2.0 mg/ kg of Anectine (Succynlcholine)
Re-sedate with Versed within 5 minutes.
Maintain paralyzation with Norcuron if needed.

Our reasoning for using Etomidate first vs. Versed is that it is faster acting with less potential for side effects especially in the hemodynamically unstable patients. If they are hypotensive we just use the Etomidate for continuous sedation as opposed to the Versed.

[Jon]

I love it.

I just started my ride time in probably the most progressive of the PA counties.

Standing orders for 4mg of MS for cardiac and non-cardiac pain control.
Standing orders for 5mg of Midazolam (I think - not 100% sure of protocols yet) for "Facilitated Intubation" We can't carry RSI drugs on ground ambulances in PA, yet. Probably not ever, if Dr. Wang keeps on turning out good, well-backed studies.


Jon

[ECC]

Originally posted by PArescueEMT+Feb 5 2005, 03:05 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (PArescueEMT @ Feb 5 2005, 03:05 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-medic03@Feb 4 2005, 12:04 PM
I hate you..... sniff.
don't forget that we can gang up on her... [/b][/quote]
Um...no.

[rescuecpt]

Originally posted by ECC+May 27 2005, 11:54 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (ECC @ May 27 2005, 11:54 PM)</td></tr><tr><td id='QUOTE'> Originally posted by PArescueEMT@Feb 5 2005, 03:05 AM
<!--QuoteBegin-medic03@Feb 4 2005, 12:04 PM
I hate you..... sniff.
don't forget that we can gang up on her...
Um...no. [/b][/quote]
:D

[Jon]

Originally posted by ECC+May 28 2005, 12:54 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (ECC @ May 28 2005, 12:54 AM)</td></tr><tr><td id='QUOTE'> Originally posted by PArescueEMT@Feb 5 2005, 03:05 AM
<!--QuoteBegin-medic03@Feb 4 2005, 12:04 PM
I hate you..... sniff.
don't forget that we can gang up on her...
Um...no. [/b][/quote]
We can, but we won't.

Jon

[Flight-LP]

The ground system that I work with utilizes the standard Etomidate, Anectine, and Vec dosing. Versed only for continued sedation which IMHO is not needed if Vec is used. In the air we use Etomidate and Zemuron (my personal fav, quicker than Vec and doesn't last as long), Diprivan to keep them down if needed and not contraindicated. I hate Sux, too many patient presentations that its contraindicated in. Not a real Versed fan either, can't use it in most traumas or in the case of hemodynamic instability.

[Jon]

Remember, though, that Vec won't put them to sleep, really, just paralyize the patient.

It is cruel to paralyize a pt. and have them awake, espicially if we are carriying on joking about the pt. being a stupid mother-****er for wrapping his corvette around a large tree with ETOH on board.

Jon

[medicNsand]

RSI is good in rare circumstances, I feel. It's a mentality We All Know. Some Medics want to do things " 'cause they can" as opposed to the patient really " Needs It" complex. I have Succ's/etomidate/versed for my regiment. Been the most helpful in head injuries ( IE, with regards to penetrating obvious mortal GSW's) didn't fit criteria then, LOL,.......