We have a somewhat limited chemical/physical restraint protocol. Chemical restraint for us is 10mg Versed IVP, but I have been on runs where med control has authorized up to 30mg Versed. Better living through chemistry right?
humeral head is preferred IO location here per protocol. That said, I much prefer the EJ in an arrest, easier to secure in an arrest and very conveniently located near the airway.
As far as the risk of air embolism...full arrest in the prehospital setting has a relatively poor prognosis as is.
Right sided MIs typically respond well to fluid boluses, so they're exactly right, give nitro per protocol. Just be conservative with dosing, and be prepared to bolus. nitro can still be beneficial. This is also why it pays to have your IV access prior to dosing someone with nitro.
And I would argue intervention is only necessary when pt is unstable or altered. Your post is contradictory. Aside from LOC and hemodynamics how else can you be symptomatic from an arrhythmia to the extent that it warrants intervention?
And I completely agree with you here. Must have misread...
I have the same pants. Knee pads make them ridiculously uncomfortable to wear around. First thing I do is pull them out. I also make it a point to not spend too much time on my knees though.
Great idea in theory, neoprene makes it uncomfortable in practice.
you mean converting a tachycardic rhythm in an otherwise stable patient? Not hypotensive, no AMS, no pulmonary edema?
If it were me, I'd give O2 and transport. If they're truly asymptomatic then why mess with it?
the only valid reason i see for creating "more" venous access would be a situation where the pre-existing venous access is insufficient.
If this is truly the case, the IV should be started in the most controlled environment possible, probably after consulting with all the necessary powers...
if they are asymptomatic all the ER would do is refer the patient to their primary care provider. My understanding of the current practices is a slow reduction in BP, over weeks, usually a trial of lisinopril or another ace inhibitor if my understanding is correct.
So, assuming his pressure...
Parkland is 4cc/kgx %TBSA burned. This volume is the total to be infused in the first 24hr, with half the volume in the first 8 hours. The formula is then modified to maintain a urine output of 0.5-1.0 mL/kg/h. Lactated Ringers is the preferred fluid.