Low RBS WITHOUT catheter.

[falcon-18]

The same as in a seizing patient. Would you rather I/O a seizing patient or give Diastat Gel rectally? Which is the best and most appropriate for the patient?

R/r 911

I think Diastat gel rectally. :unsure::unsure:

 

[emtjack02]

I would give valium or versed using a MAD then I would go valium PR.

 

[falcon-18]

rectal administration may be cause vagal stimulation, lead to arrest . :sad::sad:

 

[Ridryder911]

rectal administration may be cause vagal stimulation, lead to arrest . :sad::sad:

Actually it takes more than just administration of the medication as in stimulation of the rectal and anus area causing the stimulation of the vagus nerve. Many medications are given rectally everyday (suppository form) without problems.

R/r 911

 

[falcon-18]

Actually it takes more than just administration of the medication as in stimulation of the rectal and anus area causing the stimulation of the vagus nerve. Many medications are given rectally everyday (suppository form) without problems.

R/r 911

I am not sure about this becuase that I am asking :rolleyes . my doctor

tell me that .

 

[Shishkabob]

You'd have to do a awful lot of vagal stimulation to cause a cardiac arrest... more then is caused by anything going in/out of the rectum.

 

[Ridryder911]

I am not sure about this becuase that I am asking :rolleyes . my doctor

tell me that .

You'd have to do a awful lot of vagal stimulation to cause a cardiac arrest... more then is caused by anything going in/out of the rectum.

I would say something but surely; one is NOT that naive!

R/r 911

 

[Shishkabob]

Err... directed at me or him?

 

[falcon-18]

I would say something but surely; one is NOT that naive!

R/r 911

I do not know whay you say that . but anyway . no proplem . thanks

 

[ResTech]

rectal administration may be cause vagal stimulation, lead to arrest

I could not see rectal (or PR) admin causing vagal stimulation from the insertion alone. The only way I could see vagal stimulation being an issue is from the patient bearing down for some reason during the med insertion into the rectum. This of course would be vagal stimulation from the increase in pressure sensed by the baroreceptors and not so much from anal stimulation as it sounds was insinuated.

I do not know whay you say that . but anyway . no proplem . thanks

What Rid was trying to get across to illustrate I think is this.... people have anal intercourse everyday and people enjoy (usually ) it without any syncope or going into cardiac arrest.... so with that in mind, a tiny suppository isn't going to cause vagal stimulation.

Falcon... just curious... are you from another Country?

 

[falcon-18]

I could not see rectal (or PR) admin causing vagal stimulation from the insertion alone. The only way I could see vagal stimulation being an issue is from the patient bearing down for some reason during the med insertion into the rectum. This of course would be vagal stimulation from the increase in pressure sensed by the baroreceptors and not so much from anal stimulation as it sounds was insinuated.

When I say it can cause vagaus stimulation, that is not means in every one . but may be 1 in every 10000 .

that is what I mean . anyway this information coming to me and I tell you to confirm is it true or no.

thanks

 

[Aliakey]

My pathetic brain kinda leans to the thought: if you are initiating a significant vagal response simply by inserting a suppository intended for rectal administration, then he probably has a few more pending medical problems than originally called for. Hate to be around the next time he visits the ol' outhouse with the latest USA Today newspaper in hand or makes his appointment for the next prostate check.

:blush:

I do have a (probably naive) question for those who know the ways of duck tape and baling wire: When your EMS protocols do not have Diastat indicated on the pharmaceutical list, what's the best way to administer diazepam rectally if approved by your medical control?

We do have some good protocols here (even IM glucagon for EMT-Basics); paramedics do have diazepam (Valium), Versed, and Ativan at their disposal among others. EJs and IOs are also permitted in the standing orders. However, I am also of the opinion that less invasive is better, if another alternative can be used. We do have some pretty sick patients in my "beat", where gaining peripheral access would be a miracle in itself... and harder still when someone is actively seizing.

Can a Diastat-equivalent gel be formed with a water-based gel (KY, for example) and administered with the same effectiveness and time of onset as Diastat itself? Or, is a liquid bolus the way to go? If so, any helpful techniques on keeping the stuff inside the rectum? One topic that was never covered in my EMS classes...

Thanks in advanced!

 

[Ridryder911]

Personally, I always just took the catheter of a 20g IV and placed it on a syringe and inserted it into the rectum. This allows the medication to be placed passes the sphincter and hold the cheeks so it could be absorbed as much as possible.

R/r 911

 

[falcon-18]

Personally, I always just took the catheter of a 20g IV and placed it on a syringe and inserted it into the rectum. This allows the medication to be placed passes the sphincter and hold the cheeks so it could be absorbed as much as possible.

R/r 911

you can also cut IV sit tube and place it into the rectum I think it is better than catheter . because catheter you can not control it in this rote and you need big size like flate anema.

 

[Ridryder911]

you can also cut IV sit tube and place it into the rectum I think it is better than catheter . because catheter you can not control it in this rote and you need big size like flate anema.

Actually, you don't. One has to be careful due to the seizure activity and you are only administering < 3ml of medication.

R/r 911

 

[ResTech]

I've always wondered too what the best method of administering a med rectally in the field. Fortunately, PR admin is a thing of the past for MD... replaced with IM Versed. But I would still like to know what works best for rectal delivery.