Some Practical Q's:

[Rangat]

1. Grand Mal Seizure pt:

Diazepam or Medazolam?

2. Hx of epilepsy pt:

Rotators on near the pt, or while transporting?

3. Beta 2's Nebs:

Do you carry only a combination UDV, or a variety? like Salbutamol, Ipratroprium, Fenoterol, and mixes? For the kiddies?

4. IV's:
Is there any reason to use a 16g on a trauma (ringers) pt, instead of a 14g, except that you are scared of 14g's?

5.And lastly, do you do HGT on all pt's, or just on decreased LOC and Hx of diabetes pt? Also taking into concideration his last meal.


Go wild and free with responses, thanx for the input!:blush:

 

[Ridryder911]

. Grand Mal Seizure pt:

Diazepam or Medazolam? Both, depending on the hx., the way I see the presentation. I personally use Versed in atomizer form to stop the seizures, after checking glucose level ( I prefer to treat etiology over symptoms, if possible). Valium, usually works well, however Ativan has a longer duration.. which is good or bad dependent on the situation. If it status, I will use Ativan do the strength is stronger than Valium

2. Hx of epilepsy pt:

Rotators on near the pt, or while transporting? Not sure what rotators are, if you mean restraint's .. No

3. Beta 2's Nebs:

Do you carry only a combination UDV, or a variety? like Salbutamol, Ipratroprium, Fenoterol, and mixes? For the kiddies? We carry Albuterol, Ipratropium (prefferred Albuterol X1, then option to use combination and Xopenex.. and racemic Epi for the kiddies if they are really shut down

4. IV's:
Is there any reason to use a 16g on a trauma (ringers) pt, instead of a 14g, except that you are scared of 14g's? The bigger the better... whatever largest size of lumen you can get in. Ringer's Lactate on trauma, because Hartman's solution has more electrolyte and lactate that trauma patients need, secondary line NSS for blood administration.

5.And lastly, do you do HGT on all pt's, or just on decreased LOC and Hx of diabetes pt? Also taking into consideration his last meal. .. Not sure what HGT is? Height, hematocrit, blood sugar? I presume glucose level, then yes, I do FSBS, glucose check on any altered LOC and anyone that has hx of any type of Diabetes.



Be safe,
R/r 911

 

[Rangat]

thanx for the reply.

rotators are the flashing warning lights... the star bar, thesedays they are LED though.

HGT: Haemo Glucose Test

And so you dont do it on all pts?

 

[RALS504]

thanx for the reply.

rotators are the flashing warning lights... the star bar, thesedays they are LED though.

HGT: Haemo Glucose Test

And so you dont do it on all pts?

BGL (blood glucose level), CBG (capilary blood glucose) I am surprised we have so many names for the same thing.

 

[ParamedicBrian2000]

1. Grand Mal Seizure pt:

Diazepam or Medazolam?
Versed is nice because it can be given IN. In my experience it seems to be effective.

2. Hx of epilepsy pt:

Rotators on near the pt, or while transporting?
If the pt is stable I would transport without lights and siren unless they are experiencing status epilepticus.

3. Beta 2's Nebs:

Do you carry only a combination UDV, or a variety? like Salbutamol, Ipratroprium, Fenoterol, and mixes? For the kiddies?
Albuterol/Combivent for adults in most cases. Albuterol only in kids. For tx of croup racemic epi can be effective but you do not see it used very often anymore. This is primarily because it is contraindicated for epiglottitis. Sometimes stridor can be hard to differentiate between epiglottitis and croup in the field. Also if a pt is given racemic epi in the field most hospitals require that they are admitted for 24 hours due to rebound effects. This can cause your pt to be needlessly admitted. 1cc of 1:1000 epi mixed with 1cc of saline in a neb tx is just as effective as racemic epi for tx of croup and it does not have all of those nasty side effects and contraindications. It's also much cheaper to carry.

4. IV's:
Is there any reason to use a 16g on a trauma (ringers) pt, instead of a 14g, except that you are scared of 14g's?

Only if you cannot get a 14 in.

5.And lastly, do you do HGT on all pt's, or just on decreased LOC and Hx of diabetes pt? Also taking into concideration his last meal.

A pt with diabetes with a diabetic related emergency should always get a CBG. Any pt experiencing a Sz, LOC or ALOC, or symptoms of a stroke should also get a CBG. You don't want to intubate a pt only to find out that they have a CBG of 12.

 

[Jon]

1. Grand Mal Seizure pt:

Diazepam or Medazolam?

The paid gig dosen't carrying Midazolam (Ativan) on a regular basis because our Medical Command doc is concerned about the half life of the drug when stored at room temprature. We almost never use it, so we would have to throw out old drugs every 90 days.

For our large events, it is issued and collected, and/or stored in fridges in the tents.

2. Hx of epilepsy pt:

Rotators on near the pt, or while transporting?

In general - I'm much more concerned with some of todays LED packages than halogen Rotators...

My transport mode probably wouldn't change if they are epileptic... I don't like to use the lights unless it is really needed to begin with.

3. Beta 2's Nebs:

Do you carry only a combination UDV, or a variety? like Salbutamol, Ipratroprium, Fenoterol, and mixes? For the kiddies?

I'm not 100% sure what you are getting at... I think you are asking about straight Beta 2 Agonist vs. Combivent... It varies from squad to squad. Many just use straight Albuterol

4. IV's:
Is there any reason to use a 16g on a trauma (ringers) pt, instead of a 14g, except that you are scared of 14g's?

I'd stick 'em with whatever I think I will fit in. If they need fluid resusitation, everyone will be happy to have it later.

I remeber doing my ER clinicals and getting odd looks from nurses for starting 18's in many patients... Why? because it was the biggest availible in the rooms, and allowed greater volume delivery.

5.And lastly, do you do HGT on all pt's, or just on decreased LOC and Hx of diabetes pt? Also taking into concideration his last meal.

It varies - if patient is complaining of weakness/dizzness/syncope or any other possible hypoglycemic issues, even without any diabetic Hx, then yeah, almost all ALS providers around here will check sugar. Many of the medics will check BGl when they start an IV off of the venous blood... it does give them a vague idea of low/normal/high.

Go wild and free with responses, thanx for the input!:blush:

 

[ParamedicBrian2000]

Correction

Hey Jon,

Midazolam is Versed. Lorazepam is Ativan. Ativan is temperature sensitive and versed is not. Just thought I'd help out a bit.

- Brian

 

[Jon]

Hey Jon,

Midazolam is Versed. Lorazepam is Ativan. Ativan is temperature sensitive and versed is not. Just thought I'd help out a bit.

- Brian

Merde that would be a REALLY big brain fart - HOW DID I MANAGE TO SCREW THAT UP!

Well, in that case, most everyone uses Midazolam (Versed) over Diazapam (Valium), at least in adults... I think the reasoning is that it is more potent (lower dose, faster acting) but I'm not really sure.

 

[Ridryder911]

Apparently there is a new "form" of Ativan on the market that is not temperature sensitive, as previous Ativan. Albeit I have never personally used it, there are services I know of that does... it does however; has to be re-constituted though, then has a short shelf life.

R/r 911