the 100% directionless thread

Handsome Robb

Youngin'
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It was -4 when I started my truck this morning. Took me 10 minutes to start the damn thing though.

I haven't even started yet and I already hate Light Duty.
 

exodus

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It was -4 when I started my truck this morning. Took me 10 minutes to start the damn thing though.

I haven't even started yet and I already hate Light Duty.

Robb, you need to stop going all out in the beginning of the season. Didn't you hurt yourself doing the same thing last year?
 

TransportJockey

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Awesome. What group is teaching this refresher? Is it through a particular organization?

It was done by the UNM EMS Academy. Great bunch of people
 

chaz90

Community Leader
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I'm pretty tired of this whole being sick thing I've got going on. I'm debating how much longer I want to try to push through it with liberal doses of cold meds before finally going in to make sure it's not bacterial bronchitis.
 

SSwain

Forum Captain
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Had my day job's company Christmas party Sat night. (Non EMS)
Did my best to finish off a bottle of Dewars....got about half way, then my wife told me it was time to go...;) I think they watered it down. I had 6 on the rocks and was still standing straight and not slurring.
Seriously though....last night was first time I was called to see if I could come in and cover due to high amount of MVAs .
Friggin people forget how to drive in snow every year.
 

CritterNurse

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"Santa" looks like he's wearing PJs and a cheap piece of craft fur tied around his face! **is biased cuz her Pops is the ultimate Santa, even though he's hung up his boots for good**

My guess would be 'easy to clean or replace' since pets can be messy, destructive critters.
 

lightsandsirens5

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I don't have RSI, we were 3 minutes away. His airway was perfect, no snoring respirations, and satting at 100%. He was just drunk.

No RSI needed. You have drug assisted crash airway? (Versed maybe)? And with a GCS of 3, you probably don't even need that.

I'm sure as heck not criticizing you. Jut remember that anyone that depressed, with that much of a toxic substance on board is at an EXTREME risk of loosing their airway in a flash. I know, I have had someone with a seemingly patent airway, and 30 seconds later, I am trying to move at light speed to get it back.

He vomits without an airway in place, and suddenly those are the longest three minutes of your life, plenty long enough for him to arrest.

Just my $0.02. But then again, I am pretty darn aggressive when it comes to airway management. More so than most I would think.
 

unleashedfury

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ahhh. a break finally.. :ph34r::ph34r:

on the go since 8AM. fall with a broken wrist, 2 cardiac arrests. a stroke, and a refusal. not a good day at all.
 

Carlos Danger

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No RSI needed. You have drug assisted crash airway? (Versed maybe)? And with a GCS of 3, you probably don't even need that.

I'm sure as heck not criticizing you. Jut remember that anyone that depressed, with that much of a toxic substance on board is at an EXTREME risk of loosing their airway in a flash. I know, I have had someone with a seemingly patent airway, and 30 seconds later, I am trying to move at light speed to get it back.

He vomits without an airway in place, and suddenly those are the longest three minutes of your life, plenty long enough for him to arrest.

Just my $0.02. But then again, I am pretty darn aggressive when it comes to airway management. More so than most I would think.

The answer to a potential airway problem is not necessarily intubation. If you are close to the hospital, I think BLS airway is probably the way to go, especially if you don't have a real RSI protocol (versed is a horrible drug to intubate on).

I think trying to intubate someone who has a patent airway and is breathing fine - especially when you are really close to a hospital - is a bad move.
 
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Anjel

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I have 10mg of versed in my box. I have no protocol for drug assisted intubation. I wouldn't even know an appropriate dose.
 

lightsandsirens5

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The answer to a potential airway problem is not necessarily intubation. If you are close to the hospital, I think BLS airway is probably the way to go, especially if you don't have a real RSI protocol (versed is a horrible drug to intubate on).

I think trying to intubate someone who has a patent airway and is breathing fine - especially when you are really close to a hospital - is a bad move.

Breathing fine has nothing to do with it. I could not care less. Breathing or not.

It is airway patentcy that I am concerned about. He has a high potential of loosing that patent airway so fast, you couldn't even get your suction turned on. The man has a GCS of THREE. You probably aren't even going to need drugs, for one. Crash him, tubed in 2-3 minutes, at the ER within 5-6. With a solidly patent airway.

BLS airway has it's place, don't get me wrong. But in my opinion, this is an ALS airway patient.

Part of the reason that is my opinion is because I would get called up by QA/QI and asked why he didn't get a tube. And as previously stated, I am rather on the aggressive side of airway management.
 

Carlos Danger

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Breathing fine has nothing to do with it. I could not care less. Breathing or not.

It is airway patentcy that I am concerned about. He has a high potential of loosing that patent airway so fast, you couldn't even get your suction turned on. The man has a GCS of THREE. You probably aren't even going to need drugs, for one. Crash him, tubed in 2-3 minutes, at the ER within 5-6. With a solidly patent airway.

BLS airway has it's place, don't get me wrong. But in my opinion, this is an ALS airway patient.

Part of the reason that is my opinion is because I would get called up by QA/QI and asked why he didn't get a tube. And as previously stated, I am rather on the aggressive side of airway management.


The problem with this approach is that it exaggerates the risk of monitoring the airway (vs. intervening) and completely ignores the significant risks inherent in prehospital intubation, especially when you don't have the ability to do RSI.

What do you mean you can "lose" the airway? What are you afraid of happening that can't be corrected with an OPA, good BVM skills, and suction? What are you afraid of happening that doesn't actually become MORE LIKELY during an intubation attempt, in which case you'l likely end up BVM'ing anyway?

Prehospital intubation is sometimes appropriate, but not always. It should not be the automatic default. It is often difficult and always risky for the patient. Not everyone who needs airway management needs an ET tube. BVM is not just a rescue technique.

Being "aggressive" is not always the best thing to do.
 
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VFlutter

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He vomits without an airway in place, and suddenly those are the longest three minutes of your life, plenty long enough for him to arrest.

And then spend weeks in the ICU with aspiration PNA/ARDS/ARF/etc
 

exodus

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The problem with this approach is that it exaggerates the risk of monitoring the airway (vs. intervening) and completely ignores the significant risks inherent in prehospital intubation, especially when you don't have the ability to do RSI.

What do you mean you can "lose" the airway? What are you afraid of happening that can't be corrected with an OPA, good BVM skills, and suction? What are you afraid of happening that doesn't actually become MORE LIKELY during an intubation attempt, in which case you'l likely end up BVM'ing anyway?

Prehospital intubation is sometimes appropriate, but not always. It should not be the automatic default. It is often difficult and always risky for the patient. Not everyone who needs airway management needs an ET tube. BVM is not just a rescue technique.

Being "aggressive" is not always the best thing to do.

Don't patients with acute alcohol poisoning vomit a lot? And I would imagine it being quite difficult to suction everything faster than the patient could take a breath.
 

EpiEMS

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Aprz

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Perhaps we should split this from 100% Directionless?

I have 10mg of versed in my box. I have no protocol for drug assisted intubation. I wouldn't even know an appropriate dose.
I made a thread on this a long time ago (Rapid Sequence Induction (RSI) HOWTO), read Manual of Emergency Airway, and read a ton of online articles and protocols on it. The answer is actually very variable, however, common initial dose seems to be 0.1 mg/kg over several minutes.

I agree that the patient should have been intubated, however, not with midazolam (versed) only. I've read midazolam is a poor choice for RSI, that it's onset is still too slow, etomidate (0.3 mg/kg) or other induction agents are better. I've also read many articles that have said RSI is superior to drug facilitated intubation (ie sedated without paralytics), that providers have more difficulty larygnoscopy during drug facilitated intubation vs RSI, drug facilitated intubation has significantly higher failure rates than RSI. Since she was so close to the Emergency Room, I think it was a better choice to hold off on it. Had she been further away, I may have considered calling for orders for drug facilitated intubation, but not really sure what would be the line for that. Maybe >15 minutes transport time?

During transport, just have the suction machine on, yankauer and suction tubing connected, be prepared to suction. I'd insert a nasopharyngeal airway (NPA) or two. Also have the patient transported in the lateral recumbent position with the head of bed slightly elevated if possible.
 
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Anjel

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I wasn't saying he didn't need to be intubated... I was saying with what I have... I wasn't doing it when he was stable and I was close.
 

TransportJockey

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Ugh I absolutely hate this time of year... Never really known why, but the past two or three years, the holiday season makes me even more depressed than usual... which tends to be a rather lot
 

EMDispatch

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Ugh I absolutely hate this time of year... Never really known why, but the past two or three years, the holiday season makes me even more depressed than usual... which tends to be a rather lot

I understand the feeling... When I was kid I lost a friend around this time. I didn't realize how much it still affected me until a cardiac arrest call the other day.
 

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