Here we are again, musings of someone who wants to much change. So here we go with a list of changes that need to be put in place if you haven’t already.
Every EMS agency should have CPAP available on their trucks. This is a simple program that we can solve. There are affordable options that can allow agencies to perform this. Medical directors, if you are not insisting that your providers are performing this treatment you are leading to patients being intubated needlessly.
Why is D50 still the standard when we know that 250cc of D10 works as well without the system shock or possibility of necrosis? We are overloading our patients with dextrose when we could titrate it easier. It is less expensive for the service and better for the patient.
Pain Control Protocols
PAIN IS A DISEASE AND IT HAS ITS OWN PATHOPHYSIOLOGY. Why are we trying to do nothing help this? We have placed that still think 2 mg of Morphine is effective for patients that have a midshaft femur fracture. If a patient is in pain we need to treat them. And we need pain meds that will do this. Dilaudid, Fentanyl, and Toradol should be used more and be available. Pain does cause harm.
RSI has a positive effect on patients with head injuries. There should be no doubt about this. EMS has been doing this wrong though. We need to be putting patients on ventilators because there in the situations that we intubate in adrenaline is pumping and we are not ensuring that we are only ventilating the patients for 8 – 10 breaths per minute. RSI should only be allowed when the ambulances are equipped with automated ventilators.
We are taught to be cautious with every drug we give, except oxygen. Despite science proving that over oxygenating patients causes vasoconstriction and releases free radicals both of which have negative effects on the morbidity of patients, EMS personnel continue to give non titrated oxygen. Worse, medical directors are not stopping this. We need to be educated on the negative effects of these things.
When long spine boards are looked at in the future, people are going to ask what in the hell were we thinking. These devices have no benefit and are proven to cause harm. They should be relegated to patient movement only. That is all that needs to be said.
As always I value your opinions and comments,