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.
CPAP
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.
D10W
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
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.
Oxygen
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.
Spinal Immobilization
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,
Lone Medic.
