Words

Last night I gave my capnography CME. There was about thirty people there. I think it went over okay. It is hard to tell when you are standing up behind a podium and giving a presentation for the first time how well it is being recieved. Our medical control physician thought it was very good and that I was changing his thinking on capnography. He also mentioned he thought it would be a good presentation for the ED docs, although he said they wouldn’t sit for more than an hour. The presentation currently runs about an hour and a half. I don’t think I would be comfortable doing the presentation in front of them. I just don’t explain the science part well enough. While I understand ventilation/perfusion mismatch, I don’t explain it well in detail, not that the physicians would need that, but they might ask me a question that would tongue-tie me and expose me as a little deficient on the science side of things. I am glad the presentation is over and I can set it aside for awhile. It took up much of my summer. For those interested, here again is my capnography blog.

Capnography for Paramedics

I will continue updating it as I learn more about capnography.

**

On Tuesday at my monthly regional medical advisory meeting, we passed in principle, a protocol allowing us to give up to .15 mg/kg of Morphine for pain on standing orders,(the current protocol allows .1 mg/kg before having to call for medical control). We also expanded it to include back pain on standing orders, as well as abdominal pain, although the abdominal pain will be limited to .05 mg/kg before calling for medical control.

I have been strongly pushing for increased emphasis on pain management and have been pleased with the gradual prgress we have been making in our region. It occurred to me when I was making my case for the increased pain meds that we overtriage everything in EMS — whether it is c-spining or sending ambulances lights and sirens, but in one area where we can make a big difference – pain management — we undertreat.

***

I worked with my preceptee in the city and while there were two traumatic arrests today, we missed both of them. On one, a BLS crew was sent as the first car in (a medic supervisor and a medic car were called to aid them once it was clear there was CPR in progress). Shortly after at the hospital, I saw one of our best medics — a guy who helped me out on what turned out to be a double fatality MVA when I first started over a decade ago — coming out of the hospital with a BLS transfer with a vase of flowers in his hand as he pushed the stretcher. If I was in a bad wreck I would have wanted him first on the scene, not being tied up duing a transfer.

***

At an Alzheimer’s home today where we were sent for a patient not feeling well, we found ten old people sitting out in the common area watching the big screen TV with an aide who looked to be about 19. It was the Maury Povitch show, and someone on the show was calling his girlfiend a “Bitch and a Hoe!” and there was all this yelling and shoving going on back and forth and someone doing a booty dance, and I looked at all the old people on the couch and they were all staring at the TV with this look on their faces like they didn’t understand what they were watching and whatever it was, they had no words for it.

2 Comments

  • Anonymous says:

    I envy your pain management protocols. Ours are morphine 2-5 mg q 5 min titrated to effect. I wish they were more clear and specific. Fentantyl is weight based. 1.0mcg/kg to a max single dose of 100mcg q 5 min. For ab pain, MS is 2-10 mg titrated to effect or a single dose of fentanyl. We have to call for additional orders.These aren’t all that bad, our protocols. But few medics ever do a proper pain or anxiety medication dose. It’s sad. They’re still in the “2mg of MS is enough” camp. Or, “Only narc seekers want morphine” attitudes.

  • PC says:

    We are looking into using fentanyl in the future. As far as the narc seekers, I agree too many people withhold pain relief on the fear the person is drug seeking. i would rather give morphine to two drug seekers and one person in legitamate pain then not to give to any. I don’t feel our job is to judge. And even if we do end up giving MS to a drug seeker, at least they are getting a clean needle and entrance into the health care system where maybe they can get into rehab.Thanks for the comments,PC

Leave a Reply to Anonymous Cancel reply

Your email address will not be published. Required fields are marked *