New Tricks for an Old Dog

While I have been a huge proponent of aggressive protocol change based on evidence, I find for guideline change I have to go through a transition of retraining my call memory to adapt to the changes. I know other medics have a similar problem.

In my coordinator job when I QA run forms, it is always the older medics who still give morphine to the patient in CHF or who give epi 1:000 SQ. When I ask them about it, they just nod their heads. I know. I reverted to what I have always done, they tell me. It happens to me as well. I still reach for the atropine in cardiac arrest, although I have progressed to the point of no longer taking it out. I still first think ET tube, instead of considering an alternative airway, although I have caught myself and on several occasions, set my airway kit down without unzipping it and reached for the combi-tube or LMA.

When we first got Solu-medrol, I could never remember to give it. It wasn’t until I started placing it in the top of my house bag, nestled in with the nebulizer that I started grabbing it. I have heard other medics tell me of how well Magnesium works in severe asthma. Until recently I had never used it not because it wasn’t indicated, but because I could never think of it. Severe asthma, I pounded the patient with nebs, or even tried CPAP. I’d give fluid, solumedrol and epi 1:1000 if indicated. D’oh, I’d say later if someone asked me if I considered Magnesium.

I finally solved my dilemma. I decided to put the Magnesium right next to the solu-medrol, nestled there with the nebulizer and albuterol and atrovent. First bad asthma I had, there it was staring at me. “Yo, Magnesium here, I got what you want. Put me in Coach, I’m ready to play, today.”

For a patient, who was using all accessory muscles, wheezing to beat the band and had Jaws-like shark fins on the capnography, trending up toward hypoventilation, the Magnesium (We give two grams in 100 cc’s) seemed to work like a charm. The patient was much better on arrival at the ED.

I am also considering a new method to help me with my airway choices that was recommended to me by another medic. Taped across the Intubation kit, a message –“Consider Alternative Airways.”

Who says old dogs can’t learn new tricks.

1 Comment

  • When we first started to give ASA in the field, I never remembered to do it. I made a label and put it in the “Action Area”. The label just said “Don’t forget the Aspirin”.

    It worked to prompt me to give ASA.

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Peter Canning

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  • Comments
    BH
    Assembly Line
    Two of my major hospitals now employ scribes that accompany their assigned MD all day for the sole purpose of recording their H&P with the patient. It not only makes the doctor/patient interaction more... interactive, but since all the scribes have to worry about is documentation and not patient care, the reimbursements for the doctor's…
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    Patricia Landmesser
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    I agree with these two... thank you for writing. Your work is inspirational, entertaining and down-to-earth informative. Seems it should be a must read for any who are interested in the EMS field. Many Thanks!
    2015-08-22 11:24:54
    A35EMR
    Patient Follow-up
    I just want to thank you for doing what you do. Your book "Rescue 471" is what inspired me to start my career in EMS. I am currently 16 and working for an urban ambulance service as an EMR, and your blog has been really insightful into skills and knowledge that any healthcare provider should…
    2015-08-18 05:38:41
    Foster
    Patient Follow-up
    You're absolutely right. We don't grow if we don't see the outcomes of our work. ...Or at least, we're less likely to grow in the right direction. You're in a pretty good spot to change some of this in your hospital job. Why not set up a system where paramedics can flag patients they'd be…
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    Jon Kavanagh
    #1 Pain Management and Comfort Care
    We comfort and take care of pain when we remember that the patient is a person. A touch on the hand or shoulder, a compassion for his situation, a desire to do the right thing (vs the easy)... We need to be actively turning his bad day into something less lousy, even when the solution…
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