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 wasnt 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 wasnt indicated, but because I could never think of it. Severe asthma, I pounded the patient with nebs, or even tried CPAP. Id give fluid, solumedrol and epi 1:1000 if indicated. Doh, Id 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, Im 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 ccs) 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 cant 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
    Casey
    Intranasal Medication
    Agreed Steve. Love IN Versed for combative/ictal patients. Also IN versed is used in ED for kids. Helps with pain relief and as an amnesic and wears off fairly quick- not sure that directly applies to prehospital but food for thought nonetheless
    2015-05-07 00:36:28
    Chris
    AHA 2015 Guidelines: A Preview
    I am a 25 year veteran firefighter/medic, and 9 year veteran critial care fixed wing medic. I work in Northeast Ohio. In this region, we have all but abandoned endotrachal intubation for the intent of ease of a superglottic airway. AHA de-emphasizing ETI and we have seen this coming for a while. We either bag…
    2015-05-05 20:54:08
    Steve
    Intranasal Medication
    "either because they are seizing or are violent, then the better and quicker route would be IM. " I'm quite hesitant about bring a needle against someone fighting me or shaking... those are the perfect times to be needleless.
    2015-04-27 18:34:14
    bill
    The Ideal Medic
    very well put! aggression can be a good in moderation but over aggression can do harm. 1 year to 30 years no medic will know it all epically with our ever changing job description. thank you for your input!
    2015-04-26 11:46:50
    Ben Leighton
    Adenosine
    Hi. Im a UK Student Paramedic and I have a few questions regarding adenosine (we currently dont carry it) and I was wondering if any of you guys could e-mail me at ben-leighton@hotmail.co.uk and start some correspondance. Im aiming to set a proposal to my service in order to carry this drug and wanted some…
    2015-04-20 13:36:03

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