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.

Leave a Reply

Your email address will not be published.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

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
Thoughts on Ebola October 23, 2014
STEMI Call October 14, 2014
Ebola October 2, 2014
Breaker of Men September 25, 2014
Categories
  • ems-health-safety (7)
  • ems-topics (698)
  • hazmat (1)
  • Uncategorized (413)
  • Comments
    EMS Artifact
    STEMI Call
    Medical calls are just far more interesting and challenging than trauma calls. I've heard of, but never seen anyone use Cabrera format. It certainly can throw you off if you're not looking very carefully. As to the rest of the call, sometimes nothing seems to go right. You did your job, you're not responsible for…
    2014-12-03 23:27:43
    Jordan Collins
    Morphine
    I know this is from a while ago but I like reviewing your drug rankings. I have found, even in the 10-15mg range, Morphine has little effect on pain. I would estimate maybe 1 in 5 patients feels any sort of pain relief. It's frustrating not getting people their relief, while jumping through all of…
    2014-12-02 22:46:44
    BH
    Thoughts on Ebola
    Kent, despite all those deaths, flu still doesn't have the mortality rate that Ebola does. I think concern is warranted.
    2014-11-21 06:05:35
    Jerrid Edgington
    Racing the Reaper: Book Review
    I was surfing the web and came across this page. I am humbled by the review and comments. I can't thank you all enough. The first two books that originally were self published, were re-edited by my publisher and re-released. The third book in the series, Reaper's Requiem, will be released on December 6, 2014.…
    2014-10-29 17:06:57
    Kent
    Thoughts on Ebola
    We are only talking about one airline and two weekly flights to Monrovia and Senagal because the plane lands in Dakkar. I can tell as I have been in both of these airports that prior to entry your temp is taken and a chlorine hand wash is required, this is also repeated before boarding. Again…
    2014-10-29 00:42:00

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS