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
    Sandy
    The Ideal Medic
    As a 24 year medic, I finally figured out it wasn't me. Thank you for your article. You can't teach that in any classroom. I have always found that empathy is a great tool. Use it to benefit the patient and teach others what it is all about.
    2015-03-24 22:24:30
    Joseph Eriksen
    The Ideal Medic
    As a 30 year, now retired medic I completely agree. There is nothing wrong with second guessing although one should go with their gut. There are times to be aggressive and times to not. Also humor is one of the most powerful pre-hospital tools in the toolbox although it can't be taught. When appropriate it…
    2015-03-24 19:37:25
    Shawn McCormick
    The Ideal Medic
    I totally agree. To me those make great paramedics. I work as a Operation Supervisor and encourage teamwork/backup whenever the situation calls for it. I encourage feedback from a difficult call my crews responded to. 1) they have the chance to recall the events that took place and they may self evaluate the call. 2)…
    2015-03-24 17:14:14
    Sean Fitch
    The Ideal Medic
    Totally agree Peter, For too long I had the same interpretation and like you now, I would by far take your current description.
    2015-03-24 17:05:33
    tom combs - ER doc/author
    The Ideal Medic
    Twenty-five years as an ER doc in level one trauma centers has me in total agreement. I Interestingly what you say regarding paramedics also, in many ways, applies to ER docs. "Tries to learn from each call...puts the patient first." A great post. I salute to your wisdom!
    2015-03-24 17:04:06

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