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Ambulance: Novel Vagal Maneuver

Written by RSS Poster Medic Scribe

I never had great luck with vagal maneuvers.  Admittedly when I was a new medic, I didn’t particularly want them to work.  I wanted to give Adenosine, and watch the strip suddenly go asystole and then some wild funky beats before correcting to a nice sinus tack in the 120’s, way better than the 200’s I encountered.  Paramedic as savior!  I remember once how upset I was when I encountered a man in an PSVT in a doctor’s office.  As I got out my IV kit, the doctor ordered me to just take the patient to the hospital so they could see the rhythm for themselves.  Okay, I said, fully determined to work my magic in the ambulance.  Unfortunately for me, carrying the man down the stairs, caused a brief jostle and wallah, he was out of the PSVT.  Drat.

In time though I collected the experience of patients’ extreme uncomfortableness with Adenosine.  They’d clutch their chests in terror as their hearts stopped.  Two actually told me they would rather be shocked than get that drug.  Another pleaded with me not to give...

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Ambulance: Narcan 4mg IN

Written by RSS Poster Medic Scribe » Medic Scribe

download

I was a big initial fan of the intranasal atomizers both for pain management and opiate overdoses.  I liked them for pain management for their quick access.  I often gave an intranasal dose, and then after getting an IV, gave the rest IV.  Overtime I noticed quite a difference in response between the two methods.  IN might touch them; IV almost always worked.  Recently I have switched to IM for the quick first dose.  Sure it involves a needle stick, but the onset is quicker and it seems more effective.

I have continued to use intranasal Naloxone as my first line for opiate overdose accompanied, of course, by bag valve ventilation, but I have been having second thoughts about the IN route of late.  I have always preached patience, and when I give Narcan IN, my patience is usually always rewarded with a calm, almost placid patient.  Many of my peers have told me they prefer 1.2 mg IM as their starting dose.  That’s what I used before IN came out.  True, it does return their breathing sooner and almost...

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Ambulance: Narcan 4mg IN

Written by RSS Poster Medic Scribe

download

I was a big initial fan of the intranasal atomizers both for pain management and opiate overdoses.  I liked them for pain management for their quick access.  I often gave an intranasal dose, and then after getting an IV, gave the rest IV.  Overtime I noticed quite a difference in response between the two methods.  IN might touch them; IV almost always worked.  Recently I have switched to IM for the quick first dose.  Sure it involves a needle stick, but the onset is quicker and it seems more effective.

I have continued to use intranasal Naloxone as my first line for opiate overdose accompanied, of course, by bag valve ventilation, but I have been having second thoughts about the IN route of late.  I have always preached patience, and when I give Narcan IN, my patience is usually always rewarded with a calm, almost placid patient.  Many of my peers have told me they prefer 1.2 mg IM as their starting dose.  That’s what I used before IN came out.  True, it does return their breathing sooner and almost always wakes them,...

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Ambulance: Hear the Drumming

Written by RSS Poster Medic Scribe » Medic Scribe

Another three dead of heroin overdoses in Hartford in the last 16 hours.  The slaughter continues.  Hartford led the state in overdose deaths in 2015 with 56.  The 2016 numbers, which are not complete, are estimated to be in the high 70s.  Already there have been 5 known heroin deaths in 2016.   I recently did a cardiac arrest of a male in his 40’s just out of rehab, found dead on the couch.  No heroin paraphernalia was seen, but who’s to say the scene wasn’t sanitized before we got there or maybe he snorted outside and walked into the house and collapsed.  Not certain if he ended up as a medical examiner case, but if he did, the evidence will be in the blood, and his name will be added to the tally.

Next week, at our hospital EMS CME, a death investigator from the office of the state Medical Examiner will be speaking to us about heroin and fentanyl.  I am very excited to hear her talk.

I am encouraged that people are the crisis seriously.  From police to health care workers to elected representatives,...

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Ambulance: Hear the Drumming

Written by RSS Poster Medic Scribe

Another three dead of heroin overdoses in Hartford in the last 16 hours.  The slaughter continues.  Hartford led the state in overdose deaths in 2015 with 56.  The 2016 numbers, which are not complete, are estimated to be in the high 70s.  Already there have been 5 known heroin deaths in 2016.   I recently did a cardiac arrest of a male in his 40’s just out of rehab, found dead on the couch.  No heroin paraphernalia was seen, but who’s to say the scene wasn’t sanitized before we got there or maybe he snorted outside and walked into the house and collapsed.  Not certain if he ended up as a medical examiner case, but if he did, the evidence will be in the blood, and his name will be added to the tally.

Next week, at our hospital EMS CME, a death investigator from the office of the state Medical Examiner will be speaking to us about heroin and fentanyl.  I am very excited to hear her talk.

I am encouraged that people are the crisis seriously.  From police to health care workers to elected representatives, an extraordinary...

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Ambulance: Neuro EMS

Written by RSS Poster Medic Scribe » Medic Scribe

Check out the great post on Neuro EMS:

30 Seconds to Understanding Drug Addiction

“EMS is at the forefront of emergency medicine therefore we should be at the forefront of shattering mental health stigma and providing compassionate, non-judgemental care.”

Bravo!



Ambulance: Neuro EMS

Written by RSS Poster Medic Scribe

Check out the great post on Neuro EMS:

30 Seconds to Understanding Drug Addiction

“EMS is at the forefront of emergency medicine therefore we should be at the forefront of shattering mental health stigma and providing compassionate, non-judgemental care.”

Bravo!



Ambulance: Snowbank

Written by RSS Poster Medic Scribe » Medic Scribe

IMG_0105

It is six in the morning and we get called for an overdose outside.  The address is not a surprise — a side street off Park.  Yet when we arrive, we find no one.  We are about to clear when a police officer who has also responded finds a backpack in the snow and sure enough coming down the street is a man who seems somewhat confused.  One side of him is dripping wet as if he had been laying in the snow.  He has come to claim his backpack.  I ask him why half his clothes are soaking wet.  He hesitates a moment, and then says he was helping a friend shovel.  This answer makes no sense.  It is after all six in the morning and the snowstorm was the day before, ending well before sunset.  

We tell him we were called for an overdose, but he knows nothing about it.   I ask him if he has been using drugs in the last several hours.   “Ohhh, nooo,” he says.  “Well, maybe seven years ago, but not for s long time.”

He knows the date and his name and has no interest in going to the hospital.   I suggest we...

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Ambulance: Snowbank

Written by RSS Poster Medic Scribe

IMG_0105

It is six in the morning and we get called for an overdose outside.  The address is not a surprise — a side street off Park.  Yet when we arrive, we find no one.  We are about to clear when a police officer who has also responded finds a backpack in the snow and sure enough coming down the street is a man who seems somewhat confused.  One side of him is dripping wet as if he had been laying in the snow.  He has come to claim his backpack.  I ask him why half his clothes are soaking wet.  He hesitates a moment, and then says he was helping a friend shovel.  This answer makes no sense.  It is after all six in the morning and the snowstorm was the day before, ending well before sunset.  

We tell him we were called for an overdose, but he knows nothing about it.   I ask him if he has been using drugs in the last several hours.   “Ohhh, nooo,” he says.  “Well, maybe seven years ago, but not for s long time.”

He knows the date and his name and has no interest in going to the hospital.   I suggest we take him to the...

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Ambulance: Happy

Written by RSS Poster Medic Scribe » Medic Scribe

happy

I ask my patients who are addicted to heroin how they got started.  Many tell the same tale.  Injury.  Prescription for Percocet or Oxycontin.  They got addicted.  Prescription either went away or couldn’t keep up with their growing tolerance.  They started buying pills on the street.  Then they learned heroin was cheaper and worked even better and was more widely available.

But not all people become addicted to heroin this way.  Here are three patients’ stories.

Shelly worked in a restaurant.  She was a twenty-eight year old single mom, who was going through a hard time.  Her daughter’s father had left them and she was staying with her mother and stepdad who she felt were always judging her poorly.  She noticed one her coworkers was happy all the time, no matter what was going on in his life.  She asked him how that was.  He said he used heroin.  So she tried it with him one night.  And she had never felt so good.  All her cares when away.  Three years later I am taking her from jail to the hospital for...

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Ambulance Blog List

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InsomniacMedic (219)
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Medic Scribe » Medic Scribe (96)
Xf (92)
Minimedic's Blog (71)
A Life In The Day Of A Basics Doc (57)
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Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (46)
Jerome Mowat (26)
Emergency Egg (19)
Medic Scribe (19)
BrianKellett.net (18)
ambcontrol999 (17)
Hampshire and Isle of Wight Air Ambulance (14)
Purpleplus (11)
Minimedic's Musings (11)
Random Acts Of Reality (6)

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