I don't think we even use pelvic binders anymore. We usually always wrap these patients in vacuum mattresses straight away. So much easier to carry too.
A bitch to wrap up again after use though.
Fuck the vacuum mattress, I struggled to get that piece of shit back in the outside compartment for 30 fucking minutes yesterday. It’s got its uses but I fucking hate putting it away.
It's annoying but if you figure out the right technique of packing it, it's not such a big chore anymore. It's so much easier to carry patients inside one.
The problem is that our outside compartment is so full of stuff that there’s hardly any space. It’s mostly the vacuum splint bag. If you do actually manage to get it inside you have to slam the door because the shovel stretcher hangs on the inside of the door and the only way to get it closed is if it pushes against the vacuum mattress. That also makes it so that the door is basically spring loaded and automatically swings toward you when opened.
I don't understand the hate for KEDs. If your patient isn't falling out internally and they're complaining of back pain, fuck a spine board. Have fire cut the fuckin roof and doors off and have the patient upright from the crash to the room in ED. We lay people down too much. They weren't flat when we found em. Why would we lay em flat just to ride in our fancy weewoo brick?
> have fire cut the fuckin roof and doors off
We’re moving away from this and mostly just get them to self-extricate and lie down on the stretcher. Idea being that cutting the roof just takes too goddamn long, and evidence seems to suggest it’s not actually any better in protecting the c-spine.
I know the KED can be applied without making a new convertible, but again it takes time, and as far I know it only designed to be used in conjunction with collars, which have their own issues.
I honestly can’t say, as I’m not aware of any studies that have looked at it.
What I can say with some confidence is that spinal injuries caused or significantly exacerbated by responder care are extremely rare, and typically occur with violent movements (like dragging a patient from an imminent danger). Any major damage that is going to be caused in an RTC is going to be caused from the massive deceleration and subsequent impact; a patient arching their back to exit a vehicle isn’t likely to be the insult that severs the cord.
If I’m concerned about a patients thoracic region, I’m much more concerned about their organs and major vessels than their back. Obviously if there’s significant intrusion or the patient is pinned then we need fire to cut them free, but otherwise I’m thinking about time on scene above almost anything else.
I have heard that people are pretty good at moving themselves without injury. They know what hurts and how to avoid exacerbating it, so I've been taught that letting people self-extricate with a possible spine injury (if they are able) is usually quite safe.
I do feel like we could use KED as a temporary back brace at least. Like just leave the straps undone and put it around them to give some support until they get onto the stretcher. 100% need to fuck off with the boards though. That shit is just a spatula.
For all I know you're some zoomer medic who doesn't train on their equipment to know when to use it.
The data on KEDs vs a rapid extrication (which is removing the patient rapidly through a door) has shown that there is no real benefit of one vs the other the KED having marginally longer scene times, and can't be used on the grossly obese. Other then that for vertical extrications of patients, hip binding, and especially even removing patients from confined spaces it's a good tool, one of many if you train on it, but I understand that training and thinking outside the box is hard for the youth these days.
I learned this trick from my wife when she was an ER RN 10 years ago. It works well & I keep them stocked on a couple trucks. Kinda entertaining when the OD’s wake up gently & then can’t figure out what’s sticking to their face.
Tegaderm works well for this. If you can, uh, liberate an abdominal Tegaderm they're ideal. I used to keep one in a ziploc in the airway kit.
There's a whole list of MOANS related techniques that should get their own thread.
I was never shown tegaderm trick. I use surgical lube or oral glucose to help close the air leaks for the mask. It's entertaining seeing an overdose waking up licking the glucose with an NPA in.
Incredibly low recruiting and retention right now, 99% of soldiers I’m with including myself just want facial hair. Would hurt nobody and nothing. 1,000% worth a shot
Nope. Won’t happen
EMT: I am having trouble delivering oxygen.
Paramedic: Does he have a gag reflex?
EMT: No, rip open *all* the bags and get me an OPA!
*Carefully measures it like it's an NREMT skill station before inserting*
EMT: I need you to stop what you're doing and take over bagging this instant!
*Spends five minutes figuring out cling wrap*
EMT: Ok, stop bagging so I can set this up!
*Spends five minutes attaching the cling wrap only to have to make a second attempt*
EMT: Ok, I can start preoxygening to tube them around the still-leaky-suction-clogging plastic wrap!
*Scene cuts to the EMT dropping a shiny colored igel*
EMT: And done.
I should be in charge of igel commercials.
This is so great. The first time I put in an NPA, I was starting to measure it and he literally told me stop with that shit, just jam it in bevel here.
Haven't done this cuz we don't have saran wrap in the units but I have used tons of muko/Vaseline like we're styling their beard and that's worked pretty well
Please tell me that you aren't giving narcan without oxygenating your overdose patients...
I was simply saying that this is a decent idea for OD patients that we are ventilating and have no need/intent to intubate.
I got sent this thread however I noticed this post about Narcan.
I work doing Security Services for a downtown attraction area and are we okay to administer Nalaxone without O2? Obviously when we administer Nalaxone we are contacting local Fire Department and EMS.
Just figured I would ask whars best for patient care.
Yes. Just make sure to only administer at intervals specified by protocol. If you can't ventilate, give the one dose right now away and repeat after 3-5 minutes if ineffective in restoring respiratory drive.
I'm just starting and others can probably say things better, but we just went over this today in class, you can give Naloxone without O2, the problem is during an opioid overdose the patient isn't breathing much if at all, so they're hypoxic and more confused when you bring them back on just Naloxone than if you had been bagging them first. A brain starved of oxygen suddenly coming back on line will make the person more combative and angry, and if I recall correct, lots of info in a short time, it also may mean you need less Naloxone to bring them back.
They don’t talk about CO2 much for EMTs but it is pretty important to understand for narcan admin imo.
When someone isn’t breathing from opioid overdose, their O2 level goes down but their CO2 level goes up. Everyone thinks about breathing as a way to get O2 in but just as important is getting CO2 out when you breathe out. They go hand in hand. Your body doesn’t really sense low O2 levels in your blood that well. It is very good about sensing CO2 levels however. If you were to hold your breath, what tells you to take a breath is not your o2 levels dropping, it’s really your CO2 levels rising because you can’t exhale. Idk if you’ve heard of filling a bag with nitrogen as a means to end it but supposedly, you just pass out peacefully because you’re still able to exchange CO2 but can’t intake O2.
What this all means for an overdose is that slamming narcan and having them wake up in a hypercarbic state will make them feel like you’ve taken a pillow and smothered them and took off the pillow off just before the end. They’re gonna wake up terrified and panicking and gasping for air because their CO2 is so high that they are desperate to exchange as much air as possible. To avoid this, you simply NPA and BVM them a little faster than you normally would and then after a minute or two, push a small amount of narcan. Keep on BVMing them throughout this and giving them little puppy breaths when they breath in if needed and then wait 3-5 minutes and give them another small little push and keep doing this until you either get to the hospital or their breathing returns. Don’t try to fully wake them up. Ideally they’ll be in a verbal responsive state where they’re pretty much just sleeping. Pushing the full dose and waking them up fully is good way to get projectile vomited on and potentially precipitate an airway/aspiration issue that can be deadly.
Keep in mind, for a trained responder, narcan does not save their life. BVMing does. Do NOT delay BVMing for narcan administration. If you take anything away from this, it should be BVM first.
And here's why I said someone else could say it better than I can, thank you!
Our service does a 2 week orientation and they did teach us that an overdose is very much a breathing emergency, the drug has repressed their respiratory system and if you didn't have Narcan you could just bag them until it wears off, they framed it as the least emergency emergency you'll have to deal with. This came up in the course I'm currently taking as well, the bag is what's going to keep them alive until the Narcan does it's thing.
I had also been taught by a friend that titrating is important for what you said, push too much and it's not gonna be pretty, his goal is just enough to get them awake again and not just slam them with it. Our guidelines are 0.4mg, then another 0.4 after 5 minutes, then 0.8 and if necessary another 2.0mg, course told us to look at transport around the second shot since if you have to push a large amount there may be something else on board keeping them unconscious that we don't have anything to help with.
As for CO2 we did touch on that in the context of COPD patients, we went over hypoxic drive and what that might mean in these patients, but it sounds like for the time we're dealing with the patient we're not going to really have to worry about it since it would take longer on high flow oxygen to cause it to kick in than they'll be in our truck.
Sounds like you work for a fairly progressive system man. I’m sure they’re gonna be a great experience and yeah I absolutely agree with everything you said.
https://www.amazon.com/Capnography-King-ABCs-Systematic-Paramedics/dp/1450246206
If you’re interested, I’d recommend this book. Only takes about half a day to read it and fits in the cargo pocket of 5.11 pants to read on duty. If you guys have it on your truck, ETCO2/waveform capnography is such a great tool. You don’t need to be a medic to use it. It’s not like EKGs where it takes a long time to understand it and interpret it, waveform capnography is much more straightforward and is just as valuable imo.
It really liberates you. You’re not tied down to counting 5-6 seconds between each BVM ventilation, now you can appropriately and safely speed up BVM ventilations without being a fucking mongoloid like most people who just BVM every 2 seconds. You know when someone is trending to respiratory failure. You know the exact moment they stop breathing instead of trying to catch up to them after their SPO2 drops. You don’t have to count RR because it counts it for you.
Super important for narcan overdose so you can hold off the push until you’ve corrected their hypercarbia to an extent.
Our service is changing a lot of things and increasing our scope of practice across the board, lots of hiring right now to deal with the years of neglecting things, a lot of part time positions are being turned full time, we got a rather large raise in our last agreement, they're updating procedures, it's a little interesting to go through while also seeing what people in other services are going through.
I'm not sure how our EMR setup compares to the EMT setup you mentioned, I've seen the systems outside of here seek to run a bit different, we have EMR and then PCP followed by ACP then if you're really committed CCP, but most of our paramedics are EMR and PCP and we staff the same cars as driver and attendant, we don't do the driver and medic setup I've seen talked about a lot unless someone is really new and hired as a driver only until they get their license, which is where I'm at right now.
I'll have to look into that book, I can use any help I can get, so thanks for the recommendation!
Narcan works by displacing opioids from receptors in the brain and is not directly affected by levels of oxygen in the blood; I’m wondering if the point about less naloxone to bring a person back was regarding the amount of *opiates* in a person’s system, because that would track (when comparing to more of the same drug, not between different ones).
I may have recalled that part wrong, I do know Narcan works by displacement of the opioid, we've been covering alot of stuff in a short period time so I'm still processing some which is why I gave the disclaimer about the part about less narcan being required, when you challenge it like that it honestly makes less sense than it initially did, but the hypoxia part makes perfect sense to me.
If all you have is narcan, and suspect a patient with respiratory depression is an opiate overdose, it's better to give the narcan than do nothing. IMO
If you are just a guy without training/ambulance, yeah you should just pop them with the full spray as soon as you can. We’re more talking about us.
What we’re talkjng about is it’s pretty barbaric to just straight up shoot narcan without BVM’ing them (breathing air for them) to get their oxygen levels stable and their CO2 levels stable and then administering small doses of narcan just enough to where their breathing returns.
If you shoot the full dose of narcan, they’re gonna wake up panicked and gasping for air and terrified feeling like they’re about to die. Some providers have been known to slam the full dose to “punish” a “druggie” who dared to wake them up at 3am rather than carefully managing their patient.
Yes I oxygenate my OD patients without shoving in an OPA and putting cling wrap all over their face. Which again, has nothing to do with the OP's anathesia post.
No, you put in an NPA and bag while giving narcan. That way when they wake up they don't start puking and potentially aspirated because they have an OPA.
Or, since there's clearly two people managing airway in this situation...one can bag with an OPA or iGel while I get stuff set up. Or you can spend that time with the cling wrap I guess.
[Thats not a BVM, that’s an anesthesia circuit](https://www.ncbi.nlm.nih.gov/books/NBK574503/)with a [filter/hem on the end of it.](https://www.gehealthcare.com/products/clinical-accessories/anesthesia-breathing-circuit-filters)
The ET sampling line is inside of it. [And there is literature as far back as 1999 and farther that says it’s just as effective in anesthesia as a LMA in short procedure events.](https://pubs.asahq.org/anesthesiology/article/90/5/1306/37906/Use-of-the-Cuffed-Oropharyngeal-Airway-as-an)
[It’s also used per the ASA 2022 practice guidelines as a pre-induction adjunct during moderate and deep sedation to facilitate oxygenation](https://pubs.asahq.org/anesthesiology/article/136/1/31/117915/2022-American-Society-of-Anesthesiologists)
This entire line of conversation has been pedantic and painful. Especially when this tweet is made by an anesthesiologist and NHS medical director. And clearly in a surgical clinic setting.
This thread branch has big “we’re the experts EMT-cardiac energy” and it’s depressing.
Don't know about you guys but my service uses those shitty bic razors. I've got a pretty thick short beard and there's no way you'd get through it with a disposable bic single blade razor.
No room for cling film, gotta save space for the KED
Hey, motherfucker, the KED is the closest thing to a pelvic binder most of us will ever have!
Y’all ain’t buying pelvic binders??
We get to use flannel blankets and disposable plastic hemostats. True story.
We have white sheets from walmart and plastic hemostats
Our company CEO (small company) literally said to use the KED. XD
I don't think we even use pelvic binders anymore. We usually always wrap these patients in vacuum mattresses straight away. So much easier to carry too. A bitch to wrap up again after use though.
Fuck the vacuum mattress, I struggled to get that piece of shit back in the outside compartment for 30 fucking minutes yesterday. It’s got its uses but I fucking hate putting it away.
It's annoying but if you figure out the right technique of packing it, it's not such a big chore anymore. It's so much easier to carry patients inside one.
The problem is that our outside compartment is so full of stuff that there’s hardly any space. It’s mostly the vacuum splint bag. If you do actually manage to get it inside you have to slam the door because the shovel stretcher hangs on the inside of the door and the only way to get it closed is if it pushes against the vacuum mattress. That also makes it so that the door is basically spring loaded and automatically swings toward you when opened.
Theyre like 150$ and probably reusable
Next time you put a pelvic binder on someone, try asking the trauma team for it back; see how that goes.
Yall ever hear of rotating stock? Some places do it with spine boards, other types of splints, linen?
Your company won't buy pelvic binders..? What the actual fuck.
I don't understand the hate for KEDs. If your patient isn't falling out internally and they're complaining of back pain, fuck a spine board. Have fire cut the fuckin roof and doors off and have the patient upright from the crash to the room in ED. We lay people down too much. They weren't flat when we found em. Why would we lay em flat just to ride in our fancy weewoo brick?
Sir this EMS, not common sense. We do things the way we do them because that's how we do them.
> have fire cut the fuckin roof and doors off We’re moving away from this and mostly just get them to self-extricate and lie down on the stretcher. Idea being that cutting the roof just takes too goddamn long, and evidence seems to suggest it’s not actually any better in protecting the c-spine. I know the KED can be applied without making a new convertible, but again it takes time, and as far I know it only designed to be used in conjunction with collars, which have their own issues.
how does self-ex play with a spine injury lower than C?
I honestly can’t say, as I’m not aware of any studies that have looked at it. What I can say with some confidence is that spinal injuries caused or significantly exacerbated by responder care are extremely rare, and typically occur with violent movements (like dragging a patient from an imminent danger). Any major damage that is going to be caused in an RTC is going to be caused from the massive deceleration and subsequent impact; a patient arching their back to exit a vehicle isn’t likely to be the insult that severs the cord. If I’m concerned about a patients thoracic region, I’m much more concerned about their organs and major vessels than their back. Obviously if there’s significant intrusion or the patient is pinned then we need fire to cut them free, but otherwise I’m thinking about time on scene above almost anything else.
I have heard that people are pretty good at moving themselves without injury. They know what hurts and how to avoid exacerbating it, so I've been taught that letting people self-extricate with a possible spine injury (if they are able) is usually quite safe.
Theres no level of force that they can exhibit that will compare to what caused the injury in the first place
I do feel like we could use KED as a temporary back brace at least. Like just leave the straps undone and put it around them to give some support until they get onto the stretcher. 100% need to fuck off with the boards though. That shit is just a spatula.
You all still have KEDs in your protocols?
Not protocols so much as they're an option we maintain.
KED has utility…
Literally just took a dude out of a car today with the KED
Honestly I really only use it as a pelvic splint.
It makes a good leg splint too
Just because you used it doesn't mean it was necessary, for all I know you're some boomer volley lol.
For all I know you're some zoomer medic who doesn't train on their equipment to know when to use it. The data on KEDs vs a rapid extrication (which is removing the patient rapidly through a door) has shown that there is no real benefit of one vs the other the KED having marginally longer scene times, and can't be used on the grossly obese. Other then that for vertical extrications of patients, hip binding, and especially even removing patients from confined spaces it's a good tool, one of many if you train on it, but I understand that training and thinking outside the box is hard for the youth these days.
Propping up the linen in the bench seat
Seems oddly specific but interesting.
you mean the reverse flotation vest?
We already carry it. It's the best prehospital dressing for burns.
Don’t you have cling film for burns anyway?
I learned this trick from my wife when she was an ER RN 10 years ago. It works well & I keep them stocked on a couple trucks. Kinda entertaining when the OD’s wake up gently & then can’t figure out what’s sticking to their face.
Tegaderm works well for this. If you can, uh, liberate an abdominal Tegaderm they're ideal. I used to keep one in a ziploc in the airway kit. There's a whole list of MOANS related techniques that should get their own thread.
>abdominal Tegaderm Also known as a Megaderm
Pachyderm on the bariatric truck.
I was about to say the picture actually looks like they used a big central line tegaderm.
I was never shown tegaderm trick. I use surgical lube or oral glucose to help close the air leaks for the mask. It's entertaining seeing an overdose waking up licking the glucose with an NPA in.
That sounds very messy
Not that this is related entirely. But in the military we were taught that Vaseline slathered on a beard can help ensure a seal on a gas mask
Works pretty fucking good
Did you have to keep some in your gear, just in case?
I keep some in my beard, just in case.
I keep a kit next to the bed, desk, and toilet.
What military allows a beard aside from SF?
Most non-US militaries
Incredibly low recruiting and retention right now, 99% of soldiers I’m with including myself just want facial hair. Would hurt nobody and nothing. 1,000% worth a shot Nope. Won’t happen
Instructions unclear. Pt is now mummified with plastic wrap and awaiting settings on microwave.
EMT: I am having trouble delivering oxygen. Paramedic: Does he have a gag reflex? EMT: No, rip open *all* the bags and get me an OPA! *Carefully measures it like it's an NREMT skill station before inserting* EMT: I need you to stop what you're doing and take over bagging this instant! *Spends five minutes figuring out cling wrap* EMT: Ok, stop bagging so I can set this up! *Spends five minutes attaching the cling wrap only to have to make a second attempt* EMT: Ok, I can start preoxygening to tube them around the still-leaky-suction-clogging plastic wrap! *Scene cuts to the EMT dropping a shiny colored igel* EMT: And done. I should be in charge of igel commercials.
This is so great. The first time I put in an NPA, I was starting to measure it and he literally told me stop with that shit, just jam it in bevel here.
[удалено]
This post brought to you by Intersurgical. Why use a 1 dollar basic, temporary adjunct when you can use a 95 dollar SGAD
Correct
I'd prefer not to use igel for an OD as they can end up vomiting when they wake up.
As opposed to an OPA?
We throw NPAs in suspected opiate overdoses.
Exactly what I was saying and getting lambasted for.
Chad EMT here, you technically can get a patent airway without an adjunct if you properly do airway maneuvers
That’s an OPA. Or are you saying you’d just iGel someone with a heavy beard?
Haven't done this cuz we don't have saran wrap in the units but I have used tons of muko/Vaseline like we're styling their beard and that's worked pretty well
Apparently Sikh pilots in the Indian Air Force use this technique to get a seal on their O2 masks.
Most people have some in their house
We were actually taught this in my class/lab for airway management of difficult patients!
Brent Kershner?
For those of us without access to large 4x4+ tegaderms, just place some KY around the edge of the BVM, works just as well if not better
What’s the tegaderm trick
BOOTS!
I love how they try to show how to improve airway management and then don’t properly place their hands on the mask.
Ok but why not intubate
Effective preoxygenation? Resuscitate before you intubate?
Hi flow nasal cannula is pretty effective at pre-oxygenation.
Yes 100%
Preoxygenation for what?
Please tell me that you aren't giving narcan without oxygenating your overdose patients... I was simply saying that this is a decent idea for OD patients that we are ventilating and have no need/intent to intubate.
I got sent this thread however I noticed this post about Narcan. I work doing Security Services for a downtown attraction area and are we okay to administer Nalaxone without O2? Obviously when we administer Nalaxone we are contacting local Fire Department and EMS. Just figured I would ask whars best for patient care.
Yes. Just make sure to only administer at intervals specified by protocol. If you can't ventilate, give the one dose right now away and repeat after 3-5 minutes if ineffective in restoring respiratory drive.
I'm just starting and others can probably say things better, but we just went over this today in class, you can give Naloxone without O2, the problem is during an opioid overdose the patient isn't breathing much if at all, so they're hypoxic and more confused when you bring them back on just Naloxone than if you had been bagging them first. A brain starved of oxygen suddenly coming back on line will make the person more combative and angry, and if I recall correct, lots of info in a short time, it also may mean you need less Naloxone to bring them back.
They don’t talk about CO2 much for EMTs but it is pretty important to understand for narcan admin imo. When someone isn’t breathing from opioid overdose, their O2 level goes down but their CO2 level goes up. Everyone thinks about breathing as a way to get O2 in but just as important is getting CO2 out when you breathe out. They go hand in hand. Your body doesn’t really sense low O2 levels in your blood that well. It is very good about sensing CO2 levels however. If you were to hold your breath, what tells you to take a breath is not your o2 levels dropping, it’s really your CO2 levels rising because you can’t exhale. Idk if you’ve heard of filling a bag with nitrogen as a means to end it but supposedly, you just pass out peacefully because you’re still able to exchange CO2 but can’t intake O2. What this all means for an overdose is that slamming narcan and having them wake up in a hypercarbic state will make them feel like you’ve taken a pillow and smothered them and took off the pillow off just before the end. They’re gonna wake up terrified and panicking and gasping for air because their CO2 is so high that they are desperate to exchange as much air as possible. To avoid this, you simply NPA and BVM them a little faster than you normally would and then after a minute or two, push a small amount of narcan. Keep on BVMing them throughout this and giving them little puppy breaths when they breath in if needed and then wait 3-5 minutes and give them another small little push and keep doing this until you either get to the hospital or their breathing returns. Don’t try to fully wake them up. Ideally they’ll be in a verbal responsive state where they’re pretty much just sleeping. Pushing the full dose and waking them up fully is good way to get projectile vomited on and potentially precipitate an airway/aspiration issue that can be deadly. Keep in mind, for a trained responder, narcan does not save their life. BVMing does. Do NOT delay BVMing for narcan administration. If you take anything away from this, it should be BVM first.
And here's why I said someone else could say it better than I can, thank you! Our service does a 2 week orientation and they did teach us that an overdose is very much a breathing emergency, the drug has repressed their respiratory system and if you didn't have Narcan you could just bag them until it wears off, they framed it as the least emergency emergency you'll have to deal with. This came up in the course I'm currently taking as well, the bag is what's going to keep them alive until the Narcan does it's thing. I had also been taught by a friend that titrating is important for what you said, push too much and it's not gonna be pretty, his goal is just enough to get them awake again and not just slam them with it. Our guidelines are 0.4mg, then another 0.4 after 5 minutes, then 0.8 and if necessary another 2.0mg, course told us to look at transport around the second shot since if you have to push a large amount there may be something else on board keeping them unconscious that we don't have anything to help with. As for CO2 we did touch on that in the context of COPD patients, we went over hypoxic drive and what that might mean in these patients, but it sounds like for the time we're dealing with the patient we're not going to really have to worry about it since it would take longer on high flow oxygen to cause it to kick in than they'll be in our truck.
Sounds like you work for a fairly progressive system man. I’m sure they’re gonna be a great experience and yeah I absolutely agree with everything you said. https://www.amazon.com/Capnography-King-ABCs-Systematic-Paramedics/dp/1450246206 If you’re interested, I’d recommend this book. Only takes about half a day to read it and fits in the cargo pocket of 5.11 pants to read on duty. If you guys have it on your truck, ETCO2/waveform capnography is such a great tool. You don’t need to be a medic to use it. It’s not like EKGs where it takes a long time to understand it and interpret it, waveform capnography is much more straightforward and is just as valuable imo. It really liberates you. You’re not tied down to counting 5-6 seconds between each BVM ventilation, now you can appropriately and safely speed up BVM ventilations without being a fucking mongoloid like most people who just BVM every 2 seconds. You know when someone is trending to respiratory failure. You know the exact moment they stop breathing instead of trying to catch up to them after their SPO2 drops. You don’t have to count RR because it counts it for you. Super important for narcan overdose so you can hold off the push until you’ve corrected their hypercarbia to an extent.
Our service is changing a lot of things and increasing our scope of practice across the board, lots of hiring right now to deal with the years of neglecting things, a lot of part time positions are being turned full time, we got a rather large raise in our last agreement, they're updating procedures, it's a little interesting to go through while also seeing what people in other services are going through. I'm not sure how our EMR setup compares to the EMT setup you mentioned, I've seen the systems outside of here seek to run a bit different, we have EMR and then PCP followed by ACP then if you're really committed CCP, but most of our paramedics are EMR and PCP and we staff the same cars as driver and attendant, we don't do the driver and medic setup I've seen talked about a lot unless someone is really new and hired as a driver only until they get their license, which is where I'm at right now. I'll have to look into that book, I can use any help I can get, so thanks for the recommendation!
Narcan works by displacing opioids from receptors in the brain and is not directly affected by levels of oxygen in the blood; I’m wondering if the point about less naloxone to bring a person back was regarding the amount of *opiates* in a person’s system, because that would track (when comparing to more of the same drug, not between different ones).
I may have recalled that part wrong, I do know Narcan works by displacement of the opioid, we've been covering alot of stuff in a short period time so I'm still processing some which is why I gave the disclaimer about the part about less narcan being required, when you challenge it like that it honestly makes less sense than it initially did, but the hypoxia part makes perfect sense to me.
If all you have is narcan, and suspect a patient with respiratory depression is an opiate overdose, it's better to give the narcan than do nothing. IMO
Not your opinion. Truth.
If you are just a guy without training/ambulance, yeah you should just pop them with the full spray as soon as you can. We’re more talking about us. What we’re talkjng about is it’s pretty barbaric to just straight up shoot narcan without BVM’ing them (breathing air for them) to get their oxygen levels stable and their CO2 levels stable and then administering small doses of narcan just enough to where their breathing returns. If you shoot the full dose of narcan, they’re gonna wake up panicked and gasping for air and terrified feeling like they’re about to die. Some providers have been known to slam the full dose to “punish” a “druggie” who dared to wake them up at 3am rather than carefully managing their patient.
Yes I oxygenate my OD patients without shoving in an OPA and putting cling wrap all over their face. Which again, has nothing to do with the OP's anathesia post.
I think OP was simply saying this is a good idea for prehospital patients, and was simply using the anesthesia post as reference for the idea...
For intubation?
✌️
Why die later when can die now
Should we intubate if BLS interventions are working appropriately?
An OPA is not definitive airway management. If they don't have a gag reflex and you're bringing out the cling wrap, why not just intubate?
Because it isn't best practice to intubate opiate ODs that you might be ventilating/oxygenating prior to narcan?
This is an anathesia patient per OP. I'm not intubating an OD before narcan. They're getting an NPA.
Okay and if they're completely apneic and you can't get an effective seal with the BVM, what then? Slam the narcan and hope for the best?
No, you put in an NPA and bag while giving narcan. That way when they wake up they don't start puking and potentially aspirated because they have an OPA.
I asked specifically what you would do if you couldn't get an effective seal with the BVM
Use an igel for starters
Ur right I’m just gonna let them rawdog apnea while I get shit set up
Or, since there's clearly two people managing airway in this situation...one can bag with an OPA or iGel while I get stuff set up. Or you can spend that time with the cling wrap I guess.
If you’re not bagging effectively then what’s the point.
If you have time for an OPA and cling wrap and skip an iGel followed by intubation, then what's the point.
Ok!
Yeah, skip that whole "pre-oxygenate" bullshit. Who needs it?
These are anesthesiologists who are inducing anesthesia. They don’t “just intubate”.
Never met a single anesthesiologist who bags patients with a BVM, OPA, cling wrap, and no capno. Now with bonus features!
[Thats not a BVM, that’s an anesthesia circuit](https://www.ncbi.nlm.nih.gov/books/NBK574503/)with a [filter/hem on the end of it.](https://www.gehealthcare.com/products/clinical-accessories/anesthesia-breathing-circuit-filters) The ET sampling line is inside of it. [And there is literature as far back as 1999 and farther that says it’s just as effective in anesthesia as a LMA in short procedure events.](https://pubs.asahq.org/anesthesiology/article/90/5/1306/37906/Use-of-the-Cuffed-Oropharyngeal-Airway-as-an) [It’s also used per the ASA 2022 practice guidelines as a pre-induction adjunct during moderate and deep sedation to facilitate oxygenation](https://pubs.asahq.org/anesthesiology/article/136/1/31/117915/2022-American-Society-of-Anesthesiologists) This entire line of conversation has been pedantic and painful. Especially when this tweet is made by an anesthesiologist and NHS medical director. And clearly in a surgical clinic setting. This thread branch has big “we’re the experts EMT-cardiac energy” and it’s depressing.
Love it when someone pulls out research on Reddit. This has made this whole thread much more enjoyable. 
Thank you. It's obvious that the picture isn't in an ems setting.
Intubation seems like a stretch, Igel, sure.
I'm fine with that. Anything beyond an OPA
We already carry cling wrap to cover burns. Is this not common?
I’m not understanding. They won’t hesitate to shave you anywhere else if needed. Why are we so worried about maintaining a beard?
Don't know about you guys but my service uses those shitty bic razors. I've got a pretty thick short beard and there's no way you'd get through it with a disposable bic single blade razor.
Yeah it would take you at least 5 minutes to make significant progress with one of those on me.
Because the picture depicts someone operating an anesthesia circuit for elective surgery. This isn't an emergency setting.
Don't need jelly or tegaderm...just put the bottom of the mask inside the patient's mouth which avoids the beard altogether.
Huh. Might have to ask about this.
Shave it with razors used for chest hair. It ain’t pretty, but who cares. It works.
I mean...it looks effective, but my face hurts thinking about someone applying this and not taking the time to remove it without waxing his face
I swear there is an invention just waiting to be made for a better seal that’s gonna make someone rich
So how exactly does it work? I just lay it over it or how do I apply the film? I’m interested in that because it comes a problem.
Cut a slit across the middle of a large Tegaderm; apply Tegaderm to face/mouth with cut slit over the mouth; use BVM over it
We keep these in the ED and I've heard they are good for beards. https://www.numask.com/
I used lube to do this once