“Part of the problem with early detection of sepsis… is the lack of a definitive test. When checking for glucose, a properly administered test can definitely point to low blood sugar. But detecting sepsis can take a little more effort.” Is your agency looking for septic patients?
Well this title says it all. There are pros and cons, as discussed in the article. One of the main arguments against this is that such personnel are not trained in the pharmacology or indications of Narcan. Of course, we already have epinephrine auto-injectors… though those are mainly carried by patients. Do we want gung-ho non-medics running around giving Narcan as the first line treatment for every unresponsive patient – i.e. MI/arrest, seizure, stroke? Two of the main arguments for this are the resurgence, in some areas, of heroin and other opiates (over 16,000 deaths in 2010), and the lack of contra-indications and side effects if administered unnecessarily. Are you seeing Narcan auto-injectors where you work? Are people talking about it? What are different agencies – EMS, fire, police – saying about it?
Guess what the American College of Emergency Physicians has to say about spineboards? Well if you have been paying attention, you can guess:
“Evolving scientific evidence demonstrates that some of these current out-of-hospital care practices cause harm including airway compromise, respiratory impairment, aspiration, tissue ischemia,increased intracranial pressure, and pain, and can result in increased use of diagnostic imaging and mortality.”
In my career, I have seen most of these first-hand as a pre-hospital provider who likes to follow up on their patients.
Do you know the difference between “spinal immobilization” and “spinal motion restriction”? You should. And secondly, do you follow ACEP, or NAEMSP, or the ACS CoT? You should.
Here is what NAEMSP and the ACS Committee on Trauma said a few years back.
This post serves two purposes.
First, how do you treat your severe Pulmonary Edema patients? Do you have CPAP?
Because CPAP does not just help patients avoid intubation – it saves lives, and it brings people back from the brink of death, FAST. And, what is your nitroglycerin (and morphine/opiate) protocol for these patients? There are different ways to handle it, since EMS generally does not do nitro drips en route to the ED (if you do, let me know!).
Secondly, I wanted to introduce you to one of my favorites podcats/blogs, EMCrit.
It is evidence-based medicine at its best + aggressive treatment of the sickest patients.
A great archive plus plenty of links to the research as well.
You have probably heard stories about paramedics being able to “treat and release” patients. Well, it’s not that simple of course. But it is happening, and not just “out West.” Initially, it sounds like a nightmare to EMS Managers: “Oh my God, we are going to go bankrupt!” (esp fire-based EMS). But it sounds like a dream to (some) medics: “Oh my God, we can start getting refusals on our frequent flyers!” Fortunately, both of those perspectives miss the mark. These days, simply building more walk-in clinics, staffed by young MD’s or PA’s is not going to cut it, even in communities without overburdened ED’s and EMS systems. There are many agencies out there experimenting with having Paramedics, RN’s, and PA’s visit patients with chronic pathologies where they live – even unannounced. Since the gold standard of medicine is patient care, let’s listen to one patient’s story:
What’s more deadly than MI or stroke or lung & colon cancer combined? SEPSIS. Yes, “infections.” And that includes pneumonia and UTI’s – and yes, patients actually die from that stuff. We see these patients all the time on the ambulance, even if we don’t know it at the time. But that’s only because we are not paying attention. So what does sepsis look like? How do you treat it? Do they even teach this stuff in EMT or paramedic school? Let’s learn a little but more about this forgotten foe first…
Hey EMS! Welcome to DoubleMedic, the online multi-tool of patient care.
Every day of the week I will have a new twitter post on @doublemedic, borrowed from somewhere else on the web. That article or topic will be explored a bit deeper on my blog, doublemedic.wordpress.com. Some common topics will be: airway, trauma, medications, ICU, sepsis, operations, learning…. and whatever else it is YOU want to see discussed!
This blog & twitter handle are my attempt to weave together the different threads of Prehospital and Emergency Medicine. The full value of this endeavor will only be realized by YOUR participation. Contact me at firstname.lastname@example.org with ideas, comments, suggestions, critiques, queries, requests.
If you learn one new thing every day, you will advance your patient care.