Comments for Indy EMS Blog

Comment on Prehospital Care of Severe Hyperkalemia by Charles Miramonti M.D.

Charles Miramonti M.D. — Wed, 25 Aug 2010 14:17:11 +0000

This is an excellent summary on the approach and care for hyperkalemia. I think the most critical factor in managing hyperkalemia is simply thinking about it in your differential diagnosis. Keep in mind that while the most common EKG abnormalities are described above, hyperkalemia may present with a variety of arrhythmias: bradycardia, widening intervals, widening QRS, V-tach, and v-fib to name a few. Often the trick to picking up on it is in the history i.e. dialysis, found down for unknown or prolonged periods of time, medications, underlying concern for rhabdomyolysis…Stubborn V-tach and V-fib may also be indicators of hyperkalamia as these arrhythmias usually won’t resolve until calcium is administered.
Without a doubt calcium is the most important intervention in the prehospital environment. It stabilizes moody myocardium, and prevents further problems. Furthermore, you don’t have to wait for confirmation of high potassium to give Ca as it it’s generally very safe, even in the absence of hyperkalemia. My two cents -Charlie

Comment on The Consolidation- 1/01/11 by tmabrey

tmabrey — Tue, 10 Aug 2010 11:39:08 +0000

Bryan, thank you for putting this site together!

Comment on The Consolidation- 1/01/11 by Paul Hess EMT-P

Paul Hess EMT-P — Fri, 16 Jul 2010 19:34:35 +0000

This HAS to be a good thing. Good for the city, for EMS, and ultimately, for the patients. I have spoken with a lot of people about this, and I have heard very little negative talk.
If this indeed unfolds as they say it will, it will be the best thing for EMS in Indianapolis since the invention of drive through liquor stores…

Comment on Emergency Medical Services Intervals and Survival in Trauma by HJBennis

HJBennis — Mon, 17 May 2010 16:10:17 +0000

This is a facinating study. In my 32 years in EMS I have always thought first responder care was more critical than speed. I believe some studys in the current battlefields have shown, for example, that on scene bleeding control has a much better outcome than rapid, thus dangerous transport. This is one reason new battlefield uniforms are being made with built in tourniquets for self application.
Certainly food for thought.

Comment on New Trauma Response by Bryan Fleck NREMT-P (Editor)

Bryan Fleck NREMT-P (Editor) — Fri, 09 Apr 2010 12:49:13 +0000

The differentiation between the two levels are just mechanisms of injury. Level I is signs/symptoms of obvious major trauma. Level II is simply a high index of suspicion for major trauma. I would just call in a solid report as usual, and let them make the judgment call on the activation level.

Comment on Continuous Positive Airway Pressure Protocol Refresher and Discussion by gvonpaul

gvonpaul — Fri, 09 Apr 2010 12:33:08 +0000

Having had a chance to try out the new ‘three nitro a time’ protocol, I have to agree with Dr Miramonti. I have seen near instantaneous improvement both times I had the opportunity to use it. Neither one needed CPAP after the higher dosage of nitro. Giving Lasix, I can’t say with any confidence that I have truly ever improved anyone’s condition.
And I’m an old school guy, too. Changes don’t come easy to us. This is one I have embraced.

Comment on New Trauma Response by gvonpaul

gvonpaul — Fri, 09 Apr 2010 12:25:39 +0000

Do they really expect us to remember all of that? Add that to the two or three minute wait at triage even when you call in for a trauma alert and you bet your sweet bippy I’m going to Wishard every time.

Comment on From the Medical Directors by Charles Miramonti

Charles Miramonti — Wed, 07 Apr 2010 20:05:49 +0000

I just wanted to thank Bryan for putting all of the hard work into this site. I think this is a great start to developing better communication, collaboration, and education for all of us. All of us at the IUSM Division of Out of hospital Care are looking forward to the discussions and lessons to come.

Comment on Continuous Positive Airway Pressure Protocol Refresher and Discussion by Charles Miramonti

Charles Miramonti — Wed, 07 Apr 2010 17:29:35 +0000

Lasix was removed from the MC protocols for 2 reasons. First, because our transport times are very short (less than 12 minutes for nearly 90% runs) and there is little therapeutic benefit to administering lasix in our environment. It was not changing outcomes. Secondly, the vast majority of our chf patients suffer from high afterload (high SBP) issues. NTG is the definitive rescue drug for these patients. Case review revealed that we were failing to administer adequate doses of nitro, and continuing to push lasix (a second line drug) aggressively. Does lasix help? Of course. But we must first optimize ventricular preload and reduce pulmonary and peripheral vascular resistance before relying on lasix to have any value. For years we have heard lasix lasix lasix for CHF when the real answer is nitro nitro nitro. Nitro does change outcomes, and should be the focus for our prehospital providers in MC

Comment on Continuous Positive Airway Pressure Protocol Refresher and Discussion by Tray1979

Tray1979 — Wed, 07 Apr 2010 06:00:50 +0000

I work up in North West IN and we have as a standing order to use CPAP on all CHF pt’s who are maintaining there own airway when we have an ETA greater than 5 mins to to the ED. The few times that we have had to use it the pt’s improved by 100% from when we initiated care to the point where they have been able to talk to us and there o2 sats increase. I am a huge fan of CPAP in the field. I think all EMS providers should look into carrying them. Granted we still do treat them therapeutically with Ng and Lasix. I feel Lasix should still be an on ALS units, I heard that it has been taken out of Marion County Protocols? Why?