AKA. What the Hell are the Medical Directors Doing? Dan O’Donnell Beech Grove Audit and Review 3/11/08

 Give you some rhyme and Reason as to why we are doing what we are doing  Case by case approach  Chance to ask questions

 To provide efficient and medically up to date patient care to the citizens of Marion County and the surrounding areas  More changes will come  We hope you will participate

 You are called for unresponsive person  Upon arrival you find a 30ish y/o “regular” who isn’t breathing  Maybe breathing at a rate of 4 on a good day

 Protect airway  Determine patients glucose  That didn’t change  If patient has respiratory depression and suspected opiod overdose administer naloxone 0.4mg IV or Intra-nasal  If respiratory depression persists, you may repeat dose up to max of 2mg

 There is great blood flow to the nose  Studies have shown that intranasal administration of medications has been shown to have 100% bioavailability  Way to administer medications to high risk individuals  Decrease needle sticks…won’t have to bore you with my needlestick talk again

 Mucosal Atomizer Device (MAD)  Turns liquid medications into a fine mist that can be delivered in the nasal mucosa  Hook to a standard 3ml syringe

 Naloxone  Midazolam  Fentanyl  Glucagon (we are not doing)

 Minimal  Poor taste in mouth  Sneezing

 Naloxone-discussed  Midazolam  If in Status Seizures  Administer Midazolam either IV or IN  < 50kg  administer 5mg  >50kg  administer 10mg (5mg each nostril)  Fentanyl  Same doses for adults and kids  Have the option to give IN

 NO  This will give you the option to avoid Ivs on patients that you think would not benefit from IV  Still paramedic judgment

 Called for Cardiac Arrest  Upon arrival you have a patient who is apneic with CPR in progress  You get there and see this

 You perform some excellent ACLS and get him back  Now What?

 For ROSC continue supportive care and transport promptly  If possible infuse 0.9% iced NS through 18guage or larger into patients who remain comatosed  Infuse up to 2000ml using a pressure bag inflated to 20mm Hg  Avoid in patients in whom cardiac arrest is thought to be do to hypothermia, trauma, or obviously pregnant

 Called to scene for PI  Find a 30ish y/o male still in car  After extrication he is pulseless and apneic  Do you have to start resuscitation?

 Same ole stuff but…  Traumatic injury, including but not limited to decapitation, transection at midline of the torso, charring of the body, crushing of torso or head, severe head injury with brain tissue exposed.  We know where this is going

 Dispatched for house fire  FF pull out a 22 y/o female who is unconscious  Vitals: BP 90/p, P 128, R 4, ? O2 sat  Pt is unresponsive  After ABCs what do we do now?

 Responsive patient with evidence of soot in mouth, altered LOC or hypotension  Albuterol as needed  Draw blood if available  If available mix both Cyanokit 2.5 vials each with 100cc of 0.9% NaCl and administer all of the fluid over 15 minutes  Unresponsive patients  Same protocol

 You are called for Mental Emotional  Upon arrival you find a 30 y/o male wrestling with police  He won’t let you do anything to him  What can you do?

 Chemical restraint can ONLY be performed when the patient will be able to be adequately monitored  May only be used with online medical control approval  Rule out the reversible causes  Administer IN midazolam (10mg if >50kg)  Vital signs and airway monitoring Q 5min

 Called for injured person  Pick up a worker who has cut his wrist and it is bleeding profusely  Direct Pressure isn’t working  What do you do now

 If direct pressure and elevation does not work  Apply tourniquet  Transport to appropriate facility  Can be on for up to 6 hours

 Weight should be recorded in kg  Say hello to Zofran (Odansetron)

 Questions????