Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 Why would you use it for a benzo OD? Bledsoe, DO, FACEP Midlothian, TX Don't miss EMStock 2004!http://www.emstock.com Romazicon and Benzo's Speaking of OD's, how many people have Romazicon for a benzo OD? Standing order or Medical Direction? Have a protocol to share? How many carry it for Versed OD, but specifically do not use it for Benzo because of side effects? How many young females are single and looki.....ooops, sorry wrong list server..... 'Tater Salad' Hatfield " I had the right to remain silent, but I did not have the ability. " Don't miss EMStock 2004!!! May 21-23 in booming Midlothian, Texas!!!! www.EMStock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 I'm unaware of anyone who carries flumazenil in the field. At one time, when it first came out, we considered it, but now that we know that sudden withdrawal from benzos can produce seizures and other bad stuff, and since we know how to support respirations in patients who have taken benzos, it's really not necessary. If we've " snowed " somebody with Versed, for example, and all of a sudden the ER needs them to remember something or perk up, it can be used there. But I don't see the need for it in the field. Anybody else? GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 > Why would you use it for a benzo OD? > > With the services I have worked for, it has been the most common one used in benzo overdoses. Mostly because it is a specific benzo antagonist. We also carried it to reverse the effects of Versed in the event we could not get them intubated, that's all changed. Benefit to it, was that in an, even if it were not a benzo OD, it would not have any ill effects, (exception being too rapid a push) on the patient. The only drawback to it, is that the duration is relatively short, so repeat doses may be necessary. That said, we recently had an OD in a young patient which led to cardiac arrest found in asystole, we treated as we should have, but the best response came from the administration of Flumazenil, end result was restoration of pulse, and eventual restoration of spontaneous respirations. All credit to Romazicon? Nope, part of it, I think it helped. I think the rest of it, was a determined and agressive crew who refused to take no for an answer. All that aside, what else would you suggest Doc? Any other drugs to reverse the effects of Valium, Xanax and the family? Our protocol guru us on this list as well, and we were talking about this just this morning. Mike 'Tater Salad' Hatfield " I had the right to remain silent, but I did not have the ability. " Don't miss EMStock 2004!!! May 21-23 in booming Midlothian, Texas!!!! www.EMStock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 The only comment that I would make about using flumazenil or any other drug is that if you use it you must know, book and page, everything that it's reasonably possible to learn about it and be able to explain your use of it to just about anybody. Too many medics (not you) give drugs that they don't understand. How many medics can actually tell you why they use atropine other than " it speeds up the heart? " That's great until one begins to ask them how it works, what its side effects are, and so forth. How many can explain why vasopressin is an alternative choice in V-Fib but not in asystole? How many could understand that in asystole a combination of epi and vasopressin might be the next thing we'll be seeing recommended and discuss its pros and cons in an intelligent way? Paramedics have not genarally been taught pharmacology in sufficient depth to allow them to defend their uses of drugs when things go South. It's great to have a drug in your box, but it's another thing to be competent to use it. All I am saying is that if you want to give a drug, know about it and have the depth of knowledge that will enable you to give it without making a fatal mistake. GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 The only comment that I would make about using flumazenil or any other drug is that if you use it you must know, book and page, everything that it's reasonably possible to learn about it and be able to explain your use of it to just about anybody. Too many medics (not you) give drugs that they don't understand. How many medics can actually tell you why they use atropine other than " it speeds up the heart? " That's great until one begins to ask them how it works, what its side effects are, and so forth. How many can explain why vasopressin is an alternative choice in V-Fib but not in asystole? How many could understand that in asystole a combination of epi and vasopressin might be the next thing we'll be seeing recommended and discuss its pros and cons in an intelligent way? Paramedics have not genarally been taught pharmacology in sufficient depth to allow them to defend their uses of drugs when things go South. It's great to have a drug in your box, but it's another thing to be competent to use it. All I am saying is that if you want to give a drug, know about it and have the depth of knowledge that will enable you to give it without making a fatal mistake. GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 Re: Romazicon and Benzo's > Why would you use it for a benzo OD? > > With the services I have worked for, it has been the most common one used in benzo overdoses. What part of the benzo OD can you not manage with basic airway tools and mechanical ventilation? Mostly because it is a specific benzo antagonist. We also carried it to reverse the effects of Versed in the event we could not get them intubated, that's all changed. If you are giving somebody Versed to intubate them and then reversing it when it does not work you are assuring the emergency physician will not be able to use a benzo to sedate the patient prior to RSI? How often does that happen that you have to reverse an RSI induction? Benefit to it, was that in an, even if it were not a benzo OD, it would not have any ill effects, (exception being too rapid a push) on the patient. No ill-effects? What about seizures, increased BP. Tachycardia. Using it could be life-threatening if the patient were benzodiazepine dependent. The only drawback to it, is that the duration is relatively short, so repeat doses may be necessary. Wrong. Seizures/ That said, we recently had an OD in a young patient which led to cardiac arrest found in asystole, we treated as we should have, but the best response came from the administration of Flumazenil, end result was restoration of pulse, and eventual restoration of spontaneous respirations. Benzos do not cause cardiac arrest for the most part. There must have been another drug on board in this anecdotal case. All credit to Romazicon? Nope, part of it, I think it helped. I think the rest of it, was a determined and agressive crew who refused to take no for an answer. All that aside, what else would you suggest Doc? Any other drugs to reverse the effects of Valium, Xanax and the family? Our protocol guru us on this list as well, and we were talking about this just this morning. Why reverse it? Just manage the results until a tox screen can be run. Empiric use of flumazenil is a bad medical practice. I had a case a few years ago where I was an expert that was similar to what you provided, but the patient died when she got the flumazenil. Think about it darlin' Mike 'Tater Salad' Hatfield " I had the right to remain silent, but I did not have the ability. " Don't miss EMStock 2004!!! May 21-23 in booming Midlothian, Texas!!!! www.EMStock.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 Comments inline > With the services I have worked for, it has been the most common one used in > benzo overdoses. > > What part of the benzo OD can you not manage with basic airway tools and > mechanical ventilation? We can manage most if not all of the respiratory effects of the benzo overdose with mechanical ventialtion, but we need to reverse the overall effects of the benzo itself as well. No different than the patient that I discussed being in asystole, I can mechanically support him, but eventually I need to try to get his ticker ticking on it's own again, that's the ultimate goal, I need to reverse that which is causing the problem, be it hypoxia, hypovolemia, etc. > Mostly because it is a specific benzo antagonist. We also > carried it to reverse the effects of Versed in the event we could not get > them intubated, that's all changed. > > If you are giving somebody Versed to intubate them and then reversing it > when it does not work you are assuring the emergency physician will not be > able to use a benzo to sedate the patient prior to RSI? How often does that > happen that you have to reverse an RSI induction? Wait, wait, wait, note the closing 3 words of my sentence there, " That's all changed " . We now utilize versed to sedate, sux to knock them down, and vec to keep them down if necessary. Romazicon in the field was one of the drugs we carried when RSI came into the service, and at that time, it was carried to reverse the effects of the Versed, that's been a few years. > > Benefit to it, was that in an, even if > it were not a benzo OD, it would not have any ill effects, (exception being > too rapid a push) on the patient. > > No ill-effects? What about seizures, increased BP. Tachycardia. Using it > could be life-threatening if the patient were benzodiazepine dependent. > If it were pushed as it should be, then the possibility of side effects would be limited. The first dose being small (0.2 mg), and watching for response, then small doses until either a response is noted, or a max dosage is reached. The danger of seizures occurs mostly in patients who take benzos regularly. As with any medication it has indications and contraindications, and you have to follow them. > The only drawback to it, is that the duration is relatively short, so repeat > doses may be necessary. Wrong. Seizures/ See above. > > That said, we recently had an OD in a young patient which led to cardiac > arrest found in asystole, we treated as we should have, but the best > response came from the administration of Flumazenil, end result was > restoration of pulse, and eventual restoration of spontaneous respirations. > > Benzos do not cause cardiac arrest for the most part. There must have been > another drug on board in this anecdotal case. In this anecdotal case, there were others on board, none of them were depressants. However it was reported to us, that he took a 'fair' amount of Valium prior to going to bed the night before. The other, 'meds' in his system were from the previous night, nice little selection too I might add. > > All credit to Romazicon? Nope, part of it, I think it helped. I think the > rest of it, was a determined and agressive crew who refused to take no for > an answer. > > All that aside, what else would you suggest Doc? Any other drugs to reverse > the effects of Valium, Xanax and the family? Our protocol guru us on this > list as well, and we were talking about this just this morning. > > Why reverse it? Just manage the results until a tox screen can be run. > Empiric use of flumazenil is a bad medical practice. I had a case a few > years ago where I was an expert that was similar to what you provided, but > the patient died when she got the flumazenil. I agree that unlimited and incontrolled use is bad medicine, however in this case, it was used, and worked well. If the cons outweight the pros, what other medication is available to accomplish the same task, bear in mind that we have transport times of up to 40 minutes in some places in our county. Is it necessary to give it in any benzo OD? No, but there are times when it is the best selection. > Think about it darlin' I love you too Doc..... Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 10, 2004 Report Share Posted April 10, 2004 We are carrying it in the field for benzo OD's for the same reason that we carry NG tubes. We may be able to catch some of these early enough to assist in reversing some of the damage they are attempting to or have inflicted on themselves, or someone has inflicted on them. It should be considered with the seizure threshold in mind and the condition of the patient (loc). The intent really is to start some of the definitive care they will receive in the ER rather than postponing it. The Romazicon is on standing order, the NG tubes (in OD) is determined by the receiving physician. Most often both treatment options are at the discretion of the receiving physician and have been accepted well in our area. Steve Re: Romazicon and Benzo's I'm unaware of anyone who carries flumazenil in the field. At one time, when it first came out, we considered it, but now that we know that sudden withdrawal from benzos can produce seizures and other bad stuff, and since we know how to support respirations in patients who have taken benzos, it's really not necessary. If we've " snowed " somebody with Versed, for example, and all of a sudden the ER needs them to remember something or perk up, it can be used there. But I don't see the need for it in the field. Anybody else? GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 In a message dated 4/11/04 7:49:26 AM Pacific Daylight Time, je.hill@... writes: I agree with Dr. B on this one. Our medical director and I discussed this a while back and we decided that supportive care (airway control, IV, etc.) was much more beneficial in the field for possible benzo overdoses than using Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on top of the rest of the issues, the whole picture indicates better to NOT use in prehospitally and let them run the tox screen and use it if needed at the ED. Jane Hill I, too, have talked with our medical director about this matter both in 2003 and in 2004. He basically said the same things that Dr. Bledsoe has said. He did not want to add it to our protocol. We do have Versed in our protocol for the purpose of facilitating intubation. Education Coordinator Champion EMS Longview, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 In a message dated 4/11/04 7:49:26 AM Pacific Daylight Time, je.hill@... writes: I agree with Dr. B on this one. Our medical director and I discussed this a while back and we decided that supportive care (airway control, IV, etc.) was much more beneficial in the field for possible benzo overdoses than using Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on top of the rest of the issues, the whole picture indicates better to NOT use in prehospitally and let them run the tox screen and use it if needed at the ED. Jane Hill I, too, have talked with our medical director about this matter both in 2003 and in 2004. He basically said the same things that Dr. Bledsoe has said. He did not want to add it to our protocol. We do have Versed in our protocol for the purpose of facilitating intubation. Education Coordinator Champion EMS Longview, Texas Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 I agree with Dr. B on this one. Our medical director and I discussed this a while back and we decided that supportive care (airway control, IV, etc.) was much more beneficial in the field for possible benzo overdoses than using Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on top of the rest of the issues, the whole picture indicates better to NOT use in prehospitally and let them run the tox screen and use it if needed at the ED. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 I agree with Dr. B on this one. Our medical director and I discussed this a while back and we decided that supportive care (airway control, IV, etc.) was much more beneficial in the field for possible benzo overdoses than using Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on top of the rest of the issues, the whole picture indicates better to NOT use in prehospitally and let them run the tox screen and use it if needed at the ED. Jane Hill Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 Dexamethasone: Hypotension and/or total cardiovasuclar collapse Valium: Respiratory and/or cardiac arrest Epinephrine: Hypertension, increased ischemia, angina Lasix: Acute dehydration, leading to cardiac dysrythmias Lidocaine: Hypotension, seizures Mag Sulfate: Hypotension, cardiac arrest Thiamine: OD can create toxicity leading to cardiovascular compromise or collapse Even Narcan has, in rare cases led to pulmonary edema. Point being, is that all medications have the possibility of being harmful if they are not administered correctly, or, if the attending medic is not properly trained as to the indications, and contraindications of each and every medication that we carry, and use. I have a great respect for those that responded, especially Mr. Bledson, but I still believe that training and education would be the guiding light to proper administration. In my mind, I would never anticipate the administration of Romazicon in the same manner as Narcan. That is certainly not my intention, while I see serious issues, and concerns regarding Romazicon, I still see the benefits of pre hospital use. Mike > je.hill@... > > I agree with Dr. B on this one. Our medical director and I discussed this a > while back and we decided that supportive care (airway control, IV, etc.) was > much more beneficial in the field for possible benzo overdoses than using > Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on > top of the rest of the issues, the whole picture indicates better to NOT use > in prehospitally and let them run the tox screen and use it if needed at the > ED .. > I, too, have talked with our medical director about this matter both in 2003 > and in 2004. He basically said the same things that Dr. Bledsoe has said. He > did not want to add it to our protocol. We do have Versed in our protocol > for the purpose of facilitating intubation. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 Dexamethasone: Hypotension and/or total cardiovasuclar collapse Valium: Respiratory and/or cardiac arrest Epinephrine: Hypertension, increased ischemia, angina Lasix: Acute dehydration, leading to cardiac dysrythmias Lidocaine: Hypotension, seizures Mag Sulfate: Hypotension, cardiac arrest Thiamine: OD can create toxicity leading to cardiovascular compromise or collapse Even Narcan has, in rare cases led to pulmonary edema. Point being, is that all medications have the possibility of being harmful if they are not administered correctly, or, if the attending medic is not properly trained as to the indications, and contraindications of each and every medication that we carry, and use. I have a great respect for those that responded, especially Mr. Bledson, but I still believe that training and education would be the guiding light to proper administration. In my mind, I would never anticipate the administration of Romazicon in the same manner as Narcan. That is certainly not my intention, while I see serious issues, and concerns regarding Romazicon, I still see the benefits of pre hospital use. Mike > je.hill@... > > I agree with Dr. B on this one. Our medical director and I discussed this a > while back and we decided that supportive care (airway control, IV, etc.) was > much more beneficial in the field for possible benzo overdoses than using > Romazicon for the reasons Dr. B. stated. And considering the COST of Romazicon on > top of the rest of the issues, the whole picture indicates better to NOT use > in prehospitally and let them run the tox screen and use it if needed at the > ED .. > I, too, have talked with our medical director about this matter both in 2003 > and in 2004. He basically said the same things that Dr. Bledsoe has said. He > did not want to add it to our protocol. We do have Versed in our protocol > for the purpose of facilitating intubation. > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 Mike, I agree with what Dr. Bledsoe has said and I also agree with what you say. Yes the education of pre-hospital personnel needs to be in-depth for they can make the correct Diagnosis. But here is the situation, there are medics that believe in maintaining the bare minimum in training and that is it. And the ones that believe in knowledge and in-depth training are considered trouble makers. Basically, if a strong medic volunteered his/her time to educate and offer his/her experience for training and advancement of the EMS system, he is said to have a rebellious nature and have bad body language when he/she wants to instruct or become a FTO. I know of this and I have seen this. You try to educate and pass on experience and knowledge and the only thing you hear is things like: what if a medic with less experience, 6 months, try's that procedure and doesn't succeed. What would be the political fall out or how would we explain. I know that if the proper training and QA system was in place those excuses wouldn't have to be made...... I'm all for education and training, but as long as everyone is trained and educated the same and held to the same standards. Basically if you can't keep up with the rest of the EMS system you need to find another career and stop making excuses for themselves and their precious job and political friends........ " De Oppresso Liber " Jelal Babaa, CCEMTP/NREMTP Arlington, TX Re: Romazicon and Benzo's > > Dexamethasone: Hypotension and/or total cardiovasuclar collapse > Valium: Respiratory and/or cardiac arrest > Epinephrine: Hypertension, increased ischemia, angina > Lasix: Acute dehydration, leading to cardiac dysrythmias > Lidocaine: Hypotension, seizures > Mag Sulfate: Hypotension, cardiac arrest > Thiamine: OD can create toxicity leading to cardiovascular compromise or > collapse > > Even Narcan has, in rare cases led to pulmonary edema. > > Point being, is that all medications have the possibility of being harmful > if they are not administered correctly, or, if the attending medic is not > properly trained as to the indications, and contraindications of each and > every medication that we carry, and use. > > I have a great respect for those that responded, especially Mr. Bledson, but > I still believe that training and education would be the guiding light to > proper administration. > > In my mind, I would never anticipate the administration of Romazicon in the > same manner as Narcan. That is certainly not my intention, while I see > serious issues, and concerns regarding Romazicon, I still see the benefits > of pre hospital use. > > Mike > > > > > > > > je.hill@... > > > I agree with Dr. B on this one. Our medical director and I discussed > this a > > while back and we decided that supportive care (airway control, IV, etc.) > was > > much more beneficial in the field for possible benzo overdoses than using > > Romazicon for the reasons Dr. B. stated. And considering the COST of > Romazicon on > > top of the rest of the issues, the whole picture indicates better to NOT > use > > in prehospitally and let them run the tox screen and use it if needed at > the > > ED > . > > I, too, have talked with our medical director about this matter both in > 2003 > > and in 2004. He basically said the same things that Dr. Bledsoe has said. > He > > did not want to add it to our protocol. We do have Versed in our protocol > > for the purpose of facilitating intubation. > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 Mike, I agree with what Dr. Bledsoe has said and I also agree with what you say. Yes the education of pre-hospital personnel needs to be in-depth for they can make the correct Diagnosis. But here is the situation, there are medics that believe in maintaining the bare minimum in training and that is it. And the ones that believe in knowledge and in-depth training are considered trouble makers. Basically, if a strong medic volunteered his/her time to educate and offer his/her experience for training and advancement of the EMS system, he is said to have a rebellious nature and have bad body language when he/she wants to instruct or become a FTO. I know of this and I have seen this. You try to educate and pass on experience and knowledge and the only thing you hear is things like: what if a medic with less experience, 6 months, try's that procedure and doesn't succeed. What would be the political fall out or how would we explain. I know that if the proper training and QA system was in place those excuses wouldn't have to be made...... I'm all for education and training, but as long as everyone is trained and educated the same and held to the same standards. Basically if you can't keep up with the rest of the EMS system you need to find another career and stop making excuses for themselves and their precious job and political friends........ " De Oppresso Liber " Jelal Babaa, CCEMTP/NREMTP Arlington, TX Re: Romazicon and Benzo's > > Dexamethasone: Hypotension and/or total cardiovasuclar collapse > Valium: Respiratory and/or cardiac arrest > Epinephrine: Hypertension, increased ischemia, angina > Lasix: Acute dehydration, leading to cardiac dysrythmias > Lidocaine: Hypotension, seizures > Mag Sulfate: Hypotension, cardiac arrest > Thiamine: OD can create toxicity leading to cardiovascular compromise or > collapse > > Even Narcan has, in rare cases led to pulmonary edema. > > Point being, is that all medications have the possibility of being harmful > if they are not administered correctly, or, if the attending medic is not > properly trained as to the indications, and contraindications of each and > every medication that we carry, and use. > > I have a great respect for those that responded, especially Mr. Bledson, but > I still believe that training and education would be the guiding light to > proper administration. > > In my mind, I would never anticipate the administration of Romazicon in the > same manner as Narcan. That is certainly not my intention, while I see > serious issues, and concerns regarding Romazicon, I still see the benefits > of pre hospital use. > > Mike > > > > > > > > je.hill@... > > > I agree with Dr. B on this one. Our medical director and I discussed > this a > > while back and we decided that supportive care (airway control, IV, etc.) > was > > much more beneficial in the field for possible benzo overdoses than using > > Romazicon for the reasons Dr. B. stated. And considering the COST of > Romazicon on > > top of the rest of the issues, the whole picture indicates better to NOT > use > > in prehospitally and let them run the tox screen and use it if needed at > the > > ED > . > > I, too, have talked with our medical director about this matter both in > 2003 > > and in 2004. He basically said the same things that Dr. Bledsoe has said. > He > > did not want to add it to our protocol. We do have Versed in our protocol > > for the purpose of facilitating intubation. > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 When I read statements like the one below, I become very sad, because I know it's true. These folks are the ones that hold us all back in the quest for professionalism. Ironically, many of them are earning the premier salaries in EMS because of the systems they work in. Will this ever change? Sorry to say that I doubt it. It has not changed in 25 years and the forces that justify mediocrity are stronger than ever. Best, GG In a message dated 4/11/2004 7:13:02 PM Central Daylight Time, jbabaa@... writes: But here is the situation, there are medics that believe in maintaining the bare minimum in training and that is it. And the ones that believe in knowledge and in-depth training are considered trouble makers. Basically, if a strong medic volunteered his/her time to educate and offer his/her experience for training and advancement of the EMS system, he is said to have a rebellious nature and have bad body language when he/she wants to instruct or become a FTO Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 11, 2004 Report Share Posted April 11, 2004 Mike, can you email me the protocol for that please ? lverrett@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 2004 Report Share Posted April 13, 2004 Now, that's a cop out! Re: Romazicon and Benzo's Mike, I agree with what Dr. Bledsoe has said and I also agree with what you say. Yes the education of pre-hospital personnel needs to be in-depth for they can make the correct Diagnosis. But here is the situation, there are medics that believe in maintaining the bare minimum in training and that is it. And the ones that believe in knowledge and in-depth training are considered trouble makers. Basically, if a strong medic volunteered his/her time to educate and offer his/her experience for training and advancement of the EMS system, he is said to have a rebellious nature and have bad body language when he/she wants to instruct or become a FTO. I know of this and I have seen this. You try to educate and pass on experience and knowledge and the only thing you hear is things like: what if a medic with less experience, 6 months, try's that procedure and doesn't succeed. What would be the political fall out or how would we explain. I know that if the proper training and QA system was in place those excuses wouldn't have to be made...... I'm all for education and training, but as long as everyone is trained and educated the same and held to the same standards. Basically if you can't keep up with the rest of the EMS system you need to find another career and stop making excuses for themselves and their precious job and political friends........ " De Oppresso Liber " Jelal Babaa, CCEMTP/NREMTP Arlington, TX Re: Romazicon and Benzo's > > Dexamethasone: Hypotension and/or total cardiovasuclar collapse > Valium: Respiratory and/or cardiac arrest > Epinephrine: Hypertension, increased ischemia, angina > Lasix: Acute dehydration, leading to cardiac dysrythmias > Lidocaine: Hypotension, seizures > Mag Sulfate: Hypotension, cardiac arrest > Thiamine: OD can create toxicity leading to cardiovascular compromise or > collapse > > Even Narcan has, in rare cases led to pulmonary edema. > > Point being, is that all medications have the possibility of being harmful > if they are not administered correctly, or, if the attending medic is not > properly trained as to the indications, and contraindications of each and > every medication that we carry, and use. > > I have a great respect for those that responded, especially Mr. Bledson, but > I still believe that training and education would be the guiding light to > proper administration. > > In my mind, I would never anticipate the administration of Romazicon in the > same manner as Narcan. That is certainly not my intention, while I see > serious issues, and concerns regarding Romazicon, I still see the benefits > of pre hospital use. > > Mike > > > > > > > > je.hill@... > > > I agree with Dr. B on this one. Our medical director and I discussed > this a > > while back and we decided that supportive care (airway control, IV, etc.) > was > > much more beneficial in the field for possible benzo overdoses than using > > Romazicon for the reasons Dr. B. stated. And considering the COST of > Romazicon on > > top of the rest of the issues, the whole picture indicates better to NOT > use > > in prehospitally and let them run the tox screen and use it if needed at > the > > ED > . > > I, too, have talked with our medical director about this matter both in > 2003 > > and in 2004. He basically said the same things that Dr. Bledsoe has said. > He > > did not want to add it to our protocol. We do have Versed in our protocol > > for the purpose of facilitating intubation. > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 13, 2004 Report Share Posted April 13, 2004 Now, that's a cop out! Re: Romazicon and Benzo's Mike, I agree with what Dr. Bledsoe has said and I also agree with what you say. Yes the education of pre-hospital personnel needs to be in-depth for they can make the correct Diagnosis. But here is the situation, there are medics that believe in maintaining the bare minimum in training and that is it. And the ones that believe in knowledge and in-depth training are considered trouble makers. Basically, if a strong medic volunteered his/her time to educate and offer his/her experience for training and advancement of the EMS system, he is said to have a rebellious nature and have bad body language when he/she wants to instruct or become a FTO. I know of this and I have seen this. You try to educate and pass on experience and knowledge and the only thing you hear is things like: what if a medic with less experience, 6 months, try's that procedure and doesn't succeed. What would be the political fall out or how would we explain. I know that if the proper training and QA system was in place those excuses wouldn't have to be made...... I'm all for education and training, but as long as everyone is trained and educated the same and held to the same standards. Basically if you can't keep up with the rest of the EMS system you need to find another career and stop making excuses for themselves and their precious job and political friends........ " De Oppresso Liber " Jelal Babaa, CCEMTP/NREMTP Arlington, TX Re: Romazicon and Benzo's > > Dexamethasone: Hypotension and/or total cardiovasuclar collapse > Valium: Respiratory and/or cardiac arrest > Epinephrine: Hypertension, increased ischemia, angina > Lasix: Acute dehydration, leading to cardiac dysrythmias > Lidocaine: Hypotension, seizures > Mag Sulfate: Hypotension, cardiac arrest > Thiamine: OD can create toxicity leading to cardiovascular compromise or > collapse > > Even Narcan has, in rare cases led to pulmonary edema. > > Point being, is that all medications have the possibility of being harmful > if they are not administered correctly, or, if the attending medic is not > properly trained as to the indications, and contraindications of each and > every medication that we carry, and use. > > I have a great respect for those that responded, especially Mr. Bledson, but > I still believe that training and education would be the guiding light to > proper administration. > > In my mind, I would never anticipate the administration of Romazicon in the > same manner as Narcan. That is certainly not my intention, while I see > serious issues, and concerns regarding Romazicon, I still see the benefits > of pre hospital use. > > Mike > > > > > > > > je.hill@... > > > I agree with Dr. B on this one. Our medical director and I discussed > this a > > while back and we decided that supportive care (airway control, IV, etc.) > was > > much more beneficial in the field for possible benzo overdoses than using > > Romazicon for the reasons Dr. B. stated. And considering the COST of > Romazicon on > > top of the rest of the issues, the whole picture indicates better to NOT > use > > in prehospitally and let them run the tox screen and use it if needed at > the > > ED > . > > I, too, have talked with our medical director about this matter both in > 2003 > > and in 2004. He basically said the same things that Dr. Bledsoe has said. > He > > did not want to add it to our protocol. We do have Versed in our protocol > > for the purpose of facilitating intubation. > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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