Plavix and Heparin

[Guest guest]

Just out of curiosity, how many other services are carrying Plavix and

Heparin? Any? If there are any, what dosage are you utilizing for

Plavix?

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

[Guest guest]

Mike,

We do not carry Plavix or Heparin...although we are discussing it with the

receiving hospitals where we take our STEMI patients...there is some discussion

among cardiologists and since we are starting to activate cath labs from the

patient's house, we want to make sure we do treatments conducive to continuity

of care...the discussion we are talking on Plavix is either 300 mg or 600...I

don't recall where we are on Heparin. We are also talking about larger doses of

Aspirin above the 325mg.

Dudley

Plavix and Heparin

Just out of curiosity, how many other services are carrying Plavix and

Heparin? Any? If there are any, what dosage are you utilizing for

Plavix?

Hatfield FF/EMT-P

www.canyonlakefire-ems.org

[Guest guest]

Mike,

We currently use 300 of Plavix in our ACS MONA orders, but only for those

allergic to ASA. The recent STEMI conference in Austin shed light on a couple

of studies that suggested that higher doses of Plavix (600 mg) coupled with

heparin provided a much higher positive effect on patients studied than

previously thought to exist. Turns out it was the common denominator in many

effective reperfusions. We are currently revising our orders to take this and

other new data into account.

Soapbox:

If anyone has read Dave Jaslow's article in March JEMS, he makes a very good

point of ny and Roy talking about their datascope and sending 12 LD ecg to

Rampart. We are talking 1971. They were doing it (fictitiously) while most EMS

agencies are not using 12 leads effectively 35 years later. People, we have

seen a profound improvement in trauma care, based much on everyone getting on

the same bandwagon (MD's, Surgeons, Hospitals, EMS, etc.). We are now seeing

Stroke committees pop up within our RACs. We have however, for the most part,

eased along in milk toast fashion in pre-hospital ACS care for the past few

years. Think about it, three decades ago many political subdivisions were sold

on paramedic level care for what we can do for medical patients. I will be the

last person to debase our constantly improving trauma care, but as Bledsoe says

" Treat it with a bolus of diesel fuel. " We all know that medical/cardiac calls

don't work that way. We are sold on the Safarian concept that the patient care

continuum starts at the scene, not the ER door. So, why is it that only a few

people that speak up on this list (H.T., Dudley, Maxie) attended this

conference. In the past 30 years I am not sure that I have ever been to such a

gathering of respected practioners (EMS, Nursing, ED Docs, and Cardiologists)

where the entire group saw the problem equally, and respected all of the facets

of medicine equally as well as I witnessed there. One ER Doc that I met from

Corpus commented that he did not understand why we (EMS/ED) are not embracing

this faster. He felt we should be the catalysts for other meetings like this

one, initiated by the ACC. I was sort of surprised (appalled might be a better

word) to find I was the only paramedic from my entire COG there, with only one

RN there from my COG as well. People, with the number of hospitals that are

screaming WE HAVE A CATH LAB to the general public, we need to start working

this problem together. Studies have repeatedly proven that you can stop or slow

the muscle damage, prior to reaching the hospital. If your system is not into

that, then EMS has to do it's part for the D2D, or D2B time to work. This will

take a lot more interdisciplinary coordination in each of our respective areas

than we are currently putting into it. (How many of you made immediate changes,

only to have the ER's in your area question you for months before they figured

out why you were administering the things you were?) Before any of you go to

slobbering on your keyboards, I know that many of us are staying on top of this,

many of us had our SDO's changed as soon as the AHA prepublished on the web in

November 2005, so if you comment on this diatribe, flaming for the sake of

flaming is not productive. EMS is making great strides here in other parts of

the USA. We need to take the bull by the horns and the cohones and pull from

both ends. If we have systemically done so with trauma, and are starting to do

so with stroke care, why are we not simultaneously doing so with STEMI care?

Vernon Gresham

Ganado EMS

Plavix and Heparin

Just out of curiosity, how many other services are carrying Plavix and

Heparin? Any? If there are any, what dosage are you utilizing for

Plavix?

Hatfield FF/EMT-P

www.canyonlakefire-ems.org