Thursday, August 22, 2013

I want your opinion

I have a question and really want to hear from all of you.

Currently, the state of Minnesota defines a health officer as:

Health officer.

"Health officer" means:
(1) a licensed physician;
(2) a licensed psychologist;
(3) a licensed social worker;
(4) a registered nurse working in an emergency room of a hospital;
(5) a psychiatric or public health nurse as defined in section 145A.02, subdivision 18;
(6) an advanced practice registered nurse (APRN) as defined in section 148.171, subdivision 3;
(7) a mental health professional providing mental health mobile crisis intervention services as described under section 256B.0624; or
(8) a formally designated member of a prepetition screening unit established by section 253B.07.

I have been of the opinion that the list should also include paramedics.
That would facilitate the medic writing a transport hold on scene and taking the patient to a hospital. There have been some concerns about the MD's agreeing over the phone, because then you need to ensure that the patient is seen by that MD. Triage and bed space in a large ED with multiple providers doesn't always make that realistic. And some MD are unsure if it is appropriate to agree to a hold over the phone without really seeing the patient.

So, would it make an impact in your job if paramedics could sign the hold form? How?
On your first day of work, would you have been able to make that decision?
Recognizing that much of the state is served by EMS providers trained to the EMT level, should they be included in the definition?
Remember, I am not governor so I am not making any campaign promises, I just want to know what you think.

Thursday, August 8, 2013

Best Practice

This is the button to avoid!!
I think we all agree the Lucas 2 is an upgrade from the previous version. I understand it is top-heavy, but the auto adjusting is nice and I have been told it is much more quiet.

One new option it gives us is the choice between continuous compressions and 30:2.

Dr. Lick and I think the patients have the best circulation when the compressions are uninterrupted, even when you are only using a basic airway. This is contradictory to the current AHA recommendations, but the science is ahead of the 2010 AHA guidelines.

So, avoid the 30:2 button, use only continuous compressions regardless of what airway you use.

Monday, August 5, 2013

Watch out, it's graphic!

A little on the gory side, but it is a good demonstration of ventilating lungs.

We were using this at a training day for a different group. In the video, you can see the lungs expand with each breath. If you watch the deflation period, it is much quicker when the PEEP valve is off. When the PEEP valve is in place, the lungs deflate to a certain point but hold some volume. Think of this as maintaining open alveoli that would normally collapse. These are then ready to accept now, oxygenated air with the next ventilation.

If you watch, you can see blebs forming on the right lung, among other places. This is because we have caused injury to the lungs by over-inflating them at times.

This is also a good exercise to watch the effects of hyperventilation on lungs and how they lungs are affected when we ventilate rapidly without giving enough time for them to deflate normally.