New CFHS protocols-PCP and Adv Emerg Care

[Armymedic]

So we look back at the AEC course and I was told that the simple fact is that they want to push this so that 50% of the trade is qualified to get the spec pay??? Is that really the reason? Again I try to wrap my head around this and I can’t seem to find a clear answer.

Can't say I have heard any other reason, either. Spec pay is considered the Holy Grail of the trade.

Re: airway. Cric should be considered the last resort, when ET tube can not be placed because of a) lack of skill, or b) lack of compliant anatomy due to trauma, swelling, etc.  Bougie is considered a tool, just like the fiber-optic blades or glide-scopes, to assist in the placement of the tube into the trachea through the vocal cords.  I have tried a retrograde intubation using the Seldinger-like technique on a tissue model, and found very cumbersome and slow.  But still, it was a wire that guided the ET tube to the trachea. Personally, I love the bougie, and have others who agree that if you do not see cords (Cormack 3 or 4), it is the preferred first attempt/look intervention to ensure success.

 

[tacmed2007]

HAHA see now there you go useing a term I think I heard back in School adn so I had to go back and refresh my memory and found an interesting paper in reference to the Cormack scale:

http://www.anesthesia-analgesia.org/content/96/5/1510.full

NOw I had a question in refernece to the Resp section of the AEC... Icant help but notice that no where did it mention the use of Nebs in the Tx of a SOB,Asthmatic/COPD Pt instead the reference pointed to the use of an MDI with Aerochamber. Now granted if you put on prongs and have them use the MDI you should get results, however it is toally dependent on the Pt and thier ability to use the device correctly even if you factor in the attending controling the MDI. I also see that failing this Tx that or if the Pt is more sever that they continue with an MDI Tx with Atrovent.
So why not use the nebs? you are doing 2 or even 3 things at once: Pt is getting sup O2, getting the up to 5mg of Salbutamol or a Combivent if thats the course the attending wants. If the pt is at that point in the Tx protocol I dont think adn MDI is going to do it. ??? what about solumedrol
or Mag? thoughts??

The other question is the use of the folley Cath for an external bleed?? is the thought behind this to tamponade the bleed space?? Never thought of that for a bleed...be funny as hell to wheel in a Pt at the RAH with a folly in his nose cause the bleed would not stop!!! I would love to see the look on teh Traige RN face.

 

[medicineman]

I was taught (by a respirologist) that if you use a spacer and MDI, you'll get alot better medication distribution than by neb treatment.  One thing you also have to remember about this protocol - it's meant for someone potentially living and working out of their jump bag, so have no O2 hanging around (I sure as hell won't haul that around with the other 100 odd lbs of stuff I'm supposed to carry).  I used to use the MDI/spacer techinique alot in days gone by, and have had good success.

The Foley is supposed to be used for epistaxis that is not responding to pressure of the nares - so likely a posterior bleed.  That is a well recognized procedure if you don't happen to have the proper balloon pack to use - push the bubble into the posterior nasopharynx, inflate and pull forward.  The ER nurses won't look at you like you're a four headed alien - they've likely seen it or something similar.

MM

 

[Armymedic]

HAHA see now there you go useing a term I think I heard back in School adn so I had to go back and refresh my memory and found an interesting paper in reference to the Cormack scale:

http://www.anesthesia-analgesia.org/content/96/5/1510.full

Now we are having fun.  ;D

 

[xlq771]

There are a number of AED models that have 3 lead ECG monitoring capability, including the Lifepak 1000 and Zoll AED Pro.  Both can use 3 lead cables, in addition to pads.

 

[kj_gully]

If I may cut in with a little more on the cardiac arrest protocol/ "advanced" airway procedure- don't quote me, but it may be a case of they have it, I want it- SAR Tech have had advanced airway skills for some time. We recently dropped intubation in favour of LMA, and soon King LT (rumour). However since, like-if I read right 5A medics?- we have never carried paralytics, it was found that the time refreshing this skill in hospital did not weigh out in lives saved. To be fair, the training in use of an advanced airway is mostly (completely?) in support of a discontinue resusitation protocol that we have due to the distance we often are from care. We cannot definitively stop resus efforts until a patient is oxygenated with an airway in place, and a bolus of NS is administered. There had been very few if any cases in our practice where et tube was used save as part of the Discontinue protocol. We have bemoaned the loss of intubation capability, but as said, without paralytics it is questionable whether there ever really was any capability. Our time in ER is now much more focussed on basic resus skills- Bagging technique, head positioning, selecting and inserting opa, as LMA insertion is a relatively benign skill. I do not personally feel that LMA is a secure prehospital airway, as I find it is easily dislodged during pt handling and prolonged transport, but it suits its intended purpose, namely reassuring doctors that we checked all the boxes before calling it a day (night)
my somewhat more than 2 cents..

 

[tacmed2007]

XLQ 771 the CF does not carry either of those model's of AED's, so for us that is not practical...

KJ_gully...I feel the pain but I am at a loss as to why we dont just use an RSS protocol if we elect to use and ET or other form of advance airway, certinly the vast majority of the Pt population we would see would not need Induction, now saying that the SAR trad would have that broad spectrum Pt Population...so that could go either way. Now correct me if I am wrong but he SAR's are only PCP's?? so an EMT? and then they added advance managment skills?? so why not take the time to make you guys a full Paramedic or ACP?.....

 

[safetysOff]

I have tried a retrograde intubation using the Seldinger-like technique on a tissue model,

I've only learned of the Seldinger technique for inserting angio cathaters via either of the femoral arteries.  I've never heard of a Seldinger like technique for intubation. . . . .

*Editted: Ok, I think I know what you're referring to, a tracheostomy.  My inexperience.

 

[Armymedic]

Actually ETT intubation over the wire that was inserted through the criciod cartilage, and directed upward to the oropharynx.

 

[medic45]

There are commercially available kits that use the Seldinger technique such as the Melker kit.

 

[kj_gully]

XLQ 771 the CF does not carry either of those model's of AED's, so for us that is not practical...

KJ_gully...I feel the pain but I am at a loss as to why we dont just use an RSS protocol if we elect to use and ET or other form of advance airway, certinly the vast majority of the Pt population we would see would not need Induction, now saying that the SAR trad would have that broad spectrum Pt Population...so that could go either way. Now correct me if I am wrong but he SAR's are only PCP's?? so an EMT? and then they added advance managment skills?? so why not take the time to make you guys a full Paramedic or ACP?.....

Once fully qualified, we are pcp + (super PCP?). the time spent maintainingACP currency is prohibitive, and those skills are very perishable and would not be often utilized.

 

[mariomike]

Now correct me if I am wrong but he SAR's are only PCP's?? so an EMT? and then they added advance managment skills?? so why not take the time to make you guys a full Paramedic or ACP?.....

"Licensure of paramedics is the responsibility and domain of the various provincial regulatory bodies. Consult the provincial regulators for final decisions regarding practice."
Paramedic Association of Canada

Med Techs who have successfully completed QL5 can challenge the Ontario PCP exam:
http://www.forces.gc.ca/health-sante/hp-ps/mcsp-pmcc/aemca-eng.asp