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Ambulance: Intranasal Medication

Written by RSS Poster Medic ScribeMedic Scribe

One of the best innovations in EMS in recent years has been the introduction of intranasal medication through the use of an atomizer.  We currently carry three drugs that we can use intranasally.  These are Narcan, Fentanyl and Versed.

After several years of experience now with all of these drugs through the intranasal route, here are my impressions of the utility of each.

Narcan – I love intranasal Narcan.  I use it often and almost always for heroin overdoses.  It took a while for me to learn the patience required, but once I realized the patient would come around eventually (usually within 2-5 minutes, sometimes as long as 8-10), I stopped reaching for the IM Narcan and putting them into withdrawal with the IM Narcan added to the peaking IN Narcan. I have had conversation with many medics about this and each medic seems to have his preferred method.  Some like IV which gives you the ability to slowly titrate.  Some prefer IM for it fast action – the patient comes around sooner than the IV method...

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Ambulance: Devolution

Written by RSS Poster Xf
What's to be done? I'm actually starting to feel some despair about the situation.

I was sitting in my response car at the scene of a call. There was an ambulance behind me - the crew was in the back treating the patient, who'd felt faint but hadn't actually passed out. I was on the phone to a fellow paramedic when a man approached me and asked me to wind down my window, which I duly did (although these days I'm a little bit more cautious about doing so).

The following exchange then took place.

Man: "Sorry for interrupting but I pay for the NHS too, so can you tell me why there are so many ambulances parked on this road?" (I should remind you that there were two!)

He went on to ask, "Are you waiting for something?" to which I replied, "We are dealing with an emergency call"

Man: "Are you on stand-by?"

Me: "No sir, we are dealing with a patient. The crew in the ambulance is treating her right now".

Man: "And you are doing what?"

I have to admit I was mildly shocked at this question. I suppose being on the phone and not doing anything relevant to my role...

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Ambulance: The Jug

Written by RSS Poster Medic ScribeMedic Scribe

There is a clear plastic jug — actually it is an empty water cooler bottle — that several times a year gets put on the table by the check-in window in operations. A handwritten note is attached asking for donations to help a fellow employee in need. A lot of money has gone into the jug over the years. Few professions know about hard times as much as ours. And we are not immune to them ourselves.

People in EMS don’t make a ton of money. That wasn’t why they went into this work or why they have stayed. Most need overtime or a second job to get by. And when hard times hit, few have the cushion to absorb them. That’s where the jug comes in. It is never enough, but at least it is something. A brother or sister in need. We see the jug and we reach for our pockets. A child with cancer. A bad accident that has laid someone up unable to work and with a long road to recovery. A sudden death. Over the years I have watched my fellow employees put their money in that jug. Maybe a $5, sometimes a crisp $20, others...

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Ambulance: The Ideal Medic

Written by RSS Poster Medic ScribeMedic Scribe

I have been a full-time paramedic for over twenty years and a part-time hospital EMS coordinator for over six years. Over the years my ideas of who the best paramedic is have changed markedly. I used to think the best paramedic was the one with the swagger, the one without fear, who never hesitated to act, who never allowed doubt to enter the equation. And while I still admire many aspects of that paramedic archetype, from both my vantage of twenty plus years on the street and the newer position of someone who can actually match up what happens on the street (or at least as described in the prehospital run form) and what happens to the same patient in the hospital, I have learned that many paramedics I thought were never wrong, can actually be wrong quite often, and that some of the paramedics who I thought were rather dull, have actually pleasantly surprised me time and again.

So here is my new ideal medic(s):

A great medic will call a STEMI Alert even if he is not certain the patient is having a STEMI. He will...

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Ambulance: AHA 2015 Guidelines- Guest Post

Written by RSS Poster Medic ScribeMedic Scribe


I don’t have guest posts as a matter of course, but Anthony Randazzo,a paramedic from Knoxville, Tennesse offered to do one on the updates to the 2015 AHA guidelines, which we are all anxious to learn about, so I happily agreed. Take it away, Andrew


Back in January, Peter highlighted some of the upcoming guidelines for AHA. Today, Peter is letting me follow up with a post that will take a look at a few more changes and trends coming down the pike.

No More Vasopressin

This probably does not come as a shock to most of you. I don’t even remember the last time I used vasopressin. I think the only reason I’ve used it in a code is to say that I used it. Aside from the affects of the drug itself, it is very impractical. Typically you have to draw up 2 vials in order to get your 40 units, and it’s more time consuming than popping the caps on an amp of Epi and pushing them together.

Looking at the pharmacological effects of Vasopressin, statistics show that there is no superior benefit during...

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Ambulance: It's All Innocent

Written by RSS Poster StorytellERdoc
Happy Monday, everybody!

Although I pride myself on catching the obscure snapshots of typical life moments that occur daily while dealing with patients and their families in the emergency department, occasionally there are times when I am so focused on the task at hand that I completely fail to see a glaring moment of obvious humor, sadness, or tenderness. At times like this, then, I am glad to have our hard-working nurses and techs with me in the room to bear witness to such events.

For example, recently I treated a 62 year-old retired kindergarten teacher who presented to our emergency department for a nosebleed. By appearances, she was exactly what you would picture a retired kindergarten teacher to look like--perfectly permed grey hair, kind eyes, folded "liver-spotted" hands resting in her lap, and the perfect amount of wrinkles at the corners of her eyes and mouth. If not for the actively dripping blood from her left nare (nostril) and the gory blood stains on her white cardigan sweater, I would have sworn she was there...

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Ambulance: SEO Scumminess

Written by RSS Poster

I checked my email – something I now only do two or three times a week and found this email.

Thank you very much for getting everything wrapped up so quickly but unfortunately I cannot say the same for myself.
We are having some annoying payment issues and it has caused a pretty hefty back log, as it’s a bot running payments there is a queue, Once you are first in the queue you will be paid but until then I cannot really do much.
If you need to pull the article then fair enough but can you please keep hold of it to repost as the payment will certainly come at some point.


I think as a species we are becoming more and more adept at filtering spam, and I found it strange that this would be sent to me.

Then an hour later I got this.


I am very sorry for my previous email, I have just realised I sent the complete wrong message, the intended message is below. (if you have received this message more than once please excuse me, my email system is bugging out)

Thank you for taking the time to read...

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Ambulance: Where To Look

Written by RSS Poster StorytellERdoc
Big thanks to my many encouraging is with you in mind that I have returned with another post.

I walked into Room 30 to find two eager sets of eyes awaiting me. One set belonged to a young man, late-twenties, muscular and imposing, sitting in a chair in the corner of the room. His eyes were hazel brown, big and inviting, relieved at seeing my entry into their sheltered world. The other set of eyes, darker brown and magnified by her gold-stemmed glasses, belonged to my patient, a woman in her early-sixties. She sat  upright in her treatment cot, knees drawn up to her chest and covered by the thin hospital-issued bed sheet.

Clearly, I had interrupted a conversation between them. Upon my entrance into their treatment room, they gave me the respect and gift of silence, a pause in which I would be able to introduce myself. As many of my fellow coworkers would confirm, this does not often happen. Rather, it is not unusual for us providers to walk into a treatment room only to wait for a patient to finish a cell phone...

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Ambulance: More on Shape and well done Tom Dolphin

Written by RSS Poster Garth Marenghi
  Anyone who reads this blog will be aware of the Shape of Training review, irrelevant of this I would strongly advise you have a glance at this excellent piece in the BMJ exposing several critical flaws of the review.  It is worth reiterating that Shape's critical flaws include its methodology, its lack of transparency, its flimsy evidence base and its dangerous recommendations. It is easy

Ambulance: The Butler Did It

Written by RSS Poster Medic ScribeMedic Scribe

There are any number of different ways to give a verbal handover report at the ED. All sorts of mnemonics. What form you use may depend on what your hospital expects. I try to tell a story. But I don’t tell a story in the same way I would write one. A written story takes you from point A to point Z with all the twists and turns, ending with the Da Dumm! The Butler Did it.

The other day I was listening to a new paramedic tell a triage nurse a great story of a very interesting call. Lots of the above mentioned twists and turns. It started with “We were called for…” It could just as well have started with “It was a dark and stormy night…” The problem was even though it was a great story the triage nurse was getting very impatient, not to mention she was interrupted by other nurses, doctors and her phone during the course of the medic’s novella.

My suggestion to the paramedic was when giving an EMS report to a triage nurse, you have to start with the last line. Begin with “The butler did it,” and then you...

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Ambulance Blog List

Hampshire & Isle of Wight Air Ambulance (806)
InsomniacMedic (217)
Trying My Patients (194)
Trauma Queen (178)
Street Watch: Notes of a Paramedic (158)
Garth Marenghi (105)
Xf (91)
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A Life In The Day Of A Basics Doc (57)
StorytellERdoc (50)
Brian Kellett (dot) Net (49)
Medic ScribeMedic Scribe (42)
Jerome Mowat (26)
Emergency Egg (19)
ambcontrol999 (14)
Hampshire and Isle of Wight Air Ambulance (14)
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Minimedic's Musings (10)
Random Acts Of Reality (6)


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