C*O*R*A wrote:I didn't think she was attacking him.. I'm sure, the concern is, that "anyone" can get this equipment.. and what would happen if it got into the hands of someone who has no concept of emergency prehospital care.
Although I didn’t take Sasha’s comments as an attack, without adequate training or experience one could obviously express the very same concern with regard to my AR15, my car, several of my power tools, and even the garbage disposal in our kitchen.
Sasha wrote:I would sincerely like to apologize for how my first two posts came off. I truly did not mean to come off as confrontational. My sincerest apologies. So can we be civil? I've already been cursed at. I didn't come here for a fight, I came here to ask a question I was genuinely curious about.
While your intubation kit is impressive, how do you plan to manage an intubated patient with no paralytics or sedatives? How to you even plan to ventilate them long with one portable O2 tank?
I wouldn’t attempt to intubate someone with a stable airway as a preventative measure against aspiration, but rather only as last-ditch effort to restore a patent airway in an unresponsive PT where the gag reflex would not be present (a “crash” airway, as opposed to the “difficult airway” or “RSI” algorithm, defined by Wall’s Manual of Emergency Airway Management). If airway patency were at risk in a PT who’s gag reflex was present, I’d more than likely insert a nasopharyngeal airway, or at a minimum position the PT on their side in the rescue position.
Having never directly worked in the medical field, I obviously have limited experience with such matters, although numerous studies have been published comparing direct tracheal intubation (without neuromuscular relaxants or paralytics), intubation with sedation only (without the use of paralytics), and rapid sequence intubation (using appropriate sedation and
paralytics). While RSI is certainly the standard protocol in emergency medicine, one study in particular surprisingly indicated that even in hospital settings, sedatives were administered in only 89.5% of pediatric patients and 24% of neonates, while muscle relaxants were only used in 3% and 0.9% of the cases (respectively).
With regard to oxygen, obviously a single D-size O2 cylinder isn’t going to last very long, regardless of the metered flow rate (just over 30 minutes @15 LPM). For you to suggest that anyone on this forum would actually expect 425l of oxygen to provide long-term ventilation of a PT in a post-apocalyptic scenario strikes me as a bit naive and condescending, to say the least. Then again you are new to this forum, so your basis for such a conclusion is understandably narrow.
My justification for the expense of maintaining portable oxygen at home is exclusively to bridge the 15-20 minute rural EMS response time during a traditional (ie, non-disaster) medical emergency. I don’t possess any unrealistic expectations regarding long-term respiratory management in a PAW scenario – anyone requiring long term ventilation as a result of serious illness or traumatic injury in such a scenario is likely to be someone that would quickly deplete most anyone’s limited medical supplies.
Sasha wrote:Do you plan on getting more Narcan? You don't have nearly enough for the amount of morphine you have, and a major contraindication of morphine administration is the inability to reverse the effects should they overdose.
And should you overdose them, and not be able to reverse it with Narcan (And when you do, watch for the projectile vomiting and violent confusion.) you don't have enough oxygen to ventilate them for very long when the narcotic knocks out their respiratory drive.
First of all Sasha, I think that you’re confusing posts, as I don’t have any narcotics (or naxolene) in my ALSC kit. As far as my STOMP II pack is concerned, adding more Narcan is not really on my radar.
The likelihood of any
of the narcotics ever
being administered to anyone other than myself is incredibly remote, to the extent of almost being nonexistent. I can really only begin to envision it during a true PAW scenario involving the complete (and indefinite) breakdown of our current society, and even then I would be extremely reluctant.
From my own past prescribed use of narcotics for pain management, I'm opioid tolerant, so the amount of Narcan that I currently have on-hand is already overkill. Although respiratory depression is clearly the most serious adverse reaction associated with opioid use, it typically only occurs following the initial administration to an opioid-naive patient, and despite what you think you may know, is extremely unlikely to ocurr. With regard to your other comment, I have absolutely no interest or legal/moral obligation to “take the edge off a junkie's heroin OD” as you suggested.
Sasha wrote:You claim it's an ACLS kit, yet you only have an AED and not manual defibrillator. How do you plan to manage patients who require pacing or cardioversion?
Are you serious?
Perhaps the people that you hang out with are considerably different than the ones that I know, but the mere fact that I even own an AED places me light years ahead of 99.99% of the population in terms of preparadness. Short of converting my garage into a Level I trauma center, there are obviously going to be numerous situations that I am going to be under equipped to handle, and yes, I sleep fine at night knowing that.
Sasha wrote:Also, no pediatric masks? No Broselow tape? What's your plan for pediatric patients? They aren't mini adults.
No, as we don’t have any children. In fact, most of our neighbors are in their 50’s or early 60’s, so we don’t really even have kids in the neighborhood (I've never even seen a schoolbus around here). Other than a few miscellaneous items (pediatric BP cuff, OPA’s, etc.) my FAK is not intended or configured for kids. My CPR/AED certification includes children and infants, but other than that I wouldn’t trust myself with much more than basic wound care or sprains/fractures.
Sasha wrote:Do you have a drug guide? Have you had any IV training?
Yep (to both).
You had quite a few questions, so let me know if I missed any of them.