Paragon's ACLS Module

[feuer]

....... it was posted by a member of the forum for people to be shocked and amused by.

Stating this as such is an attack. Questioning its intent, without knowing what that intent is, is an attack.
Constructive criticism or even simple feedback would be more helpful.

Many people are caught in the illusion that you just need basic scene stabilization to save someone's life. Scene stabilization is just a small part of a very lengthy process for saving someone's life. The pack is GREAT for scene stabilization, but long term, what is his plan of action? In a true distaster, as the post above me states, you won't have access to a hospital.

Many people also jump to conclusions about what a kit is intended for, and how it may or may not be used. There are many reasons to not even share your kits contents simply to avoid being criticized by professionals/amateurs alike. The point is that the intention is honorable and if nothing else educational. Elitest mentalities do nothing for education.

It would be far kinder to let people who code (arrest for those who are unfamiliar with the term) or would require active airway assistance (Endotracheal tube, King tube, LMA, OPAs, NPAs, etc.) to die than to revive them for a short time and then die later. It is also far kinder to those in your "group" or "team" to allow them to grieve than to be tugged around by false hope that a team mate has been saved.

Situation assessment would determine this for the most part, but at the same time with that kind of mentality you might as well shoot the victim in the head so as to not waste bandaids. A care giver cannot see the future and has no right to determine the liklihood of survival outside of a triage situation. You give care until care is futile. What gives you the right to determine the outcome before an attempt at care has even been attempted.

You also must thing about your oxygen supply. You have enough to MAYBE run a non rebreather for about an hour, but those suckers suck that down quick! The ones who need the oxygen most drain the tank the fastest!

Fentanyl is a great drug, it's 80x more powerful than morphine and is short acting. It is used extensively in EMS. But it is also a narcotic and the Narcan that is carried in that pack wouldn't even take the edge off.

Without knowing the kits owners intentions for use, you critcisms are pointless.

Your questions are relevant, but lets wait and see what Paragon has to say in his own defense before we go any further.

[jnathan]

First off, awesome kit. The contents vastly exceed my ability to provide care and in that regard I have little to offer.

I do have one comment, which might seem like it's out of left field. Regarding the blood pressure cuff, I see that the the one shown is the adult sized and it maxes out at 34.3cm (13.5) inches. If you put that on my arm, it wouldn't fit, and from my experience it would give (in all likelihood) an inaccurate reading. Depending on whether the arm is largely muscle or largely fat will dictate the reading. In the case of largely muscle, you may end up with a spurious systolic hypertension indicator (though in emergency trauma care, it might be accurate or irrelevant.)

Just my (mostly) worthless two cents.

-Jeff

[wi-red]

I'm thinking the only reason Paragon needs 300mg of morphine is so that he can inject himself with the entire dose in one shot as soon as the apocalypse hits. Thus, no need for narcan. You guys are right, it really isn't that big of a deal. 90% of that stuff will be expired in the next few months and require replacing anyways. I doubt he'd given all that much thought to expiry dates though, or anything else for that matter.

[wi-red]

Elitest mentalities do nothing for education.

Get a formal education on the subject rather than from a group of gun happy wannabes on a sociopathic chat forum then.

What gives you the right to determine the outcome before an attempt at care has even been attempted.

She's obviously had medical training. She is a trained professional and has to make calls like that all the time. That's what gives her the right you redundant tool. Poke your head out of your bunker and spend time in the real world.

[feuer]

Elitest mentalities do nothing for education.

Get a formal education on the subject rather than from a group of gun happy wannabes on a sociopathic chat forum then.

You wrongly assume two things in this narrow minded statement.

What gives you the right to determine the outcome before an attempt at care has even been attempted.

She's obviously had medical training. She is a trained professional and has to make calls like that all the time. That's what gives her the right you redundant tool. Poke your head out of your bunker and spend time in the real world.

Obvious to you maybe, but my experience in real world civilian and combat emergency aid, training is only one prerequisite of the job. Things like common sense, proper situation evaluation, and minimizing assumptions are just as important. Nevermind the fact that this is a forum and no matter who you are basing professional evaluations on people based on un founded observations is dumb.

She has questions, fine. I'd like to know the answers to those questions too, but I think I can at least pose them in a manner that is non-confrontational, non-arrogant, and non-elitest.

This is a an open forum of information sharing, you take what you want and leave the rest. What you and some others fail to realize is that, like anything in life, there is good and bad, and wrong and right, and fact and fiction. Your ability in disseminating this information for yourself is where you fail, because you can't even take the time to find the answers through simple communication.
You'd rather label, assume, criticize, and attack.

I have no idea who you are, nor do I care anymore, but I can tell from your posts in this thread alone that you can't even open your mind to the possibility of accepting alternative ideas, and in fact you have already catagorized me without knowing anything about me.

[jnathan]

Elitest mentalities do nothing for education.

Get a formal education on the subject rather than from a group of gun happy wannabes on a sociopathic chat forum then.

What gives you the right to determine the outcome before an attempt at care has even been attempted.

She's obviously had medical training. She is a trained professional and has to make calls like that all the time. That's what gives her the right you redundant tool. Poke your head out of your bunker and spend time in the real world.

This forum exists on the Internet, where every diminutive asshole with an ego can be a big person. Neither you nor Sasha seem to have the judgement nor intellectual firepower to enter into productive discourse before launching into ad hominem attacks based on little to no information.

Well done, you'll be making friends in no time.

Assholes.

-Jeff

[wi-red]

ROFL, you wrongly assume that I am here looking for friends. Why, pray, tell, would I want some wannabe medic or those he consorts with to be my friend? I see no one worthy of being my friend on this forum at all. Just a group of anarchists.

Feuer, what two things to I assume to be wrong? The gun happy part, the wannabe part, or the sociopathic part? Shrug, if I was wrong on only two of them, then which one is the accurate one?

Of course I'd rather label, assume, criticize, and attack. Paragon's kit is not well thought out nor does he have the training to properly use most of that gear. I just hope he keeps it stowed until after the world ends and anarchy reigns. That way maybe someone who knows what it's actually for will find it and do some real good with it...like dump all the garbage out of it and use it to carry food supplies. I'd make some lame ass Timothy McVeigh comment, but I see that's been done to death on this forum.

[JIM]

All right people, just relax...

Paragon has built an awe-inspiring medical kit for advanced short- or longterm scenario's, in doing so he has some liability-issues with several items in his kits. However, if you look into previous posts (like the STOMP-thread) you'll see he recognises the potential for this and has explained himself more than enough.

And I'm not saying that it's the perfect medical kit, but I try to give Paragon constructive feedback on it. Telling him what he should/shouldn't carry and WHY. So please, if you have problems with his gear-selection: Please tell them to us, but be reasonable and give your motivation. If you (and others) can't do that, and have to resort to name-calling and personal comments, this probably isn't the best forum for you.

Kind regards,

Jim

[Jamie]

Wi-red...chill out and read the rules...you can consider this a warning...further issues in this thread or elsewhere will result in your being given probation or simply banned...

The rest of you need to walk away from the computer for awhile...there's nothing wrong with disagreeing with people, here or anywhere else, but you are expected to be relatively civil about it in these forums...

Jamie

[wi-red]

I vote for the banned option as I truly have no input that the institutionalized denizens of this forum would choose to find of use in their dementia.

[Jamie]

I vote for the banned option as I truly have no input that the institutionalized denizens of this forum would choose to find of use in their dementia.

Your wish is granted.

Jamie

[Sasha]

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.

[JIM]

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.

It's allright. BTW, IIRC paragon has already added more narcan to his kit.

[Paragon]

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.

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.

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.

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.

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.

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.

Jim

[Sasha]

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.

You don't plan to use your car, power tools, and a garbage disposal to directly affect the outcome of a person's life, do you??

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.

Patient's can regain a gag reflex when it is not prudent to extubate them due to the fact their condition is changing, also patients can go through periods of responsiveness and unresponsiveness. It is not always wise to extubate a patient just because they're bucking on a tube.

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.

I was, I'm sorry.

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.

That's not what I was implying. I was only relating my own experience that 0.4mg is not even enough to take the edge off an addict's OD, much less the 300mg of morphine you're toting. Even given to yourself, you run the chance of overdosing and knocking out your respiratory drive. What then? Not breathing is 100% fatal, as my paramedic instructor always said. What good is the rest of your kit if you're not breathing?

Furthermore, 0.4mg is the very minimum effective dose, that does not mean it will treat anything. From my experience with Narcan, I've never gotten a response for anything less than 2mg of Narcan. Many paramedics wont even bother with .4mg and will go straight to 2mg. And as I had warned before, be ready for the vomit volcano, it's killer and the smell is a B to get out of your clothes

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.

Be that as it may, it still doesn't qualify for ACLS. The "A" in ACLS is for "Advanced". An AED is considered basic. You also don't carry the necessary drugs to be considered ACLS. Most of my friends are in the medical profession. As for the people I hang out with, I'm good friends with a doctor, I know various nurses and paramedics/EMTs and know a couple RRTs, not one of us would carry the liability of a personal AED.

Which drug guide do you use?? I've found that the Paramedic Drug Guide put out by Brady is informative and easy to use, it even covers "in hospital" drugs. It's a little green book and can be found in the medical reference/nursing section of most major book stores.

[Paragon]

That's not what I was implying. I was only relating my own experience that 0.4mg is not even enough to take the edge off an addict's OD, much less the 300mg of morphine you're toting. Even given to yourself, you run the chance of overdosing and knocking out your respiratory drive. What then?

Furthermore, 0.4mg is the very minimum effective dose, that does not mean it will treat anything. From my experience with Narcan, I've never gotten a response for anything less than 2mg of Narcan. Many paramedics wont even bother with .4mg and will go straight to 2mg.

Agreed. It appears that you missed where I stated that there are actually 10 ampules x 0.4 mg/mL each = 4mg total.

The "A" in ACLS is for "Advanced". An AED is considered basic. I'm good friends with a doctor, I know various nurses and paramedics/EMTs and know a couple RRTs, not one of us would carry the liability of a personal AED.

Perhaps exon111 will chime in on this matter (he owns a company who's primary business is selling AED's) although I have a difficult time believing that there is any liability related to owning or using and AED. The mere fact that AED's are located throughout a number of public settings and are designed with voice prompts for use by untrained individuals seems to contradict your comments.

What is your position regarding the possession and/or use of fire extinguishers? They too are located throughout a number of public settings and are designed with concise instructions for use by untrained individuals. Are you suggesting that fire fighters don't own fire extinguishers due to liability concerns?

Which drug guide do you use?? I've found that the Paramedic Drug Guide put out by Brady is informative and easy to use, it even covers "in hospital" drugs. It's a little green book and can be found in the medical reference/nursing section of most major book stores.

I have several, including a few that I have tailored to only those drugs that I carry. Epocrates is the one that I generally refer to, although I have an 8GB flash drive that currently contains just over 6GB of medical reference that I have assembled over the years, including a large folder with drug indications/contraindications, dosing information, interactions, side effects, etc.

Jim

[BobtheBreaker]

No, we're not twins, but we probably frequent the same forum where this is being laughed at.

So it addresses the issue of post ROSC management? Continued management of an intubated patient? Not even enough narcan to take the edge off a junkie's heroin OD, much less the 300mg of morphine he's toting around? And some small adults require things like pedi BP cuffs.

I was nice when i asked, I'm generally curious. Please point out to me where he's addressed these issues.

What forum is this being discussed on now? I think Light Fighter the last place to run a hit piece on this kit. At least you aren't quite a rude as your "wi-red" twin. Maybe try contributing to the forum a bit before you start criticizing people?

EMTCity

I made a thread here titled "When Universes Collide" a few months ago when they found his Stomp, well they found his ACLS module recently. So now the same howler monkeys have something new to whoop and holler over.
http://www.emtcity.com/index.php?showtopic=14388&st=180

Exon111, they called you out too...because of the stuff you posted in the new throw down thread.

[AlmostJesus]

Patient's can regain a gag reflex when it is not prudent to extubate them due to the fact their condition is changing, also patients can go through periods of responsiveness and unresponsiveness. It is not always wise to extubate a patient just because they're bucking on a tube.

I can attest to this, my last trauma resuscitation, they had him tubed and kept going with the fluids and blood and we were able to bring back a blood pressure and pulse, along with that came a gag reflex, they had to paralyze him, he wasn't going to make it without the tube. Now I am not sure if you are going to run a trauma code in a PAW, but thats something to keep in mind with any resuscitation, you may bring back a pulse and a bp but their breathing may not be adaquate.
I do agree with a lot of the stuff you are saying Sasha. It makes a lot of sense.


I do have one question for you Paragon, without revealing too much, how do you store all your drugs? Are they under seperate lock and key?

[JIM]

I can attest to this, my last trauma resuscitation, they had him tubed and kept going with the fluids and blood and we were able to bring back a blood pressure and pulse, along with that came a gag reflex, they had to paralyze him, he wasn't going to make it without the tube. Now I am not sure if you are going to run a trauma code in a PAW, but thats something to keep in mind with any resuscitation, you may bring back a pulse and a bp but their breathing may not be adaquate.
I do agree with a lot of the stuff you are saying Sasha. It makes a lot of sense.

True, code patients that have regained circulation are usually sedated.. if also helps with the induced hypothermia.

[Paragon]

I do have one question for you Paragon, without revealing too much, how do you store all your drugs? Are they under seperate lock and key?

No, as there is simply no compelling reason to do so. However, the fact that you would even ask confirms to me that a fundamental misconception exists – that being the widespread belief that the laws concerning medications which routinely apply to healthcare facilities also apply to individuals.

Access to controlled substances within a medical facility are restricted because of the need for accountability among the large group of healthcare workers that would otherwise have unrestricted (and unaccountable) access to the drugs. On the other hand, as an individual that fills a prescription (say for 20 pills) it’s not like I need to lock them up at home to prevent myself or my wife from “stealing” a couple for resale on the street corner, or to satisfy an abusive habit that we might have. It’s analogous to how a bank “stores” it’s money versus how an individual does:

When a bank closes for the evening the tellers provide their drawer receipts (which are verified by other tellers) and the funds are locked away in the vault for the night. The next morning everything is double checked again, and each subsequent transaction throughout the day involves a paper trail to account for deposits and withdrawalws. Healthcare facilities essentially do the same thing with controlled substances as they dispense the drugs to various PT’s…

When you or I go to bed at night, we simply place our wallet on top of the dresser or wherever – we aren’t required to perform a finally count of the money by denomination, record it, and lock it up where we can’t get access to it until the next morning like a bank does. Similarly, there is no reason to do any differently with medications, other than obviously to keep them safely out of the reach of children.

Despite what a bunch of naive, misinformed nitwits on some other forums believe, the cumulative amount of prescribed controlled substances that I have amount to about 1% of what one would find in the home of a typical cancer patient, or anyone suffering from chronic lower back pain. As such, it’s not very likey that some whacked out drug addict that is looking to score is going to try to track me down and drive halfway across the country to steal 300mg of injectable morphine, when they could simply walk across their own street to the first house with a stage II cancer patient that has multiple 20,000mg bottles sitting on their nightstand, bathroom sink, and kitchen counter.

Make sense?

Jim

[WolfBrother]

Paragon,
Before engaging Sasha further, you may want to go to the site mentioned and look at it a bit.

I went there to read what was being said and found a huge amount of not thinking outside the box going on.

I read the rules and if I understood them correctly the types of comments made by a number of posters there - if you were a member of that forum and they had been addressed to you instead of at you on this forum - would qualify the posters for probation and/or outright banning on that site.

[Sasha]

Paragon,
Before engaging Sasha further, you may want to go to the site mentioned and look at it a bit.

I went there to read what was being said and found a huge amount of not thinking outside the box going on.

I read the rules and if I understood them correctly the types of comments made by a number of posters there - if you were a member of that forum and they had been addressed to you instead of at you on this forum - would qualify the posters for probation and/or outright banning on that site.

One thing I would like to say, I am a member of that forum, and it IS posted on that forum, but that is not the forum I was referring too, it's also popped up on another forum. I don't frequent that forum very much because of exactly what has been said here. They're obscene and mean. As for not thinking outside of the box? There are some very smart people on that forum, paramedics, nurses, respiratory therapists, PAs and a few Doctors... I would trust what they had to say over what I've read here, simply because they are educated to first aid and medicine, and work in the field.

And as far as enganging me? I've had questions, he's been kind enough to answer. Don't paint me with the same broad brush you paint them, I don't believe I commented on the thread on that forum. Nor do I feel that I've been trolly. I've asked my questions, and despite some of the respones I've gotten here, I've played nice.

[Sasha]

Perhaps exon111 will chime in on this matter (he owns a company who's primary business is selling AED's) although I have a difficult time believing that there is any liability related to owning or using and AED. The mere fact that AED's are located throughout a number of public settings and are designed with voice prompts for use by untrained individuals seems to contradict your comments.

What is your position regarding the possession and/or use of fire extinguishers? They too are located throughout a number of public settings and are designed with concise instructions for use by untrained individuals. Are you suggesting that fire fighters don't own fire extinguishers due to liability concerns?

It's a sad thing that society has come to this, but there is liability.

Pads expire, batteries drain (Even long lasting batteries can be defective.) and unless you prove that you check and inspect your AED regularly you're opening yourself up to liability in the case of an actual code. Say you went to use your AED and shockingly, the battery is defective and does not function properly, the person dies, the patient's family can and may sue you.

Public places often inspect their AED's regularly. Or they should. Fire estinguishers are something completely different. I've never used one with the intent to save someone else's life, but with the intent to put out the dinner that I just set on fire

Epocrates is the one that I generally refer to,

Do you have a PDA? Epocrates is available for download to PDAs. Very useful if I do say so myself.

[Paragon]

One thing I would like to say, I am a member of that forum, and it IS posted on that forum, but that is not the forum I was referring too, it's also popped up on another forum. I don't frequent that forum very much because of exactly what has been said here. They're obscene and mean. As for not thinking outside of the box? There are some very smart people on that forum, paramedics, nurses, respiratory therapists, PAs and a few Doctors...

Unfortunately the signal to noise ratio generated by all the sniveling choade worblers drowns out those few that actually have anything meaningful to say.

Jim