Hi everyone! Most of you are already familiar with me but for those who are visiting for the first time, please allow me to introduce myself. I am a Firefighter/Medic with training and experience in the following areas; HCP-CPR, Advanced Cardiac Life Support, Prehospital Trauma Life Support, Pediatric Advanced Life Support, Firefighting Operations, Hazardous Materials, Technical Rescue, Water Rescue, Emergency Vehicle Operations, Prehospital Pharmacology, and Medical Terminology. I am here to provide technical support for those seeking to broaden their knowledge of Firefighting and Emergency Medical Services. This board has a wealth of resources to answer any and all questions that may come it's way, so if you need to know, ask and we will help in any way we can!
Valium IM......One Final Question
by Cap
Hello There!
OK Valium IM it is. Now all I need is a ballpark dosage. To help my character settle down and go to sleep and sleep probably about 8 hours anyway.
This question may be a repeat but I can't go to back more than 2 pages on the site to check because for some reason my computer won't do it so anyhow my question is does anyone know what stations besides station 69 that Mike Stoker worked at??
Thanks
Jenny
Any possibilty that the surviving cast might togther and make a reunion movie, Calli Emergency!, The Reunion, Maybe Capt Stanley is Chief Engineeer, Johnny and Roy are Captain's on the same Paramedic Engine but on diffirent shifts!, Chet finally makes Engineer, Anyone have any idea for Stoker and Marco?
I saw the reunion message about not having one, but just in case, Mike Stoker became Captain in real life, why not make him one if a movie does come out.
i would like to see a new series based off of the original,with all of the new "reality shows" why not...??? or somthing like it....its been done from other shows...
Thank you for all the responses to my question. Now then, Valium IM it is!
One last question and I'm done for now. I need a dosage amount. I'm thinking that Ativan wasn't around in the 70's and I'm trying to stay true to that era. It's hard though sometimes.
First, I want to thank you in advance for your help. I actually have two questions.
If a patient has broken ribs that have punctured a lung, would they do CPR on him if he goes into cardiac arrest?
Next question - - I have a victim that is suffering from a fractured fib/tib, humerus, and the above mentioned broken ribs and punctured lung. It took hours to rescue the victim. What would his vital be and what type of first aid (I.V's, medication, etc.) would the doctor order.
If the patient is in cardiac arrest, CPR is indicated whether or not the patient has broken ribs and a punctured lung. CPR may break ribs anyway.
Now this is where I am confused. This is one patient? Well anyway...
Looking at the vital signs pre-code and assuming all injuries are closed you may have initially normal vitals except respirations which may be labored and rapid to compensate.
However, as the patient begin to decompensate the BP will drop and the heart rate increase. Level of consciousness will decrease.
Pre-Code treatment will involve airway managment including O2 via a mask, stabilizing the fractures including the ribs, initiating a pair of large bore IVs running either NSS or LR (or 1 and 1), and keeping the patient warm. As the patient's condition gets worse then a vasopressor such as dopamine may be in order. MAST pants may even be used to stabilize the femur and slow internal bleeding. As the pt goes down hill intubation may be required. Also, as a pneumothorax may develop, chest decompression may be in order.
The patient you describe has many complications which require surgical intervention. EMS may only buy time.
Post-Code treatment depends on the rhythm. However, depending on the extrication time still needed, pt access etc., the patient may not be worked at all.
I know I am missing something here but hope it is a start.
Wow, I wasn't expecting such a thorough response. I really appreciate your time in being so thorough.
I'm pleasantly amazed at myself. I guess I've learned more than I thought by watching Emergency cause my story's almost completed and your answers pretty much go along with what I've written. Guess I just wanted to check it for accuracy.
Thanks again.
Pina
These days, can a paramedic become a captain and still stay a paramedic? i know it wasn't that way in the '70s, as shown in the 2 part movie "The Greatest Rescues of Emergency", when Johnny and Roy become captains but can't also be paramedics. I'm just curious. Happy holidays!
In some depts, Captain/Paramedics are a necessity. In my dept, one of our 2 stations has cross-staffed units: a paramedic ambulance and a fire engine. The station is staffed with two people - an Engineer/Paramedic and a Captain/Paramedic. A nearby dept (with 6 stations) uses a Captain/Paramedic at one of its stations, as it has a reserve paramedic ambulance there that is used during busy times that have both of the dept's regular paramedic ambulances out on calls. Most depts (especially larger ones) use a Captain strictly as an engine company officer, though, and any paramedic responsibilities would most likely interfere with those command duties.
Today, the LACoFD has several (2,3,4??) engine companies that are paramedic engines so it is possible to be a capt. with a paramedic license. One station that I know of has a squad plus a paramedic engine due to the amount of runs the station runs.
Here in the greater Cincinnati region it is very common to have paramedic Captains (and Lieutenants). Although they typically serve as the officer-in-charge, I have witnessed many times where they put there paramedic skills to use.
The Cincinnati Fire Division itself has 12 paramedic engines (out of a total of 26 engines). Staffing on a Cincinnati Paramedic Engine Company is a total of 4 personnel; a Captain or Lieutenant and one firefighter serving as the paramedics, while 2 EMT-Basic's make up the remainder.
In my volunteer rescue squad, we have several officers(my duty shift OIC included)both Lt and Captain, who are active charge paramedics as well. This also goes with some of the fire service officers in our county system.
What exactly does a sodium bicarbonate IV do to a victim? Under what circumstances do you give it under? If anyone knows, please tell me. Also, could you tell me if patients with IVs but not in serious condition are allowed to be transported in an ambulance without a paramedic, cuz i saw on one episode of Emergency that Johnny and Roy had a problem with that, cuz their victim wasn't serious and another rescue nearby was, so they had to break the rules and help the victim. i was just wondering if that rule has changed.Thanks!
Sodium bicarbonate is used to counteract the effects of acid buildup in the blood, which often happens as a result of cardiac problems, certain poisonings, etc.
As far as IV's are concerned, in Utah an IV certified EMT can transport patients with IVs running, and a paramedic is not always required. At the time of E! the EMTs in the US were usually not IV rated and IV use was a paramedic level skill. Now we have many EMT-Intermediates who are IV trained as well as being certified to administer the drugs commonly used for cardiac emergencies (what they can do is regulated by each state and also local protocols). There are still a number of procedures that require paramedics, however. It's interesting to see how things change in 30 years.
"Two amps sodium bicarb" used to be a standard order for cardiac arrest patients to correct acidosis, but then they learned that the acidosis was caused by retained CO2 from a lack of respiration. Once the patient's airway is re-established and he is properly ventilated, the acidosis generally is corrected and bicarb is not necessary and may indeed be harmful. Bicarb is still used in cases of metabolic acidosis however.
Bicarb can also be indicated in the treatment of TCA (tricyclic anti-depressant) overdose and phenobarbitol OD. Bicarb is rarely used anymore in cardiac arrest treatment. If used in a cardiac arrest, it is usually later in the game.
I don't know who came up with that idea but what a winner that is! Great, great idea! Makes it alot easier to find something to see if that particular question has been answered.
Wonderful tool indeed!!! Nice job!! Another reason why I think this site absolutely rocks!! Cool!!
I have a question about Valium. Can you slow push Valium? I know that it is given IV Push for seizure circumstance but can it be slow pushed if giving it as a tranquilizer? I'm thinking that's how Brackett is going to have to explain it as he gives it but I don't know if that's accurate or not. IE "We're just going to inject it slowly so that it works like it should."
IM is the preferred route for diazepam. It shouldn't be given IV ***AT ALL*** unless the circumstances are severe. Seizures warrent it. Anxiety/tranquilization doesn't.
Almost all drugs that are given IV push are given 'slow push', so the word slow is unnecessary and doctors don't use it when writing orders. It is assumed that any drug you push (with few exceptions) will be pushed slowly.
Please do not give away the RN's job to a doctor. Doctors do NOT administer medication in the hospital setting, ever. Nurses do. Nurses have training in medication administration and IV therapy that doctors don't have. By law, a nurse giving an IV push med MUST be an RN, not an LPN. Please, so many writers show doctors giving shots, etc and it just ISN'T done. Doctors won't do it and nurses won't let them. Doctors order the meds, nurses give them. Doctors don't do patient care - nurses do. Doctors write orders for care and nurses carry them through.
Thank you for your response. Makes sense. I have seen Brackett give meds many a time on E! so I thought that maybe to keep his patient (who he knows fairly well) calm, he would be the one giving the meds.
I'm not sure how I'm writing this one. I'll have to bounce it around and see what works.....:-)
Doctors only very rarely give meds, no matter what E! showed. Remember, E! was TV, not real life. They did a lot of things for 'dramatic reasons' that would never happen in a real hospital. Brackett might stand by and watch the nurse give the meds, but he's not going to do it himself - it's not his job, and he doesn't have the training needed to do it. (Although it's more likely he wouldn't even be in the room. Despite what you see on TV, most doctors don't stand around and do a lot of hand-holding. They're far too busy and they're just not interested in interacting with patients that much.)
While I agree that Emergency! was TV, and they took dramatic license, I feel that fiction based on the show may take the same license. In fact, I believe that E!Fic should remain true to the series. If one wishes to write straight medical drama, one may write for ER. Emergency! was great fun, and the fiction should be allowed to keep a certain amount of fantasy.
Then WHY have a bulletin board like this at all, if people don't want to get it right? Why ask the questions in the first place - after all, it's just fantasy. Just kill this bulletin board and base it all on the TV show, even the stuff that was bad and wrong and insulting.
Can you say 'fallacious argument'?
Call it poetic license... Call it whatever you want, I don't care, but remember that these folks want to write according to what they know from E!, and if they have no real idea about something, then they can come here for help (not berating). So what if they have a doc giving a shot... at least they care enough to sweat some of the little stuff...
Most of the time, Valium (diazepam) is given IV. Absorption via IM is variable, therefore IV is preferred. The concern with Valium is venous irritation. If a large vein is used and the med is pushed slowly, little to no local irritation should occur.
Thanks for the response! OK, then Brackett will give the shot. Now then my question becomes what would the dosage be to help someone "relax and get some rest?" We have a patient who is pretty well wound up because of their circumstances and Brackett wants to give the Valium to "take the edge off" and help him rest.
The previous poster is right - IV really isn't the preferred route for Valium -in the hospital-, with the exception of in the OR and in the ICU. Patients given IV Valium have coded - the stuff's a muscle relaxant - and it is considered too risky to give it that way to a patient that is not in a critical care area. I have checked the IV push drug protocols for two different area hospitals, (One of them's just been named one of the top hundred hospitals in the country) and neither allow it to be given that way with the exceptions of in the OR and ICU.
Ativan, on the other hand, is a better drug for 'taking the edge off' and can be given IV push easily without the risks associated with Valium. It's also more 'the drug of choice' for tranquilizing someone - it works more rapidly and effectively.
If you're going to use Valium, have it given IM. If you want the patient to get it IV, use Ativan.
Versed can be an safer, effective sedative comparable to Valium. Many pre-hospital providers seem to be going to Versed (rather than Valium) for sedation. What period in history will this story take place? Bear in mind that quite a few meds that are commonly used now, were not used or even around in the days of E!.
All of these drugs have specific uses. Ativan
is used before procedures such as cardioversion
& for seizures; however it lasts much longer than either Valium or Versed. Valium on the other hand
is used before procedures such as cardioversion,
rapid sequence intubation, relocating dislocations
& seizures. Versed on the other hand is used before
procedures & for RSI. I haven't seen any literature
showing that it is safer or more effective. Some EMS
Systems don't use it because it causes respiratory
depression.
I'm no doctor, but that last post made perfect sense.
if you remmeber your anatomy correctly, and your physiology, the HEART IS A MUSCLE. If pts. have coded using Valium IV push, well, I guess so. I does something to the heart. I'm not sure what. Someone who knows e-mail and tell me what it does, Just so those who aren't in the medical field know, and they're just writer like myself. Do lots of research
before you write, so you can get it Right. That's my advice to fanfic writers, write E! Fic. Always research. If you're going to post it, Well, some site won't take your stories if there are technical errors, they're that strict.
Dentist give shots to numb your mouth before they work on your teeth, and they're doctors. I've had a doctor
give me a shot, when I was sick with meningitis back in 1974. I was pretty embarrassed too. The same doctor deaden my back, when he removed a cysts, so sometimes doctors do give shots, but not all the time, usually, that's the nurse's job. He/she just tells the nurse what meds to give, and she carries the order out, so yes, in real life, some doctors do give shots.
The reason this particular doctor gave the shot was,
no nurse was available. My sister is a nurse, and can give shots, but she doesn't deal with patients, she's
a supervisor type person. I guess, in a pinch, where
there's no nurse available, the doctor would have to be the one to give the shot. Does that make any sense?
Usually, it is the nurse's job. The doctor just gives the order for the shot.
Cool!!