gmane.science.medicine.emergency.flightmed

Re: high flow nc?

Scott DeBoer RN,MSN — 2013-05-12T15:45:41

hi eric
i'd be interested in how teams are addressing any/all forms of highflow nc
thanx!
Scott


Scott DeBoer RN,MSN,CEN,CPEN,CCRN,CFRN,EMT-P
Flight Nurse: University of Chicago Hospitals
Founder: Peds-R-Us Medical Education
9052 Beall Street
Dyer, IN 46311 USA
www.Peds-R-Us.com - scott< at >peds-r-us.com
888-280-PEDS (7337)
866-449-7337 fax
219-313-5612 cell

"In each of us, two natures are at war – the good and the evil.  All our lives the fight goes on between them, and one of them must conquer.  But in our own hands lies the power to choose – what we want most to be, we are." Dr. Jekyll and Mr. Hyde



-----Original Message-----
From: cehsah <cehsah< at >aol.com>
To: Ncline7 <ncline7< at >aol.com>; Flightmed <flightmed< at >flightweb.com>
Sent: Sun, May 12, 2013 10:11 am
Subject: Re: high flow nc?


Are you referring to vapotherm as well

Eric Howard

-------- Original message --------
From: Ncline7 <ncline7< at >aol.com> 
Date: 05/11/2013  5:17 PM  (GMT-06:00) 
To: Flightmed <flightmed< at >flightweb.com> 
Subject: Re: high flo

Re: high flow nc?

2013-05-12T15:05:58

Are you referring to vapotherm as well

Eric Howard

-------- Original message --------
From: Ncline7 <ncline7< at >aol.com> 
Date: 05/11/2013  5:17 PM  (GMT-06:00) 
To: Flightmed <flightmed< at >flightweb.com> 
Subject: Re: high flow nc? 
 
Good to see creative critical thinking skills at work!

Sent from my shoe phone

On May 11, 2013, at 14:13, Steve Stahl <peanutranch< at >gmail.com> wrote:

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oxygen gadgets inside aircraft...

Gurkan Ozel — 2013-05-12T06:44:56

Greetings,

I am wondering if any of you guys use pin index pressure regulators on
oxygen cylinders inside the rotary wing aircraft? Is constant vibration
causing loosening of the connection a valid concern?

Secondly, do you have any concern on using aluminium cylinders vs steel?
Presssure concerns? These are the questions I was asked upon recently and
wanted solicit the groups opinion on this.


Thanks for your input and happy mothers day...


Gurkan Ozel
GOKSAR Air Ambulance
Ankara, TURKEY

Re: high flow nc?

Fletcher Schubert — 2013-05-12T04:16:15

In the past, I've used nc with a NRB. This works great to get approx. 100%
Fi02. Works even better for pre-ox. Prior to RSI. Then just pull of NRB and
you have your cannula still giving o2. I bet a HFNC. Would be better. A
HFNC with side stream, even better.

Thanks,

Fletch
913-486-9144(c)
Fletchschubert< at >gmail.com

Sent from my iPhone

On May 11, 2013, at 17:22, Ncline7 <ncline7< at >aol.com> wrote:

Good to see creative critical thinking skills at work!

Sent from my shoe phone

On May 11, 2013, at 14:13, Steve Stahl <peanutranch< at >gmail.com> wrote:

How funny. I just now finished a transport with a patient in this
situation. She could not tolerate a mask due to claustrophobia, and we
carry no concentrator. We used two nasal cannulas at 15 LPM each to achieve
spo2>90%. Not ideal but a patient being moved across the country for a lung
transplant due to pulmonary fibrosis. We did what we could. Worked
excellent.


Steve Stahl, RN

Critical Care Flight Nurse

Angel Medflight Worldwide Air Ambulance

Sstahl< at >angelmedf

Re: high flow nc?

Ncline7 — 2013-05-11T22:17:04

Good to see creative critical thinking skills at work!

Sent from my shoe phone

On May 11, 2013, at 14:13, Steve Stahl <peanutranch< at >gmail.com> wrote:

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Re: high flow nc?

Steve Stahl — 2013-05-11T21:13:38

How funny. I just now finished a transport with a patient in this situation. She could not tolerate a mask due to claustrophobia, and we carry no concentrator. We used two nasal cannulas at 15 LPM each to achieve spo2>90%. Not ideal but a patient being moved across the country for a lung transplant due to pulmonary fibrosis. We did what we could. Worked excellent. 

 Steve Stahl, RN
Critical Care Flight Nurse
Angel Medflight Worldwide Air Ambulance
Sstahl< at >angelmedflight.com
(970) 946-6886

On May 11, 2013, at 15:44, "Scott DeBoer RN,MSN" <pedsrusscott< at >cs.com> wrote:

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high flow nc?

Scott DeBoer RN,MSN — 2013-05-11T19:44:00

greetings - hoping for insight from list as to what other teams are doing with interhospital transport of patients on high-flow nasal cannulas (i.e. 15-30+liters)
thanx!
Scott


Scott DeBoer RN,MSN,CEN,CPEN,CCRN,CFRN,EMT-P
Flight Nurse: University of Chicago Hospitals
Founder: Peds-R-Us Medical Education
9052 Beall Street
Dyer, IN 46311 USA
www.Peds-R-Us.com - scott< at >peds-r-us.com
888-280-PEDS (7337)
866-449-7337 fax
219-313-5612 cell

"In each of us, two natures are at war – the good and the evil. All our lives the fight goes on between them, and one of them must conquer. But in our own hands lies the power to choose – what we want most to be, we are." Dr. Jekyll and Mr. Hyde
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James, good to see you on LinkedIn

Eden Du Pont — 2013-05-07T19:25:11

LinkedIn
------------




    Eden Du Pont requested to add you as a connection on LinkedIn:
  

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James,

I'd like to add you to my professional network on LinkedIn.

- Eden

Accept invitation from Eden Du Pont
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View profile of Eden Du Pont
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(c) 2012, LinkedIn Corporat

Branding

Ira Blumen — 2013-04-10T22:12:01

A question on “branding” for hospital-sponsored or hospital-affiliated flight programs.
 
Has your program name and/or logo changed over the years?
 
With the ever changing healthcare environment, we are seeing hospitals (big and small) merge, join forces, and/or rebrand themselves for various reasons.  
If this has happened at your sponsoring or affiliated hospital, I am curious as to how it may have affected your flight program (if at all). 
Was there a rebranding of the flight program? 
A new or changed name?
A different logo?
Etc.
 
Any information, including before and after images (logo, helicopter, ambulance) would be helpful.  Feel free to respond directly to my email.
 
Thanks for your time,
Ira Blumen
IraJB< at >aol.com
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good morning

David Wuertz — 2013-03-25T18:51:08

http://bd-spin.com/modules/loveit.php?crrpfgj711gd




































































































**********
I wish this officer would understand that nought is a mark.

Re: amiodarone bristojects

David Kearns — 2013-03-05T02:50:05

David,

Thanks for the info. I'll see what I can find out from our buyer. 

David K.


On Mar 4, 2013, at 7:45 PM, Dave Dobson wrote:

Re: amiodarone bristojects

Dave Dobson — 2013-03-05T02:45:19

As an FYI Amidate (etomidate) is available in a bristoject, and
Succinylcholine is available as a pre-filled syringe. Not aware of the
distributor, but know they are both in our RSI kits.
 
David Dobson RN 
CEN  CCRN  CFRN
Bellin Hospital Eagle III / SWAT
920-676-4717


Scott,

I'll check with our hospital pharmacy buyer and see what she knows.

In a similar vein, no pun intended, some years ago we attempted a grass
roots effort to get some drug companies to provide other meds in
pre-filled syringes. Our main targets were RSI meds like succinylcholine
and fentanyl. These days, etomidate, ketamine and rocuronium would be
useful in that packaging form also. We were told back then that there
wasn't enough of a market in prehospital or transport care to make the
effort worth the (financial) while.

It is interesting that lidocaine is still available in a pre-filled
syringe and its main use is in premedication for RSI.

David Kearns
Flight For Life Colorado


On Mar 4, 2013, at 6:20 PM, Dave Dobson wrote:

am
cur

Re: amiodarone bristojects

David Kearns — 2013-03-05T02:34:53

Scott,

I'll check with our hospital pharmacy buyer and see what she knows.

In a similar vein, no pun intended, some years ago we attempted a grass roots effort to get some drug companies to provide other meds in pre-filled syringes. Our main targets were RSI meds like succinylcholine and fentanyl. These days, etomidate, ketamine and rocuronium would be useful in that packaging form also. We were told back then that there wasn't enough of a market in prehospital or transport care to make the effort worth the (financial) while.

It is interesting that lidocaine is still available in a pre-filled syringe and its main use is in premedication for RSI.

David Kearns
Flight For Life Colorado


On Mar 4, 2013, at 6:20 PM, Dave Dobson wrote:

Re: amiodarone bristojects

Dave Dobson — 2013-03-05T01:20:55

Given that Lidocaine has all but been eliminated from ACLS guidelines am
not sure where this thread is headed. Our hospital pharmacy is currently
not aware of Amiodarone supplied in bristojects. Could be a vendor
contract thing (or that our pharmacy is out of the loop)
 
David Dobson RN 
CEN  CCRN  CFRN
Bellin Hospital Eagle III / SWAT
920-676-4717


I don't disagree. But I don't think Lido is anymore effective. I
personally think amio was all pharmaceutical propaganda but that's my
own opinion. 

Jim Girvin, NREMT-P CCEMTP
Strike Team Flight Paramedic
Air Evac Lifeteam

740.648.8399 (mobile)
girvinjames< at >air-evac.com 

Isaiah 6:8

Sent from my iPhone...

On Mar 2, 2013, at 19:55, "Ncline7" <ncline7< at >aol.com> wrote:

nowhere, and without the usual rigorous testing the FDA approves it and
American heart adopts it as its number one boy. At about 100 times the
cost of lido, horrific side effects for short and long term use. Follow
the money back to the European pharmaceutical companies ( Aventis and
others) to se

Re: amiodarone bristojects

Ncline7 — 2013-03-03T17:06:10

Thanks for that update, my recollection was the $300+ vs. $1.50 when the recommendation came out ( I'm old)
N

Sent from my iPad

On Mar 3, 2013, at 4:55 AM, Sean Eaton <sean.eaton19< at >gmail.com> wrote:

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Re: amiodarone bristojects

Sean Eaton — 2013-03-03T12:55:06

I think it's important for any information that's shared on this list to be as accurate as possible, so in the interest of accuracy I did a quick search online where I used to buy drugs for my old department.  BoundTree Medical sells Amiodarone 150/3ml vial's for $11.69 each and does not offer a prefilled syringe option..  Lidocaine 2% (100mg/5ml) in prefilled syringes sells for between $4.34 and $10.99 each depending on the style of syringe (Luer Jet vs. Ansyr vs. LifeShield).  I remember back in 10+ years ago when I first saw Amidarone on my ambulance the rumor was it was over $300 a dose but of course prices come down.

Sean Eaton, Paramedic, FP-C
UNC Air Care




On Mar 2, 2013, at 8:06 PM, James Girvin <girvinjames< at >air-evac.com> wrote:

Re: amiodarone bristojects

James Girvin — 2013-03-03T01:06:31

I don't disagree. But I don't think Lido is anymore effective. I personally think amio was all pharmaceutical propaganda but that's my own opinion. 

Jim Girvin, NREMT-P CCEMTP
Strike Team Flight Paramedic
Air Evac Lifeteam

740.648.8399 (mobile)
girvinjames< at >air-evac.com

Isaiah 6:8

Sent from my iPhone...

On Mar 2, 2013, at 19:55, "Ncline7" <ncline7< at >aol.com> wrote:

Re: amiodarone bristojects

Ncline7 — 2013-03-03T00:49:42

Lidocaine was he drug of choice for years and years, then, out of nowhere, and without the usual rigorous testing the FDA approves it and American heart adopts it as its number one boy. At about 100 times the cost of lido, horrific side effects for short and long term use. Follow the money back to the European pharmaceutical companies ( Aventis and others) to see how much and to whom they "contributed" to.
N Cline, RN, JD, CFRN

Sent from my iPad

On Mar 2, 2013, at 4:18 PM, James Girvin <girvinjames< at >air-evac.com> wrote:

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RE: amiodarone bristojects

James Girvin — 2013-03-03T00:18:48

Agree Sean. I read your message too quick.

I would argue that survival to discharge is the data that matters...and that data is unavailable. I would love to know what it is.

As it stands now, the only clinically relevant therapy in OOH cardiac arrest remains early and aggressive CPR and early defibrillation.

Jim

-----Original Message-----
From: flightmed-bounces< at >flightweb.com [mailto:flightmed-bounces< at >flightweb.com] On Behalf Of Sean Eaton
Sent: March 2, 2013 13:46
To: Flightmed
Subject: Re: amiodarone bristojects

I would argue more effective.  The latest research I've read says Amio is more effective for ROSC but neither one shows better survival to hospital discharge.

Sean Eaton, NREMT-P, FP-C
UNC Air Care
(c) 303.408.9632
sean.eaton19< at >gmail.com

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On Mar 2, 2013, at 10:57, Ncline7 <ncline7< at >aol.com> wrote:

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Re: amiodarone bristojects

James Girvin — 2013-03-02T19:22:51

Is that out of hospital cardiac arrest? I'll look for the study but its been a few years, and said there was no ROSC difference between Lido or Amio with down times greater than 20 minutes. In my area that's about all of our unwitnessed OOH cardiac arrests. 

Jim Girvin, NREMT-P CCEMTP
Strike Team Flight Paramedic
Air Evac Lifeteam

740.648.8399 (mobile)
girvinjames< at >air-evac.com

Isaiah 6:8

Sent from my iPhone...

On Mar 2, 2013, at 14:14, "Sean Eaton" <sean.eaton19< at >gmail.com> wrote:

Re: amiodarone bristojects

Sean Eaton — 2013-03-02T18:46:07

I would argue more effective.  The latest research I've read says Amio is more effective for ROSC but neither one shows better survival to hospital discharge.

Sean Eaton, NREMT-P, FP-C
UNC Air Care
(c) 303.408.9632
sean.eaton19< at >gmail.com

Sent from my iPhone

On Mar 2, 2013, at 10:57, Ncline7 <ncline7< at >aol.com> wrote:

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