Caution: Approaching Rant

I recently had the opportunity to run a medical call, where a comment from another Paramedic just made my blood boil.

What was the comment, you ask?

“Just give him some Albuterol, it won’t hurt him.”

That’s the sound of my blood pressure rising.  The sound of a vacuum in between the ears of what should be a perfused, educated brain.  The potential sound of your career circling the drain.

NO

DRUG

WE

ADMINISTER

IS

COMPLETELY

HARMLESS

In this particular case, the patient (an elderly gentleman) already had a pissed off heart.  Frequent PAC’s and PVC’s indicated to me that perhaps the patient needed a few more O’s, not a beta-agonist, with the potential for angina, AMI, arrhythmia, palpitations and tachycardia, to list just a few of the side effects (Epocrates).

Lets discuss a few of the other common drugs we administer in the back of the ambulance, and list some of the common (and not-so-common) side effects.

Aspirin – pretty common, used often, and pretty much harmless, right?

        Bronchospasm
        Bleeding
        Reye’s Syndrome
        Tinnitus
        Pregnancy complications (as in fetal death)

Narcan – the first time I ever heard the term ‘benign drug’…

        Ventricular Fibrillation
        Cardiac arrest
        Seizures
        Hypotention
        Pulmonary edema – especially in those with underlying cardiac or respiratory diseases - *BTDT
        Withdrawal symptoms (nausea/vomiting/tremor) *BTDT

Succinylcholine

        We all know that once we give it, the patient is no longer able to breathe, but what about Malignant Hyperthermia? 

        I know I never learned about it during Medic School – it was a great physician advisor that taught me about it, and allowed me to immediately recognize it.  *BTDT

Fentanyl

        Blah blah blah, respiratory depression, yadda yadda yadda
        What about the chest muscle tetany if given too rapidly?  The one where you’ll have to paralyze them just so they can breathe?

Promethazine

        That ‘harmless’ drug that is a vesicant?
        Neuroleptic Malignant Syndrome
        Angioneurotic edema
        Extrapyramidal effects

        Yes, one of the drugs that some of us carry is a BLISTER AGENT.

These side effects (and we’re not even touching on drug interactions here), are just a few that I’m aware of.  I know there’s more.

It’s the attitude of ‘it must be harmless, so let’s just give it’ that burns my butt.

Again:

It is incumbent on us, the pre-hospital providers, who so desperately want the recognition, the standing, THE PAY of our in-hospital co-health-care-workers, to learn all we can about what we are doing, what we are administering, and the benefits AND risks of those actions.

Besides, I don’t like looking like an idiot.

Rant over.

*BTDT = Been There, Done That (and not much fun)