Good Drugs For Bad Drugs

It was back to work yesterday, back on the medic and more of the same. I'll be glad when the flu and upper respiratory season is over. I don't know what it is that make people that feel miserable want to go sit in the waiting room of an ER for 6 hrs just to have the Dr advise them to go home, drink lots of fluids and rest. I try to tell them that for a lot less money. It actually wouldn't have been too bad of a shift except for a Chlorine gas leak that turned into a full-fledged Haz-Mat incident. Kept us out from 2am till end of shift.

The drug bags that we carry on our ALS, (Advanced Life Support), units contain 26 drugs that we are tested on once a year in order to administer them if needed. We go through standing orders testing to prove that we know what drug to give for whatever ails ya'. We carry the basic ones like Epinephrine, Lidocaine, Atropine for cardiac emergencies. We have Morphine for pain, or cardiac. Tetracaine for eye injuries. Lasix to make you pee a lot. Vallium or Versed for seizures. At one time, they were going to give us a couple new drugs to use for rapid sequence intubations. That is for a patient that needs intubated, but wants to fight about it. One of these drugs was going to be Succinylcholine, which paralyzes you, but your still awake and aware of what's going on around you. That would just plain suck wouldn't it? You can't move, talk or breathe, but you're still awake.. Or at least until you become hypoxic and pass out. Would have been a great drug for gags at the firehouse.
Of all the drugs we carry, I personally have a favorite 3. This is just because they are the ones that I see the fastest/best reactions from.
*Dextrose.. I know a lot of people are diabetics, and even if you take your meds or insulin religiously problems can occur, but a lot of our "clients" don't take their meds correctly. A lot of diabetics become combative when their blood sugar drops. I've seen it enough to not take it personally. I had a run a couple months ago where an 80's y/o lady was flat kicking the shit out of the first responding engine crew when we arrived. It took all 4 of them, my partner and I to hold her down long enough to get a line started so we could give her dextrose. 5 minutes later she was the sweetest little old lady you'd ever want to meet. Turns out she was going in for medical tests the next day and was fasting, her blood sugar bottomed out. She even apologized to the firefighter that she kicked in the nuts.
*Adenosine.. This is a way cool drug. Some people have a heart condition that causes their heart rate to speed up. It can get up to over 200 beats per minute. If they are unstable, such as not alert, chest pain or short of breath, then we try to alter their heart rate electrically. That means using pads and zapping 'em. You know... "Charging..... Clear!" That's cool in itself, but sucks for the patient if they're still awake. If the patient is stable, we give them Adenosine. Adenosine is a short acting drug that chemically "re-boots" the electrical system of your heart. It actually stops your heart for 6-9 seconds, then when it starts back up, hopefully it's at a regular rate. We can try this up to 3 times before we have to resort to more invasive measures.
*Narcan.. This is my favorite of all the drugs we carry. I have had patients not breathing on arrival, walk to our medic 5 minutes later. Narcotics, if overdone, can depress the respiratory system. That means that if a person overdoses on Morphine, Vicodin or Heroin to name a few of the more popular narcotics, they could quit breathing. Their heart keeps beating until it arrests due to the lack of oxygen. If you've ever seen Bringing Out The Dead with Nicholas Cage, there is a scene where they go to a bar on an overdose and his partner has all the people hold hands and pray for the girl not breathing on the floor. Cage gives her something and a few seconds later she's awake and everyone thinks it's a miracle. That's Narcan. Heroin overdoses are great patients if you have a medic student with you. The patient will be out cold, breathing 4 times a minutes if at all. Students can take as many tries as needed to get an IV. Students can even intubate. Hit the patient with Narcan and boom, within 1-2 minutes the patient is awake and sometimes pissed as hell because we took their buzz away. Narcan only works on narcotics, I could shoot myself with a dose of Narcan and it wouldn't affect me at all. That makes it a little odd when you come across a person that is uncon/unresponsive, give em Narcan, and they wake right up to tell you that they haven't taken any drugs. I've had patients found with a belt wrapped around their arm and a syringe still stuck in their vein swear to me that they haven't taken anything. Better yet are the ones that admit to shooting up with Heroin, "but it was my first time". I'll ask them where they shot it at and they'll tell me "between my toes". Yep... That'd be my first spot to try it too.