Gotta love unannounced protocol change...

      Since April, the area that I currently run ALS in has revamped their protocols and added a few new drugs to our advanced life support arsenal. Normally I am all for this sort of growth/change in an EMS system. However, I don't think that this should be slipped in under the radar and no one being told of the change. Granted, I understand that it is the responsibility of the EMT-Whatever to know their local protocol. However, I think if there are changes, especially substantial ones, that there should be some sort of notice. Now, with that being said let me tell you about my latest ALS adventure...
      So we were dispatched to an elderly female with abdominal pain. Let me just say this now, I hate abdominal pain calls. Most of the time dispatch and the pt might as well just say "I don't know what's wrong, just take me to the hospital". Mainly because it could be so many different thing and a large majority of the time we can't do much about it. This call was the exception to my previous ranting. Anyway, as I digress...we arrive on scene to find a very sweet little old lady that has called everyone she has encountered from the time she was 50 either "honey" or "sweetie". I have definitely been called worse, so no big deal there. But this poor medicare beneficiary says she has been feeling weak and had some belly pain since last night. Its mid morning at this point. That will be important later. So we do the usual IV, O2, and monitor. This revealed a relatively hypertensive pt with an irregular heart rate between 180-209. No wonder she has been feeling weak. There were several follow up questions to which the pt looked at us blankly or answered no. One of which was, "Do you have A-fib?" to which I received a blank stare. Gotta love that. I guess if you don't have anything nice to say, don't say anything at all. Or in this case, if you don't know the answer, don't say a damn thing.
     Now that we have a better picture of what is going on, we decided to start treatment in the back of the truck. That gave the FD time to get the pt loaded up and my partner and I time to get the meds, tubing, and math ready. The only medicine we have that can be used to treat A-Fib with RVR is Amiodarone. The funny thing with that is that using it for treatment in this such scenario is considered "off label". However, after 150mg over 10 minutes she went from tachy and irregular to tachy and sinus and eventually normal sinus. We were not too concerned about the whole clot thing due to the time in which her symptoms started.
     She did fine for the rest of the trip to the hospital and on our subsequent return trips, she was still in normal sinus rhythm and doing well. Gotta love it when you have a positive outcome on calls like that. No big rants, insights, or epiphanies in this post. Just sharing a war story.