Know Your Drugs! Pharm Principles for the SOF Medic

[Max D]

This is some quality knowledge distilled from experience and fills the gap between your basic pharmacology classes and being in charge of a real sick person. These rules aren't just for the SOF Medics, they can be applied by anyone who pushes drugs.

Source: http://prolongedfieldcare.org/2015/...f-pharmacology-and-intro-to-the-pharm-series/
Podcast link: http://traffic.libsyn.com/specialoperationsmedicine/Intro_to_Pharm_for_SOF_Medics.mp3

Pharm Principles for SOF Medics

1. A bad memory is better than no memory; the patient doesn’t get anything until his vital signs prove he can handle it.
2. You are expected to make pain manageable; not take it away completely – this would be total anesthesia. You have to make this clear to your patient. Know the difference between sedation, analgesia, and anesthesia as well as which drugs will work to those outcomes.
3. If you are going to sedate a patient, acknowledge that you will lose mental status as a vital sign. If you find yourself about to give an aggressive dosage of medication, take a minute to think. Ask yourself how it will complicate your situation, and then decide.
4. “Cookbook” formulas are only starting points. Every patient is unique and requires a tailored approach. Although we recommend that you have “cheat-sheets” stored with your medications, recognize that these are to guide you while under stress, not as a “one-size-fits-all” approach to sedation and pain control.
5. Titrate to effect. Be patient. Wait for the medication to peak. If you don’t know the time peak effect for each of your medications, see number 9.
6. Your first experience pushing controlled medications should not be in a crisis. If you carry the medication, you have an obligation to 1) undergo training by a currently practicing anesthesia provider, and 2) to administer the medication under supervision during real cases. A Powerpoint class does not qualify you…
7. Performing procedural sedation on your own is a big deal. Don’t put unnecessary pressure on yourself; consult a specialist if possible. Assemble your equipment, devise your plan, and attempt to brief that plan to a higher medical authority. Performing sedation will likely be one of many “big deals” you are dealing with under stress. Consult – it’s the standard of care.
8. If you are going to sedate, you need to have MSMAID covered. Monitor, Suction, Machine, Airway, IV, Drugs. A professional will have access to some form of these items if they are going to sedate. A BVM can be your machine, a pulse ox can be your monitor, but you must have these items covered in some form before you sedate.
9. Know all your drugs inside and out. Be able to rattle off the class of drug, indications, therapeutic dosages, half-life, time for peak effect, contraindications, adverse effects, usual concentrations, pitfalls, and your personal strategy for dilution and titration to effect.
10. Take care of your medications – if they fall outside temperature range, they may lose efficacy. If they are stored in an extreme temperature, hot or cold, (such as during a gear shipment) seek to replace them ASAP.
11. Avoid IM administration if possible. It is often extremely variable especially in a trauma patient who is not circulating well.
12. A sedated or intubated patient has a “watcher” at all times. This person must be trained to read your monitors, listen to breath sounds, re-confirm tube placement, and look for “red-flags”.

 

[Rootbeer]

Really good post. This applies to my idea of always having two medical providers on an aircraft. Airway management is a huge undertaking for someone that could even have the slightest inclination of needing to move.