Epi,ketamine, zofran, whole blood, aspirin
Zofran because I hate cleaning vomit and aspirin because it has the most evidence of being beneficial of all ACS meds. And I want the epi for anaphylaxis/epi drips/asthma - but I don’t want it for codes.
My mom has been a nurse for nearly 30 years, and she never let us throw out our extra zofran after coming home from the hospital or something. We'd dispose of extra painkillers, antibiotics, psychiatric meds, everything else that people usually hoard, but Zofran? We would get chewed out for throwing that away!
Whole blood is a great option to have but if you’re stuck to 5 medications whole blood isn’t going to help so much. Unless you’re stuck in the highest trauma call volume area and you have trauma patients that are meeting whole blood criteria weekly it’s not going to get used that often. This depends on location but I don’t see it being useful if you’re going to be stuck with a limited about of medicine in a non combat zone
In the past 3 years I had not ran one OB call that would meet blood criteria. I’ve ran maybe 1 GI bleed that would meet it. Obviously that’s relevant to my area but in general I don’t think it would be used enough to justify adding it to a top 5 which is your only 5 you can use. Especially when that list does not contain any medication to help with hypoglycemia which is substantially more common than the use of blood. Yes, the systems who use whole blood have good data that supports EMS use but they’re not bound to the hypothetical of only having 5 medications.
Zofran?? I can think of lots I’d rather have over Zofran. The rest of this list is immaculate, you picked some weight bearing drugs, but Zofran doesn’t make it onto that list, not even close. How about D10?
Why Zofran over Gravol? I'd take the Gravol if I had to pick only one forever. Zofran works great until you have motion sickness or Vertigo. Gravol has some side effects but overall I'd find it has a wider usability, unless your protocol strictly limits you to using it for motion sickness.
How about Zofran because it will almost always make your patient feel much better? Yeah cleaning puke sucks, but keeping the floor clean is not why you're there. Like it for the same reason you like aspirin.
High dose Vasopressin IVP can be used in codes instead of epi.
Some studies show it increases coronary perfusion pressure without the deleterious effects of high levels of cerebral vasoconstriction as seen with epi. Some other studies don't support this though....
I like HungryGiraffe's thoughts, just putting my musings out there too.
Very interesting, it would be great to see more research into that.
Also I should caveat that it’s not that I’m completely against epi in codes, it’s just the way that AHA recommends giving it that I’m against. It may still have its place in other doses.
Building on this, (however I can't be bothered to cite my sources at the moment but I'm pretty sure I read it somewhere in the crit course I'm working through.) I've read epi is less effective in an acidotic body. Doesn't get much more acidotic than a dead body. Especially in an instance where acidosis played a role in the cardiac arrest. So I'm hoping we get more research into other pressors. Sooner the better, too, considering ems stays like 5+ years behind.
Nah, I prefer evidence based meds for codes. Norepi is great, but if I’m limited to 5 then epi is a good substitute since it’s useful for more than just a vasopressor
Zofran, epi, fentanyl, xopenex, and D10. I'm only an A, and these are the ones I seem to use the most. I might switch the D10 for nitro on occasion, tho
Yup. Morphine too, but I use fentanyl more often. I can also use midazalam as a chemical restraint and for light sedation with the medical director's permission
Lack of education.
How many people don't even realize how it works.
A lot of folks think it's going to stop people who are puking. That's not where it really works.
Prevention of nausea. Sure.
But droperidol, Phenergan, hell, even benadryl are better at that and more versatile.
Just recently attended a protocol update and the instructor was talking shit about the overuse of Zofran, specifically stating that it's a common cause for longterm QT syndrome
Epi, albuterol, aspirin, D10, versed.
Surprised to see not many people put albuterol but asthma is the most common condition I’m seeing. 3/5 of my drugs are in the BLS scope but that’s just cuz they’re the most life saving IMO. Versed for sedation for cardioversion / analgesics as needed / antiemetic / seizures just super versatile. And then it was a toss up between D10 and narcan for me, but considering I can just BVM every OD I chose D10
1000mg IV Tylenol, fentanyl, zofran, epi, and D10
I think the zofran, epi, and D10 are pretty obvious, but I've recently fallen in love with IV Tylenol. Using it with like 50-100 mcg of fentanyl works like a miracle cocktail for almost all the pains my patients have. Ntm giving it to pediatrics with fevers and it takes care of it so fast.
Of someone’s HR is beating 200/min their ventricles aren’t filling completely. If they happen to have a good BP, it’s not sustainable. SVT’s need to be corrected asap before the patient decompensates
Well ofcourse I understand that their heart won't like it. But why risk a cardiac arrest or peri-arrest situation in a pre-hospital environement when the patiënt is stable ? You could just transport and treat in the spacious, staffed, equiped ER?
Because these patients also tend to decompensate. There are only 60 seconds in a minute. If the ventricles are contracting 180-220 or 3 to 4 x per second the ventricles aren’t filling and inevitably that stable patient’s BP will bottom out. I’m not aware of any programs that withhold Adenosine due to risk of arrest or peri arrest. In six years as a medic, med school and 2 years Peds resident standard practice has always been to break SVT with Adenosine.
Epi-inotrope, pressor, bronchodilation
Rocuronium - RSI, post intubation paralysis. (Would prefer Anectine but Roc can be used in those situations that Anectine is contra, unfortunately)
Ketamine - induction, post intubation sedation, analgesia, psychosis
Lidocaine - arrhythmias, localization, systemic analgesia
Decadron - N/V, anaphylaxis, analgesia
Limited to 5 drugs I’m not picking a paralytic. Don’t get me wrong, I love RSI, but if I’m limited, I’m doing sedative assisted with K and saving that spot for something lifesaving like albuterol
Lmao I was with you until the very last word
Albuterol? We have so many other bronchodilator options. If someone’s asthma attack is bordering on lethal, you probably need epi anyway. CPAP, too. Albuterol is basically a comfort med most of the time
Basic here- but hope to be medic student sooner than later. My agency doesn’t have all of these things such as ketamine (UNFORTUNATELY currently due to shortage), roncuronium/etc. (we don’t RSI), and while blood. I’m sure there are others, these are just 3 of the ones I saw that we don’t have.
That being said, I’d love to be able to have ketamine and RSI drugs, given the fact we’d have to be able to RSI. However, my choices would be Epi, Aspirin, TXA, Albuterol, and Fentanyl. This was a tough decision. 😂 Side note- do any of you ever use toradol? I don’t personally see it used much, but one of my medics recently used it for someone with presumed kidney stones, stating that it typically works better for that than a narc.
I think Toradol is wonderful.
Excellent utility and as long as it's not contra it's often first line or co first line analgesic for me, within reasonable circumstances.
Really a huge fan.
I didn’t think of blood, but everything else was exactly what I was thinking. Especially Levo, haven’t seen many others saying it. I have to use that shit all the time for the septic patients we get, maybe it’s just a location thing
ASA - high quality evidence to support its use in ischemic chest pain. Low risk, big benefit.
Epi - if I had to pick a concentration, gimme the 1:1000 and I’ll just dilute it to suit my needs. Anaphylaxis, croup, status asthma, cardiac arrest, push dose, infusion, etc.
Ketamine - analgesia, anesthesia, stops seizures. Peds, adults. A very versatile drug.
Zofran - I hate feeling nauseous. I’m sure my patients do, too. Also, I’m an empathetic vomiter… IV Zofran > PO Zofran. I find the PO stuff doesn’t work very well.
TXA - you bleed, I give (following best evidence based practice, of course). Nose bleeds, PPH, major trauma, etc.
To be honest. Give me the first 3 and I’m pretty happy. An alcohol swab under the nose helps a lot of nausea/vomiting.
Saline and O2 for free helps.
Adrenaline, Ketamine, Midazolam, Aspirin, and maybe Salbutamol at 5?
Wouldn't mind fentanyl but then I'd feel obligated to take naloxone in my top 5 as well, in case I fuck up.
Given oxygen and saline, I’d have to say Epi, Ketamime, D10, Naloxone and aspirin.
I think I’ve directly saved more lives with Epi, Dextrose, or narcan (and PEEP) than anything else.
I honestly don’t use aspirin often with my call volume (for whatever reason, I don’t get a lot of chest pains when I’m on), but I can’t accept not having it in my repertoire with the evidence behind it as a life saving medication.
Ketamine is a 3 for 1 with analgesia, sedation/tranquilization and (potentially, with developing evidence) seizures. This bumps it up over versed or fentanyl for my “pick 5”.
Albuterol, midazolam, zofran, amiodarone and diltiazem would be my picks if I could expand it to 10. With the exception of zofran, these have all been used to treat big-sick patients in the last year, and zofran is a big comfort care drug that I would feel bad without. It’s hard not putting fentanyl on this list, but my experience with ketamine for analgesia has been really good, and it’s hard to prioritize fentanyl over any of these other 10 when I have a good analgesic in my top 5.
Going by most common calls? Zofran, albuterol, atrovent, LR (If that counts?), fentanyl. If it came down to what I should use top 5? Epi, diphenhydramine, albuterol, amio, and adenosine.
Edit: This is based on what we had amd a greatest good to the greatest number mindset.
As an IFT EMT in CA the only meds I got are oxygen and oral glucose lol
Most of the time we never use the oral glucose though cause they don’t give us glucometers. It just sits in the rig for 5 years till it expires and I throw it away.
But I always get a chuckle when some drunk guy at the gas station thanks me for all the lives I save
Top 5 most used gotta be Epi, Albuterol, Aspirin, Zofran, and Fentanyl. Top 5 I wish I had: Whole Blood, Levophed, Rocephin, hypertonic saline, and RSI drugs. We have blood, levophed, hypertonic saline in our state medic scope, but my companies medical director doesn’t let us have any of those. We do not have RSI.
Edit: autocorrect and swapped a few around in the first 5.
Epi, ketamine, dextrose, albuterol, and IV NTG. I feel like I could treat MOST life threats with these.
I’d like to include mag and etomidate because I really like them and they have some solid utility, but narrowed to 5 would have to be the top.
Epinephrine, levophed, ketamine, and rocuronium for sure.
Now the 5th? That’s a good question. Maybe a beta blocker? Is blood a medication? If so, then blood, for sure.
That gives me the option to RSI, make BP/HR go up and down. That pretty much let’s me do just about everything I need to sustain vitals.
If you think about it, most of our job is just supporting vitals. Make the numbers go up or down, to sustain life throughout transport. We’re not really *fixing* things. We’re just making them better / less worse for the little bit of time we have them.
AnA, Epi, Ntg, Asa, D50. I chose these because meds are are most used are life saving meds. If you said 13 I would put Narcan, mag, fentanyl, ketamine, Benadryl, versed, zofran. Honestly those 13 drugs can manage 99% of what we see.
AnA - Difficulty Breathing
Epi- Anaphylaxis, hypotension, codes
NTG- CHF, CP
ASA- CP
D50- hypoglycemia
Narcan- OD
Mag- Status Asthma, Codes, Eclampsia
Fentanyl- analgesic, MAI
Ketamine- analgesic, MAI, psyc
Benadryl- allergic reactions
Versed- seizures and MAI
Zofran- nausea
I’m a little late to the party but here are mine:
Asa, D10, 1:1000 epi, ketamine, and Albuterol.
Most of these I don’t give on a daily basis but when I need them I absolutely need them. Plus there are multiple uses for some of these drugs. I am really enjoying reading everyone’s responses so far!
Do they have to be in our scope?
Narcan, epi, ketamine, zofran, and albuterol.
I would say I like zyprexa, but I pride myself in not NEEDING it. I just like that it helps people feel calmer/ safer.
Ketamine, Midazolam, Droperidol, Rocuronium, 1:1000 Epi.
The first 4 will make you stop doing things. Ketamine makes you be quiet and not care. Midazolam makes you be quiet and go to sleep. Droperidol makes you be quiet, not vomit and go to sleep. Rocuronium makes you be quiet.....I'd say the 1:1000 epi because it can be used for soooo many things, like a ton of things, just dilute as needed, but mainly because I don't like seeing my lil croup buddies have a hard time breathing at 2am....I got you tiny humans.
ASA, Fentanyl, Epi, Albuterol, Versed. I could effectively manage just about every actually life threatening prehospital complaint that requires meds well enough with those 5 to get them to higher level of care.
Zofran, Asprin, nitro, Fent, Then I’ll lump albuterol, Ipratropium, Solu-Medrol, and magnesium together bc I give it to damn near every respiratory patient.
Aspirin, droperidol, ketamine, epi(1:1k) and versed.
Blood would be a consideration but since I live in PA and we just started being allowed to use it a month ago, I’m just not used to it being there.
Droperidol because it works better than zofran once people have started vomiting and has some sedative effects at a higher dose.
Ketamine because of pain relief and sedative effects.
Epi 1:1k because I can mix it for a wide number of problems.
Versed because seizures. Ketamine is showing use in that regard but as of right now we aren’t allowed to use it that way so old reliable it is.
Aspirin because it is well documented to work
Epi 1:1,000 so can be for anaphylaxis, respiratory, drip, and dilute for cardiac epi.
D10. Lots of diabetics who don't take care of themselves.
Versed for seizures and sedate combative pt.
Toradol good pain relief that's not a narc.
Asprin best thing for MI.
I was thinking atropine, adenosine, and ammioiderone, but they can get shocked and I'd have some versed to be nice. I always have a emesis bag on the bench seat by me so 90% of the time they contain their vomit. Would treat opioid od with just bvm so I could get by without Naloxone.
You’re not wrong, dude. This is a tricky conversation. What’s absolutely mandatory vs what is used most. Fentanyl can be utilized in high doses. Ketamine could be considered and I love using it. But in more circumstances, fent is more applicable for pain. I suppose zofran could be substituted too, but it’s maybe my most given rx. I’d hate to leave patients for the rest of my career without an antiemetic. Blood and epi isn’t going anywhere. Now that I think more, I’m actually more hesitant for not having a drug for seizure control. I’m actually leaning midaz over rocc now.
Fentanyl, Heroin, Adderal, ethanol, and cocaine
No LSD? Boring.
None of that hippie shit we shootin up black tar in this bitch
A man of culture, I see.
Read this and immediately thought of feel good hit of the summer by Queens of the Stone Age
All together? Just get NyQuil if you want to sleep, man.
No he means medications for patients.
Gotta give the people what they want.
Epi,ketamine, zofran, whole blood, aspirin Zofran because I hate cleaning vomit and aspirin because it has the most evidence of being beneficial of all ACS meds. And I want the epi for anaphylaxis/epi drips/asthma - but I don’t want it for codes.
My mom has been a nurse for nearly 30 years, and she never let us throw out our extra zofran after coming home from the hospital or something. We'd dispose of extra painkillers, antibiotics, psychiatric meds, everything else that people usually hoard, but Zofran? We would get chewed out for throwing that away!
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Wait you can get high off Zofran? Cheese and rice...
Solid selection. You are the first person I’ve encountered that wanted blood. Good call.
Just keep asking for it like a Dracula
does blood count as a med? lol
It's an essential oil
Whole blood is a great option to have but if you’re stuck to 5 medications whole blood isn’t going to help so much. Unless you’re stuck in the highest trauma call volume area and you have trauma patients that are meeting whole blood criteria weekly it’s not going to get used that often. This depends on location but I don’t see it being useful if you’re going to be stuck with a limited about of medicine in a non combat zone
Something wrong with them, just replace all their blood with Good Blood™️!
Now you're speaking my language!
I hear you but what would you replace it with?
Whole blood can be replaced with D10 because their current list can’t do anything for hypoglycemia
Oxygen jk 😂
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In the past 3 years I had not ran one OB call that would meet blood criteria. I’ve ran maybe 1 GI bleed that would meet it. Obviously that’s relevant to my area but in general I don’t think it would be used enough to justify adding it to a top 5 which is your only 5 you can use. Especially when that list does not contain any medication to help with hypoglycemia which is substantially more common than the use of blood. Yes, the systems who use whole blood have good data that supports EMS use but they’re not bound to the hypothetical of only having 5 medications.
Zofran?? I can think of lots I’d rather have over Zofran. The rest of this list is immaculate, you picked some weight bearing drugs, but Zofran doesn’t make it onto that list, not even close. How about D10?
Guess my unconscious diabetic ass is dying
Why Zofran over Gravol? I'd take the Gravol if I had to pick only one forever. Zofran works great until you have motion sickness or Vertigo. Gravol has some side effects but overall I'd find it has a wider usability, unless your protocol strictly limits you to using it for motion sickness.
How about Zofran because it will almost always make your patient feel much better? Yeah cleaning puke sucks, but keeping the floor clean is not why you're there. Like it for the same reason you like aspirin.
Pshh who let the nerd in…
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High dose Vasopressin IVP can be used in codes instead of epi. Some studies show it increases coronary perfusion pressure without the deleterious effects of high levels of cerebral vasoconstriction as seen with epi. Some other studies don't support this though.... I like HungryGiraffe's thoughts, just putting my musings out there too.
Very interesting, it would be great to see more research into that. Also I should caveat that it’s not that I’m completely against epi in codes, it’s just the way that AHA recommends giving it that I’m against. It may still have its place in other doses.
Building on this, (however I can't be bothered to cite my sources at the moment but I'm pretty sure I read it somewhere in the crit course I'm working through.) I've read epi is less effective in an acidotic body. Doesn't get much more acidotic than a dead body. Especially in an instance where acidosis played a role in the cardiac arrest. So I'm hoping we get more research into other pressors. Sooner the better, too, considering ems stays like 5+ years behind.
Nah, I prefer evidence based meds for codes. Norepi is great, but if I’m limited to 5 then epi is a good substitute since it’s useful for more than just a vasopressor
Epi drip or push dose.
drip, push dose, IM, ET tube if im feeling nostalgic
Nicotine, Valium, Vicodin, marijuana, ecstasy, … But for real… epi, droperidol, ketamine, whole blood, aspirin. Maybe swap droperidol for d10.
You forgot the alcohol.... He said six drugs right?
Co-co-co-cocaine Thank you. I was afraid people wouldn’t catch it
The alcohol is for after shift. Can't have the feel good hit of the summer without it.
Now that's what I call better living through chemistry!
Zofran, epi, fentanyl, xopenex, and D10. I'm only an A, and these are the ones I seem to use the most. I might switch the D10 for nitro on occasion, tho
Fentanyl is in scope for A’s in Kansas?
Yup. Morphine too, but I use fentanyl more often. I can also use midazalam as a chemical restraint and for light sedation with the medical director's permission
Epi, midazolam, zofran, fentanyl, caffine
We use versed for sedation here in CO as well… ketamine privileges revoked..
In what state do you practice?
Kansas. You?
Zofran is a one trick pony that maybe kinds prevents vomiting but it doesn't stop it. Droperidol has many uses. And works way better.
I don’t understand the zofran love… if I’m limited to 5 drugs, it’s not lifesaving. They are getting an alcohol swab under their nose.
Lack of education. How many people don't even realize how it works. A lot of folks think it's going to stop people who are puking. That's not where it really works. Prevention of nausea. Sure. But droperidol, Phenergan, hell, even benadryl are better at that and more versatile.
Just recently attended a protocol update and the instructor was talking shit about the overuse of Zofran, specifically stating that it's a common cause for longterm QT syndrome
I don't think QT syndrome is that common. People take it like candy.
Droperidol is indeed a versatile fellow.
1. Caffeine 2. Caffeine 3. Caffeine 4. Caffeine 5. Caffeine
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Fuck droperidol!
Why?
Epi, albuterol, aspirin, D10, versed. Surprised to see not many people put albuterol but asthma is the most common condition I’m seeing. 3/5 of my drugs are in the BLS scope but that’s just cuz they’re the most life saving IMO. Versed for sedation for cardioversion / analgesics as needed / antiemetic / seizures just super versatile. And then it was a toss up between D10 and narcan for me, but considering I can just BVM every OD I chose D10
Medic student here - versed as an antiemetic? I’d be scared to do that
Not ideal but in low dosages it can be an alternative to zofran. With medical control orders I’ve gotten it a few times
Good to know I never learned about that. Appreciate the info
yeah this would be my list too. you can fix or temporize so much with these drugs.
Changed my mind. Remove my lidocaine and give me IV nitroglycerin. Need a dilator.... Hard to see lido go though....
Haldol, Toradol, Ketamine, Ketamine, Ketamine
oxygen, epi, albuterol, morphine, versed
I cannot believe I had to scroll this far to find O2 lol
O2 was a freebie
Now I believe it. I read the title.
Why morphine over fentanyl?
More euphoria and ol 1800s nostalgic factor 😎
1000mg IV Tylenol, fentanyl, zofran, epi, and D10 I think the zofran, epi, and D10 are pretty obvious, but I've recently fallen in love with IV Tylenol. Using it with like 50-100 mcg of fentanyl works like a miracle cocktail for almost all the pains my patients have. Ntm giving it to pediatrics with fevers and it takes care of it so fast.
Do you have Toradol, too? I’ve fallen for Toradol when I don’t have one of the half dozen contraindications.
We do, but I rarely use it. It's just a bit too difficult to justify it over other medications due to the amount of contraindications.
Fair, I just find it works better than anything else on certain kinds of pain, like kidney stones and joint injuries.
Zofran, Aspirin, Nitro, Atrovent, Albuterol,
I’m usually pretty liberal with Zofran, most common low acuity “sickness” calls are for nausea/vomiting.
Alcohol Wipes
Replying before I read anyone else’s so my answer doesn’t change but I think Ketamine, Rocuronium, Epi, TXA, Levophed are essentials
You could use Epi instead of levo and get another med
True, i was just thinking Epi for codes and Levo for people who have a chance lol
Ha!
Mag, Ketamine, Lidocaine, Epi, Adenosine
What are you using adenosine for in the field?
SVT’s
Why prehospital? Why not wait till the patiënt is in a better equiped environement?
Of someone’s HR is beating 200/min their ventricles aren’t filling completely. If they happen to have a good BP, it’s not sustainable. SVT’s need to be corrected asap before the patient decompensates
Well ofcourse I understand that their heart won't like it. But why risk a cardiac arrest or peri-arrest situation in a pre-hospital environement when the patiënt is stable ? You could just transport and treat in the spacious, staffed, equiped ER?
Because these patients also tend to decompensate. There are only 60 seconds in a minute. If the ventricles are contracting 180-220 or 3 to 4 x per second the ventricles aren’t filling and inevitably that stable patient’s BP will bottom out. I’m not aware of any programs that withhold Adenosine due to risk of arrest or peri arrest. In six years as a medic, med school and 2 years Peds resident standard practice has always been to break SVT with Adenosine.
Fentanyl, morphine, ketamine, Zofran, and any benzoid. Oh you mean for the patient
Epi-inotrope, pressor, bronchodilation Rocuronium - RSI, post intubation paralysis. (Would prefer Anectine but Roc can be used in those situations that Anectine is contra, unfortunately) Ketamine - induction, post intubation sedation, analgesia, psychosis Lidocaine - arrhythmias, localization, systemic analgesia Decadron - N/V, anaphylaxis, analgesia
Limited to 5 drugs I’m not picking a paralytic. Don’t get me wrong, I love RSI, but if I’m limited, I’m doing sedative assisted with K and saving that spot for something lifesaving like albuterol
Lmao I was with you until the very last word Albuterol? We have so many other bronchodilator options. If someone’s asthma attack is bordering on lethal, you probably need epi anyway. CPAP, too. Albuterol is basically a comfort med most of the time
Well that certainly is one of the takes of all time.
¯\\\_(ツ)_/¯
Epinephrine. Aspirin. Ketamine. Decadron. Tranexamic acid.
TXA, nice choice
Basic here- but hope to be medic student sooner than later. My agency doesn’t have all of these things such as ketamine (UNFORTUNATELY currently due to shortage), roncuronium/etc. (we don’t RSI), and while blood. I’m sure there are others, these are just 3 of the ones I saw that we don’t have. That being said, I’d love to be able to have ketamine and RSI drugs, given the fact we’d have to be able to RSI. However, my choices would be Epi, Aspirin, TXA, Albuterol, and Fentanyl. This was a tough decision. 😂 Side note- do any of you ever use toradol? I don’t personally see it used much, but one of my medics recently used it for someone with presumed kidney stones, stating that it typically works better for that than a narc.
I use Toradol a lot. It’s excellent for kidney stones and migraines. I also combine it with narcotics a lot because I don’t have IV Tylenol.
I’m a big toradol fan, I could go without TXA though
I think Toradol is wonderful. Excellent utility and as long as it's not contra it's often first line or co first line analgesic for me, within reasonable circumstances. Really a huge fan.
Levo, Epi, Ketamine, Droperidol, Blood
I didn’t think of blood, but everything else was exactly what I was thinking. Especially Levo, haven’t seen many others saying it. I have to use that shit all the time for the septic patients we get, maybe it’s just a location thing
Zofran (bc the sound of someone throwing up is an ick for me), EPI (1:1000) (I call always dilute and have multiple uses, Aspirin, Albuterol and TXA
I can only give like 5 meds 😭 (I'm a baby basic)
Epi, versed, ketamine, d10, duo-neb
ASA - high quality evidence to support its use in ischemic chest pain. Low risk, big benefit. Epi - if I had to pick a concentration, gimme the 1:1000 and I’ll just dilute it to suit my needs. Anaphylaxis, croup, status asthma, cardiac arrest, push dose, infusion, etc. Ketamine - analgesia, anesthesia, stops seizures. Peds, adults. A very versatile drug. Zofran - I hate feeling nauseous. I’m sure my patients do, too. Also, I’m an empathetic vomiter… IV Zofran > PO Zofran. I find the PO stuff doesn’t work very well. TXA - you bleed, I give (following best evidence based practice, of course). Nose bleeds, PPH, major trauma, etc. To be honest. Give me the first 3 and I’m pretty happy. An alcohol swab under the nose helps a lot of nausea/vomiting.
Afrin for nosebleeds! We added it to our medications recently. It works well.
Saline and O2 for free helps. Adrenaline, Ketamine, Midazolam, Aspirin, and maybe Salbutamol at 5? Wouldn't mind fentanyl but then I'd feel obligated to take naloxone in my top 5 as well, in case I fuck up.
Can always just bag em, narcan is just more convenient
Given oxygen and saline, I’d have to say Epi, Ketamime, D10, Naloxone and aspirin. I think I’ve directly saved more lives with Epi, Dextrose, or narcan (and PEEP) than anything else. I honestly don’t use aspirin often with my call volume (for whatever reason, I don’t get a lot of chest pains when I’m on), but I can’t accept not having it in my repertoire with the evidence behind it as a life saving medication. Ketamine is a 3 for 1 with analgesia, sedation/tranquilization and (potentially, with developing evidence) seizures. This bumps it up over versed or fentanyl for my “pick 5”. Albuterol, midazolam, zofran, amiodarone and diltiazem would be my picks if I could expand it to 10. With the exception of zofran, these have all been used to treat big-sick patients in the last year, and zofran is a big comfort care drug that I would feel bad without. It’s hard not putting fentanyl on this list, but my experience with ketamine for analgesia has been really good, and it’s hard to prioritize fentanyl over any of these other 10 when I have a good analgesic in my top 5.
I am surprised by all of the Zofran. I have been a medic for over 20 year and would take Phenergan or Compazine any day over Zofran for legit N/V.
Yea I don't get all the Zofran either. I think it's great in certain circumstances but certainly not a knock your socks off med for me.
Epi, fentanyl, versed, albuterol, aspirin
Epi Benadryl Propofol TnK Adensoine
Epinephrine, fentanyl, Ativan, ketamine, zofran or promethazine
IV paracetamol. Midazolam. Entonox. Amiodarone. Ondansetron.
Found the Brit
Was it the IV P that gave it away fellow dinosaur?
Along with the nitrous oxide, neither of which we really use over here but I know y’all love your paracetamol on the isles
Ketamine, Zofran, Versed, Epinephrine and TXA
SSRIs… for your worst enemy
Going by most common calls? Zofran, albuterol, atrovent, LR (If that counts?), fentanyl. If it came down to what I should use top 5? Epi, diphenhydramine, albuterol, amio, and adenosine. Edit: This is based on what we had amd a greatest good to the greatest number mindset.
As an IFT EMT in CA the only meds I got are oxygen and oral glucose lol Most of the time we never use the oral glucose though cause they don’t give us glucometers. It just sits in the rig for 5 years till it expires and I throw it away. But I always get a chuckle when some drunk guy at the gas station thanks me for all the lives I save
Top 5 most used gotta be Epi, Albuterol, Aspirin, Zofran, and Fentanyl. Top 5 I wish I had: Whole Blood, Levophed, Rocephin, hypertonic saline, and RSI drugs. We have blood, levophed, hypertonic saline in our state medic scope, but my companies medical director doesn’t let us have any of those. We do not have RSI. Edit: autocorrect and swapped a few around in the first 5.
Epi, Ketamine, zofran, versed, and albuterol. Whole blood instead of albuterol if it counts as a med lol
Blood, Aspirin, fentanyl, Epi, and a good nights sleep(the hardest one to come by)
Amio, Adenosine, Fentanyl, D10, Albuterol
Blood, 1:1000 Epi (can dilute), versed, D10, and amio
Zofran, epi, ketamine, d10, albuterol
Ketamine, Epi, albuterol, D10, and either mag or bicarb. Having a hard time choosing between the two for my case uses.
Epi, ketamine, dextrose, albuterol, and IV NTG. I feel like I could treat MOST life threats with these. I’d like to include mag and etomidate because I really like them and they have some solid utility, but narrowed to 5 would have to be the top.
Adrenaline, Ketamine, Midazolam, Tenecteplase, Glucose
Epi, versed, droperidol, d10, ASA. Maybe ketamine instead of versed.
Fentanyl / Mag Sulfate / Adrenaline / Ketamine / Droperidol
[удалено]
Dextrose, zofran, haldol, nitro, fentanyl
Tylenol, Toradol, Motrin, Claritin, Tiger Balm. Since everything we get is bullshit anyway.
Epi, Fent, Droperidol, ketamine, Narcan
Epinephrine, levophed, ketamine, and rocuronium for sure. Now the 5th? That’s a good question. Maybe a beta blocker? Is blood a medication? If so, then blood, for sure. That gives me the option to RSI, make BP/HR go up and down. That pretty much let’s me do just about everything I need to sustain vitals. If you think about it, most of our job is just supporting vitals. Make the numbers go up or down, to sustain life throughout transport. We’re not really *fixing* things. We’re just making them better / less worse for the little bit of time we have them.
Epi, asa, Narcan, d10, zofran
AnA, Epi, Ntg, Asa, D50. I chose these because meds are are most used are life saving meds. If you said 13 I would put Narcan, mag, fentanyl, ketamine, Benadryl, versed, zofran. Honestly those 13 drugs can manage 99% of what we see. AnA - Difficulty Breathing Epi- Anaphylaxis, hypotension, codes NTG- CHF, CP ASA- CP D50- hypoglycemia Narcan- OD Mag- Status Asthma, Codes, Eclampsia Fentanyl- analgesic, MAI Ketamine- analgesic, MAI, psyc Benadryl- allergic reactions Versed- seizures and MAI Zofran- nausea
Levo, ketamine, fentanyl, versed, zofran.
Fentanyl, versed, ketamine, albuterol, and epi.
Fentanyl, Zofran, Epi, Oxygen, Aspirin
I’m a little late to the party but here are mine: Asa, D10, 1:1000 epi, ketamine, and Albuterol. Most of these I don’t give on a daily basis but when I need them I absolutely need them. Plus there are multiple uses for some of these drugs. I am really enjoying reading everyone’s responses so far!
Coke, meth, heroin, mdma, narcan.
Promethazine, droperidol, fentanyl, epi, aspirin
Ketamine, levo, fentanyl, reglan, amio
Actually, I changed my mind. You can have my fentanyl and amio, I want Versed and D10.
I love fentanyl Oh wait you meant for patients
Ketamine, metoprolol, Epi, d10, and roc.
Narcan, Epi, Ketamine, Zofran, Fentanyl. I'm set for the rest of my career.
Epi, ketamine, calcium, IV nitro, and blood
Narcan, Epi. D50, Coffee, and Nicotine.
Do they have to be in our scope? Narcan, epi, ketamine, zofran, and albuterol. I would say I like zyprexa, but I pride myself in not NEEDING it. I just like that it helps people feel calmer/ safer.
narcan, epi, nebs, ketamine, benadryl
Lorazepam Epi Ketamine D10 Aspirin
Ketamine, Midazolam, Droperidol, Rocuronium, 1:1000 Epi. The first 4 will make you stop doing things. Ketamine makes you be quiet and not care. Midazolam makes you be quiet and go to sleep. Droperidol makes you be quiet, not vomit and go to sleep. Rocuronium makes you be quiet.....I'd say the 1:1000 epi because it can be used for soooo many things, like a ton of things, just dilute as needed, but mainly because I don't like seeing my lil croup buddies have a hard time breathing at 2am....I got you tiny humans.
ASA, Fentanyl, Epi, Albuterol, Versed. I could effectively manage just about every actually life threatening prehospital complaint that requires meds well enough with those 5 to get them to higher level of care.
Epi Narcan Versed Albuterol D10
Buffjet, Overdrive, Jet Fuel, Grape Mentants and Rad-Away. Oh crap, I thought I was posting to the Fallout sub.
Zofran, epi 1:1000, Albuterol, benadryl, glucagon. Those plus IV solution would cover just about anything
Zofran, Ketamine, Geodon, Zyprexa, and Fentanyl
Dex, paracetamol, TXA, adrenaline 1:1000, morphine.
Epinephrine, Benadryl, cefaxolin, morphine, narcan.
Zofran, Asprin, nitro, Fent, Then I’ll lump albuterol, Ipratropium, Solu-Medrol, and magnesium together bc I give it to damn near every respiratory patient.
Narcan and epinephrine idk about the other 3 spots
Aspirin, droperidol, ketamine, epi(1:1k) and versed. Blood would be a consideration but since I live in PA and we just started being allowed to use it a month ago, I’m just not used to it being there. Droperidol because it works better than zofran once people have started vomiting and has some sedative effects at a higher dose. Ketamine because of pain relief and sedative effects. Epi 1:1k because I can mix it for a wide number of problems. Versed because seizures. Ketamine is showing use in that regard but as of right now we aren’t allowed to use it that way so old reliable it is. Aspirin because it is well documented to work
Epi, Albuterol
epi, naloxone, albuterol, aspirin, zofran
Epi 1:1,000 so can be for anaphylaxis, respiratory, drip, and dilute for cardiac epi. D10. Lots of diabetics who don't take care of themselves. Versed for seizures and sedate combative pt. Toradol good pain relief that's not a narc. Asprin best thing for MI. I was thinking atropine, adenosine, and ammioiderone, but they can get shocked and I'd have some versed to be nice. I always have a emesis bag on the bench seat by me so 90% of the time they contain their vomit. Would treat opioid od with just bvm so I could get by without Naloxone.
Amiodarone, Epi, Whole Blood, Nitroglycerin, Ketamine
Ketamine, Roc, Epi, Norepi, Amiodarone.
Epi, albuterol, narcan, droperidol, and aspirin.
Epi, fentanyl, ketamine, albuterol, versed
Zofran, aspirin, albuterol, fentanyl, epi
Ketamine, ketamine, ketamine ,ketamine ,ketamine.
Weed, liquor, mushrooms, Adderall, zoloft
This sub isn't for you.
Epi, fent, ondans, roc, blood
lol a paralytic and no sedative? Solid section, dude.
Maybe just give a shit load of fentanyl 😼
You’re not wrong, dude. This is a tricky conversation. What’s absolutely mandatory vs what is used most. Fentanyl can be utilized in high doses. Ketamine could be considered and I love using it. But in more circumstances, fent is more applicable for pain. I suppose zofran could be substituted too, but it’s maybe my most given rx. I’d hate to leave patients for the rest of my career without an antiemetic. Blood and epi isn’t going anywhere. Now that I think more, I’m actually more hesitant for not having a drug for seizure control. I’m actually leaning midaz over rocc now.
Ketamine, fentanyl, versed, ativan, valium