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Milnet.ca Medic Q&A

Armymedic

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Milnet.ca Medic Q&A

Here is an opportunity to answer your questions at the same time giving medics on the boards something to research in an attempt to answer for you.

It is quite simple, post a question about medical training, drugs, illness or injuries, medical procedures or anything along that lines and we will do our best to provide you with an answer.

To keep this manageable please follow these guidelines:

1) Do not put questions about your or anyone else's recruit medical in this thread. There is already a board for that in the recruiting section.

2) Do not look for a personal diagnosis. A website is not a substitute for professional medical care.
    We will not diagnosis and recommend treatment for you. But,
        a) we may be able to answer your questions as to what a treatment is for a diagnosis
        b) given a set of signs and symptoms, we may hypothesize as to a diagnosis

3) We know our lane. People who have no medical training beyond "well my doctor told me this about me so it MIGHT work for you or be what's wrong with you" should stay in their lane. This is our thread to answer your questions.

4) Do not ask questions about conditions that will result in a decision at DMed Pol, i.e. if I have been diagnosed with X will I be kicked out?

We reserve the right not to answer any question.

Fire it up.
 

TN2IC

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I was wondering, do I need a prescription for ibuprofen from the pharmacy? Like can I walk in to the pharmacy and request this without any documentation? I don't want to waste the sick parade time. Just need a some more for my ankle.

Thank you for your time,
Regards,
TN2IC
 

navymich

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MIR at CFB Esquimalt changed their policy awhile ago.  Lozenges, cough medicine and stuff like that was straight over the counter from the pharmacy with no prescription required.  Sorry, I don't know what else was included in it.  However, I do know that Sick Parade on weekends are usually very quiet, if not completely dead, so you might want to check it out tomorrow.  If not, give the pharmacy a call at least, to inquire before you go in.  Good luck!
 

nurse sarah

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Just walk in and ask for it. I'm not sure if it's always 200's or 400's but you'll get some.
 

Armymedic

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TN2IC said:
I was wondering, do I need a prescription for ibuprofen from the pharmacy? Like can I walk in to the pharmacy and request this without any documentation? I don't want to waste the sick parade time. Just need a some more for my ankle.
Ibuprofen 400 mg and 200 mg are OTC drugs, so any qualified Med Tech can perscribe and dispence them or you can buy then off teh shelf in any drug stor under the brands of Motrin or Advil.

There is always some sort of documentation if any drug, Rx or OTC is given out in a CF medical facility. You may not see it, but there is always a record of the drug being given out.

IF the person does not ask (other then name, rank, SN) you a minimum of 3 important questions;
1. What do you need it for, or what is your symptoms,
2. Do you have any allergies, or
3. have you taken it before,

then I would think that the person giving you the meds are just too busy or too lazy to care for you properly. If you do not have the time to talk for 5 mins....

Then go to a drug store and spend $5.
 

kj_gully

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Good morning. I am wondering if medics carry NPAs (nasal pharyngeal airways) . If you do, what brand, and are you happy with them. We currently carry OPA, combi tubes and ET Tubes, soon to be augmented/replaced by Laryngeal Mask Airways. However, I think NPA would be more benefitial than any of these adjuncts, as we do not have any sedatives or paralytics appropriate for RSI.
 

RCR Grunt

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I'm not a medic, but I am TCCC, so that practically makes me a doctor!  Just kidding.

We had NPA's in our TCCC kit, I'm not sure what brand they were but they were pretty alright.  The nice thing about them is you can put them into a conscious patient, which I demonstrated on a young volunteer private, much to the delight of the rest of the platoon!
 

MedTechStudent

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Well, I guess this falls under "Training."  And I know this sounds really basic but I could NOT find this anywhere on the Institute site.  After the first 16 week section of MOC training in CFB Borden, how long is the MOC Training at the Justice Institute?

Cheers, Kyle
 

Armymedic

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kj_gully said:
Good morning. I am wondering if medics carry NPAs (nasal pharyngeal airways) . If you do, what brand, and are you happy with them. We currently carry OPA, combi tubes and ET Tubes, soon to be augmented/replaced by Laryngeal Mask Airways.

Yes they should, and have better be.
Raucsh 28 Fr. They work ok. They have a moveable flange which enables the tube to be adjusted for size...They have not failed me yet.

I have used LMA...they are not as good in the field as people think. They work awesome in the OR where the patient does not move.
 

Civvymedic

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I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?

What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?

Thank you!

In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place. LMA's were originally designed for the O.R. environment and for use with fasting Pt.s. It used to actually say this on the package. We all know most people we deal with do not have empty stomachs and the LMA is a problem with gastric contents. I really like the King LT A/W!! As easy as a LMA but with 2 bladders, one blocking the Esophagus. Less movement as well.
 

X-mo-1979

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I have been talking to a couple guys who had "diluted"urine test for drugs in the regular force.They cannot think what had caused it.Honestly I do not do drugs or be around anyone who does,however what kinds of stuff would fail me on a drug test.

Also I am guilty of a few months ago taking a Tylenol 3 which I have left over from a previous injury.Does the drug testing know the difference between codeine or cocaine or just test for opiates?

 

kj_gully

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Civvymedic said:
I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?

What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?

Thank you!

In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place. LMA's were originally designed for the O.R. environment and for use with fasting Pt.s. It used to actually say this on the package. We all know most people we deal with do not have empty stomachs and the LMA is a problem with gastric contents. I really like the King LT A/W!! As easy as a LMA but with 2 bladders, one blocking the Esophagus. Less movement as well.

There is a topic going on HSD, I am interested in this product as well. As for LMA, we will be using LMA Supreme, which has a port to provide for passing an OG tube. I have questions about its use pre hospital as well, but regardless, I am more interested in getting an Adjunct we could use (my thinking is NPA) vs one we may use once or twice if ever. Our current use for ET is for Cardiac arrest, and discontinue resusitation (no paralytics required)
 

Civvymedic

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Fair enough on HSA. I was lucky enough to sit in on a presentation by 2 members of 2 Field Amb at a conference in September and I think Dextran sounds like the way to go.

NPA's? Use them, like them, although some traumas make there use difficult. Biggest problem is you still need 2 rescuers to Ventilate the Pt. Especially on the move and in cramped spaces this becomes difficult, and you still get Gastric air no matter how good you bag. If you cant Intubate I still prefer an LMA or Combitube with a C-Collar trauma or not to  minimize movement.

We looked closely at LMA's in the service I work for and settled on the King A/W after some research. You can also get a King A/W that allows for the passing of an OG tube.

www.kingsystems.com
 

Armymedic

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Civvymedic said:
I believe CF Medics are using Hypertonic saline (Dextran) in Afghanistan. If so how is this going? Do you see benefits that could be useful for civilian pre-hospital care?

What kind of studies are being done if any to compare it's use to Normal Saline or Ringers Lactate? If not is sufficient data being collected to create a retrospective evaluation or Epistry?
I am not sure about studies, but LCdr Philips (sorry for the misspell if I have) spoke at the last OPMED conference about the effectiveness of HSD vs R/L and its effect on blood acidity and volume retention. The baseline is that HSD is much better volume replacement than either isotonic solution, and the most suitable solution to infuse until the trauma patient can get blood products.

In regards to NPA's and/or LMA's. I really think that Intubation is the gold standard but other A/W adjuncts have there place.

Intubation is still the gold standard, but as it is a skill that is difficult to maintain, not everyone is proficient nor allowed to use it. Hence the purpose of the other adjuncts avail. My opinion of LMA vs King LT is that the King LT is much better for use in the field.
 
E

EMER DOC SPEC

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    The most recent randomized clinical trial of hypertonic saline versus regular crystaloid as brought into question the whole process of pre resus treatment with fluids. Retrospective studies have demonstrated that patients do worse with resus fluid.  Why?  The interstitial space needs to be resuscitated first.  When using NS it will go to the interstitial space first.  Hypertonic saline will not and will in fact draw fluid into the vasculature.  You would think that this is what you want right?  But we now know that before you give blood products use crytsaloid about 2 l in the trauma patient (weight 75kg) then packed red blood cells.  Don't forget to replace the clotting factors as they are not in PRBC's.
  A typical resus regime for a trauma patient would be 2 liters of NS + 6u PRBC's + 4u FFP (fresh frozen plasma) then 10 units of platelets.  It works well.  Many people stop after the PRBC's and having the patient go into DIC. In the field I would give the 2l NS as only a 3rd will stay intravascular anyway until transport to the field hospital.

  Just my two cents.
 

kj_gully

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thanks for the post, touches on another related aspect of prehospital care, permissive hypo tension. There has been lots (as I am sure you are aware doc) new looks at old practices, with permissive hypo tension being one. Saw some interesting stuff written during WW1, confirmed in WW2, then promptly disregarded in Vietnam, stating a systolic pressure of about 80 would be acceptable. I think that some more info will be forthcoming out of the current conflicts. I know my patient care is now less tied to a number, and more related to overall patient presentation.
 

Donut

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EMER DOC SPEC said:
    The most recent randomized clinical trial of hypertonic saline versus regular crystaloid as brought into question the whole process of pre resus treatment with fluids. Retrospective studies have demonstrated that patients do worse with resus fluid.  Why?  The interstitial space needs to be resuscitated first.  When using NS it will go to the interstitial space first.  Hypertonic saline will not and will in fact draw fluid into the vasculature.  You would think that this is what you want right?  But we now know that before you give blood products use crytsaloid about 2 l in the trauma patient (weight 75kg) then packed red blood cells.  Don't forget to replace the clotting factors as they are not in PRBC's.
  A typical resus regime for a trauma patient would be 2 liters of NS + 6u PRBC's + 4u FFP (fresh frozen plasma) then 10 units of platelets.  It works well.  Many people stop after the PRBC's and having the patient go into DIC. In the field I would give the 2l NS as only a 3rd will stay intravascular anyway until transport to the field hospital.

  Just my two cents.

Could you please cite a source for this (esp the need to resus the interstitial)? There's several threads that this might be more appropriate for this discussion (such as http://forums.army.ca/forums/threads/23137.0.html or http://forums.army.ca/forums/threads/59238.0.html) but this is news to me, and I'm always looking for evidence to back what we're doing.

Despite the rocky start, welcome to the boards, EMER DOC.
 
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EMER DOC SPEC

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Helllo,

  Here are some of the references that you requested.  It is a great topic for discussion with lots of pros and cons.  I have a PP presentation that I could e-mail you with some summaries and great slides of  intracellular, interstitial and intravascular space resus and current thoughts about it.  Really two camps.  Traditional and Interstitial.

Carlson RW. Fluid Resuscitation in Circulatory Shock
Crit. Care Clin. 1993;9:313.

Evidence against
Bickell WH. NEJM 331:17 1994

Bickell summary of results.  Sorry I did not summarize the others but they should be available online.

Survival of Delayed Resuscitation 70%
Survival of Immediate Resuscitation 62% (p=0.04)
Complication Rate: 23% vs. 30% (p=0.08)
(ARDS, Sepsis, ARF, Coagulopathy, infection or pneumonia)




Choi P, Yip G, Quinonez L, Cook D.Critical Care Medicine 27:1 1999

This is a summary from a major trauma centre in Canada that will be ready for publishing soon:

Hemorrhage Model dictates results
Medline Search and review of references
96 potential articles, 93 found
32 contained treated and untreated groups

Uncontrolled Hemorrhage – favors control
Controlled Hemorrhage – favors treatment

Thank you for the welcome.  Let me know what you think.  Its a really great topic.  Noticed I included references for both camps.






 
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