Flightmed Digest, Vol 1, Issue 13

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Today's Topics:

   1.  (bjohnson@megalink.net)
   2. Updates for Alec Buck's EMS Helicopters (Alec Buck)
   3. Re:(no subject) (RAS119@aol.com)
   4. Re:(no subject) (Marc Manley)
   5. RE:landing safety of BK117 (Doerr, Russell)
   6. RE:ventilators (Doerr, Russell)
   7. Re:Propofol (david lichtman)


----------------------------------------------------------------------

Message: 1
Date: Thu, 23 Oct 2003 16:36:56 -0400
From: <bjohnson@megalink.net>
To: flightmed@flightweb.com
Message-ID: <web-139208362@warpspeed.megalink.net>
Content-Type: text/plain; charset="ISO-8859-1"

 Our practice council is looking at Propofol for us to
carry. I am wondering if there is any one carrying/using
Propofol routinely during transport, if so are you using
just for interfaculty or are you starting on scene flights.

Thank you 
Bob Johnson LPN EMT-P FP-C
LifeFlight of Maine

------------------------------

Message: 2
Date: Thu, 23 Oct 2003 17:06:31 -0400
From: "Alec Buck" <alecbuck@alecbuck.com>
Subject: Updates for Alec Buck's EMS Helicopters
To: <flightmed@flightweb.com>
Message-ID: <002501c399a9$89ef7400$3623e518@familyroom>
Content-Type: text/plain;	charset="iso-8859-1"

Hi Everyone,

First of all, I'd like to thank everyone that has contributed to my web site. There are now almost 800 images available on the site. I would appreciate it if everyone would take a minute and check their program to see if all the information is up to date. And for any program that is not already included, I would love to add a photo of your helicopter. Please reply to alecbuck@alecbuck.com. Thanks again for all your help.

Alec Buck
Danville, PA (home of Geisinger Life Flight)
http://www.alecbuck.com


------------------------------

Message: 3
Date: Thu, 23 Oct 2003 19:22:45 EDT
From: RAS119@aol.com
Subject: Re: (no subject)
To: flightmed@flightweb.com
Message-ID: <178.21658151.2cc9bcc5@aol.com>
Content-Type: text/plain; charset="US-ASCII"

I can tell you, from my expierence, propofol is awful for txport purposes.  
It works quite well in a nice quite ICU where it can be titrated effectively, 
but once a pt. is moved around, coupled with the inherent noise issues of a 
helicopter, fixed wing, or even ground ambulance it becomes ineffective.  Also, 
its quite viscous and our minimed pumps do not seem to agree with it.  We don't 
carry it, but run in to it often on interfacility txports.  I generally use 
versed and vecuronium for the duration of our txprt.  Just my two cents.

Rick Sokolnicki  Emt-P
CareFlite

------------------------------

Message: 4
Date: Thu, 23 Oct 2003 20:06:42 -0400
From: "Marc Manley" <flightrn258@alltel.net>
Subject: Re: (no subject)
To: "Flightmed" <flightmed@flightweb.com>
Message-ID: <001a01c399c2$b5a1f0a0$c800000a@0019131280>
Content-Type: text/plain;	charset="iso-8859-1"

     I would have to agree with Rick with regard to utilizing Diprivan in
the rotor wing transport environment.  In my personal experience, it is a
great drug in the ICU where stimulation and pt. movement is at a minimum.
In the transport environment, with all of the added stimulation, numerous
patient movements, etc., it typically is not as effective as other sedation
protocols such as Norcuron/Versed.
     In addition, we also do not carry it but can maintain it throughout
transport at the flight teams discretion.
God luck,
Marc

       ----- Original Message -----
From: <RAS119@aol.com>
To: <flightmed@flightweb.com>
Sent: Thursday, October 23, 2003 7:22 PM
Subject: Re: (no subject)


> I can tell you, from my expierence, propofol is awful for txport purposes.
> It works quite well in a nice quite ICU where it can be titrated
effectively,
> but once a pt. is moved around, coupled with the inherent noise issues of
a
> helicopter, fixed wing, or even ground ambulance it becomes ineffective.
Also,
> its quite viscous and our minimed pumps do not seem to agree with it.  We
don't
> carry it, but run in to it often on interfacility txports.  I generally
use
> versed and vecuronium for the duration of our txprt.  Just my two cents.
>
> Rick Sokolnicki  Emt-P
> CareFlite
> _______________________________________________
> Flightmed mailing list
> To unsubscribe or change your email address, go to
http://www.pairlist.net/mailman/listinfo/flightmed
>


------------------------------

Message: 5
Date: Fri, 24 Oct 2003 02:50:10 -0400
From: "Doerr, Russell" <doerrr@rcbhsc.wvu.edu>
Subject: RE: landing safety of BK117
To: 'Flightmed' <flightmed@flightweb.com>
Message-ID:
	<0E85E21152F172409D147D1334CCC3DA118108@nt-exchange1.rcbhsc.wvu.edu>
Content-Type: text/plain;	charset="UTF-8"

When we had our BK117 we utilized one crew member in the co-pilot seat and
the other one in the co-pilot aft facing seat.  When landing at scene
locations we would open the sliding door and utilize a hand held spotlight
to clear the tail.  We only used the light on the co-pilots side so as not
to interfere with the pilot.  It always worked well for us.  In the EC135 we
still use the same setup but it's a little harder to see the tail by sliding
the door open.
Good Luck

-----Original Message-----
From: Loyd Helmick [mailto:loyd_helmick@mediplane.com]
Sent: Monday, October 20, 2003 3:44 PM
To: flightmed@flightweb.com
Subject: landing safety of BK117


I am looking to see what other programs do upon landing at scene calls.  I
am particularly looking at whether medical crews open the sliding doors to
help visualize the scene upon landing.  I am also looking to see where
medical crews sit going out to a scene call.  We are reviewing our
helicopter landing safety protocol.  Any and all feedback would be
beneficial.
 
Thanks
  Loyd Helmick


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------------------------------

Message: 6
Date: Fri, 24 Oct 2003 02:58:33 -0400
From: "Doerr, Russell" <doerrr@rcbhsc.wvu.edu>
Subject: RE: ventilators
To: 'Flightmed' <flightmed@flightweb.com>
Message-ID:
	<0E85E21152F172409D147D1334CCC3DA11810A@nt-exchange1.rcbhsc.wvu.edu>
Content-Type: text/plain;	charset="iso-8859-1"

We use the Crossvent 3.  It is pretty simple as far as setup and has SIMV,
AC, CPAP and allows pressure support as well as built in PEEP instead of
needing an add on PEEP valve.  We just got the entrainment instead of a
blender so we don't need an additional air source.  Battery life is good and
gas consumption is minimal.  Small enough to hook to a D cylinder for
transport to and from the aircraft too.
Good Luck

-----Original Message-----
From: Fltrt@aol.com [mailto:Fltrt@aol.com]
Sent: Friday, October 17, 2003 8:00 AM
To: flightmed@flightweb.com
Subject: ventilators


I would like to pose the following questions to the users 
1. What types of ventilators are being used? 
2. What are your pro's and con's on them?
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------------------------------

Message: 7
Date: Fri, 24 Oct 2003 09:49:33 -0400
From: "david lichtman" <davidlichtman@medscape.com>
Subject: Re: Propofol
To: flightmed@flightweb.com
Message-ID:
	<83B4FFD9B0AE3754C9A0498B9535AE1B@davidlichtman.medscape.com>
Content-Type: text/plain; charset=iso-8859-1

This is an excellent drug, and works incredibly well in the extra-
hospital environment.
1)The fact that this drug is not even listed as a scheduled class 
medication, makes the paperwork issues for certain systems a huge 
plus.
2)The drug is able to be titrated so that administration is perfectly 
tailored to the individual patient responses.
3)The drug has an incredibly quick onset (9-30 sec) and a very clean 
recovery.
4)It is cerebral-protective which is critical for those patients with 
head trauma.
5)It can be used for induction, maintenance, and procedural sedation.

The list continues, just read the drug information provided.  As far 
as the increased stimulation of the helicopter impeading the effects 
of the drug, this drug was designed to be used during surgical 
procedures.  I don't think one can stimulate a patient to a greater 
degree than with surgery.  If the current level of propofol is not 
holding the patient to a satisfactory degree of sedation, increase 
the rate.  As far as the addition of a neuromuscular blocking agent 
is concerned, virtually all of the known agents can be utilized along 
with the propofol.  Remember, like versed, etomidate, and pentothal, 
propofol is used for sedation, and is not a paralytic.

Nonetheless, no matter how much I like this particular medication, 
the one point I think we should all remember is that there are lots 
of different drugs available, and that every patient will respond to 
each of them in his/her own unique manner.  None of us would ever 
transport a patient with only a single size ET tube, so why restrict 
ourselves when it comes to medications.  Carry as many different 
medications as you can, and tailor the drug regimen to the patient, 
not the other way around.

Sorry I rambled on,
David Lichtman

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http://www.medscape.com

------------------------------

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End of Flightmed Digest, Vol 1, Issue 13
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