The Illegal Drug Discussion Thread

[TLDR20]

We had a task force medic get hemmed up over fentanyl. I guess the pilots had fentanyl lollipops in their emergency kits? This guy I guess got into the stash of them in the med shed in order to get high. It was a long time ago but I think that was a thing.

There was also an augmentee O6 that died after huffing the canned air spray we used to keep our keyboards and computers clean.

Yeah. My point I guess is never do it, ever. If you don’t try it you can’t get addicted to it. I don’t think anything on earth is more addictive than opiates, even nicotine.

 

[TLDR20]

Love it for agitated delirium but recently, hasn't been working and we are giving high dose versed and droperidol for PCP dudes punching buses.

Do you have Dexmetetomidine?

 

[Muppet]

Do you have Dexmetetomidine?

No sir, we do not. In fact, never heard of it.

For longest time, we'd use Versed but years back, K came on trucks.

Our SOPs are:

High dose K, IM and mid dose IV

Or, high dose Versed and Drop.

This depends on IMCRASS score. +1/2 gets versed or Drop.

+3/4 gets K or Versed and Drop.

I presume, streamlining meds is easier than having a bunch of different meds.

Edit: just looked it up, precedex. I've heard of it, don't know anything abiut it. Do you guys use it?

 

[TLDR20]

I deal with two common fears from two different patient populations, patients afraid of propofol because of Michael Jackson, and patients afraid of fentanyl because of someone they know dying.

I give not a lot of fentanyl in my practice. Ketamine is the perfect anesthetic drug, offering the big 3, analgesia, amnesia, and akinesia. No other drug we have does all three, and each drug normal at best offers only 1 or 2 of the 3.

I’ll normally dose a small amount of fent on induction of anesthesia, and then either try to do opioid sparing, or just use Dilaudid. It is better, cheaper by the dose, and actually lasts long enough. Even in the open hearts I do, I went from using 1000mcg of fent to 250, with the addition of a ketamine and precedex infusion.

 

[Muppet]

I deal with two common fears from two different patient populations, patients afraid of propofol because of Michael Jackson, and patients afraid of fentanyl because of someone they know dying.

I give not a lot of fentanyl in my practice. Ketamine is the perfect anesthetic drug, offering the big 3, analgesia, amnesia, and akinesia. No other drug we have does all three, and each drug normal at best offers only 1 or 2 of the 3.

I’ll normally dose a small amount of fent on induction of anesthesia, and then either try to do opioid sparing, or just use Dilaudid. It is better, cheaper by the dose, and actually lasts long enough. Even in the open hearts I do, I went from using 1000mcg of fent to 250, with the addition of a ketamine and precedex infusion.

Prop is great, milk of amnesia.

For pain, we're with Fent for opioid or Toradol, non. Hopefully, K soon for pain. Now, getting ED docs to not freak out when we bring a pt with femur break in on K will be fun.

 

[Muppet]

Do you have Dexmetetomidine?

Do you guys in your practice, have SOPs/care maps on what/when to give or can you use judgement?

 

[SOSTCRNA]

Do you guys in your practice, have SOPs/care maps on what/when to give or can you use judgement?

I’m completely independent and give my anesthetic based on the surgery, pt co morbidities etc. judgment based on experience.

 

[TLDR20]

Do you guys in your practice, have SOPs/care maps on what/when to give or can you use judgement?

It is based on the patient, co morbidities, allergies, and my judgement, sometimes mixed with drug shortages….

 

[TLDR20]

No sir, we do not. In fact, never heard of it.

For longest time, we'd use Versed but years back, K came on trucks.

Our SOPs are:

High dose K, IM and mid dose IV

Or, high dose Versed and Drop.

This depends on IMCRASS score. +1/2 gets versed or Drop.

+3/4 gets K or Versed and Drop.

I presume, streamlining meds is easier than having a bunch of different meds.

Edit: just looked it up, precedex. I've heard of it, don't know anything abiut it. Do you guys use it?

We use the shit out of precedex. However I am of the opinion that everything people think precedex does, Dilaudid does do better, however in many populations, and with our increased awareness of opioid problems precedex has a great place. For pediatrics, and the younger population in general precedex has shown to be a robust drug with fantastic pharmacokinetics and dynamics.

Many people are now mixing it into epidural infusions and the results have been fantastic. Plus if you ever did a live tissue lab you’ve probably given it in its vet form of dormitor.