Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Do Drug Shortages Really Impact EMS? – Answer 3



Here is part 3 of the details from the points I raised in commenting on the discussion of the drug shortages and the way these affect EMS. Do Drug Shortages Really Impact EMS? – EMS Office Hours and followed by Do Drug Shortages Really Impact EMS? – Answer 1, then by Do Drug Shortages Really Impact EMS? – Answer 2. This is broken up by answer. There are many points covered for a podcast that lasts less than 40 minutes. Do Drug Shortages Really Impact EMS?

3. Should we switch from Lasix to Bumex?

This presumes that filling the patient’s bladder is the best, or second best, or third best, or even just not the worst way for EMS to treat patients with heart failure.

Filling the bladder with fluid does not mean that we removed the fluid from the lungs.

Where is it taught that the lungs drain into the bladder?

Where is the evidence that any diuretics are in any way beneficial for the pre-hospital treatment of the patient who does not have peripheral edema?

Where is any evidence that any diuretics should ever be used before any of the other treatments (CPAP, NTG, High-dose NTG, ACE inhibitors, et cetera) for the pre-hospital treatment of heart failure?

Why should EMS be giving so many different treatments to a single patient?

The more treatments we give, the more likely that we the patient will have complications.

The more treatments we give, the less likely that we can figure out what caused the complications.

Where is there any evidence that these complications are good for patients?

One person on the show mentions the problems with kidney injury from Lasix. That is just one of the reasons for not using diuretics. Another problem is that medics too often give diuretics for pneumonia. This is a training and oversight issue, but that is just another example of where medical directors are failing patients.

If paramedics are treating pneumonia with diuretics, why aren’t the medical directors aware of it?

If medical directors do know that paramedics are treating pneumonia with diuretics, why aren’t the medical directors doing something about it?

How can paramedic schools graduate people who can’t tell the difference between pneumonia and heart failure?

How can paramedic schools graduate people who treat pneumonia with Lasix or Bumex?

While there can be problems differentiating between pneumonia and heart failure, if I am not able to clearly identify the condition as heart failure, I should never give Lasix or Bumex.

If I hear crackles, presume heart failure, and give Lasix, because Lasix can’t hurt, then I probably should not be a paramedic.

If I allow a medic to treat something that sounds like crackles as heart failure, because Lasix can’t hurt, then I probably should not be a medical director.

We need better paramedics.

We need to ridicule the bad paramedics that we do have.

We need better medical directors.

We need to ridicule the bad medical directors that we do have.

Continued in –
Do Drug Shortages Really Impact EMS? – Answer 4

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Comments

  1. Mark, the pharmacist here from NYC. consultant from REMSCO, we removed Furosemide or any loop diuretic for any matter from our APE protocol. BTW Bumex is more potent and reserved for pts refractory to Furosemide, seldom used, do not see much rationale for pre-hospital usage. With regards to Fursosmide in the rigs, the APE pts very often are euvolemic and not fluid overloaded and the onset of action in most metro areas exceed the transit time. There has been studies demonstrating that the administration of loop diurectics in this setting can actually contribute to increased M&M. CPAP is really the way to go. In NYC, we reserved this decision for Medical control.

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