didnt know that hey.Its funny that the company who make it had a big who har that they now export it to other countries, why was it banned ?
St John Ambulance
Moderator: Infernal
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Markmywords
Markmywords wrote:Thats a good one PFO i cant recall seeing anything that says otherwise unless it does now.
Anyone got SJA protocol book ?
Methoxyflurane 3ml (MFX) is indicated for pain of any origin. Contra indications include CNS depression of any level associated with head injury of any type, malignant hypothermia, renal impairment (cause it’s excreted via the Kidneys) and not to forget unable to understand/self administer medication.
To understand the hoo ha with the use of MFX, it is important to note that MFX has been used as both an analgesic agent and as an anaesthetic agent (in both human and veterinary medicine). The FDA withdrew the use of MFX in the USA on the basis of studies done on the risk to medical personnel during the use of MFX as an anaesthetic. In Australia, one of the ambulance services (I think it was NSW) did a complete study of the analgesic use of MFX in the pre-hospital ambulance environment in Australia and concluded it posed no risk to staff. Personal opinions on this issue are many and varied, but the use of MFX in a well ventilated ambulance while using a charcoal filter would appear to be safe.
Unfortunately, the questionable safety issues surrounding MFX are often used to push the barrow of ‘let’s just get morphine’. Now I have used MFX very successfully, particularly in the elderly and the young, and given the CNS complications of Opiates, sometimes MFX may be a more clinically prudent choice. That being said, where I use work we use Morphine diluted to 10ml with N/Saline and given IV in 1-2mL doses titrated to effect!!
MFX is available for use with chest pain of cardiac origin. However its use would be rare, as rest and 02 come first. WA carries nitrates (no shock there) in the form of Isosorbide Dinatrate 5mg (trade name Isordil). Nitrates are very efficient on pain of cardiac origin due in principle to the 7 direct action on the myocardium and are the primary line of defence. Nitrates are always used in cohorts with Aspirin, used for its platelet anti-aggregation (clot preventing) actions, not the analgesia effect.
For pain still unrelieved by rest, 02 and nitrates, one would have to be considering the time critical status of the Patient, but another option is analgesia in the form of MFX or Fentanyl. Fentanyl, a narcotic, is the better option, but in Volunteer world, MFX would be the only option other than doing nothing. Interestingly Ketamine is absolutely contraindicated in cardiac chest pain.
In relation to the use of MFX in Patients with poorly perfusing arrhythmias, there is no precautionary notes or contra indications contained in MIMS in this situation.
The lack of antiarrytrhmics is always concerning. The site I work at carries Amioderone, Atropine, Lignocaine and Sodium Bicarbonate. We also use real Adrenaline for cardiac arrest. Of note WAAS does not use Fruesemide for cardiogenic pulmonary oedema – be it cardiac or non cardiac in nature.
Ambul8 - if u break urself i'll fix u! Maybe...
[quote="Ambul8"][quote="Markmywords"]Thats a good one PFO i cant recall seeing anything that says otherwise unless it does now.
Anyone got SJA protocol book ?[/quote]
Methoxyflurane 3ml (MFX) is indicated for pain of any origin. Contra indications include CNS depression of any level associated with head injury of any type, malignant hypothermia, renal impairment (cause it’s excreted via the Kidneys) and not to forget unable to understand/self administer medication.
To understand the hoo ha with the use of MFX, it is important to note that MFX has been used as both an analgesic agent and as an anaesthetic agent (in both human and veterinary medicine). The FDA withdrew the use of MFX in the USA on the basis of studies done on the risk to medical personnel during the use of MFX as an anaesthetic. In Australia, one of the ambulance services (I think it was NSW) did a complete study of the analgesic use of MFX in the pre-hospital ambulance environment in Australia and concluded it posed no risk to staff. Personal opinions on this issue are many and varied, but the use of MFX in a well ventilated ambulance while using a charcoal filter would appear to be safe.
Unfortunately, the questionable safety issues surrounding MFX are often used to push the barrow of ‘let’s just get morphine’. Now I have used MFX very successfully, particularly in the elderly and the young, and given the CNS complications of Opiates, sometimes MFX may be a more clinically prudent choice. That being said, where I use work we use Morphine diluted to 10ml with N/Saline and given IV in 1-2mL doses titrated to effect!!
MFX is available for use with chest pain of cardiac origin. However its use would be rare, as rest and 02 come first. WA carries nitrates (no shock there) in the form of Isosorbide Dinatrate 5mg (trade name Isordil). Nitrates are very efficient on pain of cardiac origin due in principle to the 7 direct action on the myocardium and are the primary line of defence. Nitrates are always used in cohorts with Aspirin, used for its platelet anti-aggregation (clot preventing) actions, not the analgesia effect.
For pain still unrelieved by rest, 02 and nitrates, one would have to be considering the time critical status of the Patient, but another option is analgesia in the form of MFX or Fentanyl. Fentanyl, a narcotic, is the better option, but in Volunteer world, MFX would be the only option other than doing nothing. Interestingly Ketamine is absolutely contraindicated in cardiac chest pain.
In relation to the use of MFX in Patients with poorly perfusing arrhythmias, there is no precautionary notes or contra indications contained in MIMS in this situation.
The lack of antiarrytrhmics is always concerning. The site I work at carries Amioderone, Atropine, Lignocaine and Sodium Bicarbonate. We also use real Adrenaline for cardiac arrest. Of note WAAS does not use Fruesemide for cardiogenic pulmonary oedema – be it cardiac or non cardiac in nature.[/quote]
Anyone got SJA protocol book ?[/quote]
Methoxyflurane 3ml (MFX) is indicated for pain of any origin. Contra indications include CNS depression of any level associated with head injury of any type, malignant hypothermia, renal impairment (cause it’s excreted via the Kidneys) and not to forget unable to understand/self administer medication.
To understand the hoo ha with the use of MFX, it is important to note that MFX has been used as both an analgesic agent and as an anaesthetic agent (in both human and veterinary medicine). The FDA withdrew the use of MFX in the USA on the basis of studies done on the risk to medical personnel during the use of MFX as an anaesthetic. In Australia, one of the ambulance services (I think it was NSW) did a complete study of the analgesic use of MFX in the pre-hospital ambulance environment in Australia and concluded it posed no risk to staff. Personal opinions on this issue are many and varied, but the use of MFX in a well ventilated ambulance while using a charcoal filter would appear to be safe.
Unfortunately, the questionable safety issues surrounding MFX are often used to push the barrow of ‘let’s just get morphine’. Now I have used MFX very successfully, particularly in the elderly and the young, and given the CNS complications of Opiates, sometimes MFX may be a more clinically prudent choice. That being said, where I use work we use Morphine diluted to 10ml with N/Saline and given IV in 1-2mL doses titrated to effect!!
MFX is available for use with chest pain of cardiac origin. However its use would be rare, as rest and 02 come first. WA carries nitrates (no shock there) in the form of Isosorbide Dinatrate 5mg (trade name Isordil). Nitrates are very efficient on pain of cardiac origin due in principle to the 7 direct action on the myocardium and are the primary line of defence. Nitrates are always used in cohorts with Aspirin, used for its platelet anti-aggregation (clot preventing) actions, not the analgesia effect.
For pain still unrelieved by rest, 02 and nitrates, one would have to be considering the time critical status of the Patient, but another option is analgesia in the form of MFX or Fentanyl. Fentanyl, a narcotic, is the better option, but in Volunteer world, MFX would be the only option other than doing nothing. Interestingly Ketamine is absolutely contraindicated in cardiac chest pain.
In relation to the use of MFX in Patients with poorly perfusing arrhythmias, there is no precautionary notes or contra indications contained in MIMS in this situation.
The lack of antiarrytrhmics is always concerning. The site I work at carries Amioderone, Atropine, Lignocaine and Sodium Bicarbonate. We also use real Adrenaline for cardiac arrest. Of note WAAS does not use Fruesemide for cardiogenic pulmonary oedema – be it cardiac or non cardiac in nature.[/quote]
[quote="Markmywords"]Ambul8: I think you covered everything cheers [/quote]LOL impressive reaction considering that fentanyl would be much preferred over methoxy for the use on the elderly as it should be given with caution to the elderly and maybe another precaution you might find is its use with tetracyclines and other medications that can cause hepatic impairment over time or take a long time to be metabolised.
i assume the morphine you use are 10mg/1ml. who do u order that from, we can only get 15mg/1ml at the moment if you dont mind my asking
[/quote]LOL impressive reaction considering that fentanyl would be much preferred over methoxy for the use on the elderly as it should be given with caution to the elderly and maybe another precaution you might find is its use with tetracyclines and other medications that can cause hepatic impairment over time or take a long time to be metabolised.i assume the morphine you use are 10mg/1ml. who do u order that from, we can only get 15mg/1ml at the moment if you dont mind my asking
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Kyle
- 150+ posts
- Posts: 429
- Joined: Wed Jan 02, 2008 7:16 pm
- Location: South West.. MY GPS tells me so
I think Medic One may have been one of the companies that have been instigating the move away from Methoxyflurane. However don't quote me on that I could be wrong!
Just wondering PFO if you work for Med 1 or studied there, just the research sounds familiar
Also does anyone know why Entonox is not widley used on WA Ambulances / Minesites..
Just wondering PFO if you work for Med 1 or studied there, just the research sounds familiar
Also does anyone know why Entonox is not widley used on WA Ambulances / Minesites..
Last edited by Kyle on Fri Feb 22, 2008 7:02 pm, edited 1 time in total.
O.O
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
[quote="Kyle"]I think Medic One may have been one of the companies that have been instigating the move away from Methoxyflurane. However don't quote me on that I could be wrong!
Just wondering PFO if you work for Med 1 or studied there, just the research sounds familiar[/quote]kyle it was actually the late peter draper that has always voiced his opinions to myself about methoxy.i am aware that M.O also do not advocate its use, and yes i have seen sja workers use a methoxy on an elderly pt who was stuck in house with a # nof for four days and methoxy was given even though she had no fluids and weighed about 40kg. age was 80+. is there a problem with that? lol
Just wondering PFO if you work for Med 1 or studied there, just the research sounds familiar[/quote]kyle it was actually the late peter draper that has always voiced his opinions to myself about methoxy.i am aware that M.O also do not advocate its use, and yes i have seen sja workers use a methoxy on an elderly pt who was stuck in house with a # nof for four days and methoxy was given even though she had no fluids and weighed about 40kg. age was 80+. is there a problem with that? lol
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Kyle
- 150+ posts
- Posts: 429
- Joined: Wed Jan 02, 2008 7:16 pm
- Location: South West.. MY GPS tells me so
Just interesting I don't like Methoxyflurane myself I prefer to see Entonox on Ambulances as one of many alternatives. Interesting to see alike thoughts amongst industry professionals. As SJA seem to not move to a drug to quickly. However they have their reasons.. ie: Research etc. TrialsPFO wrote:kyle it was actually the late peter draper that has always voiced his opinions to myself about methoxy.i am aware that M.O also do not advocate its use, and yes i have seen sja workers use a methoxy on an elderly pt who was stuck in house with a # nof for four days and methoxy was given even though she had no fluids and weighed about 40kg. age was 80+. is there a problem with that? lolKyle wrote:I think Medic One may have been one of the companies that have been instigating the move away from Methoxyflurane. However don't quote me on that I could be wrong!
Just wondering PFO if you work for Med 1 or studied there, just the research sounds familiar
Any thoughts on Entonox as a alternative, especially useful in obstetrics. Also it seems to have minimal harmful effects. I just don't understand why it isn't used on WA Ambulances or they have it as a option..
As far as the administration side you witnessed with S*A thats a training issue and concerning.
Any medical professional should know their drugs they administer back to front, and possible reversal. Or quite simply they shouldn't be administering them in the first place. A thorough understanding of Pharmacology of the drug in question. O.O
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
[quote="Markmywords"]Banned didnt know that hey.
Its funny that the company who make it had a big who har that they now export it to other countries, why was it banned ?[/quote] which ones and in what presentation. It would be interesting to know what other countries do. As far as i know. USA,ENGLAND,SOUTH AFRICA dont use them. I honestly couldnt tellyou about anywhere else though
didnt know that hey.Its funny that the company who make it had a big who har that they now export it to other countries, why was it banned ?[/quote] which ones and in what presentation. It would be interesting to know what other countries do. As far as i know. USA,ENGLAND,SOUTH AFRICA dont use them. I honestly couldnt tellyou about anywhere else though
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Kyle
- 150+ posts
- Posts: 429
- Joined: Wed Jan 02, 2008 7:16 pm
- Location: South West.. MY GPS tells me so
Maybe because some SA Paramedics are just superior in education and skill which is causing others to winge. Tall Poppie syndrome. I have met a SA Paramedic and very impressed.PFO wrote: hey i heard a little rumour that sja were no longer accepting SA paramedics. Is this true?
Anyone considering discrimination should look past the cultural divide and more towards the benefit of the Patient..Or as my friend would say to those that try the Tall Poppie Syndrome on him
stop whining omdat ek is beter dan u. u huil baba
logeren whining omdat im beter dan u. u schreeuw baby.
O.O
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
I exclude all liability to any person arising directly or indirectly from using this site and any information or material available from it.
[quote="Ambul8"][quote="Markmywords"]Thats a good one PFO i cant recall seeing anything that says otherwise unless it does now.
Anyone got SJA protocol book ?[/quote]
Methoxyflurane 3ml (MFX) is indicated for pain of any origin. Contra indications include CNS depression of any level associated with head injury of any type, malignant hypothermia, renal impairment (cause it’s excreted via the Kidneys) and not to forget unable to understand/self administer medication.
To understand the hoo ha with the use of MFX, it is important to note that MFX has been used as both an analgesic agent and as an anaesthetic agent (in both human and veterinary medicine). The FDA withdrew the use of MFX in the USA on the basis of studies done on the risk to medical personnel during the use of MFX as an anaesthetic. In Australia, one of the ambulance services (I think it was NSW) did a complete study of the analgesic use of MFX in the pre-hospital ambulance environment in Australia and concluded it posed no risk to staff. Personal opinions on this issue are many and varied, but the use of MFX in a well ventilated ambulance while using a charcoal filter would appear to be safe.
Unfortunately, the questionable safety issues surrounding MFX are often used to push the barrow of ‘let’s just get morphine’. Now I have used MFX very successfully, particularly in the elderly and the young, and given the CNS complications of Opiates, sometimes MFX may be a more clinically prudent choice. That being said, where I use work we use Morphine diluted to 10ml with N/Saline and given IV in 1-2mL doses titrated to effect!!
MFX is available for use with chest pain of cardiac origin. However its use would be rare, as rest and 02 come first. WA carries nitrates (no shock there) in the form of Isosorbide Dinatrate 5mg (trade name Isordil). Nitrates are very efficient on pain of cardiac origin due in principle to the 7 direct action on the myocardium and are the primary line of defence. Nitrates are always used in cohorts with Aspirin, used for its platelet anti-aggregation (clot preventing) actions, not the analgesia effect.
For pain still unrelieved by rest, 02 and nitrates, one would have to be considering the time critical status of the Patient, but another option is analgesia in the form of MFX or Fentanyl. Fentanyl, a narcotic, is the better option, but in Volunteer world, MFX would be the only option other than doing nothing. Interestingly Ketamine is absolutely contraindicated in cardiac chest pain.
In relation to the use of MFX in Patients with poorly perfusing arrhythmias, there is no precautionary notes or contra indications contained in MIMS in this situation.
The lack of antiarrytrhmics is always concerning. The site I work at carries Amioderone, Atropine, Lignocaine and Sodium Bicarbonate. We also use real Adrenaline for cardiac arrest. Of note WAAS does not use Fruesemide for cardiogenic pulmonary oedema – be it cardiac or non cardiac in nature.[/quote] interesting that an IP which is obviously what you are can use all those drugs under a DRs direction, and yet people who have studied their arses off only have a small list of medications to choose from, and yes i know the current train of thought regarding time on scene and distance from hospital etc, and im sure your probably a decent IP with at least some clinical experience, but so many more are not, and go straight from the course and into the field without any experience and are but one mistake from losing their career,but hey these courses make a shitload of money for various providers, and the fact that their not endorsed or part of the hlt07 health package means its a good thing yeah?
Anyone got SJA protocol book ?[/quote]
Methoxyflurane 3ml (MFX) is indicated for pain of any origin. Contra indications include CNS depression of any level associated with head injury of any type, malignant hypothermia, renal impairment (cause it’s excreted via the Kidneys) and not to forget unable to understand/self administer medication.
To understand the hoo ha with the use of MFX, it is important to note that MFX has been used as both an analgesic agent and as an anaesthetic agent (in both human and veterinary medicine). The FDA withdrew the use of MFX in the USA on the basis of studies done on the risk to medical personnel during the use of MFX as an anaesthetic. In Australia, one of the ambulance services (I think it was NSW) did a complete study of the analgesic use of MFX in the pre-hospital ambulance environment in Australia and concluded it posed no risk to staff. Personal opinions on this issue are many and varied, but the use of MFX in a well ventilated ambulance while using a charcoal filter would appear to be safe.
Unfortunately, the questionable safety issues surrounding MFX are often used to push the barrow of ‘let’s just get morphine’. Now I have used MFX very successfully, particularly in the elderly and the young, and given the CNS complications of Opiates, sometimes MFX may be a more clinically prudent choice. That being said, where I use work we use Morphine diluted to 10ml with N/Saline and given IV in 1-2mL doses titrated to effect!!
MFX is available for use with chest pain of cardiac origin. However its use would be rare, as rest and 02 come first. WA carries nitrates (no shock there) in the form of Isosorbide Dinatrate 5mg (trade name Isordil). Nitrates are very efficient on pain of cardiac origin due in principle to the 7 direct action on the myocardium and are the primary line of defence. Nitrates are always used in cohorts with Aspirin, used for its platelet anti-aggregation (clot preventing) actions, not the analgesia effect.
For pain still unrelieved by rest, 02 and nitrates, one would have to be considering the time critical status of the Patient, but another option is analgesia in the form of MFX or Fentanyl. Fentanyl, a narcotic, is the better option, but in Volunteer world, MFX would be the only option other than doing nothing. Interestingly Ketamine is absolutely contraindicated in cardiac chest pain.
In relation to the use of MFX in Patients with poorly perfusing arrhythmias, there is no precautionary notes or contra indications contained in MIMS in this situation.
The lack of antiarrytrhmics is always concerning. The site I work at carries Amioderone, Atropine, Lignocaine and Sodium Bicarbonate. We also use real Adrenaline for cardiac arrest. Of note WAAS does not use Fruesemide for cardiogenic pulmonary oedema – be it cardiac or non cardiac in nature.[/quote] interesting that an IP which is obviously what you are can use all those drugs under a DRs direction, and yet people who have studied their arses off only have a small list of medications to choose from, and yes i know the current train of thought regarding time on scene and distance from hospital etc, and im sure your probably a decent IP with at least some clinical experience, but so many more are not, and go straight from the course and into the field without any experience and are but one mistake from losing their career,but hey these courses make a shitload of money for various providers, and the fact that their not endorsed or part of the hlt07 health package means its a good thing yeah?
gcs of 3
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Markmywords
So your assumption is that I don't have tertiary training?PFO wrote:interesting that an IP which is obviously what you are can use all those drugs under a DRs direction, and yet people who have studied their arses off only have a small list of medications to choose from, and yes i know the current train of thought regarding time on scene and distance from hospital etc, and im sure your probably a decent IP with at least some clinical experience, but so many more are not, and go straight from the course and into the field without any experience and are but one mistake from losing their career,but hey these courses make a shitload of money for various providers, and the fact that their not endorsed or part of the hlt07 health package means its a good thing yeah?
Interestingly, maybe for you, all of those meds are on CPG. Not ring first.
Ambul8 - if u break urself i'll fix u! Maybe...
[quote="Ambul8"][quote="PFO"]interesting that an IP which is obviously what you are can use all those drugs under a DRs direction, and yet people who have studied their arses off only have a small list of medications to choose from, and yes i know the current train of thought regarding time on scene and distance from hospital etc, and im sure your probably a decent IP with at least some clinical experience, but so many more are not, and go straight from the course and into the field without any experience and are but one mistake from losing their career,but hey these courses make a shitload of money for various providers, and the fact that their not endorsed or part of the hlt07 health package means its a good thing yeah? [/quote]
So your assumption is that I don't have tertiary training?
Interestingly, maybe for you, all of those meds are on CPG. Not ring first.[/quote]So your telling me that when you work on a minesite, your giving
schedule 4 and 8 drugs off your own back without contact with your medical diretor? whom ever that may be lol. You will be in a world of hurt if that is the case lol. Interesting that you didnt mention that methoxy is not indicated for use with people exposed to H.F because the flouride ions
can excaserbate the process of tissue degredation. Recent studies also show that Tolulene which is a product that is used in glues that also is in methoxy may have carcinogetic properties.Perhaps you should not base your studies on the monthly mimms you m ay get onsite lol
[/quote]So your assumption is that I don't have tertiary training?
Interestingly, maybe for you, all of those meds are on CPG. Not ring first.[/quote]So your telling me that when you work on a minesite, your giving
schedule 4 and 8 drugs off your own back without contact with your medical diretor? whom ever that may be lol. You will be in a world of hurt if that is the case lol. Interesting that you didnt mention that methoxy is not indicated for use with people exposed to H.F because the flouride ions
can excaserbate the process of tissue degredation. Recent studies also show that Tolulene which is a product that is used in glues that also is in methoxy may have carcinogetic properties.Perhaps you should not base your studies on the monthly mimms you m ay get onsite lol
gcs of 3
The CPG's we have are written by our Medical Director and are his authority to admister these medications in a given circumstance. This is his authority. Of course each administration is documented to comply with the Poisions Permit. Kind of useless being on hold for a Dr when ur Pt is in Asthma Extremis. "umm Doc, I got a Pt in extremis, may I administer 0.5mg 1/1000 adrenaline IMI??? oh neva mind, shes dead now!"PFO wrote:quote]So your telling me that when you work on a minesite, your giving
schedule 4 and 8 drugs off your own back without contact with your medical diretor? whom ever that may be lol. You will be in a world of hurt if that is the case lol. Interesting that you didnt mention that methoxy is not indicated for use with people exposed to H.F because the flouride ions
can excaserbate the process of tissue degredation. Recent studies also show that Tolulene which is a product that is used in glues that also is in methoxy may have carcinogetic properties.Perhaps you should not base your studies on the monthly mimms you m ay get onsite lol
Re MFX, I did not mention any other therories that may exist on the med as my answer was in relation to the the circumstances surrounding the push to remove MFX from ambulances.
I am aware of the questions as to whether MFX is a carcinogen. Did you have a link to a study, that proves the carginogenic properties - I would be interested in a look. While I have had good success with MFX, I often wonder if it is doing anything to me/us in the long term - in my experince things that smell bad usually are...
We dont get the monthly MIMS - we use eMIMS
Do people still use the monthly paper copy. wow! paper.....what a novel concept.Ambul8 - if u break urself i'll fix u! Maybe...