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  1. #1
    Join Date
    May 2006
    Location
    Red Bluff, CA
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    6

    Default Smelling salts - ammonia inhalants

    When would you use them- if ever. I don't recall any discussion on the use while in class and haven't see nor heard of anyone using them on the "street".

    Are they a No No in our world?

    Thanks
    Alex
    Alex
    FF/EMT-B
    Red Bluff City Fire Dept
    Tehama Cnty Fire Dept - Co. 4

  2. #2
    Join Date
    Dec 2005
    Posts
    333

    Default

    Dr. Bledsoe wrote an article a couple of years ago that was critical of ammonia inhalants. What purpose do they serve? If you ask paramedics who use them, they say something like "to see if the patient is faking" or some other such nonsense. Response to noxious chemicals is nondiagnostic from a medical standpont. It's also a draconian way to wake someone up. Leave them in the drug box.

    Quote Originally Posted by alex104
    When would you use them- if ever. I don't recall any discussion on the use while in class and haven't see nor heard of anyone using them on the "street".

    Are they a No No in our world?

    Thanks
    Alex

  3. #3
    Join Date
    Dec 2003
    Posts
    240

    Default

    Geez, maybe I am showing my age but I have found them to be another tool in the box. There are lots of tricks to check for faking (eyelash brush, hand drop, sternal rub etc). There are some pretty good fakers out there and sometimes the 'reasonable' use of an ammonia inhalant has helped. There are those out there who may be adolescent over use them to 'punish' the person. Deal with the problem person do not limit the use of the tool.

    If you can give me some good reasons medically why the limited use of ammonia inhalants should be discontinued please let me know. I did not get Bledsoe's article. I can always learn. :-)
    27 years and still having a great time in the back of the truck :-)

  4. #4
    Join Date
    Dec 2005
    Posts
    333

    Default

    The article is called "This procedure stinks: the hazards of ammonia inhalant use." I will look for the article, but in the meantime, why don't you give me some good medical reasons why noxious chemicals should be held under a patient's nose? What evidence do you have to show that a response to ammonia inhalants is in some way therapeutic or assists with the differential diagnosis of a patient? I saw them used just last week on a acetaminophen overdose. What it accomplished I am still trying to figure out.

    Quote Originally Posted by leylandauto
    Geez, maybe I am showing my age but I have found them to be another tool in the box. There are lots of tricks to check for faking (eyelash brush, hand drop, sternal rub etc). There are some pretty good fakers out there and sometimes the 'reasonable' use of an ammonia inhalant has helped. There are those out there who may be adolescent over use them to 'punish' the person. Deal with the problem person do not limit the use of the tool.

    If you can give me some good reasons medically why the limited use of ammonia inhalants should be discontinued please let me know. I did not get Bledsoe's article. I can always learn. :-)

  5. #5
    Join Date
    Dec 1999
    Location
    NW Ohio
    Posts
    8,405

    Default

    while not something we have used in a LONG time we did use one yesterday when the pt failed the "arm drop test" and had a pulse in the 80's and a good EKG & SPO2 with a good BS. Narcan bolus no change...so we tried the inhalant............and poofed it did work. Also the pt did pass "my" test ......took the ol nasal airway without flinching. Needless to say the pt was fine and at home today when I stopped to drop off a medication we forgot to leave at the ER.
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  6. #6
    Join Date
    Nov 2002
    Location
    Milford MI USA
    Posts
    419

    Default

    It's another way to awaken someone. I occasionally us them to arouse my ETOH patients (I work in a nightclub, Yes EMS in a nightclub, I get alot of them). I know I gotta do what I gotta do but I prefer them to performing a sternal rub on women.
    Never Forget 9-11-01!!!!!!
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  7. #7
    Join Date
    Apr 2004
    Posts
    250

    Default

    They work. They are harmless. They leave no mark. They are unpleasant, but so is a sternal rub. So what is the problem?

  8. #8
    Join Date
    Dec 2003
    Posts
    240

    Default

    Hi FireMed, I was not trying to be a smartass. I do try to learn from new medicine and change with the times when needed. I do respect other opinions also.
    I guess i use the tool from time to time. Commonly we have residents of the local correctional facility who 'lose conc.' If I can wake them up and cure them it saves having to do CAT scans etc to dx this persistant uncon.

    At some point, some person on the chain is going to have to do some proceedure to convince this person to open thier eyes.

    You can do plenty of tests to see if they are faking but how do you then get them to stop?

    I am open to different ideas. I have to deal with this quite often in my daily pt population.

    For those who do not use them, what do you use for the person faking? that is not a 'noxious stimula'?
    27 years and still having a great time in the back of the truck :-)

  9. #9
    Join Date
    Dec 2005
    Posts
    333

    Default

    They only "work" if your definition of "working" is "making the patient withdraw from the stimulus." What exactly do you think you've accomplished? It rules out NOTHING. And they are not harmless. That was the entire point of Dr. Bledsoe's article. Patients have sustained chemical burns to the eyes and they have triggered asthma attacks in those who are susceptible. The first rule of medicine is "do no harm." You should therefore have a clear rationale for any procedure you perform. What about holding noxious chemicals under a patient's nose benefits the patient? A moderate sternal rub is more than enough to establish that a patient is either unconscious or has an altered level of consciousness and is not just sleeping. What more do you need to know? What evidence do you have that response to noxious chemicals under the nose indicates a benign versus a serious problem? The "problem" is that this is bad medicine.

    Quote Originally Posted by montet202
    They work. They are harmless. They leave no mark. They are unpleasant, but so is a sternal rub. So what is the problem?

  10. #10
    Join Date
    Dec 2005
    Posts
    333

    Default

    In my opinion, it's not our job to determine that a patient is faking (not that response to ammonia establishes that). And if they are faking, so what? Can we agree that we have a psych patient? If you have your doubts, say so to the receiving hospital, but if you allow a patient to sign a refusal based on a response to ammonia, all you've established is that your patient did not have the present mental capacity to sign it.

    Quote Originally Posted by leylandauto
    Hi FireMed, I was not trying to be a smartass. I do try to learn from new medicine and change with the times when needed. I do respect other opinions also.
    I guess i use the tool from time to time. Commonly we have residents of the local correctional facility who 'lose conc.' If I can wake them up and cure them it saves having to do CAT scans etc to dx this persistant uncon.

    At some point, some person on the chain is going to have to do some proceedure to convince this person to open thier eyes.

    You can do plenty of tests to see if they are faking but how do you then get them to stop?

    I am open to different ideas. I have to deal with this quite often in my daily pt population.

    For those who do not use them, what do you use for the person faking? that is not a 'noxious stimula'?

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