Leaderboard

Thanks for the feedback everyone, appreciated. I’m extremely new to cannulation, my second IV ever was the other day on this patient who was in sever anaphylaxis which rebounded for 2 hours, he was semi conscious and dropped his BP so I just went for the 2 biggest veins I could find. Live and learn I guess, I’ll know for next time! Thanks.

I think perhaps one of the issues with using the "vein of shame" is not that you have placed an IV in it, it's that we have placed an IV in it when there are just as good alternatives lower down, sorta shows we didn't really have a proper look

I disagree. The more proximal the better. It's closer to where the fluids and drugs need to go (adenocard, anyone?), and the closer your IV is to the trunk of the body the less the catheter moves around when the patient flails. There is no such thing as the "vein of shame" in an emergency.

The caveat with the difference with B/P in disecting thoracic aortic aneurysms is dependent on whether it extends to the brachiocephalic or left subclavian artery. Type A aneurysms start fromt he base of the aorta and extend to the apex of the arch. Type B's are fom the apex of of the arch to the ?? diaphragm (escapes me atm) For there to be a difference in B/P the aneurysm needs to extend to the vessels i mentioned. The loss of vessel wall integrity and reduced resistance in the brachiocephalic (read as right arm) for example, would show as a difference in B/P with the left arm as the left subclavian (read left arm) is not compromised. Its the effect of the difference in peripheral resistance by the vasculature of the right or left arm. What i don't know is its specificity like i said, pub ammo, nice to know, not very useful in a real world setting.

No disrespect meant to you brother. I love to see you participating! Not many do... My comment was in reference to those that repost the 'fireman's prayer' and such shit. You know, the one that ends with, "You've done your time in hell.." What a bunch of crap. They see that fire and EMS are in the 'hero' business, get a basic cert and then suddenly every bullshit cliche' in the book applies to them. They are over worked, over tired, covered in blood, yadda yadda, or at least will be if they ever get off of the couch and actually go and get an EMS job some day. Your post certainly didn't fit this criteria, I only made the comment because I've made it before and didn't want to look like a hypocrite by turning around and doing it myself. Yours were appropriated, and even if, in my opinion, they weren't? Screw it...mine is just one opinion. Thanks for participating man...it's cool to have you here. Dwayne

I think you did fine, caught everything. One thing Iv gotten into the habit of with any chest pain is a BP on both arms.

There are still 3 other extremities.... Also, just because you have a proximal infiltrate doesn't mean you can't still go distal. How do you think the blood still circulates when you blow a vein? There are tons of collaterals, and big ones too. I agree it wouldn't be my first choice to go more distal, but it's a bit much to suggest the distal arm is vascularly dead after you puncture the cephalic vein.

That BP is pretty worrisome. I would transport for evaluation. So.. good job. As far as what else you could have done.. more detail on medical history and history of present illness. Has she ever felt like this before? What did she do? Any change in life circumstances? diet? Dysuria? Constipation? Does she live alone? What does her house look like? Is she in a well ordered "healthy" environment, or does she seem overwhelmed by things? Ovarian cancer is usually a bad one. How long ago was it diagnosed? What treatment did she get? The more you find out about this patient, the better it will be for you to come up with a clinical picture, if for no other reason than to make yourself a better provider. Can you follow up with the ER and find out what if anything was going on. Think of it as a puzzle that you need to figure out. Do this for every patient. Some people have 1 year of experience 5 times. Be one that has 5 years of experience. All the best

There is a Fremont County Iowa Flood Support Page on facebook. I am unable at present to copy and paste the link. Click on any of the pictures and you will get a view of what it looks like, that is if you want to see homes, farmland and highways under water or devastation. I get to clean the place every day in part we have a 11 month old and 10 year old granddaughters living here along with their parents. I do the cooking and rotate who does dishes and laundry. None of the 10 families here sleep very well at night so I am not alone in that. All of us walk every day and part in part of us living here for free we donate our time to mowing the grass and cleaning. Also our fire/rescue department was made part of the local fire/rescue near here and we being non working individuals and available are taking over their calls when local personnel are unavailable, including transfers from the local community hospital to Omaha or Council Bluffs. I am bored because I am use to working 8 hours a day 40 hours a week every week and to suddenly not have that! I have started crocheting after thirty years. Also I am trying with my friend to work on another book, but this wireless card and connection I have here at camp is incredibily slow. We all get together about once a week and talk and listen to all the rumors that abound and get a good laugh over it. We are keeping a sense of humor and work to try and keep the children in a sense of normalacy as much as possible. Making new friends too boot. Yes there are days where we do not care to associate with anyone and we get thru it. I have found out that I can relax just watching the hummingbirds fight over the feeder I put up and shut off the i phone and pager. I figure I have lost about ten pounds which is great I could loose more, so I can work on that as well.