Lock or Line?

[mrmeaner]

Where do you work that you have to call for something as simple as an IV? Are you and your coworkers so incapable as providers that you have to call for everything?

There are some places that are so medical order heavy that the EMTs and medics call for everything. I have no idea if this is the situation medictx is in, but in services like this the protocols and orders lead them to make no independent decisions. I don't know if it's because the Med. Directors have been burned before, don't trust what they can's see, don't like medics, etc. The end result is a non-productive EMS system and disgruntled and/or poor providers.

[DwayneEMTP]

I stand corrected...evidently is was what it appeared to be... :oops:

[paramedicmike]

There are some places that are so medical order heavy that the EMTs and medics call for everything. I have no idea if this is the situation medictx is in, but in services like this the protocols and orders lead them to make no independent decisions. I don't know if it's because the Med. Directors have been burned before, don't trust what they can's see, don't like medics, etc. The end result is a non-productive EMS system and disgruntled and/or poor providers.

I know. That's why I asked. I want to know where he is so I know who and where to avoid.

[Doczilla]

The point I was trying to communicate is that: 1) starting an IV should not be an issue of convenience. 2) Protocols and standing orders are in-place to be followed. If a doctor states that when you start an IV and he/she wants fluid hung, then thats what you do. If he/she states you can lock off the catheter without fluid, then thats what you do.

It's not your decision to make, you are in-place to follow doctors orders and not do something just because its one more thing to hold or get in the way.

No protocol can cover every conceivable situation that a paramedic will encounter. Some amount of independent thought is required. As a medical director, I leave this type of decision up to the medics. They have standing orders for vascular access to employ as they see fit. I have to depend on their good judgment.

'zilla

[tniuqs]

As I typically do, I checked this thread as many others, from last to first posts.

My first impression of this thread was "LOCK and LOAD" what was I thinking !

Working in flight a few times, I have always found that a back up i.e. hep/saline locked line was a great idea, 2 lines for any potential serious patient is my personal protocol, venous access is all my medical director intends, how we get there pacifically doesn't really matter.

For the OP, to answer your query, most patients in ER are NPO and most that warrant a line are as per normal fluid maintenance, generally speaking about 125 cc/hr. Sometimes (I believe) this has a tendancy to keep the patient in the bed as do those french designer backless gowns.

cheers

[Scaramedic]

The point I was trying to communicate is that: 1) starting an IV should not be an issue of convenience. 2) Protocols and standing orders are in-place to be followed. If a doctor states that when you start an IV and he/she wants fluid hung, then thats what you do. If he/she states you can lock off the catheter without fluid, then thats what you do.

It's not your decision to make, you are in-place to follow doctors orders and not do something just because its one more thing to hold or get in the way.

First off welcome to the city. We have a fine group of lads and lassies here. They are willing to answer questions and debate a host of issues. They do not approve however of ad hominem attacks on our members. So please refrain from attempting to bully your way into our home and insult our family.

Now to the the issue at hand. Sadly your system must be what we in the Sunny NW refer to as a 'Mother may I' system. In other words your protocols are spelled out in a five hundred page manual or you must call Medical Control for the simplest of procedures. This is a sign of a very weak system. A system that does not trust it's Medics to make proper judgments on the patients condition and interventions necessary.

My system for example has a protocol Manual of about 90 pages. They are seen as a guideline for the Medics to follow. Our Medical Director has left us a very wide latitude in the treatment of our patients. Why? He believes that the education we have received is sufficient to use our judgment rather than paw through a book looking for treatment regimes.

In our protocols for IV access it simply states 'I.V. TKO or saline lock.' If fluids are needed it is left up to the Medic to decide when and at what rate. This is a sign of a strong system. A system that EDUCATES rather than TRAINS it's Paramedics. A system one can be proud to work in.

By your statements so far it seems you are 'cookbook' Medics. You follow the recipe without thought or judgment. That is once again, the sign of a weak system and one I would not be so proudly boasting about on a forum that respects professionalism via education. A forum that is trying to further the profession of EMS not leave in the 70's with Johny and Roy. So you can get on the horn with Dixie and Dr Brackett if you like. The rest of us are using our education to further patient care and advance our chosen profession.

PERSONAL ATTACKS REMOVED - ADMIN

[tniuqs]

FLASHBACK:

Thanks Scara .... Oh yes that Dixie (with the big hair) was how you say .... oh yeah

HOT !

[align=center:a96a6d39ef] :shock: :shock: [/align:a96a6d39ef]

[Dustdevil]

As I typically do, I checked this thread as many others, from last to first posts.

As did I. Seeing what this thread turned into, I was sure that there was some gross misunderstanding that I had missed earlier on that, if I just went back and found it, this would all make sense. I thought for sure that medictx had simply overlooked a key point and consequently misspoke. I thought, 'no way is s/he saying what it sounds like s/he is saying!' Obviously, I was mistaken.

This reminds me of a "Back To The Future" scenario, where Johnny Gage has somehow stumbled into a worm hole, transporting him thirty-seven years into the future, and he finds himself appalled that laymen with 12 weeks of first aid training are practising medicine autonomously in the streets, wholly unaware of how the times have changed.

I can relate to that. I too am appalled. But, I digress.

Either medictx is not really a medic (most likely), or else s/he is a rookie with the Houston or Dallas FD (less likely, but possible). If s/he is a medic, s/he has to be an A&M grad. s/he is certainly not representative of the state of EMS in Texas.

[Asysin2leads]

My vote is paramedic student who just learned venipuncture.

When it comes to a lock or line, there are for more important things to debate when it comes to patient care. However, if you want to get technical about it, even our protocols here in NYC state "0.9% saline at KVO or saline lock".

A bag is a nuisance. It gets tangled and increases the risk of accidently ripping out the IV. On the other hand, even in a needless system, repeatedly having to draw up flushes and use them increases the risk of injury. I guess you have to just use like, judgement and stuff in each situation.

(BTW, its specific. Pacific is an ocean).

[DwayneEMTP]

I'm finding that my new touchy feely approach to giving all n00bys the benefit of the doubt still has a few bugs to be worked out.... :?

Dwayne