Tunnel Vision, ignorance or both

[ccmedoc]

So just to clarify, the majority of you would go for an EJ before you would administer glucagon?

We don't use glucagon anymore..I'm not sure why, it was stopped long before I arrived..

I have had an E.J. IV with a saline lock in awake and alert patients. No problem. The majority of patients, in my experience, do not complain of excessive pain..during or after. I have actually had patients with bad veins request this site.. :shock:

Being that the E.J. is relatively superficial (relatively)..I have never seen a cannulation dangerously near the airway. Hematomas are a different story and you should be careful. I can't see starting an E.J. and then pulling it for a refusal. I would want to monitor for a couple minutes before releasing the patient.

[OHMEDIC187]

How altered was the patients mental status? Was he awake and disoriented? Was he unresponsive? A BGL of 52 doesnt seem too bad to me. Although, I know different people respond differently to a BGL of 52. More patient information might help understand why he went with the EJ, opposed to just going with glucagon. For me, the EJ is the last resort.

[Ridryder 911]

That was not "tunnel vision" that was bull headed ignorance! Majority of services as well most medics with experience realize if you cannot obtain IV access by the second time, then you will not be able to.

If you are able to administer Glucagon, then that would be the next step, or even oral glucose bucossal and monitor the airway closely. Yes, be careful of aspiration but a Paramedic should be able to suction and place the patient in lateral recumbent position and again closely monitor their airway.

I much rather prefer starting an EJ over distal IV sites such as in the feet. Diabetics are known to have phlebitis and other complications r/t IV's in the feet, especially when using hypertonic solutions is risky if infiltration occurs. EJ is just another peripheral site, although one has to be careful if infiltration does occur, yes swelling may occur thus the reason one should only attempt once only on one side.

[firedoc5]

I believe that tunnel vision is a human response that everyone has, but in most jobs, especially EMS it's something you have to condition yourself to overcome. And I've seen those that has years of experience that still tend to do it.

But to me, FOUR attempts in one area? Sounds like he was bound and determined to get the stick probably in the same place he's always gotten it before of other patients. Maybe if he looked else where he's feel out of his comfort zone. I've seen medics that would not try anywhere else but AC. I'd explain to them that there are other sites available, and sometimes those are easier. But they were "taught" in class that the AC was had the highest percentage rate of success. The lab tech hated it, that was their spot.

[emt322632]

The ONLY time we are allowed to even think about starting an EJ is during an arrest. Personally I wouldn't ever think about starting an EJ on a person who's awake.

As has been noted, diabetics may tend to be a bit combative. I had a hard enough time starting a peripheral line on a combative 86 y.o. woman once, can't imagine trying for an EJ.

[Ridryder 911]

The ONLY time we are allowed to even think about starting an EJ is during an arrest. Personally I wouldn't ever think about starting an EJ on a person who's awake. .

Why not? It is a peripheral IV. I could see if the patient was combative but otherwise I have no problem sticking one in the neck. I have stuck in worse places.

R/r 911

[ccmedoc]

I have stuck in worse places.

R/r 911

He he he...Yeah, I've seen IVs in these places on burn patients.... :shock: :pale:

You know they would rather have one in the neck!!

[emt322632]

Why not? It is a peripheral IV. I could see if the patient was combative but otherwise I have no problem sticking one in the neck. I have stuck in worse places.

R/r 911

Maybe it's just the region I was "brought up" in. I haven't really had this sort of situation arise, nor heard of this situation before.

I may have to talk to a few of my local ER docs and see what their opinion would be, often times opinions around here are a tad bit conservative, this is definitely something I would consult med direction for.

Maybe it's just my comfort level though.

[spenac]

I've started EJ's on patients in the ER when they could not get an IV. Why me you ask? The nurses there are not allowed to do it, only the doctor can. We are allowed to continue working off our protocols while assisting ER staff. Thus if doctor is not immediately available and patient is in bad shape we can help the nurses out. I have never understood why an RN is not allowed this but we are. Who knows? Only the shadow knows.

[Richard B the EMT]

BLS is monitoring the proceedings. What is an "EJ"?

And now, BLS commentary: I have seen some very good Paramedics try twice on each arm to start an IV, and fail, and then the partner makes the attempt. Usually, somebody gets the good "flash", and then they continue with the rest of the protocols.

Nobody hits it good all the time. If the Paramedic under discussion repeatedly tried to get the IV started, and didn't shift to a slightly different location, or the other arm, perhaps it is not "tunnel vision", but bullheadedness instead? "I was taught to start an IV with the needle entering at this specific inch of the arm. I cannot, indeed, I WILL NOT fail in my endeavor to start the IV exactly at this spot!"

(PS: Spell Check confirmed the spelling of "bullheadedness", which surprised me immensely)