Tunnel Vision, ignorance or both

[theotherphil]

I've done a few EJ's now but all were on Cardiac Arrest patients. I don't think I'd ever go EJ on a Hypoglycaemic. We treat and discharge at scene most of the time with IV Glucose and a referal to their own Doctor. I'm not sure I'd be comfortable doing an EJ and then removing it to leave the patient at home. I'd certainly use EJ as my first choice in medical/ trauma emergencies if it were time critical though. Never had an ACF that I've missed though.

[DwayneEMTP]

I don't think I'd ever go EJ on a Hypoglycaemic. We treat and discharge at scene most of the time with IV Glucose and a referal to their own Doctor. I'm not sure I'd be comfortable doing an EJ and then removing it to leave the patient at home.

Why is that? I'm not challenging you, just trying to figure out what I'm missing...

Dwayne

[theotherphil]

Why is that? I'm not challenging you, just trying to figure out what I'm missing...

Dwayne

I just can't see the immediate need for siting an EJ IV for a hypo. We carry glucagon that we can fall back on should we need to. I really wouldn't like to leave a patient for 30 mins or so after removing a 16-14g from their neck for fear of haematoma. If it's gonna bleed, it'll be my luck it'll be significant. It'd be a different matter if I was going to transport to hospital as they have the staff and resources to monitor the patient after IV removal.

[Ridryder 911]

I just can't see the immediate need for siting an EJ IV for a hypo. We carry glucagon that we can fall back on should we need to. I really wouldn't like to leave a patient for 30 mins or so after removing a 16-14g from their neck for fear of haematoma. If it's gonna bleed, it'll be my luck it'll be significant. It'd be a different matter if I was going to transport to hospital as they have the staff and resources to monitor the patient after IV removal.

Okay, maybe I am missing something. EJ is nothing more than an peripheral site. D/C it just alike another IV site, place firm pressure and dressing on it. So if they have hematoma> Place some cold pack on it, just alike any other IV. again, its just an IV.

R/r 911

[Richard B the EMT]

Again, as a BLS provider, I ask for a clarification.

You say "hematoma", which is the dollar fifty word meaning "bruise". Don't you mean an ongoing bleed, as in "Hemorrage"?

(Spell Check allowed these spelling- "hematoma", and "hemorrage". I admit uncertanty if they are spelled correctly, but at least you know I tried to address it.)

[DwayneEMTP]

Again, as a BLS provider, I ask for a clarification.

You say "hematoma", which is the dollar fifty word meaning "bruise".

Hematoma could more accurately be thought of as an encapsulated bleed. It is a bleed, yes, but contained in a pocket created by the tissue around it.

A bruise would be a contusion. Still some bleeding, but most often dispersed throughout the local tissue without creating the 'pocket' necessary to make it a hematoma.

Hemorrhage, which I think most correctly simply means bleeding. As in 'internal hemorrhage' or 'uncontrolled extremity hemorrhage' etc. Bleeding as in the two examples above, but will likely need intervention to be controlled as it's not limited by tissue or 'capsule' space.

Does that help?

Dwayne

[Dustdevil]

Speaking of tunnel vision, I'm not absolutely convinced that hypoglycaemia was this guy's main problem. Did it turn out to be just simple hypoglycaemia, or did the ER find something more?

[DwayneEMTP]

Good God! You're alive!

I thought maybe you'd gone the way of Elvis while in Nashville....whew...

dwayne

[mshow00]

I am just a basic so don't take what I am about to say as gold, but I believe as it stands now in our SOPs we are only allowed to start EJs in arrest pts. And as of this moment (new SOGs coming soon) our SOPs also do not allow for us to carry or use glucagon. We carry d50 and oral glucose. And even though the new SOGs will allow is to carry it it will be a system specific carry. So we in the private sector still will not carry it.