Pushing D50

[crotchitymedic1986]

I stand by my statement, as most Paramedics have average IV skills at best. Work some time in a pediatric hospital or as a phlebotomist at a busy hospital, and you will dramatically watch your skills improve. Are there some patients who do not have ANY venous access, yes, but most of those are chronically ill to terminally ill, and usually have a port in place. Your average overweight diabetic patient has veins, you just forgot your vein anatomy diagram, and are relying on sight instead of feel. One of the things I always did with newbies was to blindfold them and make them find veins on their partner by feel, with no use of sight. And now that you can buy those vein finding lights, there is no excuse to poke holes in people's bones. 20 years from now, the next generation of EMS professionals will look at IOs like we do lobotomies or intracardiac injections.

Edited September 23, 2009 by crotchitymedic1986

[ERDoc]

I stand by my statement, as most Paramedics have average IV skills at best. Work some time in a pediatric hospital or as a phlebotomist at a busy hospital, and you will dramatically watch your skills improve. Are there some patients who do not have ANY venous access, yes, but most of those are chronically ill to terminally ill, and usually have a port in place. Your average overweight diabetic patient has veins, you just forgot your vein anatomy diagram, and are relying on sight instead of feel. One of the things I always did with newbies was to blindfold them and make them find veins on their partner by feel, with no use of sight. And now that you can buy those vein finding lights, there is no excuse to poke holes in people's bones. 20 years from now, the next generation of EMS professionals will look at IOs like we do lobotomies or intracardiac injections.

Wrong as usual, Crotchity. There are many pts that EMS sees that are chronically ill and have sclerosed veins from medications/multiple IVs. Yes, there are even overweight diabetics who do not have any veins. I've seen plenty where even with ultrasound, no peripheral line could be placed. You may just be better than the rest of us. There are times when it is appropriate to use an IO, even in the hospital.

[pamedic152029]

when i come across this problem i give glucagon intranasally.... works fast. then i can go back and see if i can find a i.v. site.

[AnthonyM83]

Crotchity, again not saying prehospital personnel don't seem to have lower IV skills.

But in reply to: "If you have to use an IO, you have poor IV skills. "

Yes, but that's more due to the under training. Sometimes we're going to have to deal with it and use alternative methods.

I pride myself in IV and airway skills because I made the most of clinical time. But even with that, I only get a limited number of hours to train with real patients. I've even seen my skills go down slightly from first to last day of internship (because I was only doing a few a day versus two dozen with live feedback from experienced nurses).

I guess my point is, even if you want to be the best and take your education and work seriously, you're limited. Medics can't get hospital jobs and start IV's around here. I guess I could put the investment into a whole phlebotomy course eventually when I get out of debt from medic school in awhile.

[tniuqs]

Ah again both feet.

='crotchitymedic1986' date='23 September 2009 - 06:36 AM' timestamp='1253712968' post='224006']

I stand by my statement, as most Paramedics have average IV skills at best.

A gross generalization, funny but in some rural facilities EMS are called to pop a line in for the medical staff ... put that in your pipe and smoke it.

Work some time in a pediatric hospital or as a phlebotomist at a busy hospital, and you will dramatically watch your skills improve.

Well interesting again because here in my hood phlebotomist is a intensive 2 week traing course and the ante cubuital fossa is the only access they look at- besides, every time I get blood drawn they can't and do not look anywhere else.

hint: I have ropes all over my hands, I am pasty white and if one turns of a light in the room when I have my shirt off one does not need an xray machine.

Are there some patients who do not have ANY venous access, yes, but most of those are chronically ill to terminally ill, and usually have a port in place. Your average overweight diabetic patient has veins, you just forgot your vein anatomy diagram, and are relying on sight instead of feel. One of the things I always did with newbies was to blindfold them and make them find veins on their partner by feel, with no use of sight

.

Yea like most previously health kids.

Vein anatomy is always different in every patient as most patients just don't read greys anatomy book your obese diabetic does have veins buried deeply under layers of adipose tissue so do you go blind and hope its a vein or maybe its a tendon ?... and quite the visual there a blindfolded student with a cath in hand .. umm this would not be the way I would teach, use all one senses.

And now that you can buy those vein finding lights, there is no excuse to poke holes in people's bones. 20 years from now, the next generation of EMS professionals will look at IOs like we do lobotomies or intracardiac injections.

Inter cardiac worked in Pulp Fiction and the newest trend is ICP probe stat in head injuries.

Disagree ... do you actually KNOW whats going on in IRAQ and AFGAN land ? When a critical patient arrives at the trauma center door btw (when IOs really count as peripheral veins are flat when one is bleeding out) ...

Its 2 IO one in each humerus just why play around when one has immediate access to treat with very few complications and faster to the door of the OR the better the outcome in fact messing around on scene could be increasing Mort Morb .... meh this attitude and your crystal ball needs some serious re evaluation as Wars Zones these are the place's we historically improve emergent medical care .. crotch please go back to the medical history books, Nam, Korea, Falklands as these events changes the way we treat and think and what we will in future be practicing on the street, we as Public Corpsmen were an invention from these "adventures" not the other way around.

Oh late note AHF in PALS suggests that if a perf line can not be established in a kid in under 90 seconds then IO IS the Preferred route ... you know like LIFE SAVING, after working in ICUs I can tell you with a great deal of confidence that scalp veins and butterfly's are a constant challenge/ PITA unless the kid is absolutely flat.

cheers

[P_Instructor]

when i come across this problem i give glucagon intranasally.... works fast. then i can go back and see if i can find a i.v. site.

What is the therapeutic effect time? Aren't you afraid of any aspiration from this, or does it actually mistify enough to get it all in?

[stcommodore]

What is the therapeutic effect time? Aren't you afraid of any aspiration from this, or does it actually mistify enough to get it all in?

IN Glucagon is within our protocal just as much as IN Versed, Valium, Fentanyl, etc.

[P_Instructor]

IN Glucagon is within our protocal just as much as IN Versed, Valium, Fentanyl, etc.

Understand within your protocol. Just wondering how fast glucagon works given this route as compared to IM.

[crotchitymedic1986]

Also remember that D50 can be given orally, if conscious enough, and that your average 12oz canned soda has 39 grams of sugar versus the 25 in D50. As stated previously, there are a small percentage that do not have veins, but I will bet that if you followed up on all your diabetic IO patients, you would find that 99% of them had a peripheral IV started and the IO removed in the ER, shortly after you left. It is unethical to inflict that kind of wound on a diabetic unless they are in cardiac arrest, especially when it is not necessary. Quit being lazy, improve your skills.

[chbare]

[quote name='crotchitymedic1986' date='01 It is unethical to inflict that kind of wound on a diabetic unless they are in cardiac arrest, especially when it is not necessary.