FireEMT2009 Posted November 15, 2011 Author Posted November 15, 2011 ABCs do always come first. Define respiration. Compare that to ventilation. What's the difference between the two? How does that difference apply to what you're trying to say? Ventilation is the act of moving air in and out of the lungs from the outside in or vice versa. Respiration is the act of the transferring of oxygen molecules to carbon dioxide molecules which is what happens at the aveoli-capillary level. I need to fix my signature cause I can not truly cause respiration due to having no control over a person's respirations. I can cause them to ventilate. I will correct it ASAP. Thanks Mike! FireEMT2009 1
DFIB Posted November 15, 2011 Posted November 15, 2011 (edited) In a few places paramedics can start arterial lines. This is usually reserved for true critical care paramedics, and the lines are used for invasive pressure monitoring, not for med / fluid administration! If you were to have problems with peripheral IV access, and you need to give a medication desperately that can't be given by any other route than IV / IO, then the IO seems like a good solution. If for some reason this isn't an option, if your scope allows it, a central venous line would be the next obvious step. Very few places do many of these any more, as the IO works pretty well. Giving meds arterially presents a host of problems. The drug has to pass through the distal tissues before it can enter the venous tissue, and will be present in much higher concentrations there than when given intravenously / systemically. There's also a chance they get partially metabolised. Not to mention, that starting an arterial line on purpose is a lot more difficult than starting a venous line on purpose. If you can not get an IV started and meds are desperately needed can't you inject directly into the vein or go for the bum? How about a sublingual injection? Absorption should be pretty quick SL. Edited for sp. Edited November 15, 2011 by DFIB
2Rude4MyOwnGood Posted November 15, 2011 Posted November 15, 2011 There is a popliteal vein, too. Initiating an a-line in the field is outside of your scope of practice. If your supervisor intentionally went for an artery, no matter where it was, he was wrong to do so. I did not know there was a popliteal vein, although it makes sense now that i think about it. What do you mean by 'go for' and 'went for'? You don't mean intentionally do you? Yes, it was intentional....and unsuccessful.
paramedicmike Posted November 15, 2011 Posted November 15, 2011 If you can not get an IV started and meds are desperately needed can't you inject directly into the vein or go for the bum? How about a sublingual injection? Absorption should be pretty quick SL. Edited for sp. Injecting directly into the vein is called mainlining. It's what heroin addicts do. In every place I've worked it has been frowned upon or just outright not allowed. In one place I think it was even illegal. As for sublingual injections, well, that would just be painful. Would you open your mouth for someone wanting to stick a needle under your tongue?
DFIB Posted November 15, 2011 Posted November 15, 2011 (edited) As for sublingual injections, well, that would just be painful. Would you open your mouth for someone wanting to stick a needle under your tongue? Depends, If it is a needle under the tongue or a 20 cc syringe up the butt ..... hmmmm ..... the needle doesn't seem that bad. Injecting directly into the vein is called mainlining. It's what heroin addicts do. In every place I've worked it has been frowned upon or just outright not allowed. In one place I think it was even illegal. I am interested in why IV injection would be called "mainlining" among healthcare professionals and be frowned upon or made illegal. I understand phlebitis is a concern but can be avoided by proper dilution of the meds. Would you please explain. Edited November 15, 2011 by DFIB
flamingemt2011 Posted November 15, 2011 Posted November 15, 2011 (edited) You can always stick an ETT in their anus, and push any med you need. If you are conscious enough to refuse a SL stick, you probably do not need an IV. But if your IV success ratio is less than 95%, it is more about you than it is the lack of veins.And if you have vein big enough to "mainline" in, then you should be able to get a 20 or 22ga IV catheter in it as well. Edited November 15, 2011 by flamingemt2011
DFIB Posted November 15, 2011 Posted November 15, 2011 I don't think I would mind the sublingual needle that much. I means they could inject right under my jaw. Seems preferable to violating my "exit only" orifice.
HERBIE1 Posted November 15, 2011 Posted November 15, 2011 We used to do SL injections for Narcan- worked well. Now they want us to use IN. Sorry, but I have not had good luck with the IN route. Too many factors that impede the absorption of the drug.
scott33 Posted November 15, 2011 Posted November 15, 2011 Yes, it was intentional....and unsuccessful. I am still baffled as to why any EMS provider would intentionally wish to cannulate an artery.
nypamedic43 Posted November 16, 2011 Posted November 16, 2011 I am baffled as well about why anyone would want to cannulate an artery. DFIB...the popliteal is behind the knee. Why would you want to start one there? and as for a sublingual injection?? I've never heard of that. Well except in the dentists office when he is poking me with needles in my gums but never under my tongue. And all I can muster in my head to say to flaming is this....WTF DUDE!!!! I'm pretty sure a tube in thier butt is about as effective as giving meds down a tube in thier lungs...
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