tcripp Posted November 14, 2011 Posted November 14, 2011 This obviously wouldn't work for fluid resuscitation as outlined in the OP, but intranasal administration of certain medications is a viable alternative to IV placement as well. Would you believe that not all services allow for IN administration?
paramedicmike Posted November 14, 2011 Posted November 14, 2011 I would believe it. What the rationale given by yours for not allowing it? I'm just curious.
tcripp Posted November 14, 2011 Posted November 14, 2011 I've asked but have never been given an answer. Finally gave up.
HERBIE1 Posted November 14, 2011 Posted November 14, 2011 I know a few people have mentioned about using IO's here, but to me it's my absolute last option. I have never used an IO except for extreme burns or a cardiac arrest situation. In the OP, the patient was supposed to be hypovolemic- no mention of vitals. That's fine, but unless this is an impending arrest, I don't think I would be using an IO. Depending on the BP and/or level of hypovolemia, IO would not be a very efficient way to infuse a lot of fluids. It would also depend on transport times. If the person needs IV medications, then obviously an IO would be more important. I have no problem telling an ER that I could not get a peripheral IV on a patient who has borderline or stable V/S's. My ego is not that fragile- sometimes we just have bad days. I figure I could either make a person a pin cushion and make it more difficult for blood draws and IV's in the ER, or I could admit defeat and do everything else I could.
DwayneEMTP Posted November 14, 2011 Posted November 14, 2011 ...a patent IV is almost always superior to IO... In what way? Herbie, I think someone posted studies on the City before showing that you can actually run equal amounts or more fluid through an I/O than through a peripheral IV if placed and started properly. (No time to look now. I'm packing to go home! Yeah, love you guys, but not enough to research this today!) Dwayne
FireEMT2009 Posted November 14, 2011 Author Posted November 14, 2011 normally I would have started an IV in this patient but the contractures had me confused about where to start said IV. I have no actual status saying that the EJs are only used for Codes and Traumas, it is jjust hearsay but i am relatively nnew and am taking it from the medics i precept through.
DwayneEMTP Posted November 15, 2011 Posted November 15, 2011 normally I would have started an IV in this patient but the contractures had me confused about where to start said IV. I have no actual status saying that the EJs are only used for Codes and Traumas, it is jjust hearsay but i am relatively nnew and am taking it from the medics i precept through. Yeah man, I get that. But you need to be really careful about that. Medics, in my experience, are really bad about coming up with tons of 'logical' reasons for not using valuable tools that they are simply afraid to use. Don't limit yourself on hearsay. You're going to need to step away from the pack now. Decide to make your own path, or you'll be another one of the sheep that make the ERs think that we're all a bunch of yahoo wannabes. Also, watch your presentation, ok? I really love your spirit, but part of it's getting lost in your poor presentation. Write, proof read, spell check, reread and then post, ok? That's really important not just here, but for your professional life in general. There is something about you that makes me really glad that you're here. Good on you for having the balls to participate. Dwayne
paramedicmike Posted November 15, 2011 Posted November 15, 2011 normally I would have started an IV in this patient but the contractures had me confused about where to start said IV. Why did this have you confused? Seriously. Talk this out with us. It'll be good practice for when you're in the ambulance and need to think things through. What about the contractions threw you? I have no actual status saying that the EJs are only used for Codes and Traumas, it is jjust hearsay but i am relatively nnew and am taking it from the medics i precept through. I'm with Dwayne on this one. You need to start marching to your own drum, so to speak. While most of the medics with whom you're working probably aren't going to steer you wrong, you need to be able to answer questions for yourself. Please trust me when I tell you that, "Because <insert senior medic's name here> said so" is NOT a valid answer to anything. There is a time and place for questions. There is a time and place for doing your own research. Please don't be complacent with an answer just because a senior medic said so. Or, for that matter, because one of us said so. I also agree with him on presentation. Spelling and grammar count. With all that being said, why would you, or wouldn't you, start an EJ on a patient needing IV access? Also, I'm curious. Your sig has this phrase: ...I can give a patient a respiraton rate... There's something wrong with this statement. Can you tell me what it is?
HERBIE1 Posted November 15, 2011 Posted November 15, 2011 In what way? Herbie, I think someone posted studies on the City before showing that you can actually run equal amounts or more fluid through an I/O than through a peripheral IV if placed and started properly. (No time to look now. I'm packing to go home! Yeah, love you guys, but not enough to research this today!) Dwayne You may be right about IO fluids but I have never tried it. It is also counter intuitive to me. If I start a 14 gauge IV, I can administer an entire liter of fluid within a few minutes via gravity alone and I'm free to do other things while the bag is draining. IO's need a pressure bag or BP cuff to facilitate the infusion, which tend to need closer observation. In my experience, fluid resuscitation is also not the primary reason you need IV access in a code situation- it's simply a route to give medications. We've also gotten past the days of dumping gallons of fluid into trauma patients, so unless there is obvious frank blood loss, hypovolemia is a relative thing, and probably not our primary concern. I've seen many ICU patients who were fluid overloaded, dealing with ARDS and other issues thanks to 3rd spacing and fluid shifts. I look at this from a perspective where at most, our transport times are15 minutes or so- even to a Level 1 trauma center. If someone has data on this I would love to see it, but I am still going to be reluctant to do an IO on any patient who is not at the very least obtundant or completely unconscious.
FireEMT2009 Posted November 15, 2011 Author Posted November 15, 2011 Yeah man, I get that. But you need to be really careful about that. Medics, in my experience, are really bad about coming up with tons of 'logical' reasons for not using valuable tools that they are simply afraid to use. Don't limit yourself on hearsay. You're going to need to step away from the pack now. Decide to make your own path, or you'll be another one of the sheep that make the ERs think that we're all a bunch of yahoo wannabes. Also, watch your presentation, ok? I really love your spirit, but part of it's getting lost in your poor presentation. Write, proof read, spell check, reread and then post, ok? That's really important not just here, but for your professional life in general. There is something about you that makes me really glad that you're here. Good on you for having the balls to participate. Dwayne Yea, I have realized in my time here precepting for school that using other medics advice is helpful but at the same time might steer me down the wrong path, especially when they try to pick my brain and I end up getting in my own way too much.... Had that happen a bunch of times but thats an obstacle im working to overcome and a thread for a different day. I try and get a ED doc or whatever specialty doc I can talk to's advice so that I can better think and rationale things. My OMD for my school comes in every month and challenges us on drugs making us give him rationale why things work the way they do and why they don't work on some things. I really learn alot from that and him overall., I appreciate the constructive criticism. I am trying to improve my forum rapport through breaking up my posts and communicating more fluidly. Why did this have you confused? Seriously. Talk this out with us. It'll be good practice for when you're in the ambulance and need to think things through. What about the contractions threw you? I'm with Dwayne on this one. You need to start marching to your own drum, so to speak. While most of the medics with whom you're working probably aren't going to steer you wrong, you need to be able to answer questions for yourself. Please trust me when I tell you that, "Because <insert senior medic's name here> said so" is NOT a valid answer to anything. There is a time and place for questions. There is a time and place for doing your own research. Please don't be complacent with an answer just because a senior medic said so. Or, for that matter, because one of us said so. I also agree with him on presentation. Spelling and grammar count. With all that being said, why would you, or wouldn't you, start an EJ on a patient needing IV access? Also, I'm curious. Your sig has this phrase: There's something wrong with this statement. Can you tell me what it is? The contractures through me due to the fact that I have started IVs in the ACs of patients and as soon as they bend their arm, BAM its occluded and It no longer runs fluid. I was confused because I figured no matter where on the hand or AC I can start the IV it would be occluded by the contractures. I have not had much luck with forearm veins but did get a nice stick today on the back side of one. I would start an EJ on a patient needing IV access. The patient in this scenario was not extremely hypovolemic, but could have definately used some fluids to help replenish some of the fluids he had lost over the time frame of his sickness. I have been told EJs are always for last resorts by every medic I have worked with in the field that is why I am hesitant. Also I have never started one bbefore so it is alien to me right now. I would perfer to use the response I gave to Dwayne about listening to other people as the response to your question instead of retyping it all over again. About my status, It is meant to be seen as I can make someone breath, whether by face mask, ET tube, LMA, combi-tube, king airway, etc. I have always had the motto that is set as my signature and that is why I placed it there. I should update the wording of it cause apparently I did not proof-read that very well either. ABCs always come first and you can't have one without hte one prior and all three has to be present to have life. Hopefully that clears it up. If not please tell me how to better correct it. Thanks Dwayne and Mike. FireEMT2009 1
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