paramedicmike Posted November 15, 2011 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?
DFIB Posted November 15, 2011 Posted November 15, 2011 Oh, I like this topic. I've yet to do an EJ and I've done 2 IOs on live patients with one of them being called "over zealous". I used it on a CHF exacerbation patient. Not to hijack this thread too much, what is your criteria for using the more invasive access? EJ? EJ? I looked it up. Duh!
DFIB Posted November 15, 2011 Posted November 15, 2011 When you guys say leg, are you refering to a popliteal line?
2Rude4MyOwnGood Posted November 15, 2011 Posted November 15, 2011 When you guys say leg, are you refering to a popliteal line? I would hope not! If you are referring to all of the talk about IOs, they go into the Tibia.
DFIB Posted November 15, 2011 Posted November 15, 2011 I would hope not! If you are referring to all of the talk about IOs, they go into the Tibia. Nope. Not tthe IOs. Since I wasn't thinking of drilling a bone, any thoughts on a popliteal IV?
2Rude4MyOwnGood Posted November 15, 2011 Posted November 15, 2011 Nope. Not tthe IOs. Since I wasn't thinking of drilling a bone, any thoughts on a popliteal IV? That is an artery, pretty dangerous to go digging around in there. Ive only seen one person, the EMS supervisor, go for an artery (brachial). It wasnt pretty. I would absolutely drill and IO before i went for an artery.
paramedicmike 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.
DFIB Posted November 15, 2011 Posted November 15, 2011 That is an artery, pretty dangerous to go digging around in there. Ive only seen one person, the EMS supervisor, go for an artery (brachial). It wasnt pretty. I would absolutely drill and IO before i went for an artery. Nope. Not the artery. Since I wasn't thinking of taping an artery, any thoughts on a popliteal IV? I think nurses can put in an arterial cath to monitor BP in the radial artery but it may be a Doc. level procedure.
scott33 Posted November 15, 2011 Posted November 15, 2011 Ive only seen one person, the EMS supervisor, go for an artery (brachial). It wasnt pretty. I would absolutely drill and IO before i went for an artery. What do you mean by 'go for' and 'went for'? You don't mean intentionally do you?
systemet Posted November 15, 2011 Posted November 15, 2011 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.
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