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Posted

What good is all the education you receive when you don't carry the drugs that can help treat patients?

Drugs I'm talking about are Cardizem, Mag Sulfate, Ativan, and RSI drugs?

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Posted
  ERDoc said:
Out of curiosity, what kind of central lines are being put in by field providers? Where I'm from the most invasive line is an EJ and this does not constitute a central line.

We are doing subclavian and internal jugular. We are allowed femoral, but most field providers are more comfortable staying above the waist.

Posted
  AZCEP said:

We are doing subclavian and internal jugular. We are allowed femoral, but most field providers are more comfortable staying above the waist.

Just wondering what benefit these are in the field?

I truly don't know and want to :lol:

Posted

My experience with them has been that they are significantly better than IO in the adult patient. Easy to establish, rapid response to treatments, etc.

The adult IO devices have yet to prove that they are reliable, and any quicker than an experienced provider with a central line. Asepsis is a bit of a concern, but the patients that are receiving the central IV are going to be receiving some heavy antibiotics on arrival at a trauma center/cath lab most times.

Just another option to have. Similar to the procedure of RSI, or long bone traction splinting. Other procedures may work, but when the time comes, this may be the only option that will work effectively.

Posted
  AZCEP said:
My experience with them has been that they are significantly better than IO in the adult patient. Easy to establish, rapid response to treatments, etc.

The adult IO devices have yet to prove that they are reliable, and any quicker than an experienced provider with a central line. Asepsis is a bit of a concern, but the patients that are receiving the central IV are going to be receiving some heavy antibiotics on arrival at a trauma center/cath lab most times.

Just another option to have. Similar to the procedure of RSI, or long bone traction splinting. Other procedures may work, but when the time comes, this may be the only option that will work effectively.

Fair enough. Like I said, I just didn't know :lol:

Out of curiosity, is there a big time difference between central line and IO?

Posted

What sort of equipment are you using to start the IJ ans SCs? By starting a line "above the waist," you are at an increased risk of causing a pneumothorax, it is less hazardous to do a femoral.

Posted

We are using 3-5 inch angiocath's for the SC/IJ approaches, and the risk of pneumothorax has been drilled into us.

Yes, we have used the EZIO, the BIG, and the FAST. None have been terribly successful to date, while the central IV's have not had any significant problems in the last 5-10 years.

Each of the adult IO devices have had their own issues. The BIG caused a few fractures in elderly patients. The FAST didn't want to release the infusion tubing from the handle, and the users would remove it from the patient with the handle. The EZIO hasn't been in service long enough to have documented good or bad yet. To date the biggest problem with the EZIO is the need to maintain the angle while drilling, otherwise it spins off the bone surface and bends the needle.

Posted
  akroeze said:

Fair enough. Like I said, I just didn't know :(

Out of curiosity, is there a big time difference between central line and IO?

central lines - slow, require prep and sterile filed can't actually infuse a great deal move via a centrla line than you could with a nice big 14 or 16 in the ACF or EJ

Adult IO is a bit of evidence desert as has been suggested but given the tools now on the market for IO placement in adults i suspect it will be a lot quicker than a central ine

unless 'central line' in USAn EMS terms isn't a central line in UK Emergency Medicine / critical care medicine terms

Posted

The asepsis of the field is more than adequate for the patients that receive the central lines.

Sight prep is no more involved than that for a peripheral IV, and the infusion rate is significantly greater. The whole pupose of using central lines and IO's is to obtain vascular access in patients that you can't get a peripheral IV in. Cardiac arrest and multisystem trauma are just a couple of examples.

An experienced provider, with the line prepped beforehand, will have central access in a similar time frame to IO access. We don't go through the triple lumen progression, so the time frame is much quicker. Just a big needle on a syringe, going into a central vein.

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