# EJ's



## trauma1534 (Dec 18, 2006)

I was performing an EJ last night, and I had major problems with this one.  Do you have any better suggestions as far as tourniquet placement for this precedure other than around the neck???!!!


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## FFEMT1764 (Dec 18, 2006)

I have started numerous successful EJ's without the use of a tourniquet, in fact I think they are contraindiacted. I have always been taught and heard that if you cant see it you cant sitck it, and whip the adult IO device out.


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## Ridryder911 (Dec 18, 2006)

When they discuss "tourniqueting" for an EJ of course they do not mean literally as such. Tourniqueting is performed by two approved measures: 
Applying pressure proximal or closure to the chest and allowing the vein to engorge and the same time if possible to place in a slight trendelenburg position will allow the vein to engorge. 

The other method I use quite often is the "stethoscope" method; where you place your stethoscope around the neck (like you were wearing it) and allow the tubing to drape across the neck near the supraclavicular area, this too allows the vein to engorge. 

Some patients (especially hypovolemic) may not have visible external jugular distention; so having a very good in-depth of anatomy helps. 

R/r 911


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## jeepmedic (Dec 18, 2006)

13 loops in the noose. uh I mean Tourniquet.


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## Airwaygoddess (Dec 18, 2006)

Jeepmedic, I swear you are just a little nuts for therapeutic levels!!


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## jeepmedic (Dec 18, 2006)

Airwaygoddess said:


> Jeepmedic, I swear you are just a little nuts for therapeutic levels!!



Who me :wacko:


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## trauma1534 (Dec 18, 2006)

Airwaygoddess said:


> Jeepmedic, I swear you are just a little nuts for therapeutic levels!!



You haven't seen nothing yet!  LOL  Wait till he, Fedmedic and Prizenmedic all three get going at the same time!  They are better than TV!  LOL  Just think... I came up through the hoops with these guys!!  Poor me!!!


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## Fedmedic (Dec 18, 2006)

The last time I started an EJ, I had to do it quick....they were almost blue before I could get the tubing attached and release the tourniquet.....hmmm...I wonder if I did that right?


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## jeepmedic (Dec 18, 2006)

"Almost" so they were still OK.


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## trauma1534 (Dec 18, 2006)

Fedmedic said:


> The last time I started an EJ, I had to do it quick....they were almost blue before I could get the tubing attached and release the tourniquet.....hmmm...I wonder if I did that right?



Ya know, that's the same problem I had!!!  Do you think we were taught right?


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## jeepmedic (Dec 18, 2006)

trauma1534 said:


> Ya know, that's the same problem I had!!!  Do you think we were taught right?



didn't **** teach you. Then Nope


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## trauma1534 (Dec 18, 2006)

jeepmedic said:


> didn't **** teach you. Then Nope



Nope... actually I was taught by a certain medic you can find now riding the halls of the local nursing home riding his black leather seated power chair with his strobe light on the front and the little horn that goes "booka booka"!!!  Right Fed?  Isn't that what your horn sounds like?  "Booka Booka"


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## jeepmedic (Dec 18, 2006)

How did he teach you he can't even see a EJ.


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## trauma1534 (Dec 18, 2006)

jeepmedic said:


> How did he teach you he can't even see a EJ.



He could back in the day... actually, he just had caterack surg, so he is good to go again


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## jeepmedic (Dec 18, 2006)

He got them Harry Cary glasses. You know the Coke bottle bottoms.


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## trauma1534 (Dec 18, 2006)

jeepmedic said:


> He got them Harry Cary glasses. You know the Coke bottle bottoms.




Yeah he did the last time I went to visit him, but I heard that he got to do away with them after his recent surgery!!!  And what do you know... he got him a Dell laptop now at that nursing home since he can see, he is now on myspace... the pic he posted on there was taken about 40 years ago... he just wants everyone to think he is still young and can get the ladies... well he can... he got up with Inez last night so I hear at the home!  They were both going "booka Booka!"  all night!! LOL


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## jeepmedic (Dec 18, 2006)

trauma1534 said:


> he got up with Inez last night so I hear at the home!  They were both going "booka Booka!"  all night!! LOL



OK I just threw up in my mouth.


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## trauma1534 (Dec 18, 2006)

jeepmedic said:


> OK I just threw up in my mouth.



Well, it's true!!!  I get the insides to all the goods!  If you want to know who is up with who... I can tell ya!


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## MeckRS83 (Dec 18, 2006)

What is with all this EJ stuff. Real medics just get the AC's. I don't need a EJ.


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## trauma1534 (Dec 18, 2006)

MeckRS83 said:


> What is with all this EJ stuff. Real medics just get the AC's. I don't need a EJ.



Whatever!!  Sometimes you have to do an EJ, now way around it!!!


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## jeepmedic (Dec 18, 2006)

plus EJ's are so easy. Like getting water out of a pond with a straw.


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## Ridryder911 (Dec 20, 2006)

MeckRS83 said:


> What is with all this EJ stuff. Real medics just get the AC's. I don't need a EJ.



Spoken like a probie...( unless you were stating for fun...) True A/C's are great, most patients in decompensated shock will not have enough PVR to display A/C's.. as well since it should be cannulated with a large bore (14g or greater) one can administer blood and fluids without compromise. 

After being exposed to many patients with several past history (i.e diabetes) vasculature is difficult to see or find.. 



R/r 911


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## VinBin (Dec 21, 2006)

jeepmedic said:


> plus EJ's are so easy. Like getting water out of a pond with a straw.


 

Unless they are very obese, and it always seems the ones who need EJ's are the ones who are > 60 tons...

And on that note, any tips on getting EJ's on the larger pt's??


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## trauma1534 (Dec 21, 2006)

VinBin said:


> Unless they are very obese, and it always seems the ones who need EJ's are the ones who are > 60 tons...
> 
> And on that note, any tips on getting EJ's on the larger pt's??



Yeah, stand them on thier head, tie a rope around thier neck and there stands a beautiful EJ just winking at ya!!!  lol


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## Ridryder911 (Dec 21, 2006)

Performing EJ's on grossly obese and those with "no-neck or bull neck". 
Some of the 'tricks of the trade" I have found is to slight pull down the arms and shoulders, place a rolled towel under the shoulder, then turn the head to the side. Many people forget trendelenburg will also aid in increasing venous filling. 

I realize obese patients are hard to stick, I have tried to remember the "navel" (nerve, artery, vein, empty space, ligament) acronym where the jugular can be found anatomically. This also helps locating it...

I personally have found chest wall veins are prominent on some obese. I established one yesterday just above the breast MCL, worked great (20g). 

R/r 911


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## Jon (Dec 23, 2006)

Wow...

I save the touniquet around the neck for the really annoying patient, or partner


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## Ridryder911 (Dec 24, 2006)

Jon said:


> Wow...
> 
> I save the touniquet around the neck for the really annoying patient, or partner



I thought that was the Duct tape was for !...


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## firemedic (Jan 4, 2007)

I am fairly new to being a paramedic, but I was taught not to use a tourniquet for an ej. An ej is done by sight and feel.


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## Airwaygoddess (Jan 5, 2007)

Jon said:


> Wow...
> 
> I save the touniquet around the neck for the really annoying patient, or partner



Quick! hide the touniquets and duct tape from Jon and Rid!!!^_^  ^_^


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## jeepmedic (Jan 5, 2007)

firemedic said:


> I am fairly new to being a paramedic, but I was taught not to use a tourniquet for an ej. An ej is done by sight and feel.



So that's what we have been doing wrong. Thanks


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