# IV bag placement for pt in Stokes



## lifeway (Nov 21, 2014)

Hey,
Currently volunteering with a SAR organization and just finished a technical training for pt extrication using a Stokes. During training we used the Stokes with belay and pulley systems to pull pt up cliffs etc... If the pt requires an IV would securing the bag on the chest provide enough fluid pressure to prevent blood flow back in the line? I'm used to ambulance based operations and wilderness emergency medical care is still new.


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## STXmedic (Nov 21, 2014)

If the patient is in dire need of fluids, then why not throw a pressure bag in your kit and keep it on their chest. If they aren't dying from dehydration, I'd rather just throw a lock in place, if you even need an IV in place at all during extrication (pain management is about the only reason I could see)


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## DesertMedic66 (Nov 21, 2014)

Clamp the line and wait until the patient is pulled all the way up to open the line back up. The last thing you want if for the bag to fall out of the stokes, taking the cath with it and leave the patient bleeding..

If the patient is in need of fluids badly then get the fluids in before you start to move the patient.


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## lifeway (Nov 21, 2014)

STXmedic said:


> If the patient is in dire need of fluids, then why not throw a pressure bag in your kit and keep it on their chest. If they aren't dying from dehydration, I'd rather just throw a lock in place, if you even need an IV in place at all during extrication (pain management is about the only reason I could see)


Where I work there could easily be several hours of hiking to get a pt out even once they're extricated but the pressure bag is a good idea.


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## DesertMedic66 (Nov 21, 2014)

lifeway said:


> Where I work there could easily be several hours of hiking to get a pt out even once they're extricated but the pressure bag is a good idea.


I'm not a SAR expert but a patient who needs an IV mixed with a several hour hike to get them out = a helicopter extraction/rescue


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## lifeway (Nov 21, 2014)

DesertEMT66 said:


> I'm not a SAR expert but a patient who needs an IV mixed with a several hour hike to get them out = a helicopter extraction/rescue


That would be nice but where I live there are no helicopters  I work in Central America. The only airlift is a Cessna.


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## OnceAnEMT (Nov 21, 2014)

lifeway said:


> That would be nice but where I live there are no helicopters  I work in Central America. The only airlift is a Cessna.



That, and unfortunately half the time a helicopter isn't as easy as it seems.

The SAR team I'm with only credentials for EMT-B (through ATCEMS), and does not provide opportunity for ALS credentialing. Meaning, we do not deploy with ALS gear, nor will our patients receive ALS treatment in the field, naturally including IVs. The only exception I see to this is that in the event of a mutual-aid deployment (which is the most common) which includes an ALS provider actually going out in the field and not staying back at the CP. All of that said, my point is that we get by without ALS interventions, because unfortunately the patients we come by need nothing or more than a bag of saline. 

I also suggest a pressure bag. They are cheap, easy, light, storable, reusable, and surely could be multifunctional. Perfect match for SAR. That said, assuming there is insistence for IV access, I don't think that having a line running, let alone even attached to the lock, is a great idea. As mentioned, if the bag falls, so does the cath, and now you are stopping hemorrhage. As well, depending on whether you are going horizontal or vertical and your setup of the bridal, in addition to having a tender on board, there is a whole lot of rope, equipment, and body involved in a difficult rescue. If your patient can't make a haul or lower without fluid, they aren't going to make it through the trek out, especially if it is as long as you say.

As it seems you are new to technical rescue, I suggest that you ask the veteran team members if they frequently obtain IV access and run fluids before/during rope work. For yourself, and for my own interest. Like I said, the team I am on doesn't use ALS in the field, so its not even a consideration.


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## Tigger (Nov 22, 2014)

We do ALS SAR, ostensibly. I have started lines on people before hiking them out, though the goal is to give them fluid while extrication is being set up. If we are doing a carry out we can usually figure out a way to hang the IV bag (off a person generally), if we cannot, a BP cuff is a reasonable facsimile for a pressure bag (our supply guy says they're too expensive...). If they desperately need fluids while being roped down then I suppose we'll try and pressure it in, but I have yet to encounter that situation.  

I'd much rather wait a bit (if conditions permit) and given some a liter and walk them out then carry them out...


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## lifeway (Nov 23, 2014)

The bp cuff for pressure bag is good. One could probably set up a line, administer fluids during extrication set up, then cap with a saline lock during extrication and redo the lines afterward.


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## dutemplar (Nov 23, 2014)

Previously my rescue "EMS" go bag would fit in a thigh rig.  2 CAT.  SAM splint.  Combat dressing. 2 gauze.  2 saline locks and flushes.  Angios (2x18, 2x20)  .4 alcohol wipes, 1" tape.  Micro medications (benadryl, brethine, 1:1000, versed, morphine, ).  General fluids arent gonna happen without a good reason to be taken out.  Stop bleeding.  Stabilize a fracture.  Support life-threatening allergic reactions, asthma attack, a little pain management and potentially chill their butt out so they aren't a danger during extrication.


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## lifeway (Nov 24, 2014)

dutemplar said:


> Previously my rescue "EMS" go bag would fit in a thigh rig.  2 CAT.  SAM splint.  Combat dressing. 2 gauze.  2 saline locks and flushes.  Angios (2x18, 2x20)  .4 alcohol wipes, 1" tape.  Micro medications (benadryl, brethine, 1:1000, versed, morphine, ).  General fluids arent gonna happen without a good reason to be taken out.  Stop bleeding.  Stabilize a fracture.  Support life-threatening allergic reactions, asthma attack, a little pain management and potentially chill their butt out so they aren't a danger during extrication.


That's basically what my kit contains too except I don't carry brethine or versed, out of my scope. I love duct tape though, great for splinting.


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## dutemplar (Nov 24, 2014)

Absolutely on the tape.

We debated what meds to carry, long debate on a steroid for asthma/ head injury, etc.  it's what the padded med pouch fit and was less of a "shotgun" than the Epi for asthma/copd.

No o2 tank for albuterol/duoneb, and not hauling an aminophylline drip.


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## Tigger (Nov 24, 2014)

Currently we carry epi 1:000, benadryl, solu-medrol, inapsine, narcan, albuterol, and atrovent in our backcounty pack to go along with an IV setup, small O2 cylinder, among other things. Narcotics come off the ambulance. 

Realistically though we are not doing true SAR work. While we have multi day hikes in our jurisdiction we aren't going to be called to calls that far out, the county SAR team will handle that. Most of our "backcountry" calls are less than an hour hike in so we can afford to bring a fair amount of crap with us.


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## WestMetroMedic (Jan 30, 2015)

In the US&R environment, we use pressure bags and set up our systems with absolutely no air in the system, set our rate appropriately and maintain pressure in the bag and document when the infusion should be done, tuck it between their legs and leave the pressure bag bulb and a medication port leafed out of the patient burrito.


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## DWR (Sep 24, 2015)

The tourniquet from a IV start kit works (slightly) also. Or a BP cuff if you don't have a pressure infuser or an IV pump.


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## medicdan (Sep 24, 2015)

WestMetroMedic said:


> In the US&R environment, we use pressure bags and set up our systems with *absolutely no air in the system*, set our rate appropriately and maintain pressure in the bag and document when the infusion should be done, tuck it between their legs and leave the pressure bag bulb and a medication port leafed out of the patient burrito.


 (emphasis added)

^ that's the key when using a pressure bag with a potentially inaccessible or unattended line.


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