mycrofft
Still crazy but elsewhere
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20 ga for blood? We were taught minimum of 18, preferably 16, due to cell damage and haemolysis because of turbulence in smaller catheters and needles.
Blood product initiation in the field by EMS
- Thread starter MedicBender
- Start date
It is really agency/population specific, I have run it through 22 ga on infants and 26 ga on neonates.
While central access is prefered, sometimes early peripheral access is needed.
As my first ever rescue instructor said:
"The book tells you how to rescue somebody in a perfect world. If the world was perfect, nobody would need rescued."
And if the patient only had a 20 g in the foot with a non-compatible medication running (I'm guessing octreotide), and they were concerned enough about rupture to send blood with the crew, I would say that central access would have been required. In fact, I probably would have insisted before I left.
For sure.
But we could go on about what you get from community facilities for hours I'll bet.
Sometimes you just have to do what you have to.
Which is sometimes holding the sending facility responsible. I don't take dump jobs. I'm all about being part of the solution, but that scenario was incredibly irresponsible.
Yes, additional access would have been necessary. RIC line, EJ, Subclavian, something.
2 units of blood for an emergent rupture is definitely equivalent to pissing in the wind.
Was there consideration given to a more rapid method of transport with an appropriate specialty team? I.e. fancy way of saying perhaps this would have been a patient that could have benefited from air transport?
2 units of blood for an emergent rupture is definitely equivalent to pissing in the wind.
Was there consideration given to a more rapid method of transport with an appropriate specialty team? I.e. fancy way of saying perhaps this would have been a patient that could have benefited from air transport?
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MedicBender
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I doubt they would have flown him. It's a state run hospital, they were sending him so far away in am effort to keep him in the state system. I've taken higher priority patients out of there by ground. Usually they stabilize and transfer when necessary. Not sure what happened with this guy
kindofafireguy
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Bureaucracy happened.
Sadly, I understand their dilemma. I am surprised they do not have a contingency in place for State facilities. Do they really send all populations and levels of care by ground with a standard crew?
There is a point where medicine prices itself out of the market.
A brief glimpse at a lesson that will be hard learned it not fixed.
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MedicBender
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Yes, I don't remember the last time they flew some one. They are sending them to the only level one hospital in the state. In town we have two level 2 hospitals. In the event its very critical, they may keep them in town and send them to a level 2. However I can think of one that I transferred downtown in the last 5 months. The rest go to the level 1 hospital.
They will 99% of the time send them by regular paramedic truck. However they may send a CCP if it meets the requirements (over 3 meds running, biPAP, art line monitor)
A Level II trauma center ought to be a lot more prepared/competent than what is being described here. Just sayin...
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MedicBender
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The issue is these hospitals are not part of the state program. In an effort to cut down on cost, the hospital tries to keep the patient in the state system. Sending them to one of the level IIs would take them out of this system.