Getting the hard IV's.

[Sasha]

I really like the IO myself. I think its just one of those things every service should have, having access is very important, I couldn't imagine transporting anybody to the hospital without access that needed it.

Just because you don't have IV/IO access doesn't mean you can't give drugs. There are drugs that can be given IM, Subq, transdermal, sublingual, nebulized, and if your patient is intubated, there's another route for some specific drugs, too. Not the ideal choice of drug administration but it's possible!

 

[sir.shocksalot]

Just because you don't have IV/IO access doesn't mean you can't give drugs. There are drugs that can be given IM, Subq, transdermal, sublingual, nebulized, and if your patient is intubated, there's another route for some specific drugs, too. Not the ideal choice of drug administration but it's possible!

But I can't give fluid IM, SQ, TD, SL, IN, nor can I dump a bag of saline down a tube :sad: Sorry I'm being a smarta$$. For most drugs the circulatory system is the best way to go, and I just like having the ability to drill a hole in a bone and have access just like that. But the grand majority of patients don't really need an IV anyway, just a taxi.

 

[AJ Hidell]

Almost all protocol within 100 miles of me states that after two attempts AC
the medic shall immediately switch to the I-O drill/gun.

Man, I can't imagine having to function in a system where a medical practitioner were constrained to painting by the numbers or working out of a cookbook like that. What a sad comment on the state of affairs in EMS.

But the grand majority of patients don't really need an IV anyway, just a taxi.

I have always found it ironic that so many "Emergency" Medical Service systems tailor their systems to the needs of the so-called "grand majorty", with little concern for the needs of those with true emergencies. Sort of defeats the purpose.

 

[ILemt]

AJ,

There was nothing cookbook about the directive I mentioned, it merely is meant to enforce common sense.

In my Region, a good many (new) Paramedics and even RN's (in and out of the ER) had a tendency to attempt IV's the usual way until the patient looked like the loser in a knife fight.

This directive merely ensures that access is achieved. Two attempts with an 18 or 20 and then go for the gun. It serves the patients needs.

And after all that is what we are here for.

 

[AJ Hidell]

There was nothing cookbook about the directive I mentioned, it merely is meant to enforce common sense.

Anytime you have to enforce common sense, you are cooking by the book. Common sense tells me that the person who wrote the "protocols" has not the slightest clue what is wrong with my patient, or what the condition of his veins are, yet he is attempting to write a flow chart for his or her care. I can envision multiple scenarios where this guideline would be medically inappropriate, can't you? Automatically drilling into bone just because you're having difficulty with an IV is insane. There are so many other ways to achieve IV access. A great deal of the time, simply stopping the truck and focusing takes care of the problem. But now, if two paramedics are absolutely convinced that this patient has nada for veins, and lack any confidence in the situation, then why wait until two futile, time wasting attempts are taken before going for the sure thing? See what I mean? There is no common sense behind this protocol. It's just an arbitrary number that may or may not be relevant to, or good for my patient.

This is why my statement specifically said that it was a sad comment on the state of affairs in EMS. There is absolutely no reason that true healthcare professionals should have to have "common sense" written in a flow chart for them. Anyone cut loose with a patch should have this decision making process down pat without having to whip out a field guide. Unfortunately, "common sense" is not so common in this field, and neither is professional education. Consequently, we are stuck with the madness you cite in Illinoise.

 

[CurbDoc70]

I've heard a little nitro spray will pop up a vein, but the few times I tried, I got little effect.

Also, using a saw and cutting off the opposing arm works. All of the blood comparments over to the other arm and BINGO, veins a poppin'.

 

[benkfd]

I've heard a little nitro spray will pop up a vein, but the few times I tried, I got little effect.

Also, using a saw and cutting off the opposing arm works. All of the blood comparments over to the other arm and BINGO, veins a poppin'.

That's just wrong!!! (but funny)

 

[AJ Hidell]

I've heard a little nitro spray will pop up a vein, but the few times I tried, I got little effect.

Is there anything written in your MD approved protocols, or in the nitro manufacturers literature that endorses, recommends, or orders this practice? Please tell me you are not just randomly experimenting on your patients with dangerous drugs because of a rumor you heard somewhere. That would be off the scale unethical and illegal.

 

[Sasha]

I've actually heard of the "nitro trick" from quite a few people.

I don't really get how it works... Dilates the veins, yes, but doesn't increase blood volume in those veins you just dilated, just widened the container, I would think they'd lay flat.

Gravity works real well, just hang their arm off the side of the stretcher for a few seconds and let the veins "fill up" tourniquet and pop in an angiocath.

 

[CurbDoc70]

Is there anything written in your MD approved protocols, or in the nitro manufacturers literature that endorses, recommends, or orders this practice? Please tell me you are not just randomly experimenting on your patients with dangerous drugs because of a rumor you heard somewhere. That would be off the scale unethical and illegal.

Actually, I just told you. A few patients. My medical director, and a highly respected ER physician is the one who showed me. Suggesting that is is unethical or illegal is like saying slapping the top of the skin to raise a vein is assault and patient abuse.

 

[reaper]

Yes, It could be!

Funny, I never have to "slap" a vein, to make it stand up.

 

[maxwell]

Lots of tourniquets, nitropaste <_<, heating packs, hanging the arms and legs off the stretchers, use EJs (<3!)