Got my first IV in the ambulance.

8jimi8

8jimi8

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Yesterday, responded to a 1 vehicle MVA. Pt complaining of lower back pain, no entrapment. Pt was restrained.

Since we are checked off on intubations and IV access, I was allowed to perform the IV stick. My hugest worries, were "is the bouncing box gonna throw me off and make me miss my sticks?!!" No! is the answer... i didn't even notice that we were moving, other than having to brace my knees between the cot and the bench.

She looked like she was gonna be a hard stick too, tiny little spidery and wavy veins. Catheter threaded with no problems and had good flow, so I'm happy!
 
I know the awesome feeling! I've had a few patients that appeared difficult and got em while moving.
 
What about sticking pts where you have to feel for the sponginess, because u can't see a vien and see if you can get a vein.
 
... lol... well if i couldnt see a vein that is what i would have to do.

if it was a critical patient, then i'd get out the EZ-IO.

random trivia: Our medical director is the inventor of the EZ-IO
 
8jimi8 said:
... lol... well if i couldnt see a vein that is what i would have to do.

if it was a critical patient, then i'd get out the EZ-IO.

random trivia: Our medical director is the inventor of the EZ-IO
Click to expand...

Okay, here we go... abuse of a skill and tool. How about developing your IV skills and leave the drill for the last option.

R/r 911
 
Sorry , Rid,

in this case I am actually correct! (wow isn't that cocky!)

Our protocols state IO as first intervention for critical patients. (first intravascular access intervention)
 
Uh oh. Someones gonna freak out about the protocols!
 
This won't end well!



I got my 3rd stick ever the other night. Then I got stuck and taped. I'm am going to shave my arms from now on before class.
 
if you tear the tape off in the direction of the hair growth, it doesn't hurt.

Sorry if people will be angry about our protocols... i didn't write them.

In any case, that is the protocol for critical pts.

not everyone.

and i've hit plenty of invisible veins :)
 
op they won't necessarily get get mad at your protocols but at your willingness to more or less blindly follow them. I've gotten a few remarks about my post and protocols before..no worries. Develop your way of practicing and stick to your guns..you know when you are right.
PS: good job!
 
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8jimi8 said:
if you tear the tape off in the direction of the hair growth, it doesn't hurt.
Click to expand...

When it's taped directly to the catheter, it hurts. It hurt a helluva lot more than the IV and I hate needles.
 
rhan101277 said:
What about sticking pts where you have to feel for the sponginess, because u can't see a vien and see if you can get a vein.
Click to expand...

I was taught very early in my career, "If you can't feel it, don't stick it". That helps out alot when your vision is as bad as mine. It's amazing the quality, and size, of veins you'll find when you hone your sense of touch.
 
Protocols should be guidelines or suggestions only and should not to be in place for thee and thou shall for mindless attempts of treating patients.

"I followed my protocols"... what a cop out. I have seen protocol driven medics and services that treat patients as robotic care. Medics that make their patient fit the protocol instead of treating the patient as an individual with individual treatment plan.

Let's review such debate as even intubation, RSI and so forth all because the ..."they told me I could do it"... mentality.

There is no way any service could have enough protocols to dictate on what to do, as well the opposite could bite you. Not following them could have consequences.

I remember discussing with a Paramedic at a protocol type service on the stabbing patient she had transported, and noted she had marked "nitroglycerin did not relieve chest pain. I had also noted that it was a 20 year old male and asked did he have hx of cardiac.. "no, my protocols state to "treat all chest pain with oxygen, ASA and NTG". Shocked to find out the chest pain was only related to the knife wound. Yeah, how about some common sense or critical thinking skills? ....

Any idiot can read a protocol tree and match that to a chief complaint. It takes an educated medical professional to differentiate and diagnose to what degree (if any) procedures and medications should be administered or not.

I wonder what the public would say knowing that those needles costs an additional $118 because their medics skills were poor or other options was not attempted.

I/O are wonderful devices when and ONLY other means (peripheral, EJ) have been excluded because of poor vasculature or failed attempts.

R/r 911
 
emtjack02 said:
op they won't necessarily get get mad at your protocols but at your willingness to more or less blindly follow them. I've gotten a few remarks about my post and protocols before..no worries. Develop your way of practicing and stick to your guns..you know when you are right.
PS: good job!
Click to expand...

I can definitely understand Rid's point about not abusing technology. The rationale that I was given was in the form of a cardiac arrest patient. They want us to drill the leg first (barring any contraindications) because it pulls a provider away from the torso, where there is already alot of things going on. ABCs and cardiac monitoring / defib.

Hope that makes sense, but I am also, as always open to other peoples' experience.
 
Ridryder911 said:
Protocols should be guidelines or suggestions only and should not to be in place for thee and thou shall for mindless attempts of treating patients.

"I followed my protocols"... what a cop out. I have seen protocol driven medics and services that treat patients as robotic care. Medics that make their patient fit the protocol instead of treating the patient as an individual with individual treatment plan.

Let's review such debate as even intubation, RSI and so forth all because the ..."they told me I could do it"... mentality.

There is no way any service could have enough protocols to dictate on what to do, as well the opposite could bite you. Not following them could have consequences.

I remember discussing with a Paramedic at a protocol type service on the stabbing patient she had transported, and noted she had marked "nitroglycerin did not relieve chest pain. I had also noted that it was a 20 year old male and asked did he have hx of cardiac.. "no, my protocols state to "treat all chest pain with oxygen, ASA and NTG". Shocked to find out the chest pain was only related to the knife wound. Yeah, how about some common sense or critical thinking skills? ....

Any idiot can read a protocol tree and match that to a chief complaint. It takes an educated medical professional to differentiate and diagnose to what degree (if any) procedures and medications should be administered or not.

I wonder what the public would say knowing that those needles costs an additional $118 because their medics skills were poor or other options was not attempted.

I/O are wonderful devices when and ONLY other means (peripheral, EJ) have been excluded because of poor vasculature or failed attempts.

R/r 911
Click to expand...


Rid, I completely respect the fervor with which you post. I would never unnecessarily "drill" someone. I'm not a lights and siren happy gumby who is going to do something, just because I can. I also certainly would not treat a knife wound to the chest with ASA and NTG. O2, yes. I know you were not specifically ascribing such behaviors to me, but, the point does make its way home. My earlier comment was definitely off the cuff. Yes, of course I am excited about all my new "skills." But I have enough common sense and professionalism to know that a good assessment, critical thinking and basic patient care are the cornerstones of pre-hospital care. I do want to thank you for always keeping us on point. I have taken many of the things you have imported to heart and I will continue to carry them with me throughout my career.
 
8jimi8 said:
Rid, I completely respect the fervor with which you post. I would never unnecessarily "drill" someone. I'm not a lights and siren happy gumby who is going to do something, just because I can. I also certainly would not treat a knife wound to the chest with ASA and NTG. O2, yes. I know you were not specifically ascribing such behaviors to me, but, the point does make its way home. My earlier comment was definitely off the cuff. Yes, of course I am excited about all my new "skills." But I have enough common sense and professionalism to know that a good assessment, critical thinking and basic patient care are the cornerstones of pre-hospital care. I do want to thank you for always keeping us on point. I have taken many of the things you have imported to heart and I will continue to carry them with me throughout my career.
Click to expand...

No problem, sorry for the rant toward you. I just have seen more and more posts on EMS forums as they are using second line procedures before they even try first entry for IV therapy. I am currently reviewing our protocols and have been reading several others (from all over the nation) for comparison. It is literally scary!

I have decided this if you have more than 150 pages of protocols, the chances are :
A. Your medical director has no interaction with your medics
B. The service is so large, it has to have a step by step to ensure control over the treatment
C. Your medics lack proper medical education.

Wow! To read protocols on how to splint and when one can call for additional units? Are we truly enforcing hiring mindless medics?
 
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