What do you mean, all your 911 ALS patients don't get Swan lines???
Intraosseous access in cardiac arrest.
- Thread starter Smash
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What do you mean, all your 911 ALS patients don't get Swan lines???
Hunter
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IJ PA lines?
Hunter
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and as far as what I learned is that IV and IO are basically the same to deliver meds, as far as how long it takes for the meds to reach their target.
It's a form of central catheter that enters through the internal jugular vein and part of the catheter threads through the right side of the heart and into the pulmonary artery. Rarely placed outside of CVICUs, and even that's getting rarer.
OP
OP
Smash
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My next handover: This is Mavis, she is an 84 year old resident of a nursing home. She fell this morning in the shower, resulting in a suspected fractured right NOF, with marked rotation and shortening. I have done a femoral cut-down and administered a total of 100mcgs of fentanyl......
Shishkabob
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Probably get the same reaction I did when I brought in a patient I gave fentanyl and Ativan to.
Nurse: "But, that's conscious sedation!? "
Me "yes, yes it is"
Seeing hospital staff's reaction to what Paramedics really do when we use our brains and do what they deem to be exotic, is like watching someone who has never seen fire.
For some reason they seem stunned when therapies work that are initiated by a Paramedic, yet do not bat an eyelash when it is ordered for them to do.
For some reason they seem stunned when therapies work that are initiated by a Paramedic, yet do not bat an eyelash when it is ordered for them to do.
I think they're sometimes surprised because our scope of practice / medical control guidelines, allow us to do a lot of acts in a relatively austere environment that are typically done in a far more cautious manner by far more experienced providers (usually physicians) in the hospital.
There's a reason, for example, that ER often calls anesthesia to help manage difficult airways. It's not that the ER fellows aren't great at intubation / airway management. It's because its safer and better for the patient.
My experience has been, that sometimes we're not as well aware of the risks that the procedures we perform entail. EMS isn't about doing the best medicine possible, unfortunately. It's about doing the best medicine possible when performed by a paramedic with limited support, in the prehospital environment.
I would politely suggest that may be either (i) more aware of the risks than we are, or (ii) less in touch with the idea that EMS is about doing what's best for the patient when the best isn't readily available.
Just my opinion.
Personally, I am well aware of what the possible negative outcomes, risks etc of the therapies I provide. The people I have worked with know their :censored::censored::censored::censored: inside and out. That said, some systems are stronger than others, just like some Paramedics and EMT's are stronger than others.
Woe unto the clinician who is not acutely aware of all possible negative and positive outcomes and or effects of his or her treatment.
I think they cannot fathom that what we do works and seem to struggle giving credit where it is due, because it was not done in the ED for them to see where the patient started at and where they are now.
Gosh you blokes seem to have such a strained relationship with hospital, everbody likes the ambos here
Agreed, there's a range of skill / competency levels amongst providers, and some systems seem to perform better than others.
BTW, I'm not trying to suggest that you're a bad clinician. I've got no information to form a basis for that judgment.
I just think that sometimes, as a group, we're a little cavalier when it comes to medical procedures with a potential to cause serious harm.
I guess. It's best to know when you do something difficult / dangerous and screw up, that it was at least worth doing in the first place.
I don't know that I've really had this problem. The way I see it, I do my job as best I can, they do theirs. That's the minimum we should expect. If we're all doing what we were paid to do today, and we're being mutually respectful, then I don't think I need any credit.
I've had situations where the patient's condition has changed as a result of my treatment. One that comes to mind was a near-death anaphylaxis patient who was extremely bronchospastic, unconsious, severely hypoxic and seizing, who we gave over a 1mg of epinephrine (some of it IV), and intubated. It wasn't until the epinephrine started wearing off, that they realised quite how sick the patient was. I can forgive them for that. He didn't look that sick once he was intubated, and no longer hypoxic.
I've had situations when I've felt that the physician or nursing staff were being rude. But everyone has bad days. These were exceptions to the norm.
Agree completely. I think it's very commonly because 1). we (as a group) often haven't seen one of whatever procedure we're performing go really badly 2)when it goes very badly it's not reviewed in an eduational setting 3) we rarely get to follow up on a patient and 4)EGO . I've met a disturbing number of paramedics who think they're that much better than the next guy, or even a physician who's specialty is something like airway control simply because they do it in an austere environment.