iStat

luke_31

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Anybody using iStats in the field? We are getting them to run chem 8s on the off chance that our patient is hyponatremic. Curious to see how durable the device is in the back of the ambulance and if anyone has had problems with getting them to work while bouncing down the road.
 

dutemplar

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Uhm, I've used some elsewhere but not here. Designed for field use, so it wasn't bad but if you're off-roading insanely it can probably be an issue. My use for them was USAR and also prolonged field care in very forward deployed positions.

You're using a $11,000 machine and $25 test to check everyone on the offhance that someone is hyponatremic?
 

TransportJockey

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Used it in WesternTexas. We didn't ever have any issues with it. We carried chem 8, lactate, and troponin cartridges

Sent from my SM-N920P using Tapatalk
 

Summit

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Why look for random hyponatremia? What are you going to do about it?
 

EpiEMS

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Why look for random hyponatremia? What are you going to do about it?
If it's acute, can't hypertonic saline be administered? Not sure if anybody carries it, though.
 

MonkeyArrow

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Why look for random hyponatremia? What are you going to do about it?
Push sodium bicarb, although that would have to be a gutsy protocol.
 
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luke_31

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We are going to be carrying hypertonic saline. We've had hyponatremic patients and the thought process above us is to try and identify it faster, as some of our transports can be twenty to thirty minutes, so they want the treatment started ASAP once identified. We have some pretty roagh terrain that we ride on and use improvised roads to get to patients. I think it's a little bit overboard but it's not our call to be doing this, so we have no choice but to go along with it.
 

E tank

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Our medical director is actually considering that instead of hypertonic saline after one of our paramedics brought it up.
NaHCO3 works pretty well, is fast and really convenient.

As to the iStat, the lab lady tells us that once the cartridge is placed and the start button pressed, the whole unit shouldn't be touched at all because motion artifact can somehow cause an error. I think I've seen that once or twice where I have to start all over (don't get rid of the blood you draw). Set it down, start it and don't touch it. The smoother the ride the better, stopped is best, IME
 

luke_31

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NaHCO3 works pretty well, is fast and really convenient.

As to the iStat, the lab lady tells us that once the cartridge is placed and the start button pressed, the whole unit shouldn't be touched at all because motion artifact can somehow cause an error. I think I've seen that once or twice where I have to start all over (don't get rid of the blood you draw). Set it down, start it and don't touch it. The smoother the ride the better, stopped is best, IME
Thanks, good advice on keeping the blood draw. We already have the blood tubes in the trucks and are doing the in-service with the manufacturer and the hospital this week. They are looking to get us in the field with them in the next week or two. The no movement issue will be fun though, we have a protocol for heat injuries that involves getting the patient to the hospital in ten minutes, sort of like trauma patients, but it's not all that realistic as some locations are much further away. Guess starting the iStat before transport will probably be a good thing to do.
 

luke_31

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Unless they are actively seizing I do not really see a point in treating hyponatremia in the field.
Very true, our protocol will be to call for orders before treating the hyponatremia. I think in the end this will end up being more for our ER benefit, rather then us treating, as it's more then likely we will be at the ER before he test finishes.
 

hometownmedic5

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So they spent the money to write a protocol, buy the gear and train the people; and they made it a mother may I protocol?

:smh:
 

luke_31

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So they spent the money to write a protocol, buy the gear and train the people; and they made it a mother may I protocol?

:smh:
Yup, one of the few drugs that we need to call for orders on. Except they made us use our budget to purchase the devices and now we are over budget for the year and only half way through the budget cycle. 95% of our calls all we do is notify the ER of what we are bringing them. We have pretty liberal protocols and if we want to use one of the drugs outside of protocol all we do is contact the ER doc for permission which is rarely denied.
 

E tank

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Very true, our protocol will be to call for orders before treating the hyponatremia. I think in the end this will end up being more for our ER benefit, rather then us treating, as it's more then likely we will be at the ER before he test finishes.
And if its really out of whack, they'll just repeat it.
 

Summit

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Hyponatremia should make you ask "WHY" and "HOW LONG" not react with "OMG FIX A LAB VALUE" unless:

Unless they are actively seizing I do not really see a point in treating hyponatremia in the field.
EXACTLY
 
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luke_31

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Hyponatremia should make you ask "WHY" and "HOW LONG" not react with "OMG FIX A LAB VALUE" unless:


EXACTLY
Our protocol to test sodium levels doesn't go into effect unless they are altered and there is no other identifying cause. We had a real bad hyponatermic patient that ended up dying and this is one of the solutions to try and avoid the situation again. The possibility of this happening again is likely as we are dealing with a very healthy athletic population that can overdue the fluid intake without having enough sodium in the diet to counter all the water they intake.
 

Summit

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iStats have purpose in the field... randomly screening for hyponatremia is NOT one of them. I think they are useful in long rural transport times... like 45mins... maybe driving a transport decision... or identifying the cause of a code... or terminating a code on K+... or on a CC IFT...

Hyponatremia? Was this something someone thought up to get a grant to buy these devices?

Honestly, I wouldn't trust lab values from an iStat that ran in a moving ambulance. Your receiving facility won't.

Right, but most ground paramedics won't/ don't carry HNS, so again, how will they stop the sz?
Apart from your other tools to stop muscle activity, give NS unless contraindicated. It will raise SerumNa. Your receiving facility might anyways. Bicarb.

Think about the various etiologies behind hyponatremia... is this SIADH? Post op? CHF? Cirrhosis? Overhydration?

We don't want to raise Na very fast unless we know it was acute. Who can name the complication we are worried about here?
 
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