IVs for EMT-B

[tanner72]

The time comment is tied to the patient's complaint and condition and the location of the patient. We have some areas that are a 35-45 minute drive to the nearest medical facility. One example would be if we as a BLS transport have a stroke patient, the medic unit is not available or is to be met en-route, the objective would be to have an IV in place for the medic to use or for when we transfer that patient to the ER, that would be one less step to take.

 

[Handsome Robb]

The time comment is tied to the patient's complaint and condition and the location of the patient. We have some areas that are a 35-45 minute drive to the nearest medical facility. One example would be if we as a BLS transport have a stroke patient, the medic unit is not available or is to be met en-route, the objective would be to have an IV in place for the medic to use or for when we transfer that patient to the ER, that would be one less step to take.

Stroke patients get 3 lines. One TKO and two locks.

 

[usalsfyre]

So are your basics versed in appropriately sized and located lines for diagnostic imaging and neuro resuscitation?

 

[zmedic]

Stroke patients get 3 lines. One TKO and two locks.

Why? Now they get to the ER and they still need to draw blood, a patient who likely will get anticoagulated and now has been stuck at least 4 times.

I think very few patients need 3 lines in the field.

 

[Ghostnineone]

Not an EMT but this thread made me curious about something, if EMT's can do king tubes and laryngeal masks why can't they do ET tubes? From my limited googling it seems like you could easily put a king tube down the wrong hole, maybe not a LM though.

Also, why would you use one over the other?

Being able to start an IV but not put anything in it seems like putting AED pads on a PT but not being allowed to shock.

 

[JPINFV]

King tubes are made to go down the "wrong" hole, and laryngeal masks don't go down either of the two holes.

 

[Handsome Robb]

Why? Now they get to the ER and they still need to draw blood, a patient who likely will get anticoagulated and now has been stuck at least 4 times.

I think very few patients need 3 lines in the field.

One line to draw labs off of, one line to push contrast through, one line for med/fibrinolytic administration.

That's 3 pokes last time I checked...

They get 3 lines in the hospital, if we can get three good lines in the field why shouldn't we? I'm not dumb, I'm not going to go fishing around for lines that I'm not confident I can get all the way to the ER just to poke holes in someone.

 

[Christopher]

Not an EMT but this thread made me curious about something, if EMT's can do king tubes and laryngeal masks why can't they do ET tubes? From my limited googling it seems like you could easily put a king tube down the wrong hole, maybe not a LM though.

Yeahhhh, but no. Paramedics largely are intubation-incompetent and have 8-10 times the training of an EMT.

It would be tough to legitimately place a King in the trachea. Combitube happens occasionally (Kelly Grayson recently blogged about his first ever experience) to find its way into the trachea. LMA's can't go fully into the glottic opening, but they could block it.

That being said, EMT's with waveform ETCO2 and bougies or tube exchangers could probably place a supraglottic airway (e.g. a KingLT, Air-Q, i-Gel, or LMA-FastTrach) and convert it to an ETT with sufficient training.

Do I think it is necessary? No.

A properly placed SGA is perfectly fine for almost any length of transport that an EMT would be with a critical patient.

Also, why would you use one over the other?

One SGA over one another, or ETI over SGA? They're all equivalent when properly used. But this is horribly off topic.

Being able to start an IV but not put anything in it seems like putting AED pads on a PT but not being allowed to shock.

I'd agree. No practical help with EMT IV starts.

 

[zmedic]

One line to draw labs off of, one line to push contrast through, one line for med/fibrinolytic administration.

That's 3 pokes last time I checked...

They get 3 lines in the hospital, if we can get three good lines in the field why shouldn't we? I'm not dumb, I'm not going to go fishing around for lines that I'm not confident I can get all the way to the ER just to poke holes in someone.

You can push the meds through the same line you just pulled the labs off of. So 2 lines. In the hospital we tend not to draw labs off existing IVs because they tend to be hemolyzed or diluted. Also are you drawing labs in the field? If you are great. But lots of ambulances don't draw labs so the patient needs to be stuck again at the hospital.

 

[Christopher]

You can push the meds through the same line you just pulled the labs off of. So 2 lines. In the hospital we tend not to draw labs off existing IVs because they tend to be hemolyzed or diluted. Also are you drawing labs in the field? If you are great. But lots of ambulances don't draw labs so the patient needs to be stuck again at the hospital.

We draw in the field and only stick twice on STEMI/CVA. 3 IV's seems much when the ED could easily butterfly labs around 2 existing lines.

 

[Bullets]

The time comment is tied to the patient's complaint and condition and the location of the patient. We have some areas that are a 35-45 minute drive to the nearest medical facility. One example would be if we as a BLS transport have a stroke patient, the medic unit is not available or is to be met en-route, the objective would be to have an IV in place for the medic to use or for when we transfer that patient to the ER, that would be one less step to take.

I see this argument as attempting to make a responsibility for EMTs where there its no need. Or to make EMTs feel more important. You really don't need medics on a stroke patient, you need a hospital. Plus I feel starting lines in an ambulance causes the patient unnecessary exposure to infection which can be managed in the hospital.

Around here the hospitals view field IVs as "dirty" and are quickly replaced

 

[Tigger]

I see this argument as attempting to make a responsibility for EMTs where there its no need. Or to make EMTs feel more important. You really don't need medics on a stroke patient, you need a hospital. Plus I feel starting lines in an ambulance causes the patient unnecessary exposure to infection which can be managed in the hospital.

Around here the hospitals view field IVs as "dirty" and are quickly replaced

Studies show that there is lite difference in infection rates between IVs started in and out of hospital. Hospital, better know as a large building full of sick people.

 

[Handsome Robb]

You can push the meds through the same line you just pulled the labs off of. So 2 lines. In the hospital we tend not to draw labs off existing IVs because they tend to be hemolyzed or diluted. Also are you drawing labs in the field? If you are great. But lots of ambulances don't draw labs so the patient needs to be stuck again at the hospital.

3 is our protocol for CVAs, and two for STEMIs. That's how the hospitals want it, so we do what we can to make it happen. One TKO and two NS locks, preferably 18s or 20s.

There's been talk about us drawing labs on STEMIs/ACS symptoms and CVAs in the field but it hasn't been implemented yet. It's a tough one with our generally short transport times. The hospitals here all draw labs off of our field IVs on a regular basis, I've seen nurses get grumpy when a line will flow but wont draw.

 

[rmabrey]

3 is our protocol for CVAs, and two for STEMIs. That's how the hospitals want it, so we do what we can to make it happen. One TKO and two NS locks, preferably 18s or 20s.

There's been talk about us drawing labs on STEMIs/ACS symptoms and CVAs in the field but it hasn't been implemented yet. It's a tough one with our generally short transport times. The hospitals here all draw labs off of our field IVs on a regular basis, I've seen nurses get grumpy when a line will flow but wont draw.

I haven't seen a medic draw labs in 8 months here. One hospital quit requiring it when they found out the nurses were throwing our blood draws away anyway, so everyone just quit doing it period

 

[NomadicMedic]

Only one hospital in our county pulls field IVs. The others all use our lines and expect bloods to be drawn if we have a line up.

It's different everywhere you go.

 

[ZootownMedic]

Just for the record too.....2 of my best friends are SOCM qualified. They both were 18D's out of 10th Special forces group. For the record they are NOT tested at the NREMT-P level. The one went to Paramedic school and the other had to do Practicals and then national registry. They are authorized to test through Ft. Bragg however as long as they still have their NREMT-B. Then they can take the NREMT-P practicals and written exam. They are really great guys and are definitely very well trained. For the record though....their cardiology SUCKS.

 

[Doczilla]

Yes, a SOCM medics cardiology leaves much to be desired. However, they do know enough to perform prehospital ACLS-- and most of them are humble enough to use a reference when needed.

But they will run circles around you in trauma. And not just "military" trauma. They can transition from "keep them alive until you get to the hospital" to "keep them alive, you ARE the hospital "quite easily.

 

[ZootownMedic]

Yes, a SOCM medics cardiology leaves much to be desired. However, they do know enough to perform prehospital ACLS-- and most of them are humble enough to use a reference when needed.

But they will run circles around you in trauma. And not just "military" trauma. They can transition from "keep them alive until you get to the hospital" to "keep them alive, you ARE the hospital "quite easily.

Oh I know....their trauma is great. Trauma is just one branch of the tree that is emergency medicine however. Keep in mind that 2 of these guys are my really good friends but.....how many 6 year old asthma patients have they ran? How many 88 year old PE/chest pain/SOB? how many COPD exacerbations? I am not knocking their skills but the bottom line is that they were trained to operate in a combat environment. The streets of the USA are full of sick, ungrateful, unhealthy, old, young, fat, and weird people. Not the poster cut-out 18-35 year old male. Its just a fact that they will have to accept and they don't seem to want to. Their medicine has suffered for it on the streets.

 

[Pavehawk]

Like all medical professionals, SOCOM types never stop learning their trade. Not all military medicine is trauma under fire, and not all SOCOM missions involve blazing gun battles in far away places. Ask any 18D who has been the "family practice doc" for a remote villiage (or several of them). You might be surprised at the depth of knowlwdge these guys pick up during training and then after they get to their units.

 

[Tigger]

Oh I know....their trauma is great. Trauma is just one branch of the tree that is emergency medicine however. Keep in mind that 2 of these guys are my really good friends but.....how many 6 year old asthma patients have they ran? How many 88 year old PE/chest pain/SOB? how many COPD exacerbations? I am not knocking their skills but the bottom line is that they were trained to operate in a combat environment. The streets of the USA are full of sick, ungrateful, unhealthy, old, young, fat, and weird people. Not the poster cut-out 18-35 year old male. Its just a fact that they will have to accept and they don't seem to want to. Their medicine has suffered for it on the streets.

But they don't practice medicine on "the streets of the USA." I see no issue with training someone to preform a specific role so long as everyone is aware of what that role is and what its limitations are. I have a hard time believing that these guys are not smart enough to realize that.