New NRP bridge and scope

I must have tossed the binder with the protocols, but if you're really doubting that we did place central lines, Dr Smith-Poling is still the medical director and I'm sure she can corroborate my claims.

Also, King County Medic One doesn't have an IO device. They, last I knew, still place central lines.
 
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n7lxi said:
Also, King County Medic One doesn't have an IO device. They, last I knew, still place central lines.
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Interesting, but kind of silly. Especially since EZ-IO's are becoming very commonplace in emergency departments. It sure was nice to have a catheter in place while my EMT was still finishing flushing out the bag...
 
I am not doubting your honesty in the least, but hopefully with the introduction of the EZ I.O. they have gone away from this. The outta hospital infection rate alone would be a huge concern, gained you have gotten access pre-hospital but now the pt. is going to die of a overwhelming sepsis. The hospitals around my way will not even keep a field I.V. start over 24hrs.
 
CANMAN13 said:
I am not doubting your honesty in the least, but hopefully with the introduction of the EZ I.O. they have gone away from this. The outta hospital infection rate alone would be a huge concern, gained you have gotten access pre-hospital but now the pt. is going to die of a overwhelming sepsis. The hospitals around my way will not even keep a field I.V. start over 24hrs.
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Well said. Central line placement is supposed to be a sterile technique. There's no way you can say that's going to happen in a Wal-Mart, parking lot, bathroom, etc. Especially not in an ambulance.
 
Funny thing is, back in early 90's when we still did chest tubes in the field. There was a big study that showed the infection rate for chest tubes were twice as high in the ED, then in the field. The reason they found was that in the field we would try harder to keep it clean and sterile, because we were worried more about it then the drs in the ED.

So the sterile issue on ivs gets old. I know I clean the sites better then the ED does. Tegaderm placed right away keep things pretty clean. Just takes having caution in your procedures. Btw, our hospitals will use field ivs up to 48hrs. They change all ivs at 48hr intervals.
 
My old service placed subclavian lines in the field. Went away with mainstream introduction of EZ-IO.
 
Dwindlin said:
My old service placed subclavian lines in the field. Went away with mainstream introduction of EZ-IO.
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Were y'all able to do chest tubes as well, or at least needle decompression? If you're going to be doing procedures then you need to be able to handle the complications.

From a prehospital standpoint I don't see the need of central lines being put in in the field, especially with the IO if you just can not get peripheral access. You're not going to be able to push fluids any faster through a typical 8Fr multi-lumen central line as opposed to a good large bore peripheral line, with something like a cordis being an exception.

When I use an IJ or subclavian, I'm also using it for measuring CVP and/or ScVO2 which isn't done prehospital.
 
FLdoc2011 said:
Were y'all able to do chest tubes as well, or at least needle decompression? If you're going to be doing procedures then you need to be able to handle the complications.

From a prehospital standpoint I don't see the need of central lines being put in in the field, especially with the IO if you just can not get peripheral access. You're not going to be able to push fluids any faster through a typical 8Fr multi-lumen central line as opposed to a good large bore peripheral line, with something like a cordis being an exception.

When I use an IJ or subclavian, I'm also using it for measuring CVP and/or ScVO2 which isn't done prehospital.
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We did needle decompression. And I happen to agree with you about pre-hospital CVL's but again this was before IO's were easily available for adults. Also we placed a cordis, not a multilumen line.
 
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I'd like to see data on the efficacy of needle decompression vs. chest tube placement.
 
Central lines take too much time in an emergent situation. Just grab the IO gun and drill baby, drill. Two finger widths below the bony notch on the shoulder and drill. Humoral head IOs are larger and more effective then a central line, much larger fluid volumes can be pushed through vs a CL. The only thing I can see with CLs is the monitoring aspect. If you have one in place you can thread additional lines for PWP, MAP, Etc. through them without having to redo the line.
 
Action942Jackson said:
Central lines take too much time in an emergent situation. Just grab the IO gun and drill baby, drill. Two finger widths below the bony notch on the shoulder and drill. Humoral head IOs are larger and more effective then a central line, much larger fluid volumes can be pushed through vs a CL. The only thing I can see with CLs is the monitoring aspect. If you have one in place you can thread additional lines for PWP, MAP, Etc. through them without having to redo the line.
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Errr, the only thing you can monitor off a normal central line is CVP....I REALLY don't think any program is going to float a PA cath....

The situation where central line placement is useful is CCT, some smaller (esp NP/PA or FM covered) EDs aren't real comfortable placing them. Useful to throw in a central prior to transport rather than manage multiple pressors in peripheral lines. Outside that, kinda pointless.
 
Fox800 said:
I'd like to see data on the efficacy of needle decompression vs. chest tube placement.
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Even better, give us finger thoracostomy.
 
Err my bad. I was talking CC sense with swan ganz caths through the EJ. Got the two confused. Still trying to get the CC stuff down pat.
 
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