Nitro spray on skin before IV

[Shishkabob]

I never understood people who will putz around on-scene for an extra 10 minutes making someone a pin cushion when they could be halfway to an ER.

Because in some situations we do the exact same things the hospital will do for the issue at hand, so there's no point in rushing?

 

[NomadicMedic]

For what it's worth, my fiancé is a critical care vet, and they use the dab of paste trick to get a vein on dogs and cats that they are having a hard time sticking. She swears by it.

Of course, she also can dump in a liter of fluid subq, so she does have options.

 

[Jon]

Why not just go the IO route?

Because not everyone even has one.

And sometimes it's less cruel if you can put a needle in WITHOUT a power tool.

 

[Tigger]

Because not everyone even has one.

And sometimes it's less cruel if you can put a needle in WITHOUT a power tool.

Even though it's supposed to hurt the same if not less than an IV insertion? Supposedly only med pushes are what causes pain.

 

[bigbaldguy]

Even though it's supposed to hurt the same if not less than an IV insertion? Supposedly only med pushes are what causes pain.

Perhaps physical pain is less but the mental trauma of seeing someone screwing a needle into your leg with a black and decker is going to leave a mark. We need to remember that physical pain is usually more transient and less important than psychological pain.

 

[NomadicMedic]

If they need an IO, usually they are past caring about my driving a needle into their tibia.

There is ALWAYS access if you really need it. Let's not forget about EJs.

 

[Tigger]

Perhaps physical pain is less but the mental trauma of seeing someone screwing a needle into your leg with a black and decker is going to leave a mark. We need to remember that physical pain is usually more transient and less important than psychological pain.

I think if you take the time to explain the procedure you can mitigate much of the emotional trauma. Alternatively you could tell them to shut their eyes, and as nlixi notes, if they need an IO they're likely already in trouble.

 

[Handsome Robb]

Why not just go the IO route?

You better have a damn good reason as to why you're drilling an IO on a live patient. "I couldn't get IV access" doesn't count unless they are in extremis.

 

[Handsome Robb]

Even though it's supposed to hurt the same if not less than an IV insertion? Supposedly only med pushes are what causes pain.

That's why you flush it with lidocaine first 20-40 mg should be plenty.

 

[Tigger]

That's why you flush it with lidocaine first 20-40 mg should be plenty.

From what I have seen the lidocaine may have made some difference but the patient(s) were still less than pleased. The local EMS was also not carrying lidocaine at the time, though that has been remedied with the increased use of IOs.

 

[Shishkabob]

Perhaps physical pain is less but the mental trauma of seeing someone screwing a needle into your leg with a black and decker is going to leave a mark. We need to remember that physical pain is usually more transient and less important than psychological pain.

Hence the retrograde amnesia with benzos. They won't remember a thing! h34r:

And sometimes it's less cruel if you can put a needle in WITHOUT a power tool.

 

[abckidsmom]

Hence the retrograde amnesia with benzos. They won't remember a thing! h34r:

I'm still scarred for like from that stupid jamshidi needle.

The only live patient I ever drilled was a simple hypoglycemic. It was the right choice at the time.

 

[jwk]

Hence the retrograde amnesia with benzos. They won't remember a thing! h34r:

That's largely a myth - hope you don't count on that routinely.

 

[bigbaldguy]

Hence the retrograde amnesia with benzos. They won't remember a thing! h34r:

I don't know. Just because you don't remember something doesn't mean it doesn't still effect you on other levels.

 

[PVC]

Here is a link where in trials Cardiologist use topical Nitro to facilitate Radial Arterial Cannulation.

So topical Nitro works on arteries, Has anyone seen any studies on veins.

http://techtransfer.universityofcalifornia.edu/NCD/20036.html

The difficulty I would see is medics/cardiologist using a drug and without it being approved for that effect.

It concerns me that the lower levels of care are willing to attempt experiments with medications that are not approved that use for t. I would worry of legal complications regardless of production of desired effects.

I think the nitro spray is a bit much. I have seen a couple of old school medics use a very very SMALL amount of nitro paste on the area they are looking at, about the size of a ball point pen. Not enough to cause any pressure drop but just enough to get the vein to pop up. I know what yall are going to say and i will be chastised but i will say from what I have seen.. It works.

Did you notice if they documented their topical Nitro administration in their PCR?

 

[Asclepius911]

Lol I don't mean to sound rude but, you guys are beginning to sound like Mexican witch doctors, rub some alcohol mixed with vapor rub and "yerba Buena" (mint leaf) on your forehead and it will make you smarter ... don't believe people that haven't done clinical research on the effect of untraditional application of drugs, you don't want to be the first to find out the adverse side effects as a result of curiosity

 

[PVC]

Lol I don't mean to sound rude but, you guys are beginning to sound like Mexican witch doctors, rub some alcohol mixed with vapor rub and "yerba Buena" (mint leaf) on your forehead and it will make you smarter ... don't believe people that haven't done clinical research on the effect of untraditional application of drugs, you don't want to be the first to find out the adverse side effects as a result of curiosity

Getting rubbed all over with an egg has got to be the best.

 

[Asclepius911]

I heard if they rub you down with a tabacco leaves and decapitate a chicken causing the blood to squirt on you, it cleanses your spirit to take out the stress demon.. lol .. sometimes I wonder how the witch doctor's crazy ideas were taken serious

 

[NYMedic828]

I'm still scarred for like from that stupid jamshidi needle.

The only live patient I ever drilled was a simple hypoglycemic. It was the right choice at the time.

Story behind that one?

 

[medicconnor]

And you have a patient, with poor venous access, and you're planning on spraying 0.4mg of nitroglycerin on their hand / forearm?

I hope the patient doesn't have poor vascular access because they're hypotensive.

yep, nitro works transdermal, not a good idea just get better at your IV skills.