Paramedics get ultrasound

46Young

Level 25 EMS Wizard
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I believe linuss is referring to Texas based agencies. The agency you picked is in Florida.

I picked nothing. The article, you know, the very subject of this thread is about that dept, in FL. It's apparent that he didn't read the article prior to making blanket implications about fire based EMS, which I called him on. Clear as mud?
 

zmedic

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For those advocating US for IV placement, I'd argue that if they are sick they should be considered for an IO, if they aren't sick it can wait till the ED. US guided IV is hard enough when you aren't in the back of a moving ambulance.
 

WTEngel

M.Sc., OMS-I
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Being critical care transport, ultrasound guided IV access is a usable and practical tool. I understand the concern over utilizing US on a scene, however when doing interfacility transports on NICU, PICU, and trauma patients, there are many beneficial uses for this technology, IV access being one of them.

Doing an IO is all well and good, however, US guided IV access for a patient can be done just as efficiently and expediently as an IO placement can. IO is only first choice access in a code situation, and in most other situations is only used after two failed peripheral attempts.
 

VentMedic

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Being critical care transport, ultrasound guided IV access is a usable and practical tool. I understand the concern over utilizing US on a scene, however when doing interfacility transports on NICU, PICU, and trauma patients, there are many beneficial uses for this technology, IV access being one of them.

Doing an IO is all well and good, however, US guided IV access for a patient can be done just as efficiently and expediently as an IO placement can. IO is only first choice access in a code situation, and in most other situations is only used after two failed peripheral attempts.


$18,000 IV finder? If it is a true emergency, the IO or EJ could be just as efficient. If a peripheral IV is that difficult to find, the chances of it be viable for very long before it blows are slim.
 

usafmedic45

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Yeah, but CCT is a specialized subset that most of us don't really take part in if you really want to get down to it. I see your point but also think it is overstating the issues since most hospitals have an ultrasound machine available, even in the smallest of facilities. They may not have the tech there 24/7 to do full studies but if you have someone who knows how to use the equipment on your team (as you are implying you do) then why does the team need their own US machine? Also how often does it really become useful?

Having operated as part of a CCT team myself, I can say that very seldom did we ever do the FAST study or anything of that sort. Normally, it was done (as it should be) before our arrival and was used in the decision to transfer the patient. If they are unstable enough to need to be transferred, you (or even myself) should not be wasting time trying to do a diagnostic study where there is no or insufficient backup should the patient go downhill abruptly. To be quite blunt, I just don't see there being an absolute need for US in that setting. The need becomes even less in the neonatal and peds cases you mention. The only case I can recall it making a significant difference on were a kid we ID'ed as having structural cardiac defects on and that led to his evacuation. It triggered the transfer, not the other way around.

IO is only first choice access in a code situation

Depends on the protocol. If the patient is unstable and obtunded enough that I'm not concerned about hurting them (and if they are unstable enough I would being seriously thinking about doing an IO, their comfort is a secondary consideration anyhow; being alive and hurting is better than being dead and not in most cases), it is going to be high on my list of tricks to use to get access.

in most other situations is only used after two failed peripheral attempts.

We took that caveat out of our protocols and went straight for IO access if the patient was unstable without "good veins". This was before the recent big push for the aggressive use of IOs and the reasoning was that it's better to have the access with low complication rates as are associated with IOs than to **** around and try to get an IV when you aren't sure you can get one in the first place. Actually the fact that a lot of us were just taking this approach and not worrying about the peripheral IV option in critical patients without obvious vascular options played a huge role in the change. Basically our medical director realized that our "jury nullification" of a rule was technically to the benefit of the patients rather than their detriment so he took away an archaic and baseless rule.

US guided IV access for a patient can be done just as efficiently and expediently as an IO placement can

Do you have any evidence to back that up? I am not aware of any head to head comparison and the only US guided IV access articles I am aware of that discuss time to cannulation are not really applicable to the setting of a critical patient since they generally involve ICU patients or non-critical ED patients. The only potentially useful study I am aware of is Resnick et al from 2008 (Acad Emerg Med. 2008 Aug;15(8):723-30) which indicated a 2.9 to 4 minute median time depending upon which method of ultrasound-guided access was being attempted. It's been a while since I read the full article, but I seem to recall that the time stated did not include the time required to set up the ultrasound machine, etc which would add at least 30 seconds, etc to the times. That is significantly longer than the time it takes to establish IO access which can be done in under 90 seconds. One study I recall (but don't recall the citation for and I'm too tired to dig for it in my Endnote library at the moment) cited 50 seconds as an average time for performance of IO insertion. That is not to mention there are not the training and proficiency issues, costs, etc associated with IO like their are with anything involving US. As much as many of us are loathe to admit, sometimes the cheapest and simplest solution is the best for more reasons than not. Until I see some hard evidence to support it, I will remain vehemently skeptical of your contention on this matter.
 
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