SVT: Unable to obtain IV...IO?

Stable SVT without access? Try a vagal then go to the hospital.


Unstable SVT without access? Make access. Still no access? Shock. It's unstable.
 
Jon said:
Was the patient diabetic? Did you have a hypoglycemic blood sugar reading?
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Only did it once. I was a student on rotation and the medics i was with simply ran the cookbook of the protocol. The patient was a diabetic but they never took a glucose reading. But for the sake of the thread, it was an epic PIA to push d50 through an IO.

Now I know better, and don't do it unless there is reason to be pushing d50.
 
NYMedic828 said:
Only did it once. I was a student on rotation and the medics i was with simply ran the cookbook of the protocol. The patient was a diabetic but they never took a glucose reading. But for the sake of the thread, it was an epic PIA to push d50 through an IO.

Now I know better, and don't do it unless there is reason to be pushing d50.
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I know what you mean. In the NYC 911 system, glucometers weren't mandatory, just like CPAP isn't mandatory. I never took a BGL until I left the state. It was stupid in that we had to give D50 for the AMS, even if the pt's BGL was taken PTA with their own glucometer which was showing high. If we didn't it would be breaking protocol, even though we knew better. I've been a medic long enough to have used the unresponsive cocktail: D50, thiamine and narcan. You're pushing all this stuff because you have to, knowing that it isn't going to be of any benefit.
 
46Young said:
I know what you mean. In the NYC 911 system, glucometers weren't mandatory, just like CPAP isn't mandatory. I never took a BGL until I left the state. It was stupid in that we had to give D50 for the AMS, even if the pt's BGL was taken PTA with their own glucometer which was showing high. If we didn't it would be breaking protocol, even though we knew better. I've been a medic long enough to have used the unresponsive cocktail: D50, thiamine and narcan. You're pushing all this stuff because you have to, knowing that it isn't going to be of any benefit.
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A glucometer is certainly an ALS requirement in NYC...

It isnt required to get a sugar reading on an arrest.
 
NYMedic828 said:
A glucometer is certainly an ALS requirement in NYC...
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I am not sure if that is the case, or if it is more an agency-specific thing. Certainly the wording of the current MAC protocols would suggest that glucometry is still optional - "A glucometer (if available) may be used to document blood glucose level prior to Dextrose administration".
 
Scott33 said:
I am not sure if that is the case, or if it is more an agency-specific thing. Certainly the wording of the current MAC protocols would suggest that glucometry is still optional - "A glucometer (if available) may be used to document blood glucose level prior to Dextrose administration".
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You actually raise a good point there. That is strange...

I don't know anyone though that would be willing to administer dextrose to an AMS patient without checking blood glucose. I have never in my 3 years with the city encountered a unit that did not carry a glucometer.

CPAP equipped units on the other hand is rare, but lets stay on topic in this thread.
 
When one is talking about the critical status of his/her pt with regards to vascular access, or even the lack thereof, one must also define to what extent he/she is unable to gain vascular access. In this hypothetical situation, was the EJ assessed? Was the hepatojugar reflux assessed? Was the pt instructed to swallow to engorge EJ?

One must also use critical thinking skills. Though IO is available for administration of adenosine, the distanceis key. ACLS/protocols (most/mine anyway) dictate a PROXYMAL vascular site no further from the heart than the AC. Unless you are able to establish an IO in the humeral head, Then IO in not practical for adenosine.

However, it is feasible to improve proxymal vascular access with IO by giving fluid boluses. Just make sure breath sounds are able to tolerate the boluses.
 
I had success giving Adenosine with a 22 ga. IV in a foot. My partner and I thought it was a long shot but gave it a try and it worked. I did have a syringe of saline in the port above the port for Adenosine. I pushed the Adenosine and my partner pushed the saline at teh same time.
 
I vote for:

If stable, drive calmly to hospital.

If unstable, pull out all stops, but I would probably start with electricity if they were bad.
 
NYMedic828 said:
A glucometer is certainly an ALS requirement in NYC...

It isnt required to get a sugar reading on an arrest.
Click to expand...

It wasn't required when I last worked in the system back in Oct. 2007.
 
Scott33 said:
I am not sure if that is the case, or if it is more an agency-specific thing. Certainly the wording of the current MAC protocols would suggest that glucometry is still optional - "A glucometer (if available) may be used to document blood glucose level prior to Dextrose administration".
Click to expand...

That's how I remember the MAC. I think that the Redimedics field guide said the same thing.
 
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