the 100% directionless thread

Akulahawk said:
Not a stupid question. This is what a cutdown is...

https://www.youtube.com/watch?v=AHuJZHvTNGE
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Thanks!

Yeah that does seem to be an extremely invasive procedure best done in a stable environment, as opposed to the field.

When would this be done? In my mind, at least for the field use, seems like if you have a critical trauma patient that needs large bore needles but unable to otherwise gaib IV access coupled with an extended transport time?

I'm lucky here at my new service, we literally have our choice of 3 different trauma centers, no more than 30 min by ground (ok granted thats without traffic, but still...) so I very seriously doubt there'd ever be a need for this here (besides the fact its LA County's protocols so yeah lol)
 
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You're right... performing a Saphenous Vein cutdown is quite invasive. You're not simply puncturing the skin, you're completely destroying any protection against infection that the skin provides if you do it under non-sterile conditions. Given that there are MANY other options available for fluid resus than doing a cutdown, at least in the field setting, I really don't see the need to perform them except under some VERY specific circumstances where you might need to be able to infuse a LOT of fluid very quickly in a patient where IV access is otherwise unobtainable and you can't manage to do an IO or three...

While I probably could do a cutdown, there's absolutely no way I'd ever contemplate doing that procedure without being formally trained to do it, even if someone "blessed" me with the authorization to do it without the formal education.
 
Boxed wine is bad for your brain. Mkay. No story with this........ yet.
 
Jim37F said:
When would this be done?
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Pretty much never, these days.

It used to be a commonly taught method for gaining access in peds when you couldn't get large PIV access, and either couldn't get an IO for some reason, or the IO didn't give the flow you needed. CVC's were considered more difficult/risky to do by landmark in peds, so cutdowns were taught to non-surgeons as an alternative in trauma and other critical situations. The technique has largely obviated by ultrasound-guided CVC techniques and better IO devices, and it's been quite a while since I've even heard of a cutdown mentioned as an option.

I've never heard of cutdowns appearing in EMS protocols, even in aggressive HEMS programs. I don't know how you would train on it or maintain competency. Same goes for CVC's, for that matter.
 
Halothane said:
Pretty much never, these days.

It used to be a commonly taught method for gaining access in peds when you couldn't get large PIV access, and either couldn't get an IO for some reason, or the IO didn't give the flow you needed. CVC's were considered more difficult/risky to do by landmark in peds, so cutdowns were taught to non-surgeons as an alternative in trauma and other critical situations. The technique has largely obviated by ultrasound-guided CVC techniques and better IO devices, and it's been quite a while since I've even heard of a cutdown mentioned as an option.

I've never heard of cutdowns appearing in EMS protocols, even in aggressive HEMS programs. I don't know how you would train on it or maintain competency. Same goes for CVC's, for that matter.
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CVCs we can get some in the ED when we do our currency rotations, and they primarily would like us to do femoral as our field option. Cutdowns are a legacy in the protocols that no one is sure why they're there. We have so many other methods I can't ever imagine needing it. With EZ-IO, manual IO, vein-lights, and ultrasound coming, I can't see a need for htem.
 
Jim37F said:
Thanks!

Yeah that does seem to be an extremely invasive procedure best done in a stable environment, as opposed to the field.

When would this be done? In my mind, at least for the field use, seems like if you have a critical trauma patient that needs large bore needles but unable to otherwise gaib IV access coupled with an extended transport time?

I'm lucky here at my new service, we literally have our choice of 3 different trauma centers, no more than 30 min by ground (ok granted thats without traffic, but still...) so I very seriously doubt there'd ever be a need for this here (besides the fact its LA County's protocols so yeah lol)
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It'll never be done in the field here. And we are over 200 miles from the nearest Lvl 1, and our local Lvl 3 is 90 minutes away. We bypass our local Lvl 4 that's in the county to take patients to a fixed wing pretty regularly. I thought being 45 minutes minimum out from the state Lvl 1 was a long transport.
 
On the bright side, I hung my first levo drip last night, and got to play with a King Vision VL on that call :) I like it.
 
Robb said:
I don't understand CVCs in the field because they just get replaced, you haven't helped the hospital with anything.

Nate, screw you lol.

I miss work :(
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Dude, the Lvl 3 we take people to replaces everything, from the hub down on IVs, ETTs, foleys, you name it, they replace it.
 
TransportJockey said:
Dude, the Lvl 3 we take people to replaces everything, from the hub down on IVs, ETTs, foleys, you name it, they replace it.
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Alright that's excessive and I could see a lawyer going after a botched airway swap as negligent but hey if that's what they like to do that's what they like to do.

I'm running out of seasons of House...started season 7 episode 17 this morning...started at season 1 episode 1 after they cut me open. Watched House of Cards in it's entirety. Starting to need some suggestions.

Also who's had shoulder surgery? They keep saying 6 months minimum. That means I'm not even halfway through this bull:censored::censored::censored::censored:. I wanna find out what I need to do to chop that 6 to a 3.
 
Robb said:
Also who's had shoulder surgery? They keep saying 6 months minimum. That means I'm not even halfway through this bull:censored::censored::censored::censored:. I wanna find out what I need to do to chop that 6 to a 3.
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Patience, my friend.

Some people have done almost the entire Excelsior College nursing program in 6 months.

Just sayin....
 
Robb said:
Alright that's excessive and I could see a lawyer going after a botched airway swap as negligent but hey if that's what they like to do that's what they like to do.

I'm running out of seasons of House...started season 7 episode 17 this morning...started at season 1 episode 1 after they cut me open. Watched House of Cards in it's entirety. Starting to need some suggestions.

Also who's had shoulder surgery? They keep saying 6 months minimum. That means I'm not even halfway through this bull:censored::censored::censored::censored:. I wanna find out what I need to do to chop that 6 to a 3.
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Just started season 1. I am down to 3 pts a day in my clinic...... so thankgod for netflix and usdrama. Net.
 
Drug box pron. Was doing the non controlled and non refrigerated checkoff this morning
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Halothane said:
Patience, my friend.

Some people have done almost the entire Excelsior College nursing program in 6 months.

Just sayin....
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My only issue with excelsior is I don't know how well I'd d o in a program without deadlines. That and the TC here won't hire EC grads and they have the highest acuity ICUs.

67 credits in 6 months? Thats impressive.
 
Robb said:
My only issue with excelsior is I don't know how well I'd d o in a program without deadlines. That and the TC here won't hire EC grads and they have the highest acuity ICUs.

67 credits in 6 months? Thats impressive.
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I'm debating doing it. A big hospital in abq will hire ec grads for the ed. And you can transfer to icu after a year or so
 
TransportJockey said:
I'm debating doing it. A big hospital in abq will hire ec grads for the ed. And you can transfer to icu after a year or so
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My understanding of it here was EC means they won't hire you period. I'm sure if I did EC then RN to BSN from the university here and had experience I'd be alright but I'd lose my mind working med/surg or something trying to get there.
 
Robb said:
67 credits in 6 months? Thats impressive.
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Well the people I've heard of doing it really fast only took the nursing exams -
they already had all the other coursework.
 
Halothane said:
Well the people I've heard of doing it really fast only took the nursing exams -
they already had all the other coursework.
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That's what I was figuring you were saying. I need to do something, I'm losing my mind.
 
Robb said:
That's what I was figuring you were saying. I need to do something, I'm losing my mind.
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I recommend going to watch some live sports. Even if you can't make it to a pro park/field, go check out the games at your local high school. Helps kill a few hours and is decently entertaining.
 
TransportJockey said:
Drug box pron. Was doing the non controlled and non refrigerated checkoff this morning
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I got a feeling your new service just adds new medications, but doesn't pull the old ones, yeah?

Ammonia inhalants, wtf?
 
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