the 100% directionless thread

StCEMT

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This is some awesome info. Definitely a precipitous delivery with an initial APGAR of 8 and mostly from some blue hands and feet that improved with warming. Baby appeared tired to me, but seems expected. Definitely not floppy but again I think EMS is kind of afraid of non-feisty infants.

I did learn to do UVCs but have not ever done one.
The baby description doesn't sound bad, but that BGL would definitely have me cracking a book. Not gonna lie, I didn't remember the cut off for little ones was quite that low.
 

PotatoMedic

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Got to see a migraine mimic a stroke this past tour.
I had a patient with one of those a few weeks ago. Those are trippy.
 

StCEMT

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Planning this Elk hunt with a college buddy out to Idaho this fall and holy **** is there a lot of stuff I need to either buy or learn in the next few months. Gonna be a trip of the blind leading the blind since we are both from the East Coast and have never hunted anywhere further West of Missouri before.
 

PotatoMedic

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Planning this Elk hunt with a college buddy out to Idaho this fall and holy **** is there a lot of stuff I need to either buy or learn in the next few months. Gonna be a trip of the blind leading the blind since we are both from the East Coast and have never hunted anywhere further West of Missouri before.
Where in Idaho?
 

PotatoMedic

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Sawtooth Zone. Might tack on an OTC antelope hunt in Wyoming on the way back.
Well if you get down and west to the Boise area let me know.
 

PotatoMedic

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GMCmedic

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Planning this Elk hunt with a college buddy out to Idaho this fall and holy **** is there a lot of stuff I need to either buy or learn in the next few months. Gonna be a trip of the blind leading the blind since we are both from the East Coast and have never hunted anywhere further West of Missouri before.
I bought my annual Kentucky Elk draw for bull archery, they only draw 15 non resident hunters but it only cost me 10 bucks a year.

A buddy and I have access to 4100 acres in Idaho for whitetail so we started buying points for that.

Im sure you know this but Wyoming wilderness land is off limits to non residents unless you have a guide. BLM land is good to go.
 

StCEMT

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@PotatoMedic I don't know if we will make it the Boise area, but we haven't settled on a plan. I'll let ya know if we do.

@GMCmedic I haven't ever really looked into Kentucky, but I knew they had some. Is that something they are growing over time. And yeah, I saw. We would probably hunt the Eastern part of the state just due to ease of getting a tag there despite the **** access with public land.
 

StCEMT

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Unrelated note....for those of y'all who carry whole blood, y'all mind sharing the spark notes version of how y'all store it, rotate through with new blood, and any other information you deem pertinent? I'd like to try to push a partnership with out local level 1 in getting blood. We have a really good relationship with all the staff there and I think I know a few docs who would be interested in helping us. Just have some homework to do before I actually present this as an idea. I'd rather have logistics, process, storage, a protocol, and any relevant research laid out.
 

GMCmedic

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@PotatoMedic I don't know if we will make it the Boise area, but we haven't settled on a plan. I'll let ya know if we do.

@GMCmedic I haven't ever really looked into Kentucky, but I knew they had some. Is that something they are growing over time. And yeah, I saw. We would probably hunt the Eastern part of the state just due to ease of getting a tag there despite the **** access with public land.
I think the elk herd is pretty stable where they want it, or above. They increased amount of licenses this year cause of low success rates.
 

GMCmedic

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Unrelated note....for those of y'all who carry whole blood, y'all mind sharing the spark notes version of how y'all store it, rotate through with new blood, and any other information you deem pertinent? I'd like to try to push a partnership with out local level 1 in getting blood. We have a really good relationship with all the staff there and I think I know a few docs who would be interested in helping us. Just have some homework to do before I actually present this as an idea. I'd rather have logistics, process, storage, a protocol, and any relevant research laid out.
We carry 4 units of PRBC's and 4 units of plasma refrigerator at base, of that 2/2 in our cooler. Plasma gets tossed when it expires and blood is returned to the vendor prior to 10 days before expiration for credit. I assume the vendor then pushes it out to hospitals.

PRBC's are low titer O pos. We will eventually move to whole blood, I dont know what the hold up is.

As far as protocol, it's essentially suspected hemorrhage with low blood pressure.
 

RocketMedic

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Here’s the transfusion protocol for Cypress Creek. Low titer O Positive whole blood.
 

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Peak

ED/Prehospital Registered Nurse
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I'm curious how systems rotate through fresh whole blood and justify the relative high volume of loss. I can certainly see the potential benefit, but things like HEMS not included I would think those systems that would have the greatest benefit (rural systems with long transports) would also have pretty high product waste.

We have entertained the idea a couple of times in our system but even at our our sister level 1 when they looked at uncrossed transfusions there still isn't enough volume to justify implementation (granted here there are way too many trauma centers in the state). We are also very limited with what we can do with the blood afterwards as we cannot use it for routine inpatient administration, priming bypass, and so on; and once you pass the initial resuscitation the value of whole blood over lab guided resuscitation (Pt/INR, TEG, hemogram, lytes, etc) quickly wanes. Our primary and specialty teams teams are BCT, I don't think there is any really push towards FWB currently.

I wonder what percentage of services that carry blood product actually use a warmer, it seems like a battle to get smaller centers to use them consistently in the ED and even in larger trauma centers it doesn't seem to be a priority outside of the ED and OR. I remember it was quite the battle on our department to even keep fluid bags warmed and that cost was minimal.

I would hope that any service that carries blood would also carry an iStat or similar device so that you can look at your pH and electrolytes and treat accordingly. We test our blood before priming our bypass and ECMO circuits and it is amazing how not compatabile with life stored blood can be.
 

RocketMedic

King of the Improbable
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I'm curious how systems rotate through fresh whole blood and justify the relative high volume of loss. I can certainly see the potential benefit, but things like HEMS not included I would think those systems that would have the greatest benefit (rural systems with long transports) would also have pretty high product waste.

We have entertained the idea a couple of times in our system but even at our our sister level 1 when they looked at uncrossed transfusions there still isn't enough volume to justify implementation (granted here there are way too many trauma centers in the state). We are also very limited with what we can do with the blood afterwards as we cannot use it for routine inpatient administration, priming bypass, and so on; and once you pass the initial resuscitation the value of whole blood over lab guided resuscitation (Pt/INR, TEG, hemogram, lytes, etc) quickly wanes. Our primary and specialty teams teams are BCT, I don't think there is any really push towards FWB currently.

I wonder what percentage of services that carry blood product actually use a warmer, it seems like a battle to get smaller centers to use them consistently in the ED and even in larger trauma centers it doesn't seem to be a priority outside of the ED and OR. I remember it was quite the battle on our department to even keep fluid bags warmed and that cost was minimal.

I would hope that any service that carries blood would also carry an iStat or similar device so that you can look at your pH and electrolytes and treat accordingly. We test our blood before priming our bypass and ECMO circuits and it is amazing how not compatabile with life stored blood can be.
You and your science don’t sound cool, so the clear answer is to take the ideas of a few EM docs and people and substitute their limited anecdotes for your real-world concerns!/sarcasm

In all honesty, to my knowledge, none of the systems that are transfusing blood pull labs beyond a hemoglobin assessment, and although they do use warmers, I don’t think there’s much consideration given beyond “blood is good”.
 
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