the 100% directionless thread

Tigger said:
My AMR Springs op was forced to pull 14ga IV catheters after city fire's EMS people decided that a 16 has "almost the same flow" and "we do permissive hypotension now."
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To be fair-ish, a 16g does have almost the same flow rate and you can do permissive hypotension regardless of IV catheter size. Removing the 14g catheters from inventory does save a few dollars though... my ED doesn't normally stock 14g catheters - 16g is the biggest we usually use. Caveat: we're a non-trauma center and the only traumas we get are those dumped by the public at our doors even though there's a L2 trauma center literally just up the road.
 
Woot, first fire with my new shift! Granted it was a small brush fire some homeless guy set to some construction equipment off the side of the freeway, but still, got some nozzle time on a bit of flames lol
 
StCEMT said:
I can get by with permissive hypotension, doesn't mean I don't prep my patient for mass transfusion. 🙄
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Such statements fell upon deaf ears. Also 16ga = 180ml/min, 14ga =240ml/min.
 
Tigger said:
My AMR Springs op was forced to pull 14ga IV catheters after city fire's EMS people decided that a 16 has "almost the same flow" and "we do permissive hypotension now."
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Akulahawk said:
To be fair-ish, a 16g does have almost the same flow rate and you can do permissive hypotension regardless of IV catheter size. Removing the 14g catheters from inventory does save a few dollars though... my ED doesn't normally stock 14g catheters - 16g is the biggest we usually use. Caveat: we're a non-trauma center and the only traumas we get are those dumped by the public at our doors even though there's a L2 trauma center literally just up the road.
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Most 14s will flow at about 300 mL/min to 1 meter of gravity with isotonic crystaloid, 16 is a bit over 200.

That difference becomes magnified though when you are pressure infusing a high viscosity fluid (in this case blood product), as we would expect with poiseuille's law. A 14 can dump a bag of fresh whole or PRBCs almost twice as quick when at a pressure of 300mmHg.
 
CALEMT said:
I have come here to chew bubblegum and kick ***.... and I’m all out of bubblegum.
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Okay Duke Nukem

VentMonkey said:
****ing John Carpenter. People truly missed the mark on great cinema these days. Over the top action mixed with cheesy sci-fi? Check.

FWIW, Alien Nation was also a solid go to. Maybe I’m just an Inigo Montoya fan, or maybe I just think Jimmy Caan was a dying breed of tough guy. Either way...
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The Thing. I had nightmares. But boy was it a show.
 
Tigger said:
My AMR Springs op was forced to pull 14ga IV catheters after city fire's EMS people decided that a 16 has "almost the same flow" and "we do permissive hypotension now."
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That almost made me spit my coffee out.

We don't have 14g readily available at my place (you can find them if you really want one) and instead will place a RIC when needed for the occasional large-volume infusion.
 
VentMonkey said:
Solid choice.


He’s a FF, he can’t count that high in English numerals.
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I can count to 10... I can also count to 20 providing my boots and socks are off.
 
Carlos Danger said:
will place a RIC when needed for the occasional large-volume infusion.
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I have been begging to get RICs for our base. You'd be amazed how many times we pick up an ECMO patient with only a triple lumen for access and no sheath or circuit access. Or the Corids is slicked with a Swan and not ideal.
 
VFlutter said:
I have been begging to get RICs for our base. You'd be amazed how many times we pick up an ECMO patient with only a triple lumen for access and no sheath or circuit access. Or the Corids is slicked with a Swan and not ideal.
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Out of curiosity, a true Cordis or a MAC?
 
So we were at the hospital we had a pt. Some lady was outside the ED in the ambo/walk in bay. She was screaming and saying she wanted to see a Dr. The nurses didn't want to let her in. She may be homeless (maybe low income) is my guess, but she's obviously got mental health issues.

While we are being triaged that lady gets in. She sits in a chair and is causing a decent scene. She's not throwing anything or whatnot but she's occasionally getting up and yelling at folks that work there.

She refuses to give info to the triage nurse why she wants to be seen. But she's demanding a dr. She even makes gun hand shapes, pointing it at people saying "Dead"

The nurse wants the cop (full cop not security) to remove her. He says he can't because she's asking for a dr. But they both agree she can't cause a scene and to sit down and be quiet.

So she sits there grinning kinda unhinged. She makes a point to stare at the triage nurse as in "Ha ha they aren't removing me. I'm still here. Look at me"

She starts getting riled up again mad about how other people are being seen sooner than she is. She's going on about suing them and having their jobs.

We get called back with our pt before she does and as we walk by, she lunges with a fist. I pull back but I guess she was just feigning to get a reaction? Even our pt commented on her how she looked like she was trying to hit me.

I'm not sure if that's why, but a minute or so later they had a hospital admin or head of security type in a suit down there and they had the cop take her out.

Where is the line drawn on what is legal and what isn't? Does she have to be triaged to see a Dr?
 
DragonClaw said:
So we were at the hospital we had a pt. Some lady was outside the ED in the ambo/walk in bay. She was screaming and saying she wanted to see a Dr. The nurses didn't want to let her in. She may be homeless (maybe low income) is my guess, but she's obviously got mental health issues.

While we are being triaged that lady gets in. She sits in a chair and is causing a decent scene. She's not throwing anything or whatnot but she's occasionally getting up and yelling at folks that work there.

She refuses to give info to the triage nurse why she wants to be seen. But she's demanding a dr. She even makes gun hand shapes, pointing it at people saying "Dead"

The nurse wants the cop (full cop not security) to remove her. He says he can't because she's asking for a dr. But they both agree she can't cause a scene and to sit down and be quiet.

So she sits there grinning kinda unhinged. She makes a point to stare at the triage nurse as in "Ha ha they aren't removing me. I'm still here. Look at me"

She starts getting riled up again mad about how other people are being seen sooner than she is. She's going on about suing them and having their jobs.

We get called back with our pt before she does and as we walk by, she lunges with a fist. I pull back but I guess she was just feigning to get a reaction? Even our pt commented on her how she looked like she was trying to hit me.

I'm not sure if that's why, but a minute or so later they had a hospital admin or head of security type in a suit down there and they had the cop take her out.

Where is the line drawn on what is legal and what isn't? Does she have to be triaged to see a Dr?
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Yes, there is an EMTALA obligation to see all patients who present to the emergency department.

She easily could have already been seen and discharged though.
 
silver said:
Out of curiosity, a true Cordis or a MAC?
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Usually a 8.5fr Cordis. Most places we fly don't have MACs which is unfortunate. But even with a MAC you still have to use the central lumen for a Swan and then the 12g for volume.
 
VFlutter said:
Usually a 8.5fr Cordis. Most places we fly don't have MACs which is unfortunate. But even with a MAC you still have to use the central lumen for a Swan and then the 12g for volume.
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That is unfortunate, it makes everything so much easier. Though even with a Swan in, the 9Fr lumen runs faster than the 12ga lumen. We use the 9Fr w/ swan for volume and 12ga as our infusion line.
 
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Peak said:
Yes, there is an EMTALA obligation to see all patients who present to the emergency department.

She easily could have already been seen and discharged though.
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They said she's a frequent flyer. So I dunno.
 
DragonClaw said:
They said she's a frequent flyer. So I dunno.
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She's allowed to be seen as many times as she wants. But there are ways to have patients banned from hospitals including the emergency room. It takes a lot of paperwork. I knew one patient that was only allowed at the county hospital and required a 1:1 sitter that had to be a security guard.
 
PotatoMedic said:
She's allowed to be seen as many times as she wants. But there are ways to have patients banned from hospitals including the emergency room. It takes a lot of paperwork. I knew one patient that was only allowed at the county hospital and required a 1:1 sitter that had to be a security guard.
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Hospital I worked in as security had about a half-dozen of those types of patients. ER would call us to come babysit them as soon as they were spotted on the property.
 
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