NomadicMedic
I know a guy who knows a guy.
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Funny, I just told my partner I was gonna look for an EJ on my next code. It's been a while since I started one.
Trouble with Ivs
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Sounds dumb- I usually forget. I've never done one.
RocketMedic
Californian, Lost in Texas
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It's honestly never crossed my mind. I like to drop a C-collar on after we intubate to appease the Protocol Gods.
Just as an aside...on a totally anecdotal level I'm not sold on the utility of c-collars for this purpose.
NYMedic828
Forum Deputy Chief
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Never have I used a C-collar for maintaining airway. Tape the tube and don't kick the head around...
I also have never personally started an EJ. My partners have. I just find it easier to grab the IO if I don't have a peripheral vein.
I also have never personally started an EJ. My partners have. I just find it easier to grab the IO if I don't have a peripheral vein.
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Our medical director prefers us not to use the EJ if an IO is available, but it's not forbidden outright. Just strongly discouraged.
RocketMedic
Californian, Lost in Texas
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Neither am I, but it is what it is. Personally, I've always thought that the best answer to maintaining a stable position of an intubated patient is to tape it in, recheck it after every move, and monitor capnography thoughout. Collars and backboards put a lot of unneeded manipulation of that head, neck and airway into place and breed complacency.
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I'm the youngest medic at my company and people look at me like I have 3 heads when I bring in patients with EJs courtesy of yours truly.
"Why didn't you just do an IO?"
While an EJ is definitely invasive an IO surpasses it, no reason to put a hole in someone's tibia when you can easily drop a peripheral line in their EJ and yes, an EJ is a peripheral line. Plus, they tend to flow better, in my experience, even if the IO was properly placed and flushed.
Still generally go straight to the IO in arrests though.
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Same here..
Reminds me I havnt started an EJ in years. Ive either had good luck with the arms or it was a code which for us is EZIO for access.
It's funny, I hear a lot of "911" medics state the c-collar method as gospel, but most CCT medics/nurses (the people who move intubated patients all the time) don't do this yet don't seem to displace tubes all that often....
I havnt thought about it before but you're right.
None of my vented patients have collars unless the hospital left it in place/or applied it because imaging showed an injury.
And we've never displaced one moving someone without it.
RocketMedic
Californian, Lost in Texas
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I think the collar instills false confidence.
VFlutter
Flight Nurse
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Are you guys using commercial ET tube holders or tape?
The ICUs around here use the hollister anchor fast and they seem to work great. I assume they would be good for transport as well.
NYMedic828
Forum Deputy Chief
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Are you guys using commercial ET tube holders or tape?
The ICUs around here use the hollister anchor fast and they seem to work great. I assume they would be good for transport as well.
Volly establishment has the clamping tube holder with the velcro, FDNY uses Hy-Tape.
Sublime
LP, RN
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I worked in a level 1 trauma center ER and all we used to secure tubes (in non c-spine precaution patients) was string. Can't think of the name of the string/tie we used for some reason but it looks like shoe lace kind of. We would move people from the bed to the CT machine then back to the bed and up to the ICU bed... never needed a c-collar to keep the tube secure.
Aidey
Community Leader Emeritus
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Here that gospel was started by the ED docs after a couple of tubes were displaced. There were a couple of incidents in which the crew swore the tube was in, but the hospital found it was bad. The c-collar rule was implemented along with a couple other rules in an attempt to prevent fighting between us and the hospital about who displaced the tube.
Shishkabob
Forum Chief
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Meh, it can't hurt, and that's probably the only thing in medicine that is true in regards to no evidence.
I pop one on when I remember... and when I'm not doing every single damn other thing.
I pop one on when I remember... and when I'm not doing every single damn other thing.
firecoins
IFT Puppet
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On my last cct of an intubated pt, I put a c collar on to protect to tube. We hit some rough roads under construction around the receiving facility and wanted extra protection.
Thricenotrice
Forum Lieutenant
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Why are the EJs discouraged? Possibility of an embolus? Only been trough internship with no job yet but I started one almost every shift on people with terrible vasculature