What is your protocols for admin of IV NS

[rhan101277]

I wanted to get some feedback on this. I have never been on a ALS call where normal saline wasn't administered. It must be a pre-cautionary measure for any call. I guess giving it can't hurt since if its not needed the kidneys will filter it out. Just wanted to see what others though.

We simply just don't give high flow 02 for those that don't need it, so why is this an exception?

 

[medic417]

I wanted to get some feedback on this. I have never been on a ALS call where normal saline wasn't administered. It must be a pre-cautionary measure for any call. I guess giving it can't hurt since if its not needed the kidneys will filter it out. Just wanted to see what others though.

We simply just don't give high flow 02 for those that don't need it, so why is this an exception?

Are they just starting IV's to start them? If so that is bad practice. Also NS can be harmful you can throw the how system out of whack, you know screw up the electrolytes and such. Some systems do the IV's to try and bump payment rates to ALS level but it is fraud.

 

[divinewind_007]

at my service we usually start a saline lock and draw blood most everyone that will allow it...except for certain situations such as 4am tooth pain...but we dont hang a bag unles we need it

 

[tazman7]

our system wants an iv on everybody unless they are already flooded with fluid, then you just need to be careful in how much you give. Kidneys dont always filter out excess fluids. It is possible for the fluid to get backed up into the lungs.

Alot of times the ed nurses complain if you dont bring them in with an iv..

Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..

 

[rhan101277]

Yeah I forgot about the electrolytes if they are well hydrated. But 1 IV bag is how many ounces?

 

[tazman7]

1000ml in a bag.
There is more to worry about then electrolytes.

 

[triemal04]

Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..

So...what's a good reason to not get an IV?

 

[reaper]

Sorry, I do not start IV's unless I am giving meds or they really need fluids. To start an IV because you can or because you are afraid the ER nurse will yell at you, is not professional or ethical.

If they need it, then do it. If they don't, leave them be!

 

[tazman7]

Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint.

Reaper, maybe i worded that wrong.
I never said dont follow protocol...


If I just stuck people even if they didnt need it do you think I would be able to keep my license...

And alot of times giving a little fluid bolus of ns and some o2 to someone will make them feel alot better anyways.. You think 80 year old grandma couldnt use a little hydration...

 

[Epi-do]

Personally...I see it like this. I went to school to be a paramedic, i am going to use every tool in the back of that ambulance on you that I think is necessary for your complaint. If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help? They could drive themselves for cheaper.. If you get in my ambulance you better have a good reason for me to not stick you with an iv...its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurts or you can go get you arm botched by some careless nurse in our ed..

Oh, where to start. First of all, not every complaint needs an IV. Alot of the time, an asthmatic does need a neb treatment, but nothing else. Why would you start an IV on them? Or what about the peds patient who's mom called because he/she stuck a bead up their nose or might have swallowed a coin? There are plenty of patient's out there that there is no good reason for starting an IV on them. They simply do not need it. Part of the job of a paramedic is knowing when NOT to do something.

As for why some people call for help...Maybe they just want the reassurance that they are doing the right thing. New parents are easily spooked, especially if they haven't spent much time around babies/kids. We've all been on the little old lady (or man) that is just lonely and wants some company, even if it is only for 15-20 minutes. We will never know why some people choose to call EMS, but they do. Just because they pick up the phone, it does not mean that they all need XYZ procedure/treatment.

 

[tazman7]

Ok let me rewrite my post...

Im not saying to jump out of the ambulance with a tournaqit in one hand and a 18ga in the other am I? I never said dont follow protocol. Yeah your right an asthmatic might just need a neb treatment... or a pediatric might not need an iv...honestly if I can avoid giving a kid an iv i will..just for the simple fact that i dont want to miss and its alot easier with more hands holding the child down to do it. But if the child needs it or needs some kind of med your damn right i will stick them.

But how is every kind of med in the ambulance besides 2 (on our ambulance at least) given...by iv.

So are you saying that on a call for abdominal pain your not going to start an iv because you prob wont end up giving any kind of pain meds anyways.....

But what I am saying, is yes if I think an iv is needed im not afraid to start one.

Reaper, my thinking on what is unprofessional or unethical is the paramedic that doesnt want to use all the tools in the back of the ambulance on the pt. If they just wanted a ride to the hospital then they would have called a taxi not an ambulance.

 

[Sasha]

If the pt doesnt want me to give them an iv or to not touch them then why did they call for my help?

Because to them it's an emergency and sometimes people just don't know what else to do. That doesn't mean they warrant an IV, especially if they decline the IV.

If you get in my ambulance you better have a good reason for me to not stick you with an iv

They need no other reason besides the fact that it's their body and they said no.

its either you get an iv in the ambulance by me who rarely misses and is always told that it never hurt

Purely anecdotal, but the last person who told me that they're always told their IVs don't hurt, stuck my tendon the first time, and the second time started it over a knuckle. Both times they hurt like a witch.

 

[medic417]

Because to them it's an emergency and sometimes people just don't know what else to do. That doesn't mean they warrant an IV, especially if they decline the IV.


They need no other reason besides the fact that it's their body and they said no.


Purely anecdotal, but the last person who told me that they're always told their IVs don't hurt, stuck my tendon the first time, and the second time started it over a knuckle. Both times they hurt like a witch.

Good answer. Tell her whats shes won Chuck.

A patient has the right to refuse any procedure. Its just like backboarding. Some say if they are trauma they will be backboarded or they can not go in the ambulance. Bull. Patient says no, have them sign refusal of that treatment then take care of any other problems they have.

IV's just because is just sadistic. Plus it even puts the provider at additional unnecessary risk of exposure. No matter how good you are something could go wrong.

 

[tazman7]

Never said to give an iv just because. Thats why I rewrote my post, is because thats kinda how i made it sound..

What I am saying is you have to follow protocol and if a pt shows the need for an iv, I am going to start one. im not just going to stick anybody and everybody, but if I think there is potential for them crashing or if they are in need of fluids, I will stick them. I would rather have an iv in and not really need it then to have to stick them while they are crashing.

Your right though, they can refuse all they want to. But sometimes people need a little "push" to get them to do the right thing.

 

[Sasha]

Never said to give an iv just because. Thats why I rewrote my post, is because thats kinda how i made it sound..

What I am saying is you have to follow protocol and if a pt shows the need for an iv, I am going to start one. im not just going to stick anybody and everybody, but if I think there is potential for them crashing or if they are in need of fluids, I will stick them. I would rather have an iv in and not really need it then to have to stick them while they are crashing.

Your right though, they can refuse all they want to. But sometimes people need a little "push" to get them to do the right thing.

A little push as in commiting battery?

 

[rmellish]

Oh, where to start. First of all, not every complaint needs an IV. Alot of the time, an asthmatic does need a neb treatment, but nothing else.

I would probably make sure I had access. If the nebs don't take well there's always IV steroids, either in the truck or the ER depending on protocols.

Disclaimer: nebs are out of my scope, so I'm just armchair quarterbacking this one.

 

[csykes]

Treat the patient and no the protocol is basically what ours says, save for hypovolemia-maintain systolic at or above 90 with LR and NS. burns-parkland formula with LR and NS. ped sepsis- 5 boluses based on weight before pressors come into the game. If a medic deems it necessary to give 2 liters that is fine. Just when bolusing big, monitor lung sounds.

 

[tazman7]

A little push as in commiting battery?

Yeah, what you have to do is get in their face and scream profanity at them and tell them they have no other choice.... then pick out a 14 ga needle or an io and show it to them and then start stabbing around so you can commit assault and battery at the same time...

Are you kidding me? Battery? What I mean by "push" is sometimes a pt will say well I dont think I need to go to the hospital, I have chest pain like this all the time. Or the call for the pt who fainted but says she feels fine now and doesnt want to go to the hospital...im sure you will be learning this sometime in medic school that SOME pts need to be talked into going to the hospital. not everybody is willing or thinks they need to go to the hospital...

And some people dont think that they need an iv, because they know nothing about medical stuff, and they dont realize that the reason you want to give them an iv because you see a firemans hat on the monitor and you dont really want to come out and say "look mrs. johnson, the monitor is showing a firemans hat, that could mean that you at having a heart attack!"

 

[Ridryder911]

Technically only two reasons: Giving fluids and or route for medications.

Now that said, approximately 90% of our patients get an a IV. The reason is simple, our medical director wants them to have one. He feels that it is a lifeline for multiple reasons and weighing the risks vs. the benefits; he much rather of with having a saline lock.

Our ED is busy (alike all others), and alike others it usual standard of care to obtain immediate labs, and route for analgesics, antibiotics, etc...

R/r 911

 

[tazman7]

Our ED is busy (alike all others), and alike others it usual standard of care to obtain immediate labs, and route for analgesics, antibiotics, etc...

R/r 911

Hence the reason why I said the nurses get mad at you....I have been asked quite a few times why is there no iv? What did you do to help this pt? And that was by a dr...