I think we've only had 1 IV started on the last 50 calls and the physician/nurse never complained about us not starting one. However, many of our calls have a minimal transport time, so there simply isn't an opportunity. The only drug we give IV is D50W, so our IVs are mostly for fluid resuscitation and as a precaution (as with nitro administration). For that matter, we don't really start an IV on a medical pt very often.
What is your protocols for admin of IV NS
- Thread starter rhan101277
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Agreed.
I usually explain that I'm simply trying to do my job (if the IV is indicated of course), you can't force them, but with a little explanation most everyone agrees to it. In fact, I don't think I've ever had a patient refuse an IV, in fact most expect to get one when there's an ambulance called. I can remember a number of instances where I had to explain why a patient wasn't getting one when I was a basic.
Juxel
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We have extremely conservative fluid administration protocols because our QA department was finding that people were giving boluses because "grandma is old, she can use fluid" only to find out that grandma is in renal failure. That's just one example.
That's a terrible reason to give fluid. If grandma's pressure is low or she is obviously dehydrated (hx of n/v, diarrhea, unable to keep fluids down), then sure, give her a bolus. If you are doing it because "she's old, it won't hurt", you won't have a job here for long.
In adults, we only administer boluses if the SBP is <90 and then the first bolus is 500ml (250ml if over 65 or hx of CHF). We don't even carry liter bags. We carry 250cc and 500cc bags so someone can't open a bag up and forget about it.
When I'm working in the ED I'm similarly conservative with my stable patients.
That's a terrible reason to give fluid. If grandma's pressure is low or she is obviously dehydrated (hx of n/v, diarrhea, unable to keep fluids down), then sure, give her a bolus. If you are doing it because "she's old, it won't hurt", you won't have a job here for long.
In adults, we only administer boluses if the SBP is <90 and then the first bolus is 500ml (250ml if over 65 or hx of CHF). We don't even carry liter bags. We carry 250cc and 500cc bags so someone can't open a bag up and forget about it.
When I'm working in the ED I'm similarly conservative with my stable patients.
DarkHuntressMedic
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Maybe I'm just simple but start and IV if its needed, or foreseen to be needed. A key part of your job is being able to recongize and act or not act.
Use fluids when you need them. If you don't know when NSS is needed, you have more issues then we can help.
There is always a saline lock option also. 10cc flushes work well to move the meds through the cath into the vein... if you need more then that- attach a bag.
Stay safe out there
Use fluids when you need them. If you don't know when NSS is needed, you have more issues then we can help.
There is always a saline lock option also. 10cc flushes work well to move the meds through the cath into the vein... if you need more then that- attach a bag.
Stay safe out there
BLSBoy
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Every pt gets a lock.
Pts needing fluid get...... FLUID!
Of course, I only see ALS calls, so of course, the toe pains don't get IVs.
Pts needing fluid get...... FLUID!
Of course, I only see ALS calls, so of course, the toe pains don't get IVs.
medic417
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Every pt gets a lock.
Pts needing fluid get...... FLUID!
Of course, I only see ALS calls, so of course, the toe pains don't get IVs.
Wow is your dispatch so good that you actually only see patients in need of ALS?
BLSBoy
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^_^We actually rarely hang a bag. Cardiac problems, dehydration and trauma are the majority of the times that we'll hang a bag and even then I've only been on 1 call so far that they ran anything more than TKO rate.
On the other side usually the senior medics are better at this but they have a pretty good feeling if the hospital will want an IV when they get there or not. If they think the hospital will want an IV but it doesn't fall into a category above we will start a lock, otherwise we let them be. Also if the veins are questionable or the patient is apprehensive we will skip on the lock and let the hospital deal with it, don't want to stick and miss.
On the other side usually the senior medics are better at this but they have a pretty good feeling if the hospital will want an IV when they get there or not. If they think the hospital will want an IV but it doesn't fall into a category above we will start a lock, otherwise we let them be. Also if the veins are questionable or the patient is apprehensive we will skip on the lock and let the hospital deal with it, don't want to stick and miss.
medic417
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That sucks as dispatch could be wrong. ALS should be the standard for all responses. No offense to basics but the "training" is not sufficient to actually determine true status of a patient. Plus if they need advanced care sending basics delays proper care.
BLSBoy
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EMD is usually pretty good at screening callers.
Since there are only 4 MICUs and 2 MICU/CCT trucks for the entire county, skill retention is quite high.
Not every pt is ALS.
medic417
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But it should be confirmed with ALS then downgraded to BLS. Less likely mistakes would be made that way.
BLSBoy
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Caller calls for a ride to the hospital, or toe pain, or arm pain, there is absolutely no need for ALS.
The run through the is the pt conscious, breathing, etc.
medic417
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Until a hands on exam by someone with some education there is no accurate way to determine if a call is BLS or ALS. All those flash cards with questions mean nothing. A person calls ALS should respond. If found to be BLS, send for BLS. If the patient really does not need an ambulance the ALS provider should inform the person they do not need an ambulance and they will need to find another means of transport.
Yeah, EMD algorithms are great if you're running with a limited number of ALS units.
medic417
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Actually they have been proven to be a failure point of many a syatem that has tried them. It sounds as if your system needs an upgrade.
BLSBoy
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You have no clue about NJ EMS do ya?
Not trying to come off like an ***, but we are.......different.
Not trying to come off like an ***, but we are.......different.
medic417
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Actually that is what is wrong with EMS in the USA, everyone thinks they should not come up to proper standards. Based on the many reports about the poor state of EMS in Jersey different is an understatement.
The biggest downfall of EMD is that you're essentially making a diagnosis based on a laypersons perception of the incident. Due to poor information given to dispatchers we have been dispatched non emergency to a PNB and we more often get dispatched emergency to someone that cut their finger while making supper. One trigger I know of that will kick out an emergency response is spurting blood, to a lay person that has never seen a real severed artery spurting blood is exactly what they see. Not a perfect system but it usually works pretty well.
ALS vs BLS debate I could go either way and it would depend on the entire setup of your system as to which would work most efficiently but generalizing saying that ALS should always be dispatched first I cannot agree with.
ALS vs BLS debate I could go either way and it would depend on the entire setup of your system as to which would work most efficiently but generalizing saying that ALS should always be dispatched first I cannot agree with.
BLSBoy
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Would I like to see more ALS? Sure.
I would also like to see EMTs educated better.
Most of the calls up here are flagrant abuse of the 911 system. No need for anything more then a taxi, let alone ALS.
I would also like to see EMTs educated better.
Most of the calls up here are flagrant abuse of the 911 system. No need for anything more then a taxi, let alone ALS.