# Warming of IV fluids with MRE heater



## kaja (Feb 11, 2013)

Hi

I was thinking about using MRE heaters for warming IV infusions, mainly during winter, when jut carrying them under gear won't help that much. Also, I found some suggestions that it can be done, but I'd like to ask more experienced professionals on how to do it best.

Is it preferable to just put IV bagl into heater, and during the exotermic reaction start administration, or coil tubing through the inside of heater, or just tape it side-by-side? is there any simple and field expedient way to control temperature of fluids administered this way? 

I would really appreciate if you'll share your experiences!

Thanks!


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## TLDR20 (Feb 11, 2013)

Why don't you use an approved device like a thermal angel? Using an MRE heater could lead to fluids being too warm and potentially harming the patient.


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## Muppet (Feb 11, 2013)

I agree with cback...I have tried the first years ago when we had no thermal angels and had, well, poor results. I also currently use the thermal angel with / when I work USAR and have good results BUT... First, you must make Kcals or a measurement of heat to produce warming of the blood with the fluid, if I am not mistaken. Second, warmed blood in IMHO is difficult. Why you ask. First as the docs and medics on here can attest to, permissive hypotension is considered stardard of care in the presence of intact mentation, controlled bleeding and ANY kind of fluid, warmed or cold can cause hemodilution, of course I understand the fear of cold fluids resulting in stuff like DIC / hypotension and hypothermia. I hope you understand. So, I would control fluuids by the above, cover the pt. with a blanket(s) AND spoon if needed amoung the other typical shock stuff.

F.M.


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## kaja (Feb 12, 2013)

First, thanks for replies

Thermal Angel- Don't have access to them, they are not approved here, too big/ bulky for small aid bag/ CLS bag.I'd love to have these available for vehicle bag, but no joy either.

I don't plan on using it for any blood products. If I'll have blood, I'll most likely have way to warm it properly.

I understand current TCCC guidelines regarding fluid resuscitation. But I may need to get some fluids into casualty in progressed shock, with burns, dehydration or just drip to keep IV access open. I don't want to do this with cold fluids.
I, or my CLSs, don't always carry IV fluids on my/their body (body armour, layering of clothes, ... or just pure laziness and comfort prevents it) and while operating outside in winter, or just chilly night the fluids in bag can get cold enough too create serious problem when administered.

Overheating may be an issue, hence the question about temperature control. Just the feel may be enough, but maybe taping elastic thermometer may work.

I do plan to do my part and try various application methods, but wanted to first get some advices/ experiences to prevent starting from zero.


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## pardus (Feb 12, 2013)

My first thought is to simply carry the bag against your body... Simple fix.


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## Ranger Psych (Feb 12, 2013)

While you say you can't use them and I get that, there's room in your aid bag for one. Right now, with everything you have in there already. A thermal angel is smaller than a 1000cc bag, battery included. The size argument is pretty much a non-argument...

The other thing is that you mention burns. You're going to be pushing a large amount of fluids for burns as everyone knows... and having a TA for that patient with 1, or even 2 batteries for longer duration use for those Liters of fluid you'll be throwing at them will be a huge deal.

I've never done the MRE heater method, but if I were going to do it I would probably get the heater going, and make someone HOLD THE IV TUBING TO IT. Don't wrap it around it, just hold it against it. Cheap thermometer, basically. If someone can't hold it with the IV tubing just running past it, then you need to figure out something to put between them to buffer the heat. Meanwhile, everyone who can needs to be prepping their bags in their armpits if they're on security.

My next personal choice I would go with if I was having to go without a thermal angel, would be the IV rigs that http://www.doctordown.com/ carries.

If it's cold enough to be worried about IV temperature you might also want to be looking at a combination of Ranger Wraps from doctor down, and active patient heating solutions like http://www.chinookmed.com/cgi-bin/i...ady-Heat-Disposable-Heated-Blanket-36"x60"---  as an example.


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## policemedic (Feb 12, 2013)

Are you saying you have no access to a commercial, approved heating method ?

Here are some other issues to consider when you're getting inventive, along with others previously mentioned:
-inability to heat, particularly if you're putting the heater on the drip tubing itself
-inability to heat evenly
-melting/damaging the tubing/bag


It took me 19 nanoseconds to find this poster, and I didn't even have to hit PubMed.


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## Ranger Psych (Feb 12, 2013)

Well, there you have it. MRE heater's about the only way to do it other than with a stove, and the temperature varies enough on the hot end to be >130 Fahrenheit.

I'm pretty sure if I was a casualty that would wake me up enough to rip the tubing out of my arm then work on using my last breath to take yours. LOL


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## policemedic (Feb 12, 2013)

By the way, are you talking about just running NSS, Hextend, etc., or also using additives e.g. mixing an epinephrine drip?


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## TLDR20 (Feb 12, 2013)

Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? Also, by the time you are to the point in your treatment where IV fluids are needed you prolly would have had about 20 mins to warm them next to a body.


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## Ranger Psych (Feb 12, 2013)

Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.


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## pardus (Feb 12, 2013)

cback0220 said:


> Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? .


 
Not that I'm aware of. They are still not supposed to do IVs.



Ranger Psych said:


> Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.


 
Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.


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## kaja (Feb 12, 2013)

Regarding IV and CLS- Our guidelines allow that, but generally we are also moving away. But since there are CLS guys who take extra time to get schooled, drives ambulances and generally know what they are doing, I feel comfortable to let them administer IV fluids. But that's for different discussion....


policemedic: thanks for that poster. I'm currently on winter exercise, so I have only access to internet through my phone. And very likely I'd have problem finding it even at home...


"Are you saying you have no access to a commercial, approved heating method ?"
Yup. Actually I may try to buy it with my own wallet and pass in under the radar of superiors, but right now I have my hands full with getting everybody at least useful IFAK, not to mention that we are issued tourniquets which, as far as I know, hadn't been properly tested/evaluated.

MRE method just seemed quite functional (at least in my mind), cheap and easily packable. Of course using body heat is still preferred method, but I was looking for possible alternative way.


Although I feel like I poked hornet's nest with my dick, I'm glad for information/ recommendations I got here.


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## The91Bravo (Feb 12, 2013)

pardus said:


> Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.


 
I like the concept, and agree completely with eliminating that step (for the most part). we were running charter students through CLS at Ft Lewis in the late 80's and I often thought, "If we are training them to administer IVs we either need to extend the training so they get a better grasp on how when and why to give it or abandon that portion of the training and add more emphasis to another portion." Ya know what I mean?

We were also planning on a war with Warsaw Pact nations and the battlefield we planned to fight on never came to fruition.


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## TLDR20 (Feb 12, 2013)

With the hypovolemic resucitation protocols in effect now, there is very little reason for a CLS provider to give IV fluids.


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## Totentanz (Feb 12, 2013)

Ranger Psych said:


> Erm, when did that change? CLS incorporated IV administration from back in the 80's when veteran buddies were in, 98 when I did it as well.


It was shortly before Oct 2009.  IV was part of CLS in Feb when I did basic, and was gone by the time I did CLS again in Oct as part of BOLC 2.


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## policemedic (Feb 12, 2013)

Good move, IMHO.


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## Ranger Psych (Feb 12, 2013)

pardus said:


> Not that I'm aware of. They are still not supposed to do IVs.
> 
> 
> 
> Changed about 2 years ago now, too many retard CLS guys giving hextend for dehydration, not to mention spending far too much time trying to give the magic bullet IV while the PT was dying of everything else. We have really moved away from IVs now compared to a few years back.


 
LOL  what the fuck was hextend doing in a CLS bag anyway.   RFR we just focused on IV access once everything else was good. Oh well.


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## pardus (Feb 12, 2013)

Ranger Psych said:


> LOL what the fuck was hextend doing in a CLS bag anyway. RFR we just focused on IV access once everything else was good. Oh well.


 
I'd say at least 50% of regular medics out there are incompetent fucks who I wouldn't allow near me if I was hit, so I wouldn't trust any CLS unless I personally _knew_ they were good to go.
IV access is good if they can keep it open (as I'm sure you know). One problem was that CLS pers and medics were concentrating on IV access at the neglect of actual life saving interventions. 
The only reason for CLS to have fluids was to save lives, immediately on the battlefield and hextend was the only fluid that could really do that, hence it's issue. But being tards, they though all liquid rehydrates because... tits, where?


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## policemedic (Feb 12, 2013)

pardus said:


> I'd say at least 50% of regular medics out there are incompetent fucks who I wouldn't allow near me if I was hit, so I wouldn't trust any CLS unless I personally _knew_ they were good to go.
> IV access is good if they can keep it open (as I'm sure you know). One problem was that CLS pers and medics were concentrating on IV access at the neglect of actual life saving interventions.
> The only reason for CLS to have fluids was to save lives, immediately on the battlefield and hextend was the only fluid that could really do that, hence it's issue. But being tards, they though all liquid rehydrates because... tits, where?


 
In my last unit I removed all the Hextend from the CLS bags.  It was bad mojo, and here's why as I see it.

The CLS class, and to a great degree the 68W schoolhouse, produces people with skills e.g. IV starts _but_ an insufficient understanding of what they're doing.  Hextend is a great example; no CLS or Whiskey in my unit could explain how it works, soooo...you can't have it until you learn more.  Contraindications for flu vaccine we had to administer, same same.  

CLS training should focus on what you identified above--actual life saving interventions in the tactical setting--and the Whiskey schoolhouse needs to step it up.


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## pardus (Feb 12, 2013)

Absolutely! The focus is now on effective placement of a tourniquet as people cant even do that fucking properly.


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## JustAnotherJ (Feb 15, 2013)

pardus said:


> My first thought is to simply carry the bag against your body... Simple fix.


I've done that a lot as long as I had time to actually warm the fluid or if I was responding to a mass-cas.  A consideration to this is the length of travel for the fluid through the IV tubing can rapidly cool the fluid.  If my thermal angel was too bulky to carry or simply not allowable by weight, I would wrap the IV tubing around the guy's arm and wrap it with coban to create a slight warming effect prior to entry.


cback0220 said:


> Using an MRE heater could lead to fluids being too warm and potentially harming the patient.


 That is the main concern as to why I would consider an MRE heater as a last ditch effort.

The best practice, that I found was to use a space blanket and wool blankets, sewn together, with air-reactive heating blankets underneath the patient.   Regardless of fluid temp, the patients body was being heated effectively and seemed to provide the best outlook.


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## TLDR20 (Feb 15, 2013)

That's what I teach.


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## kaja (Feb 16, 2013)

JustAnotherJ said:


> to use a space blanket and wool blankets, sewn together


 
OK, we do use space blankets (or blizzard, helios, whatever) in conjunction with normal blankets/ sleeping bags/..., but I never heard of sewing them together. Can you please elaborate on this a bit? I would assume that any kind of sewing would make the space blanket tear :/


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## Teufel (Feb 16, 2013)

cback0220 said:


> Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? Also, by the time you are to the point in your treatment where IV fluids are needed you prolly would have had about 20 mins to warm them next to a body.


 
I'm pretty sure Marine Corps CLS still teaches and allows IVs.


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## arch_angel (Feb 17, 2013)

Teufel said:


> I'm pretty sure Marine Corps CLS still teaches and allows IVs.



Sir, I recently completed the CLS course myself. To our disappointment IV's are no longer in the curriculum. 

Sent from my DROID RAZR using Tapatalk 2


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## pardus (Feb 17, 2013)

kaja said:


> OK, we do use space blankets (or blizzard, helios, whatever) in conjunction with normal blankets/ sleeping bags/..., but I never heard of sewing them together. Can you please elaborate on this a bit? I would assume that any kind of sewing would make the space blanket tear :/


 
I'm guessing it's one of the heavy duty space blankets, like this...


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## TLDR20 (Feb 17, 2013)

Getting away from IV's is a good move. Hypovolemic resuscitation is the standard. We no longer even give NS or LR. Hex tend is dangerous in the hands of people who are not well versed in its use.


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## policemedic (Feb 17, 2013)

arch_angel said:


> Sir, I recently completed the CLS course myself. To our disappointment IV's are no longer in the curriculum.
> 
> Sent from my DROID RAZR using Tapatalk 2


 
Trust me, it's a good thing.  Concentrate on stopping bleeding and staying in the fight.


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## JustAnotherJ (Feb 18, 2013)

pardus said:


> I'm guessing it's one of the heavy duty space blankets, like


Exactly


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## kaja (Feb 18, 2013)

Thanks Pardus and J, I never saw these before.



cback0220 said:


> We no longer even give NS or LR.


Cback, that means no crystalloid at all, or just during hypotensive resuscitation?


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## TLDR20 (Feb 18, 2013)

kaja said:


> Thanks Pardus and J, I never saw these before.
> 
> 
> Cback, that means no crystalloid at all, or just during hypotensive resuscitation?



No we still give crystalloids for burns and some other things. But not for hypotension.


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## Ranger Psych (Feb 18, 2013)

pardus said:


> I'm guessing it's one of the heavy duty space blankets, like this...
> View attachment 7883


 
The only space blanket I'll ever buy and/or carry. Multiple uses, unlike the mylar waste of a fiscal equivalent of a can-o-chaw.


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## DoctaJ (Jul 17, 2013)

cback0220 said:


> Last I checked CLS's were not allowed to administer IV fluid. Has this changes back? Also, by the time you are to the point in your treatment where IV fluids are needed you prolly would have had about 20 mins to warm them next to a body.



When I graduated medic school 29 October 2011, CLS couldn't do IV's, as they shouldn't. However, my CO and 1SG are okay with me teaching one or two joes from each platoon everything I know, which, is impossible but every bit of information and skill is worth it if I am incapacitated for one reason or another. As for heating IV fluids, just put the fluid in and use passive warming to warm the pt.


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## pardus (Jul 17, 2013)

DoctaJ said:


> When I graduated medic school 29 October 2011, CLS couldn't do IV's, as they shouldn't. However, my CO and 1SG are okay with me teaching one or two joes from each platoon everything I know, which, is impossible but every bit of information and skill is worth it if I am incapacitated for one reason or another. As for heating IV fluids, *just put the fluid in and use passive warming to warm the pt*.



What exacly do you mean "just put the fluid in"?


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## DoctaJ (Jul 17, 2013)

pardus said:


> What exacly do you mean "just put the fluid in"?



Rather than pissing around with warming the fluid, just give them the appropriate bolus. Without knowing what the OP's definition of "winter" is, I cannot comment on what affect a cold 250 or 500ml bolus on an already cold, hypovolemic pt (of course, assuming that's what the fluids would likely be for.)


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## pardus (Jul 17, 2013)

DoctaJ said:


> Rather than pissing around with warming the fluid, just give them the appropriate bolus. Without knowing what the OP's definition of "winter" is, I cannot comment on what affect a cold 250 or 500ml bolus on an already cold, hypovolemic pt (of course, assuming that's what the fluids would likely be for.)



 You realize that has the potential to kill the PT right? 
Have you ever had a bag of room temp fluids administered to yourself? Cold right?

The OP is in Eastern Europe BTW.


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## Diamondback 2/2 (Jul 17, 2013)

Man I liked getting the chills from a room temp bag. 

CLS no longer gets to push IV = one boring ass course. That was the best part (watching privates freak the fuck out).

I took CLS every year I was in and the advanced CLS three times. I'm still pretty confident that I can kill someone with a rifle or a CLS bag.


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## DoctaJ (Jul 17, 2013)

pardus said:


> You realize that has the potential to kill the PT right?
> Have you ever had a bag of room temp fluids administered to yourself? Cold right?
> 
> The OP is in Eastern Europe BTW.



Yes. I do. Rapid infusion of 1000 bag that is European winter cold would likely cause MI and send the pt into cardiac arrest. 

Considering the argument can be won either way based on the copious amounts of variables (injury, EBL, temperature, fluid type, etc.), a more satisfactory post may have been to be proactive. Spend the money on te warmer, or have a plan in place to warm your fluids. 

My winter doesn't get too frigid. CONUS training likely won't produce a multisystem, hypothermic and hypovolemic patient. All situation dependent.


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## pardus (Jul 17, 2013)

DoctaJ said:


> Yes. I do. Rapid infusion of 1000 bag that is European winter cold would likely cause MI and send the pt into cardiac arrest.
> 
> Considering the argument can be won either way based on the copious amounts of variables (injury, EBL, temperature, fluid type, etc.), a more satisfactory post may have been to be proactive. Spend the money on te warmer, or have a plan in place to warm your fluids.
> 
> My winter doesn't get too frigid. CONUS training likely won't produce a multisystem, hypothermic and hypovolemic patient. All situation dependent.



Argument? 

Always plan/train for the worst case scenario and trust me, that isn't an FTX in Ohio.


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## policemedic (Jul 17, 2013)

DoctaJ said:


> When I graduated medic school 29 October 2011, CLS couldn't do IV's, as they shouldn't. However, my CO and 1SG are okay with me teaching one or two joes from each platoon everything I know, which, is impossible but every bit of information and skill is worth it if I am incapacitated for one reason or another. As for heating IV fluids, just put the fluid in and use passive warming to warm the pt.



Just for clarity, do you mean the 68W class or actual paramedic school?  I see from your intro that you're both.


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## DoctaJ (Jul 17, 2013)

policemedic said:


> Just for clarity, do you mean the 68W class or actual paramedic school?  I see from your intro that you're both.


Both.


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## DoctaJ (Jul 17, 2013)

policemedic said:


> Just for clarity, do you mean the 68W class or actual paramedic school?  I see from your intro that you're both.


Sorry. I shouldn't post when I'm this tired. I was referring to 68W school.


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## TLDR20 (Jul 17, 2013)

DoctaJ said:


> When I graduated medic school 29 October 2011, CLS couldn't do IV's, as they shouldn't. However, my CO and 1SG are okay with me teaching one or two joes from each platoon everything I know, which, is impossible but every bit of information and skill is worth it if I am incapacitated for one reason or another. As for heating IV fluids, just put the fluid in and use passive warming to warm the pt.



Holy shit there is some bad info going on in this thread. First of all what is the one of the leading causes of preventable death on the battlefield.....? Hypothermia. Hypothermia should ALWAYS be treated prior to any fluid administration. Further 1000 cc's of anything is terrible medicine for anything but a simple dehydration or a hangover.


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## DoctaJ (Jul 17, 2013)

cback0220 said:


> Holy shit there is some bad info going on in this thread. First of all what is the 3rd leading cause of preventable death on the battlefield.....? Hypothermia. Hypothermia should ALWAYS be treated prior to any fluid administration. Further 1000 cc's of anything is terrible medicine for anything but a simple dehydration or a hangover.


Are we absolutely making shit up now? Hypothermia is certainly not the third leading cause of preventable death on the battlefield. "Further," I don't believe anyone even hinted at the notion of giving 1000ml of fluid.


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## TLDR20 (Jul 17, 2013)

DoctaJ said:


> Are we absolutely making shit up now? Hypothermia is certainly not the third leading cause of preventable death on the battlefield. "Further," I don't believe anyone even hinted at the notion of giving 1000ml of fluid.




I misstyped I edited my comment accordingly, I did that first thing this morning.

Hypothermia is a leading cause of death and is not something that should be overlooked in the battlefield setting. As an instructor at the SOC-medic course it is one of the points we hammer into our studs. It is what kills guys. Just not directly.


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## x SF med (Jul 17, 2013)

DoctaJ said:


> Are we absolutely making shit up now? Hypothermia is certainly not the third leading cause of preventable death on the battlefield. "Further," I don't believe anyone even hinted at the notion of giving 1000ml of fluid.


 
YooHoo, ....  step back, and get a clue about the people you are spouting off to.

Cback is not only a very well respected 18D, he happens to teach Advanced Medical Techniques at the Schoolhouse...  if you ever planned on going to SOCMS/SOMC you just stepped all over your junk with track shoes.

PoliceMedic has more time as a Paramedic in bad areas than you could imagine.

Firemedic - well, see Policemedic....

We have Doctors of all stripes, and nurses and medics and PAs on here.... you are not the king shit of the pile like you think you are at your NG Unit.

Show respect to the people her if you ever even want to be treated as anything other than a smartassed joker...  your SA and people skills suck.

I gave you the benefit of the doubt until you pulled the crap quoted above.   and BTW...  hypothermia can set in at 90* with a blood volume loss of 1.5 pints...  secondary to shock...  it kills more people on the battlefield than you know.   But, hey, wtf do I know... I was only an 18D too....

ADMIN EDIT: PM inbound


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## DoctaJ (Jul 17, 2013)

Apologies. Point taken.


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## pardus (Jul 17, 2013)

DoctaJ said:


> Point taken.



Good. The sooner you learn humbleness the better, for you and your patients.


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