pre-action IV line

[pardus]

I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
This in itself would stop me from wanting to do this.
Please educate me if i am wrong.

Please post an intro as per the rules you signed before posting again.

 

[pardus]

I know this post is old guys but im just new to the site, no one has really touched on the increased chance for blood infection due to the direct access to the vein, and if anyone has been in combat you know just how impossible it is to keep anything clean.
This in itself would stop me from wanting to do this.
Please educate me if i am wrong.

I would hope they would sterilize the skin pre IV and I know I would place a tegaderm over the site if it was me. Should be OK short term I would think.

@TLDR20 ?

The Israelis are pretty good with medicine from what little I have seen.
I'm interested in knowing if they've continue to do this given time and experience.

 

[TLDR20]

I would hope they would sterilize the skin pre IV and I know I would place a tegaderm over the site if it was me. Should be OK short term I would think.

@TLDR20 ?

The Israelis are pretty good with medicine from what little I have seen.
I'm interested in knowing if they've continue to do this given time and experience.

Yeah I agree. I just don't think that it is worth it. These days I can drill an IO in someone before you can get your IV flowing, guaranteed. So I'll just do that post injury.

Also I forgot what was in the beginning of this thread, but giving someone an IV every night for 3 months? Seems excessive.

 

[TLDR20]

Hextend and other like hetastarch products. 500cc bolus, wait 10-15 minutes, with no improvement and trended vitals, re-administer the other 50cc to get to your 1000cc total. No further hex after that.

The fluid resus question is more of an art than science- some places it will say get peripheral pulses back then titrate, in between 80-100 in some books, patient presentation in some. Hypo resus is the latest and greatest, no more "2 large bore IVs in different big veins with fluids wide open".

This is an old thread but I wanted to point out changes to the fluid resuscitation protocol. The standard for TCCC, and the TMEPs, for a patient in hypovolemia is to administer a 500cc bolus of Hextend. then wait 30 mins, then reassess the patient, if the patient is still not to a strong radial pulse or over 90, they get another 500cc bolus of Hextend, at that point, you do not want to give more fluids as it will likely lead down a road that turns your blood into red water.

Now I personally taught that if you felt any radial pulse, to titrate the second 500 bag up to a strong radial pulse. I know this thread is old but I wanted to throw out the latest information, as people are obviously still reading these old ass threads.

 

[pardus]

Yeah I agree. I just don't think that it is worth it. These days I can drill an IO in someone before you can get your IV flowing, guaranteed. So I'll just do that post injury.

Also I forgot what was in the beginning of this thread, but giving someone an IV every night for 3 months? Seems excessive.

Do you use a FAST1 as standard? Does an IO impede you in anyway after the fact? i.e. Ive heard people say it makes you non deployable for a while.

This is an old thread but I wanted to point out changes to the fluid resuscitation protocol. The standard for TCCC, and the TMEPs, for a patient in hypovolemia is to administer a 500cc bolus of Hextend. then wait 30 mins, then reassess the patient, if the patient is still not to a strong radial pulse or over 90, they get another 500cc bolus of Hextend, at that point, you do not want to give more fluids as it will likely lead down a road that turns your blood into red water.

Now I personally taught that if you felt any radial pulse, to titrate the second 500 bag up to a strong radial pulse. I know this thread is old but I wanted to throw out the latest information, as people are obviously still reading these old ass threads.

It's important that a thread like this is kept up to date, I certainly appreciated it.

 

[TLDR20]

Do you use a FAST1 as standard? Does an IO impede you in anyway after the fact? i.e. Ive heard people say it makes you non deployable for a while.
.

I don't know as to the IO making you non-deployable. But I doubt it changes your status more than a wound requiring fluid resuscitation, know what I mean?

 

[pardus]

I don't know as to the IO making you non-deployable. But I doubt it changes your status more than a wound requiring fluid resuscitation, know what I mean?

Yeah absolutely, sounded weird to me. I mean a serious bone break heals in approx 6 weeks and skin/flesh will close and seal a lot quicker than that so I see no reason to have some out of action past the wound healing. FYI the timeline I was told was (IIRC) 12mths non deployable after an IO.

 

[Muppet]

Are anybody using EZ IO's out there (TFC / TACEVAC) or just FAST's? Just wondering. I see North American Rescue Products / Vida Care are selling sternal sets (manual)...

F.M.

 

[policemedic]

I never was much of a fan of sternal IOs.

 

[Muppet]

I never was much of a fan of sternal IOs.

Did not have any of this in the 90's. I like EZ IO's. Got in trouble about 6 years ago when we (EMS) first got them. Every shitty, unstable pt. got a I.O. Then bosses were all "MONEY, THEY COST MONEY"! Gotta love pt. care governed by billing.

F.M.

 

[TLDR20]

EZ IO's are what are issued to SOCM medics.

 

[amlove21]

Are anybody using EZ IO's out there (TFC / TACEVAC) or just FAST's? Just wondering. I see North American Rescue Products / Vida Care are selling sternal sets (manual)...

F.M.

FAST is pretty much done. Hard to get out without the removal tool, easy-ish to mess up, whatever. The Ez IO is way better, we carry both the hand driven and drill IOs on the bird. There is also a sternal needle in the EZ IO, if that's the only site you have.

 

[policemedic]

EZ-IO is the tits.

 

[Ranger Psych]

FAST is pretty much done. Hard to get out without the removal tool, easy-ish to mess up, whatever. The Ez IO is way better, we carry both the hand driven and drill IOs on the bird. There is also a sternal needle in the EZ IO, if that's the only site you have.

Sounds like a win win, wouldn't have minded trying out/playing with other IO options but the FAST seemed to be the way to go at the time.

Plus, it was always good for frightening privates with, considering a threatening of a prince albert done with that would cure what ails ya.

 

[amlove21]

Sounds like a win win, wouldn't have minded trying out/playing with other IO options but the FAST seemed to be the way to go at the time.

Plus, it was always good for frightening privates with, considering a threatening of a prince albert done with that would cure what ails ya.

hahah yea. It would really piss the CSH/Role docs off when you dropped a patient but didnt have the removal tool. If they didn't have one either, that guy was getting cut open to remove it.

The EZ IO is dope, light, and has the hand-driven option if the batteries fail. Pretty great.

 

[Muppet]

hahah yea. It would really piss the CSH/Role docs off when you dropped a patient but didnt have the removal tool. If they didn't have one either, that guy was getting cut open to remove it.

The EZ IO is dope, light, and has the hand-driven option if the batteries fail. Pretty great.

Bro. You just used the word "dope" That's fucking epic awesomeness! It's also pretty dope!

F.M.

 

[amlove21]

Bro. You just used the word "dope" That's fucking epic awesomeness! It's also pretty dope!

F.M.

I'm VERY hood. I always fit in well in South Philly, believe me. I was not the Bucks County medic.

 

[Muppet]

I'm VERY hood. I always fit in well in South Philly, believe me. I was not the Bucks County medic.

What are you trying to say hood rat? I am all Bucks and no Fucks? . I did my Rescue time @ Medic-11, South Fucking Philly yo. I also grew up in the Lindonfield Projects. For real, I did. Not fun. Who was the Bucks medic you knew besides me? Oh, come to my local in Lower Bucks. Some A.O.'s are very similar to North Philly, especially Bloomsdale, Fleetwing, Venice Ashby, Winder Village, yada yada yada....

F.M.

 

[amlove21]

What are you trying to say hood rat? I am all Bucks and no Fucks? . I did my Rescue time @ Medic-11, South Fucking Philly yo. I also grew up in the Lindonfield Projects. For real, I did. Not fun. Who was the Bucks medic you knew besides me? Oh, come to my local in Lower Bucks. Some A.O.'s are very similar to North Philly, especially Bloomsdale, Fleetwing, Venice Ashby, Winder Village, yada yada yada....

F.M.

hahahah nice! I was at 37s, our local backed up to 11. Two of our guys got Bucks for ride alongs, and we used to mercilessly make fun of them- although truth be told, we had no idea why (nor did we care), we just did it because our preceptors said it would piss off the Bucks medics.

 

[Muppet]

hahahah nice! I was at 37s, our local backed up to 11. Two of our guys got Bucks for ride alongs, and we used to mercilessly make fun of them- although truth be told, we had no idea why (nor did we care), we just did it because our preceptors said it would piss off the Bucks medics.

They prolly rode at Medic-168's (Penndel-Middletown EMS), my part time gig. A very busy place, like my place, not far but not alot of penetrating trauma, mostly blunt trauma. I precepted many students but none from the pipeline (that would be fucking rad). I always got the kids going zero to hero. City Rescue always got the pipeine dudes. I saw many down there. If I recall, black BDU pants, grey polo and tan boots and cock deisel attitude. LMAO. Medic-37 was the first medic unit my current boss at Bristol worked at in the city during the early 90's.

F.M.