Fishing for IVs

[akflightmedic]

Just a question....

Does your respective system place IO last "in the ladder"? Is an EJ still preferred prior to an IO? Even on pediatric?
Do you have to attempt an EJ before moving onto IO?

 

[NomadicMedic]

Just a question....

Does your respective system place IO last "in the ladder"? Is an EJ still preferred prior to an IO? Even on pediatric?
Do you have to attempt an EJ before moving onto IO?

Not for me. An EJ is just another peripheral IV site.

 

[chaz90]

Just a question....

Does your respective system place IO last "in the ladder"? Is an EJ still preferred prior to an IO? Even on pediatric?
Do you have to attempt an EJ before moving onto IO?

No to all of the above. We place EJs, but we use IOs far more frequently. There's no rigidly defined "ladder" in place either. Some patients end up getting an IO placed after a missed attempt or two, and some get it right off the bat.

On a semi-related note, I've never even attempted an EJ on a pediatric patient. Is that an overly common access point?

 

[RocketMedic]

There is a significant difference between an educated anatomical stick and blindly harpooning a limb.

 

[DesertMedic66]

Just a question....

Does your respective system place IO last "in the ladder"? Is an EJ still preferred prior to an IO? Even on pediatric?
Do you have to attempt an EJ before moving onto IO?

IVs are the preferred route for vascular access. They want us to try for an IV twice before we go to an IO but we have the option of just going for an IO. EJs are just considered a normal IV for us.

 

[akflightmedic]

Thanks for the swift replies...I was trying to make a point based on the various replies in this thread. It seemed "EJ" had an elevated status and one which would delay an IO attempt when in many circumstance an IO might even be first line. Just seeing what is going on out there.

 

[NomadicMedic]

There are LOTS of new providers that wouldn't even consider an EJ in a conscious person, because "a needle in the neck! ZOMG!!11!!!" And in a CTD patient, an IO is just so damn quick

 

[Tigger]

I find a tibial IOs to just be more practical for the super sick, obtunded patient. Odds are that this patient also requires airway management, so it's just easier to drill one real quick while staying out of the airway person's way.

Our EMTs start IVs and IOs so if it's a medic/basic truck odds are the paramedic is at the head working the airway thing while the EMT takes care of access.

 

[NomadicMedic]

I agree with the tibial IO. It was my favorite method to work a code. One medic on the airway, the other at the legs, with the Lucas, monitor and drugs.

However, were now only allowed to drill a Humeral head IO. :/

 

[Carlos Danger]

were now only allowed to drill a Humeral head IO. :/

Do you know what is their rationale for that?

 

[NomadicMedic]

Because someone took a drug to central circulation study as gospel and now "if we're going to save lives, we need to only drill the Humeral head." Piffle.

http://emtlife.com/threads/humeral-head-vs-tibial-io.38091/

Also, if you read the above, I'm now working for a different agency, in a different state.

 

[Carlos Danger]

Because someone took a drug to central circulation study as gospel and now "if we're going to save lives, we need to only drill the Humeral head." Piffle.

http://emtlife.com/threads/humeral-head-vs-tibial-io.38091/

Also, if you read the above, I'm now working for a different agency, in a different state.

Yeah, I thought I vaguely remembered this thing coming up a while back, but I wasn't sure.

I guess I can see a protocol listing the humeral head as the "preferred" site where a critical drug is indicated ASAP, but to disallow alternative sites altogether seems really dumb. It ignores all the other factors that go into a resuscitation that can affect the time-to-central-circulation way more than the site of IO access. I know I'm preaching to the choir, though.