the 100% directionless thread

[gotbeerz001]

Just had to walk out of my patients room after giving a hand over to the nurse. Nurse said "ooh you're a student? Well just so you know don't ever give a patient nitro without a line on them".

I'm a student so I can't afford to have a nurse make a complaint about me.

While I may give NTG before I have a line, I will certainly get a line before I transfer care.

 

[chaz90]

In DE, NTG without a line or without a med control variance,is a protocol violation and will get you flagged in QI.

Well, in this case we would have been okay since Desert mentioned she takes her own NTG.

 

[NomadicMedic]

Well, in this case we would have been okay since Desert mentioned she takes her own NTG.

D'oh. Missed that! Good catch.

 

[TransportJockey]

"You cannot breathe with a vagina wrapped around your chest"

Gotta love random quotes from EPC class

 

[gotbeerz001]

"You cannot breathe with a vagina wrapped around your chest"

Gotta love random quotes from EPC class

I'm willing to give it a try.

 

[Handsome Robb]

We can give up to 3 doses of NTG with or without a line as long as their SBP is greater than 100mmHg.

I've done it but I prefer to have a line first. Usually a good assessment will clue you in on if they're preload dependent or not but after seeing more than a few patients drop their pressure drastically I will usually either have a line started or be in the process of starting one before I give any NTG.

Yea people take it at home but considering there's not a ton of proof as far as its benefit outside of pain management and the associated risks personally I think having a line is prudent.

 

[DesertMedic66]

Our protocols say "consider early vascular access". We have no cap on how much nitro we can give before base contact. As long as the patient has pain and the patients BP is good we can keep on going

 

[Anjel]

BP greater that 120 and we don't have to have a line first.

 

[MonkeyArrow]

**** the Falcons. Fire Mike Smith!!! Someone please tell me how you can possibly lose the game with 55 seconds left and you're leading. Also, you took a timeout on a 3rd and 2 and then threw on said 3rd and 2, whereas you could've either run the clock out or forced the other team to take 2 of their timeouts...

 

[MrJones]

**** the Falcons. Fire Mike Smith!!! Someone please tell me how you can possibly lose the game with 55 seconds left and you're leading. Also, you took a timeout on a 3rd and 2 and then threw on said 3rd and 2, whereas you could've either run the clock out or forced the other team to take 2 of their timeouts...

Here's a towel you can use to dry your tears....

 

[Angel]

Really? How restrictive. there is no absolute requirement when an line has to be started. What if they're a REALLY hard stick, IO/EJ is not indicated and they have cardiac chest pain? Do you stop the nitro? Call for an IO/EJ?

 

[DesertMedic66]

Really? How restrictive. there is no absolute requirement when an line has to be started. What if they're a REALLY hard stick, IO/EJ is not indicated and they have cardiac chest pain? Do you stop the nitro? Call for an IO/EJ?

That's what I was thinking aswell. I'm not going to be doing an IO or an EJ on someone who has a GCS of 15 and perfect vitals just for me to give nitro (in my case the lady used heroin for 20 years and only stopped because she could no longer find veins).

 

[Handsome Robb]

I put EJs in people all the time who have a GCS of 15 and need a line...

 

[DesertMedic66]

I put EJs in people all the time who have a GCS of 15 and need a line...

Key phrase being need a line

 

[Handsome Robb]

Key phrase being need a line

If your index of suspicion is high enough to be treating someone for ACS I'd argue they need a line...but we also have an "ACS" protocol rather than a "Chest Pain" protocol.

 

[Burritomedic1127]

BP above 100 and need to have a line, if not its med control

 

[NomadicMedic]

You can give NTG without a line. It's a simple med control contact. "hey doc, I'm having a hard fine getting a line, are you out if I give the NTG without access?"

I'd never had a doc say no.

But I would also argue that if you're treating a patient with the ACS protocol, they need access.

 

[exodus]

You guys are getting on topic

 

[JPINFV]

No indictment in the Michael Brown case... guess Ferguson, MO is getting a second Brown stain tonight.

 

[Akulahawk]

No indictment in the Michael Brown case... guess Ferguson, MO is getting a second Brown stain tonight.

Not at all surprised in either instance. Lots of tear gas, some rioting/vandalism. Hopefully nobody dies.