Question on IV training

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Question on IV training

Post by Citizen Simon » Tue Mar 06, 2007 8:16 pm

So, I don't know how things are ran on the civillian side of the house, but I'm going to share a little story that got me heated today!

I had a patient come in today complaining of nausea, vomiting, and diarrhea. I do a tilt on him and he's pretty damn dehydrated. Before it's always been our SOP to run an IV on severly dehydrated people but now the HMFIC decided that if they are still concious they have to drink water. 'IVs are an invasive procedure and not necessary unless they are unconcious.' Hot damn I am heated.

The doctor fail to realize that although yes we are a medical facility, we are also a training facility. Before this weekend the last time I ran an IV was in a rolling uparmored humvee that had six people in it (There are 4 seats) while we drove the roads of Afghanistan shooting and being shot at. If it hadn't been for a lot of pratice I would have never gotten that stick. I'm not too worried about my IV sticks, I am very very solid with sticking, however that came from sticking a lot of dehydrated soldiers before deployment. Now I see young medics running this aid station that go months and months between IV sticks. (unless they do it in their own time, which I do in my spare time too, however most don't) Now when they go to Iraq with me later this year what happens if my ass is one that's shot and I get one of these guys. 'Hold on, i read about this a few times, the needle goes here right?' I can see it now.

I think these pukes that run the show don't understand how medics deal with training. Infantry grunts go train in field problems, cooks cook, drivers drive, mechanics work on trucks, paper pushers push the paper. Medics...been reduce to not even being alowed to train on one of our very basic job functions. It gets me furious sometimes.

I guess it's mostly venting, just wondering if anyone else has this problem. Also wondering if on the civilian side if on a tilt the BP and Pulse both vary over 25 respectively if an IV would be indicated.
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Post by Gunny » Tue Mar 06, 2007 8:39 pm

Doc:

Firstly, I would do my best to teach the other medics the tradecraft.

Secondly, I'm not sure why the doc was so against the idea of an IV. It seems he took two steps backwards instead of properly addressing the situation.

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Post by Ricky Romero » Tue Mar 06, 2007 8:58 pm

Doc, do you mean orthostatics? BP and pulse while lying, sitting, standing?
Dehydration on this side of the fence is case to case, usually. As I'm sure you know, there's a big difference between conscious and barely conscious. Both look the same on paper to your higher-ups. I haven't started many IVs (I'm an IV certified LVN in California with a grand total of 6 successful sticks in a year and half of experience, three of those to get my certification), but in my short time, all the sticks I've done have been on fully conscious patients suffering from dehydration. In one of those cases (the only case in which I was present at the time of Dx), orthostatics were done with low numbers across the board, with little variance posturally. Skin turgor was assessed (severe tenting), and that was it! 1000 mL NS to gravity! Of course she had fluids encouraged, but there was no debate on invasiveness. I would think that in your current location, dehydration is a common Dx. They could be quick fixes and give greenhorns some much needed practice. Sounds like a shitty spot to be in. On one hand, I understand the need to keep skilled hands free and not starting 100 IVs a day when the patients are able to take PO fluids, but monitoring and encouraging fluids actually takes more time than IV fluid replacement. Hope that was some help. Keep up the good work, Doc!

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Post by jamoni » Tue Mar 06, 2007 11:41 pm

Sounds to me like somebody is having trouble with their budget, and is looking for ways to keep costs down. Still, that's bullshit. If someone is dehydrated enough to go on sick call, they should get an IV. And if they AREN'T, but go anyway, they should get a nice COLD bottle of saline in that IV. :twisted:
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Post by Citizen Simon » Wed Mar 07, 2007 9:37 am

jamoni wrote: If someone is dehydrated enough to go on sick call, they should get an IV. And if they AREN'T, but go anyway, they should get a nice COLD bottle of saline in that IV. :twisted:
IV tricks abound for me! More than one person figued out with me that you may be able to malinger with a doctor, but a medic will make it not worth your time!
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Post by tacmedic22 » Wed Mar 07, 2007 8:25 pm

Well I agree, now after the TCCC BS came out the rules of sick call and trauma are very different. And well our doc (SHE) is all about sick call. Im not to sure how she would react if a real F'in trauma came in.

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Post by CLEAR CUT » Thu Mar 08, 2007 1:58 pm

Well that was SOP when I was a medic. After A,B,C,'s the patient was then hooked up on a monitor and an IV started. For a situation like that I probably would have got on the radio and asked if I could administer a 250cc fluid bolus after checking the vitals( heart rate/rhythm, blood pressure, and respiration-particularly lung sounds) and check them again after the fluid bolus if I got the okay.

I think to radio in first gives the care facility the opportunity to make the call. Typically transport times were very short so we seldom got the opportunity to intervene in cases like this. I guess it all boils down to the SMO's that your system follows, some will allow actions like this and some will want you to radio in for permission.

As for getting rusty doing sticks, I remember when we had a lull in the action we would often stick each other to stay sharp.

That makes me want to design a better and more realistic IV Trainer. I bet I could make a fortune.
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Post by tacmedic22 » Thu Mar 08, 2007 8:24 pm

WOW only 250cc that’s not a lot. It is our (mine and Doc Simon's) SOP to do a 500cc challenge. And higher medical authority… … what’s that ???? When we play out in the sticks we are the medical authority. He only report higher if we are ever in the aid station.

And Clear Cut I would agree on a better IV trainer, some weeks I look like a crack addict…. with all the holes in my arms/feet/hands.

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Post by Citizen Simon » Thu Mar 08, 2007 9:04 pm

I've taken 11 IV sticks in the same day before, WOO! Bet you can't top that. I think only 9 were successful. The two that missed bruised me the worst though. Watch out Gunny's got a perfect record with sticking...lol. He's 2 for 2. Right on! (And 1 for 1 with NPAs. Sacrifice the body to let others train.... (hard to justify letting someone put a tube up your nose (Gunny, you sooooo owe me))
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Post by Tac Medic » Thu Mar 08, 2007 11:37 pm

Simon. Your Doctor is completely correct. Fluids should go by mouth whenever possible.

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Post by Gunny » Fri Mar 09, 2007 10:44 am

Doc Simon wrote:I've taken 11 IV sticks in the same day before, WOO! Bet you can't top that. I think only 9 were successful. The two that missed bruised me the worst though. Watch out Gunny's got a perfect record with sticking...lol. He's 2 for 2. Right on! (And 1 for 1 with NPAs. Sacrifice the body to let others train.... (hard to justify letting someone put a tube up your nose (Gunny, you sooooo owe me))
Hahaha dude I can stick an IV in the elbow.

The whole time during the NPA practice all I could think was, "only a fucking soldier, only a fucking soldier..."

Was much fun though. Who can say they practiced IV sticks and NPA applications and then watched the UFC fight?

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Post by numberthree » Mon Mar 26, 2007 8:51 pm

Here in BC, Canada, our local protocols allow us to use our own discretion for administration of IVs. If we suspect dehydration or loss of volume, or even potential for either, we can stick 'em. We also can stick 'em if we know that the hospital would do it once we got them there. We do 500 ml bolus' (boli) if the BP drops under 90...
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Post by TheBearBoy » Tue Mar 27, 2007 2:14 pm

I feel like such a newbie asking this :roll: . But what does IV means :?: ( Im from sweden thus the lacking knowledge)

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Post by Citizen Simon » Tue Mar 27, 2007 3:01 pm

intravenious - as in a cathater in the vein and fluids being pumped in though clear tubing
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Post by zombiemagnet » Wed Mar 28, 2007 12:41 am

Case by case. But I have a very low trigger for starting an IV on anyone. It's much easier and faster to rehydrate someone, and the dehydrated can vomit oral rehydration solution. Also, you only need someone to crash on you once without an IV in to learn to put one in whenever you even think you may need it. Also, not only is it for volume replacement but a critical rapid drug administration route. Better to have it and not need it than the other way around.

What's the downside of sticking one in? Superficial phlebitis? Who cares. Cost? Shouldn't care. I always breathe a little easier when I have a sickie and the IV's in.

If you're talking to the WHO about kids with cholera in the 3rd world, sure ORS is the best route for rehydration, if tolerated. But exposure? Migraine with vomiting? Gastroenteritis? If you've ever had any of these personally you know how much a 1L bolus can help you (to start!).

I'd agree. IV access is a crucial skill, and an insurance policy. Start them often and early.

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Post by TheBearBoy » Wed Mar 28, 2007 11:45 am

Ok thanks always somthing new to learn :) .

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Post by El Maximo » Wed Mar 28, 2007 1:20 pm

I've had some seriously bad experiences with IV's and incompetants who can use them. It's bad when the patient can do better than the nurses.
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Re: Question on IV training

Post by Jay » Sun Apr 08, 2007 5:03 pm

Doc Simon wrote:So, I don't know how things are ran on the civillian side of the house, but I'm going to share a little story that got me heated today!

I had a patient come in today complaining of nausea, vomiting, and diarrhea. I do a tilt on him and he's pretty damn dehydrated. Before it's always been our SOP to run an IV on severly dehydrated people but now the HMFIC decided that if they are still concious they have to drink water. 'IVs are an invasive procedure and not necessary unless they are unconcious.' Hot damn I am heated.

The doctor fail to realize that although yes we are a medical facility, we are also a training facility. Before this weekend the last time I ran an IV was in a rolling uparmored humvee that had six people in it (There are 4 seats) while we drove the roads of Afghanistan shooting and being shot at. If it hadn't been for a lot of pratice I would have never gotten that stick. I'm not too worried about my IV sticks, I am very very solid with sticking, however that came from sticking a lot of dehydrated soldiers before deployment. Now I see young medics running this aid station that go months and months between IV sticks. (unless they do it in their own time, which I do in my spare time too, however most don't) Now when they go to Iraq with me later this year what happens if my ass is one that's shot and I get one of these guys. 'Hold on, i read about this a few times, the needle goes here right?' I can see it now.

I think these pukes that run the show don't understand how medics deal with training. Infantry grunts go train in field problems, cooks cook, drivers drive, mechanics work on trucks, paper pushers push the paper. Medics...been reduce to not even being alowed to train on one of our very basic job functions. It gets me furious sometimes.

I guess it's mostly venting, just wondering if anyone else has this problem. Also wondering if on the civilian side if on a tilt the BP and Pulse both vary over 25 respectively if an IV would be indicated.
The Medics and CLS certs in our unit stick Joes before they go out drinking in the b's man. They get pretty good practice on the weekends. Course if they were ever caught doin it I'm sure it'd be a whole nother issue.
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Post by randomusername » Sun Apr 08, 2007 7:13 pm

I had food poisoning three days ago and ended up in the student health clinic here on campus. I was vomiting, and had diarrhea. By the time i got there my lips were dry, my nail beds were blueish and i had almost no color anywhere. The staff asked if I'd take an IV and i humbly agreed. I ended up with one collapse, and four veins that "rolled" away from the needle. With very sore hand, wrist and elbow i had to stay in the clinic for 6 hours, until i could keep down some Gatorade with the staff as witness.

if it had been up to me, i would have made the IV work rather than sit there waiting... Doc Simon's boss from the original post sounds like a dumbass.

My 2 cents.

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Post by Citizen Simon » Mon Apr 09, 2007 11:18 am

Sandman wrote:. I ended up with one collapse, and four veins that "rolled" away from the needle. With very sore hand, wrist and elbow
All amature excuses for 'I can't start an IV for shit' haha!

Thanks though for all the input back on this. Sometimes good things come from venting!
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Post by Tac Medic » Mon Apr 09, 2007 1:52 pm

Simon is right, those are shitty excuses for an inability to start a line. I'll give you some advice. Do not, I repeat DO NOT EVER! Go to a clinic on campus ever again. They provide notoriously shitty care. I have had to rescue students from UCONN's "Health Services" several times.

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Post by consultant2006 » Tue Apr 10, 2007 10:55 pm

Hey Doc,
Tell your "Doc" that treatment that falls into the basic area , like IV's, falls in the perview of you as the NCO. Let him know that unless you have a loogie that you need to know is Gram neg or Gram pos, he can stay in his cushy little office and study how he wants to set up his Roth IRA when he starts his own practice. Tell him you will keep him sitting as you start the IV so that he can drnink ORS while you are sticking him.

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Post by Citizen Simon » Wed Apr 11, 2007 7:36 pm

consultant2006 wrote:Hey Doc,
Tell your "Doc" that treatment that falls into the basic area , like IV's, falls in the perview of you as the NCO. Let him know that unless you have a loogie that you need to know is Gram neg or Gram pos, he can stay in his cushy little office and study how he wants to set up his Roth IRA when he starts his own practice. Tell him you will keep him sitting as you start the IV so that he can drnink ORS while you are sticking him.
Trust me, if I ran that aid station it would be something along those lines, however the aid station is not my section I only get over there (by that I mean I am forced over) every couple of months. Unfortunately the provider is a major, and the NCOIC of the aid station is a huge tool. So there isn't much I can do. If that guy decided to tell me how to run my ambulance then it would be muthafuckin on.
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Post by jamoni » Wed Apr 11, 2007 10:17 pm

Doc Simon wrote: If that guy decided to tell me how to run my ambulance then it would be muthafuckin on.
Doc, I like you. :D See you at ZCON!
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