Guest guest Posted November 7, 2007 Report Share Posted November 7, 2007 I agree with you Gene. I'd also like to add that it has been my experience where we " treat the protocol " rather than the patient. I know that I've been guilty of this. > > By the time you got through doing your vitals and looking for an IV site, you > should have been pulling into the hospital. So take her inside, write your > report, and go back in service. > > Gene G. > > > > > > > You have a 24 y/o female that is hyperglycemic with initial BGL of over 600 > > " machine reads high " . She takes 20 units of insulin before calling EMS. On > > EMS arrival she is now 492, but is a/o x 3, c/o nausea and vomiting, headache, > > some dizziness. V/S are within normal limits, not high or low. > > > > Pt is placed in unit, you look for a vein, but pt tells you that she has a > > med port in her right upper chest. You carry no needles to access such a port, > > so no IV access. Under normal circumstances, an IV would have been started > > and run wide open per protocol. However, since pt has no veins, you don't to > > stick the pt just to try. > > > > You are about 10 minutes from the ER, where they are able to access the > > port. > > > > What is everyone's thoughts on this one? Access the port with regular > > needle? Take the chance of messing up the port and causing more problems for the pt > > because you don't have the correct needle? > > > > Service director said crew should have stuck the pt even though she had no > > veins, just to try and get a line. > > > > Wayne > > > > ____________ ________ ________ ________ ________ _ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2007 Report Share Posted November 10, 2007 This is what the crew tried to explain to the EMS Director that the pt was not in any distress and was fine. They still said tha the crew should have poked around on the pt to get a line. The service has no " protocol " to access ports nor the equipment to do so. As Gene pointed out, this is about what happened, when you are 8-9 miles from the ER. Wayne Brent McCain wrote: I agree with you Gene. I'd also like to add that it has been my experience where we " treat the protocol " rather than the patient. I know that I've been guilty of this. > > By the time you got through doing your vitals and looking for an IV site, you > should have been pulling into the hospital. So take her inside, write your > report, and go back in service. > > Gene G. > > > > > > > You have a 24 y/o female that is hyperglycemic with initial BGL of over 600 > > " machine reads high " . She takes 20 units of insulin before calling EMS. On > > EMS arrival she is now 492, but is a/o x 3, c/o nausea and vomiting, headache, > > some dizziness. V/S are within normal limits, not high or low. > > > > Pt is placed in unit, you look for a vein, but pt tells you that she has a > > med port in her right upper chest. You carry no needles to access such a port, > > so no IV access. Under normal circumstances, an IV would have been started > > and run wide open per protocol. However, since pt has no veins, you don't to > > stick the pt just to try. > > > > You are about 10 minutes from the ER, where they are able to access the > > port. > > > > What is everyone's thoughts on this one? Access the port with regular > > needle? Take the chance of messing up the port and causing more problems for the pt > > because you don't have the correct needle? > > > > Service director said crew should have stuck the pt even though she had no > > veins, just to try and get a line. > > > > Wayne > > > > ____________ ________ ________ ________ ________ _ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2007 Report Share Posted November 10, 2007 Wayne, Your EMS director is wrong. Rigid adherence to protocol is mindless bad policy, and it will end up getting your service in trouble. Sounds like your EMS director is badly in need of some continuing education. Your EMS director is a plaintiff's lawyer's dream. GG > > This is what the crew tried to explain to the EMS Director that the pt was > not in any distress and was fine. They still said tha the crew should have > poked around on the pt to get a line. The service has no " protocol " to access > ports nor the equipment to do so. > > As Gene pointed out, this is about what happened, when you are 8-9 miles > from the ER. > > Wayne > > Brent McCain wrote: > I agree with you Gene. I'd also like to add that it has been my > experience where we " treat the protocol " rather than the patient. I > know that I've been guilty of this. > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1 > > > > By the time you got through doing your vitals and looking for an IV > site, you > > should have been pulling into the hospital. So take her inside, > write your > > report, and go back in service. > > > > Gene G. > > > > > > > > > > > > You have a 24 y/o female that is hyperglycemic with initial BGL > of over 600 > > > " machine reads high " . She takes 20 units of insulin before > calling EMS. On > > > EMS arrival she is now 492, but is a/o x 3, c/o nausea and > vomiting, headache, > > > some dizziness. V/S are within normal limits, not high or low. > > > > > > Pt is placed in unit, you look for a vein, but pt tells you that > she has a > > > med port in her right upper chest. You carry no needles to access > such a port, > > > so no IV access. Under normal circumstances, an IV would have > been started > > > and run wide open per protocol. However, since pt has no veins, > you don't to > > > stick the pt just to try. > > > > > > You are about 10 minutes from the ER, where they are able to > access the > > > port. > > > > > > What is everyone's thoughts on this one? Access the port with > regular > > > needle? Take the chance of messing up the port and causing more > problems for the pt > > > because you don't have the correct needle? > > > > > > Service director said crew should have stuck the pt even though > she had no > > > veins, just to try and get a line. > > > > > > Wayne > > > > > > ____________ ________ ________ ________ ________ _ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 10, 2007 Report Share Posted November 10, 2007 Gene, You couldn't have said it any better. My personal thoughts have always been that common sense is more important than a protocol book. -Ben wegandy1938@... wrote: > > Wayne, > > Your EMS director is wrong. Rigid adherence to protocol is mindless bad > policy, and it will end up getting your service in trouble. Sounds > like your > EMS director is badly in need of some continuing education. Your EMS > director > is a plaintiff's lawyer's dream. > > GG > In a message dated 11/10/07 3:21:04 PM, rxmd911@... > <mailto:rxmd911%40yahoo.com> writes: > > > > > This is what the crew tried to explain to the EMS Director that the > pt was > > not in any distress and was fine. They still said tha the crew > should have > > poked around on the pt to get a line. The service has no " protocol " > to access > > ports nor the equipment to do so. > > > > As Gene pointed out, this is about what happened, when you are 8-9 > miles > > from the ER. > > > > Wayne > > > > Brent McCain <rufus@... <mailto:rufus%40okwhatever.ruf>> > wrote: > > I agree with you Gene. I'd also like to add that it has been my > > experience where we " treat the protocol " rather than the patient. I > > know that I've been guilty of this. > > --- In texasems-l@yahoogrotexasem, wegandy1938@, wegandy1 > > > > > > By the time you got through doing your vitals and looking for an IV > > site, you > > > should have been pulling into the hospital. So take her inside, > > write your > > > report, and go back in service. > > > > > > Gene G. > > > > > > > > > > > > > > > > > You have a 24 y/o female that is hyperglycemic with initial BGL > > of over 600 > > > > " machine reads high " . She takes 20 units of insulin before > > calling EMS. On > > > > EMS arrival she is now 492, but is a/o x 3, c/o nausea and > > vomiting, headache, > > > > some dizziness. V/S are within normal limits, not high or low. > > > > > > > > Pt is placed in unit, you look for a vein, but pt tells you that > > she has a > > > > med port in her right upper chest. You carry no needles to access > > such a port, > > > > so no IV access. Under normal circumstances, an IV would have > > been started > > > > and run wide open per protocol. However, since pt has no veins, > > you don't to > > > > stick the pt just to try. > > > > > > > > You are about 10 minutes from the ER, where they are able to > > access the > > > > port. > > > > > > > > What is everyone's thoughts on this one? Access the port with > > regular > > > > needle? Take the chance of messing up the port and causing more > > problems for the pt > > > > because you don't have the correct needle? > > > > > > > > Service director said crew should have stuck the pt even though > > she had no > > > > veins, just to try and get a line. > > > > > > > > Wayne > > > > > > > > ____________ ________ ________ ________ ________ _ > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2007 Report Share Posted November 13, 2007 I know it is late but I will take a stab at this one. You never ever disturb a port that has been placed due to obvious complications in the past. Pt. doesn't have veins, port is inserted for a reason. It is still the patients option to let you stick them or not. If it is an ok, go for it. For the sake of pt. comfort it may be better to withhold the IV. Just because you can do something does not mean you should all the time. Want to make the primary, secondary and any other physician displeased with you, tear up the port. This pt. does not appear to be in distress yet. Facility is close so transport only would be an appropriate action. You would also perform a good assessment to assure you are not missing anything. As for the irritated supervisor; everyone has their opinion as to proper course of action. As long as there is no paperwork, i.e. writeup; a little chewing of the backside never hurt anyone. If this were to escalate the reasons for the withholding of the IV initiation would definitely need to be discussed. My personal opinion I would never as a supervisor get concerned with the withholding or non-intervention as long as the pt. did not suffer ill from it. Wayne D wrote: You have a 24 y/o female that is hyperglycemic with initial BGL of over 600 " machine reads high " . She takes 20 units of insulin before calling EMS. On EMS arrival she is now 492, but is a/o x 3, c/o nausea and vomiting, headache, some dizziness. V/S are within normal limits, not high or low. Pt is placed in unit, you look for a vein, but pt tells you that she has a med port in her right upper chest. You carry no needles to access such a port, so no IV access. Under normal circumstances, an IV would have been started and run wide open per protocol. However, since pt has no veins, you don't to stick the pt just to try. You are about 10 minutes from the ER, where they are able to access the port. What is everyone's thoughts on this one? Access the port with regular needle? Take the chance of messing up the port and causing more problems for the pt because you don't have the correct needle? Service director said crew should have stuck the pt even though she had no veins, just to try and get a line. Wayne __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.