Pushing D50

[mobey]

Quit being lazy, improve your skills.

Why do we still facilitate arguments with this prick??

Anyone been over to EMTLife lately? There are some really good educational posts over there lately and the ADMIN does not allow these mud-slinging losers to spew this shit all over the boards and destroy every thread!

I dunno what happened to this site over the last year or so, but I am ready to find a new primary where I am not belittled and accused of being lazy/racist/pregidous/sexist/etc etc.

It is a shame that we have such high quality posters here that are wasting away with this nonsence.

[AnthonyM83]

Quit being lazy, improve your skills.

Did you completely look over my post?

How does one just "improve your skills"?

I made the most out my clinicals. I stayed 4 to 12 hours extra every single day of ER clinicals. I started almost every single IV for every nurse in that period of time (while colleagues did 5 - 10 per 12-hr day).

I practiced on manikin IV arms repeatedly. I practiced on myself. On friends (though not technically allowed to). I continuously asked for feedback from the best nurses (the ones other nurses turned to for IV help). I looked up literature online and from books on starting IVs.

All this repeated for airway skills, too. I got good.

When I got to internship, I challenged myself by not turning on the lights. Not going for the easy vein. Never ever finding a vein by sight first. Waiting for the ambulance to start driving. (Unless patient was critical...didn't risk outcome for my own gain if they needed immediate intervention).

And for my level (brand new medic), I became pretty darn good. YET I'll occasionally still not get an IV. Or certain patient types (certain disease states) I'm not a pro at.

So how the heck should I just stop being "lazy" and "just improve" my skills??

Edited October 2, 2009 by AnthonyM83

[Eydawn]

I'll admit this freely. I struggle with IV's. Haven't done one since I left the prehospital service I was with back in February. I practiced with mock set-ups during a lot of my down time. I came on here and solicited advice. I poked people who were kind enough to let me stick them. I studied venous anatomy until I was sick of it.

I don't think people resort to IO's from sheer laziness, I think a lot of people initiate IO's when they face ridiculously difficult vascular access and decide that time is more important than multiple failed attempts at difficult venous access. There is a reason the IO is a tool for things like pediatric cardiac arrest... you don't have time to screw around, and even in the best of settings some patients are going to be extremely difficult to gain venous access on. Weighing your options and utilizing them appropriately (and to protocol) is intelligent and in the patients' best interest, not just "lazy" for the sake of not wanting to get the IV.

In my circle of acquaintances, most of the folks I know hate going for an IO and won't unless they feel the need to.

As far as the original question, I would really try to obtain venous access where I could ascertain patency via being able to aspirate blood. If that wasn't possible, I'd definitely use many of the other techniques mentioned to ascertain whether or not my line was patent, and I would proceed very cautiously with D-50 administration.

Just pondering... if I as a mere care provider can administer a rectal suppository via a Medication Administration Record (following a doctor's order), why couldn't we write up protocols for rectal glucose access? I know I've said this before... it just occurs to me that you could be trying the honey-bear approach in conjunction with your D-50 in a difficult situation like this...

Wendy

CO EMT-B

[NRPinNEPA]

Anyone been over to EMTLife lately? There are some really good educational posts over there lately and the ADMIN does not allow these mud-slinging losers to spew this shit all over the boards and destroy every thread!

There's been a massive drop in educational content on EMTLife for this very reason... all of the educational powerhouses don't post out of fear of being banned because some whacker who dun need no edumacation arbitrarily takes offense.

[tniuqs]

What happens when the diabetic with the IO in their leg wakes up and wants to refuse transport?

I would never go IO on a diabetic low D-stick reading unless they look like they didn't have the stores for Glucagon to convert. Even than I would use medical to the pt's advantage.

If the IV doesn't aspirate than look for swelling and an easy drip from the bag. Also pain noted at the site, but if your giving D50 they probably can't tell you about the pain.

So are like U saying inter cranial D50 W is a bit excessive ?

cheers

[crotchitymedic1986]

Rectal D50 is appropriate,you do not need a protocol in my opinion, but if you feel you do, by all means do so. The IO is to IV skills what the EGTA or Combitube is to Intubation skills.

And I did not make any statements about literature, I believe that quote was attributed to me by mistake chbare