What would you do?

[paramedicmike]

Yeah, plus you may as well spread the love and give the admitting doc something to do. If you are really lucky everybody will complain about going IO even though it's a quick, safe and effective option...but that is another discussion.

I can hear the ICU teams now... "What the hell is this?!"

[scubanurse]

Is possibility of osteoporosis and a weak bone matrix a factor in IO placement? Just curious.

[ERDoc]

Aw, come on now. You can't dump your responsibility on another provider. IO isn't an option since you cannot give contrast, nor can you through a foot or IJ. You drop in subclavian line that works well. What do you need to do next?

[chbare]

We will need labs a XII lead, a chest x-ray and a post intubation ABG, assuming we are satisfied with subjective and objective confirmatory findings. Also look at a foley and send for a UA.

[paramedicmike]

Along with that, if not already completed, CBC, chem panel and BUN/CREAT (especially before the CT).

[ERDoc]

Sorry, I'm being vague. I know it is not EMS level stuff but what do you think is one of the most common adverse events with the insertion of a subclavian line? Let's let the people without hospital experience take a stab at it first. Hint, think of the anatomy.

[scubanurse]

Pneumothorax?

[mobey]

I'll go with perforation causing hemothorax (though I think pneumo is more likely).

As a side note, when this lady was in her excited state I would have been quite aggressive with benzo's. Elderly just can't handle this much stress.

[ERDoc]

The subclavian vein sits in close proximity to the lung (as well as a few other things). Sometimes an iatrogenic pneumothorax can be produced. Since you are working with Murphy today, you get the CT which shows no pneumonia or PE but does show a small pneumothorax. Does this pt need a needle decompression? Why or why not? Does she need a chest tube? Why or why not?

[scubanurse]

What do her labs look like? How is her O2 sat now that she's tubed and appropriately sedated? Was the pneumo before or after the central line was placed?