How much does Trendelenberg/Shock position actually work??

[emt-b_wa]

The only time that I use trendelenburg is when an IV is not easily obtained. This is because it is estimated to give the patient an extra two liters of fluid in the upper body. This makes IV access easier and as was said earlier pop up real nice if you need to go that route. but others make very good points as well. Lung function an ICP can be effected by doing this. It all comes down to weighing the risk and benefits at the time for your specific patient

[CBEMT]

In the hospitals, I commonly see patients with their feet in a Trendelenburg position, but the head is elevated by the back of the stretcher. Intubated patients also seem to get T-burg often. It seems that once again, nursing hasn't gotten the message yet, just like hypoxic drive.

As for EMS, our upcoming protocol revisions state that hypotensive patients are to be placed supine wherever possible.

[chbare]

"It seems that once again, nursing hasn't gotten the message yet, just like hypoxic drive."

I would be careful regarding sweeping generalizations. I think the problem is much like the problems discussed regarding EMS providers. You have individuals who are stuck in one mind set and refuse to change their practice. This is a problem that is not isolated to a specific group of providers.

Take care,

chbare.

[CBEMT]

"It seems that once again, nursing hasn't gotten the message yet, just like hypoxic drive."

I would be careful regarding sweeping generalizations. I think the problem is much like the problems discussed regarding EMS providers. You have individuals who are stuck in one mind set and refuse to change their practice. This is a problem that is not isolated to a specific group of providers.

Take care,

chbare.

My point is more or less that you'd expect healthcare providers with all this education that EMS "doesn't want" to be leading the way in their temples of healthcare. Instead, I have yet to meet a (college educated) nurse who doesn't make O2 decisions by SPO2, automatic T-burg for hypotension, and on and on.

Furthermore, I don't think the problem is individuals, I think the problem is endemic- in other words, I think things like hypoxic drive and Trendelenburg are still being taught as dogma in nursing school. At least EMS is trying. I don't want to hear how bad EMS is from people who still have a ways to go themselves.

[AnthonyM83]

Honestly, a lot of things we do in the field are because of protocols and liability, rather than actually believing that's what the patient needs at the time. One example is how often we c-spine everyone...girl on bike gets hit by car at low speed...bumper against lower leg, she falls in sitting position, no KO, witnessed fall, head and back don't touch the ground, oriented and alert, only complaint is lower leg pain...but FFmedics get on-scene and cpsine! I doubt they really think she needs it either...but it's the whole liability thing...

[Ridryder 911]

I highly recommend that everyone read Dr. Bryan Bledsoe's : "Are We Setting the Bar Too High" ; in this month's JEMS. Describing so much of our treatment and ideas are set off ....."myths and common rules of this is how we always done method",,,,,, So much of what we do and perform has never been proven to be correct.

Some of this includes such thought of major standards such as the .. the common 8 minute response time and the controversial mythical "Golden Hour" hoax (which has been proven to be false).But, we continue to endorse such B.S. because that is what has been handed down, now for generations.

There are many treatment regimes that need to be evaluated and studied. This is just not for EMS but in all of medicine as well. That is why scientific studies are so important, but those studies have to be performed under stringent criteria.

R/r 911

[chbare]

CBEMT, I think we are on the same page. It looks like our terminology is a little different, but I think we agree on the cause.

Take care,

chbare.