ALS Skills
http://www.youtube.com/watch?v=3pZxOqfB3YA
I recently read a post on FlyingVan, a blog by a San Diego Fire Rescue helicopter paramedic. Apparently his coverage area approved the EZ IO drill for use in prehospital care. We've had it in New England for a little while now and in fact have just approved it for use by New Hampshire EMT Intermediates in adult patients.
The EZ IO itself is something I have used on several patients, basically its a power drill that inserts a needle dirrectly into the bone for vascular access. While it sounds fairly barbaric it is a lot better than the old IntraOseous system which was pretty much an awl that used the brute strength of the medic to drive the hollow needle into the bone.
There's been some debate in New Hampshire as to whether or not the Intermediates should have been given access to the IO but my theory is that with the right training and propper guidance they can use this new tool effectively as paramedics.
The IO drill or bone gun as we call it in my service area, is particularly useful for dead and dying patients with poor blood pressure or compromised vascular access due to drug use or just plain "bad veins". When you absolutely, positively must have a line, the IO is there to bail you out with its easy Black and Decker style usage.
Its also not something to be taken lightly, like a lot of the paramedic toys. I recently had a student riding third on the ambulance, he's one of our volunteers, and I told him "A good call is when the ALS boxes stay closed." And its true, I am not a lazy medic but every ALS skill has consequences and reprecussions. BLS comes before ALS for a reason.
Having said that, some patients trully need ALS interventions for either life saving or life quality preservation.
Such as last night, I was working out of Station 1 when we were toned to a pizza dough manufacturing plant for a worker who had got his hand wrapped up in the dough hook of a mixer. He'd luckily self extricated before our arrival but his right hand was clearly deformed, starting at the wrist and swelling to about four times the size. His fingers were cool and clammy to the touch and his hand was continuing to swell.
He complained of 7 out of ten pain, stating that he felt fine otherwise. We propped his hand on pillows and towels in an effort to make him as comfortable as possible. His blood pressure was around 160/palp so I decided to push 4mg of morphine. All that did was lower his pressure slightly and did very little to touch the pain, but he asked me not to push anymore because it "Made me feel like when I used to use, I don't need that shit."
Fair enough, I pushed Toridol in an effort try and relieve some of the pain, the combination of both dropped his pain level to a more barable 5 out of ten.
ALS interventions do have their place and its not always for "lifesaving" purposes.
I also find it rather surprising that it has taken a California system this long to have brought out the IOs, it was always my impression they were far more advanced than us on the east coast.
I recently read a post on FlyingVan, a blog by a San Diego Fire Rescue helicopter paramedic. Apparently his coverage area approved the EZ IO drill for use in prehospital care. We've had it in New England for a little while now and in fact have just approved it for use by New Hampshire EMT Intermediates in adult patients.
The EZ IO itself is something I have used on several patients, basically its a power drill that inserts a needle dirrectly into the bone for vascular access. While it sounds fairly barbaric it is a lot better than the old IntraOseous system which was pretty much an awl that used the brute strength of the medic to drive the hollow needle into the bone.
There's been some debate in New Hampshire as to whether or not the Intermediates should have been given access to the IO but my theory is that with the right training and propper guidance they can use this new tool effectively as paramedics.
The IO drill or bone gun as we call it in my service area, is particularly useful for dead and dying patients with poor blood pressure or compromised vascular access due to drug use or just plain "bad veins". When you absolutely, positively must have a line, the IO is there to bail you out with its easy Black and Decker style usage.
Its also not something to be taken lightly, like a lot of the paramedic toys. I recently had a student riding third on the ambulance, he's one of our volunteers, and I told him "A good call is when the ALS boxes stay closed." And its true, I am not a lazy medic but every ALS skill has consequences and reprecussions. BLS comes before ALS for a reason.
Having said that, some patients trully need ALS interventions for either life saving or life quality preservation.
Such as last night, I was working out of Station 1 when we were toned to a pizza dough manufacturing plant for a worker who had got his hand wrapped up in the dough hook of a mixer. He'd luckily self extricated before our arrival but his right hand was clearly deformed, starting at the wrist and swelling to about four times the size. His fingers were cool and clammy to the touch and his hand was continuing to swell.
He complained of 7 out of ten pain, stating that he felt fine otherwise. We propped his hand on pillows and towels in an effort to make him as comfortable as possible. His blood pressure was around 160/palp so I decided to push 4mg of morphine. All that did was lower his pressure slightly and did very little to touch the pain, but he asked me not to push anymore because it "Made me feel like when I used to use, I don't need that shit."
Fair enough, I pushed Toridol in an effort try and relieve some of the pain, the combination of both dropped his pain level to a more barable 5 out of ten.
ALS interventions do have their place and its not always for "lifesaving" purposes.
I also find it rather surprising that it has taken a California system this long to have brought out the IOs, it was always my impression they were far more advanced than us on the east coast.
posted by Nick Stabile at 2:51 PM
1 Comments:
I love the EZ IO. I've only seen it used a couple of times, but its great when all hands are on deck for a code & all that is left is to start pushing meds.-- I can only imagine what the family is thinking when we pull it out & they hear that little drill start.
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