Posted: 3/27/2008 7:08:19 AM EDT
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I saw the locked IV thread, respect the decision, don't want to go down that road, but having said that: just wanted to let you know that combat lifesaver course in the Army is mostly about being able to start an IV. Death from blood loss kills more soldiers than we previously realized, and by being able to return fluids to the body we can save lives. This angle of the IV would seem to be OK for discussion, I hope. I highly recommend you all learn to start an IV, even if you don't have fluids, by the time your loved one gets to the hospital, if you already have a "port" in you can speed the time to get fluids in, since after leakage occurs, the veins are...hard to locate and stick...stick them while they are moderately full. |
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IV solutions don't replace red blood cells which carry 02. The "fake" blood has not been proven to work. Even stored blood is coming under question as to it's effectivness. For many years we were told to push the fluids to keep the BP up. I started questioning this thought in the early 90s and a few years later mainstream EMS started questioning it too. No we are being told that pushing fluids in trauma just blows out the forming clots and causes further bleeding. Flat veins are not a big problem if you are traind in cutdowns or are decent with a catheter. The simple point of this post is that in the civillian world, most people don't have the training or need for IVs and will do more harm than help if they try to use them. |
Look, the ONLHY medical training I've had is the army combat lifesaver course and recerts, and I'll assure you that is minimal training and does not qualoify me to debate any medical topic with you. But my common sense says what you wrote would seem to indicate that no one needs to know how to give an IV but you? I'll go right now and tell the CG of TRADOC so he can implement your theory armywide.
I guess that ensures traied guys like you will always have work. |
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My point is that taking time to start IVs in the field only slows the time it takes to get people to surgical care. More can be done by simply elevating the legs than by running two lines WFO and turning the blood pink. I don't rember the last time I took the time to start a line on a trauma Pt on scene. Quality BLS care can save more lives than the high speed ALS care so many want to jump right to. Im not trying to slam you, just share some thoughts on a topic. The military is a great test ground for trauma care and we have all learned a lot from them. |
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"Surely there is a doctor in SF that can explain just why what you just said is asinine in medical terms." Let me try this again so you can understand it. For years we were told to push fluids to keep the BP at a "normal" level. The resuld was lots of pink blood with little blood carring capacity. Now we are told to only push enough to keep it at a 90 or 100 range. Shock involves the body shunting non critical blood to the most important organs. Adding too much fluid tricks the body into "unshunting" which is counter productive. One more example of simple humans trying to outsmart a very good designed body. No need to get pissy, Im just trying to explain it. |
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A little knowledge can be a very dangerous thing. Unless you're trained, a 'home IV' is something that should only even be DREAMED of if there was mass chaos, and it really was your ONLY chance at life. There are just too many variables involved in IV therapy for just any untrained joe blow to be able to make that judgement call without some professional training courses. I don't know what the military is teaching, and I don't care. They operate under their own set of rules because they have a whole different set of people/resources than we do. Just go take the EMT classes. It'll be some of the most worthwhile money you can spend preparing for a SHTF scenario. (I didn't see the locked thread until after it was locked.) BTW, I understand that you're wanting to come at this from a different angle, but if you're just wanting to start a 'port' in order to have access once you get near somewhere with whole blood/etc, that's not a concern. EMS workers, doctors, etc have WAY more tools in their toy chest than just simple peripheral IV sets. Hell, I can drill a hole with my EZ IO and get fluids (including blood) going even FASTER than I can start an IV anymore. Docs can start a central line or do a cut-down in no time flat. In a true, life threatening emergency, peripheral IV access isn't an absolute necessity UNLESS you're going to have limited resources/training and want to get stuff on board NOW. |
 I don't have any more medical training than you but probably have probably taken little more physiology and other related coursework. Based on my understanding of this information and from what I've read on ground combat lately, it is often a function of hours rather than minutes like typical civilian cases before a lot of the critically injured soldiers are able to be CASEVACed--whether because of location, fighting, or weather. In the case of soldiers with extended times before reaching a CSH, it makes sense to teach them how to stick IVs so that fluid levels can be maintained to some degree. It seems like you are advocating scrapping the whole army-wide CLS requirements, whereas the training is fine but implementation needs to be supervised by the medic. |
Well for a guy who claims little training, you sure nailed that one. I was a 91B20 and 92B40. All field treatment even first aid is a matter of time/timing. We discuss this a lot here even snake bites. Combat/Survival situations can be dramatically different than emergency services during normal times. Its that knowing what is that takes a bit more than what we can post or for that matter you can learn in EMT course. Nothing replaces experience and why doctors the top medical people go though internships. Though there is no way we can learn medicine on the internet especially when and what concerning IVs. There are some aspects that have a practical application in life. Finding a vein and hitting the vein may not be something you do in the field under some combat situation that never arises but grandma needing hospice in your home isn't that far fetched. In fact, it was my medical training that has me giving myself shots monthly instead of $80 doctor visits. The more training and classes you can take, the better prepared you will be, however I fear the man who ever claims he is 100% prepared for everything for he truly hasn't seen enough in his life yet. I pray he never does for it is truly a humbling experience to know your training and experience is not enough. There are some great exercises you can do at home just to get an idea of what is involved in hitting veins. Here's one I used in rudimentary training. All of you have blood drawn so this shouldn't be a surprise to you. Try with your left arm to find the vein dead center in the bend in your arm. Not hard huh? Now, close your eyes and do it by touch. Harder huh? Now feel how it rolls. Try this on others and discover the difference. Now look for the smaller vein to the outside of your arm. Yep, there's one there. Now feel for it. Lot more difficult huh? Hitting that vein is not something I can teach you here on the net. There's threading it, knowing when you went through it, and major bruises if you miss. This is taught in class both with images as well as practical application. I can tell you an amusing training story and a technique I later used for amusement. The first day in Hematology, I would place an orange in front of ever desk. I was actually hospital/field not classrooms so my classes were always very small in comparison say to the Academy of Health and Sciences. I would say, "You remember how you have always heard you will practice on oranges?" Pause for effect. "Now look to your left and then to your right and say, pleasure to meet you Mr. Orange." "That orange setting in front of you is lunch." Tj |
Please don't. Learning to stick needles into people should be in a controlled environment just like yours was. Tj |
| The only training I had for treatment of shock was to elevate the legs/feet, and cover the torso with a blanket of some kind. I took two red cross first aid classes in college and the first aid training I had in basic. My neighbor was an EMT for many years, we have talked about him giving me some training we just have not gotten around to it yet. |
well, you might not realize this, but you're saying a large part of army training is worthless. Think about that. So if you are some voice in the wilderness with your opinion that field IVs are worthless, could there be a reason for that? |
well I guess I need to explain again so YOU can understand - what you are saying is completely topsy turvy with current Army doctrine - as long as you understand that, fine. The army has been wrong before and will probably be wrong again, but you adress my original post as if Im some know it all who's spouting off about things he knows nothing about and you are going to set me straight.  I was just telling you what we are taught, and whether you are an EMT or nurse, something tells me if there was any credence to your theory - the military would not be doing what we're doing.
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bedhead, my course was taught by the following individuals: An Army nurse, female old enough to retire and had been a nurse all her life; a civilian EMT; a male PA a female PA. I can't see any holes in that crew's professionalism - but I do agree with the rest of your post. |
it was a "modest proposal" if you follow me. I didn't really mean it... |
I want to clarify that I agree completely with this, and what bedhead posted - I posted originally that learning to give an IV is one tool you need in your tool kit. Then someone came along and basically said I was full of &&&t in a nice way. |
I understand that, and I'm certain that your courses ARE taught by professionals. That comment was more directed towards the lay person/joe blow, who is reading this thread thinking, "Hey, I can do that!" without any professional training. Or going strictly on something they read that someone else was taught. I think we all pretty much agree and are just going round on semantics. It's just not something that's a good idea, unless you have training. And even better, training PLUS experience. But if it came down to it, and you were 1000 miles from the nearest civilization, and someone was on death's doorstep, I'm sure a lot of us would do things we weren't really 'supposed' to do.... |
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I guess part of what has me confused is you guys keep referring to letting the professional do it... am i not in the survival forum? do you guys think 1. you'll always have fuel to get to the hospital? 2. it will be safe to travel to the hospital? 3. that there won't be other bugs you will catch there? have you been to the ER lately? better speak spanish...(just so you can assert your place in line...) that's like saying why do you need a gun, just call the police and let the professionals do it... I am all for professional training, and I never advocated an internet education on IV, or doing it on yourself, but I am just opposing the guy that basically said IVs are un necessary. |
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No tongue in cheek, you ever see a junkies veins? Better yet, ever try to stick a needle in their veins? They don't get those nice tracks that explode on contact because of using proper techniques.  I use to take one look at bad ones then say, "OK, where can I get a vein that you haven't destroyed?" They'd show me too, usually one very weird place since the usuals were all trashed. Tj |
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We're on the same page. IV's are a GREAT tool. I believe everyone who wants to truly be prepared for SHTF should have some professional training... even better yet, volunteer etc to keep those skills sharp. (kind of like learning to shoot a pistol, and then continually training with it to keep those skills up) The professional training will just give you that extra and indispensible information that's needed to not make a bad situation worse by starting/running an IV in the wrong way. And like the carbine vs shotgun or 9mm vs. .45 arguments, the tool might do the job, but that doesn't mean something else isn't a BETTER tool for that particular job. I must have missed the part where someone said IV's were unnecessary..... I did catch it when someone said that in major bleeding, running lots of fluid can potentially do more harm than good, and that's true. (In raising the BP, it also dilutes the blood with lower RBC to 'fluid' ratio, and that higher pressure CAN cause faster bleeding, and cause the person to either bleed out faster in the end, or eventually just leave them with nothing but normal saline running through their veins (extreme scenario, but legitimate nonetheless)) (just to relate this to the gun website.  )
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like, yah...this is what I've been saying... 
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As an EMT, one thing I can bet the house on is that no medical professional is gonna use an IV that wasn't started by a medical professional. If I was to have ever gotten onto a scene and someone said "I already got em stuck for ya" chances are, I'm ignoring that and starting my own line. That said, I'm prepared for a lot
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WTH? 
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What about the part about the lateral thoracotomy with Ao cross clamp! See one, do one, teach one!
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Piece of cake, I have the clamp. The rest I just figure out as I go.
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Here is a link to the abstract for the original study involving fluids in penetrating trauma: www.ncbi.nlm.nih.gov/pubmed/7935634?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum The concept is simple: You have a system which was designed to be closed- with a pump (heart), fluid (blood), and a container (vessels). If your shock is due a big hole in the container, and the fluid is leaking out, the more pressure you put the fluid under, the worse the leak is. This is just common sense. That is why Dr. Pepe first questioned giving immediate vs delayed fluids to penetrating truama patients. In his system, he showed that withholding fluids actually resulted in better survival. The difficult question is who else does this information apply to? If I remember right, his study was in Dallas or Houston. This is a lot different than the field in combat. In a big city the trauma center is close, and the delay seems to be beneficial. If there is not an immediately available trauma center, this may not be the case. What I tell my medics to do is exactly what was described above- shoot for a blood pressure, but a low one. I recommend either enough blood pressure for the patient to be conscious and oriented, or else a systolic of 80. If the pressure is more than 80- no fluids. If it is below 80 then give enough to get it to 80, or enough that the patient is awake and oriented. Theoretically this should get blood to the vital organs without excessively elevating the pressure and causing more blood loss. I would say that in civilian EMS this is the current standard of care. I cannot comment on the military, as I have never practiced in their system. |
Not true. It's easy enough for a medical professional to tell if a line is patent, and in a truly critical patient, you're going to use what's there NOW. I may not like the idea, but I'm not going to look a gift horse in the mouth.... at least after I make sure it's a horse and not an elephant. Of course, they'll get at least one more line after that, followed by central lines, etc in a hospital. |
i knew what you meant. mine was as well.
I understood the other posts to mean "let a professional teach it." Experimenting on this stuff by yourself without having the background or at least a pro supervising it has some potentially serious risks which is probably what the mods were concerned about. juslearnin gave a little more explanation on AK's concerns. They are certainly legitimate; and both of us know the Army is always the forefront of technology and modern technique...
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Funny, I don't seem to be all alone here now do I? Dude, I didn't say you were full of whatever, I just corrected some misinformation you posted. As a medical professional, I am obligated to. Don't get a knot in your panties, learn from it, thats why we are all here, to share info. |
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Want to look at another interesting abstract? www.ncbi.nlm.nih.gov/pubmed/12560770?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum Here is a study which looked at survival in three EMS systems in Canada concerning trauma patients. Here's the punchline: Ambulance with MD on board: 35% of patients die Ambulance with EMT Paramedic on board: 24% die AMbulance with EMT Basic on board: 18% die Why? Because the more training the rescuer has, the longer they screw around on scene, delaying transport to the trauma center. Many people believe this is why Princess Di died- if I remember right she had a pulmonary vascular injury, but she got an ambulance with an MD on board who spent 90 minutes on scene attempting to "stabilize" her instead of transporting her to a trauma center which was ?less than 10 minutes away. |
First, isn't there a distinction between internal bleeding and an external wound? if internal bleeding, then I agree it would seem to make sense that an IV could do more harm than good...but what about an external wound, or perhaps a gunshot that penetrated the calf, thigh, something you could put a pressure dressin on? Isn't this diferent than a gut shot where with internal bleeding an IV may be of less value? You seem to paint bright lines, and though I have virtually no medical training, even I am smart enough to know that the if medicine were full of bright line rules, it would be the science of medicine...it is instead the "practice of medicine." I believe there is an important distinction between what I believe you said, and what juslearnin posted - In my circumstance, and in a survival situation, a "trauma center" may not be available: your whole argument is that IV is worthless in that it is just "making the blood pink." If I can get myself, or a buddy, to a trauma center quickly, then I agree - let a pro do it. The problem with yout theory arises where there are no doctors. Not only do you question IVs in general, but you question blood banks and I guess direct infusions of real blood. Here are your statements: *The "fake" blood has not been proven to work. * Even stored blood is coming under question as to it's effectivness. * For many years we were told to push the fluids to keep the BP up. I started questioning this thought in the early 90s and a few years later mainstream EMS started questioning it too. No we are being told that pushing fluids in trauma just blows out the forming clots and causes further bleeding. * The simple point of this post is that in the civillian world, most people don't have the training or need for IVs and will do more harm than help if they try to use them. I can agree with this, as my post was oriented toward the value of learning - the right way - to do an IV. Where did I ever advocate getting "IVs for dummies" and practicing on yoruself? |
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Let's try a new direction here - do you know how susceptible to shock YOU are? I guess no one really does, but try this: go donate blood, and see how you react. I was surprised by doing so. The first time I gave blood, I was young & strong, still in the Marine Corps. Not afraid of needles, nothing like that. They hooked me up, and the bag started filling. I started getting cold pretty quickly, then I noticed gray seeping into my vision from the "outside" moving in. I had enough time to say "Ma'am, I think I'm going to pass out" - then I was OUT COLD. Next thing I know I'm hearing the nurse and my wife almost yelling "Wake up! WAKE UP!" I awoke to find ice packs in my arm pits and crotch (?). They said I was only out for a couple seconds. I deduced from that experience that I am probably prone to shock in the event of blood loss. Funny thing is, I remember dreaming while I was out. |
I'm not surprised at all. In fact, that's one thing I've ALWAYS told my new paramedic students..... just because you have new toys in your chest, doesn't mean you can forget about the old ones. The best paramedics are the best EMT-Basics. EMT-I's and medics want to go STRAIGHT to IV's for treatment for shock, and when yes, that's a great tool, it *should* be done after you place the patient in trendelenberg position, and DON'T forget to keep them warm..... (They do the same thing with intubations.... just because you CAN stick a tube down their trachea to breathe for them, doesn't mean you can forget about using a regular ol' bag valve mask to breathe while you're getting your stuff ready..... etc etc etc...... |
Well of course it's not ideal, but it takes one 3cc syringe and about 5 seconds to see if a line is good, rather than spending at least 45-90 or more seconds finding, cleaning, setting up tubing for, and sticking a new vein. If it's patent, I don't care if Obama or Hitlary put it there, I'm going to use it..... I have other things to spend that time on.
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LOL, I knew at least one of you guys would identify with my post. I'll give you another one that was different. I was often called to the OB Ward to start IVs on premature babies. Often there would be a doctor over my shoulder asking "how about this one?". Boy did we use some odd places. (BTW, I want to note, doctors were drafted in those days and some of those Pediatric physicians were some of the finest doctors I have ever worked with or known since.) What was even more odd is I played guitar so seven of my fingers were useless for palpitation. That often got a chuckle as to which fingers I used. I imagine it hard for many people to fathom hitting veins with needles over 200 times a day then pulling a full shift afterwards. You get pretty good. I was damn good at my job guys. I ets'ed with the GCM and two letters of accommodation as well as made Mortality and Morbidity with two published articles. I simply found I wasn't cut out for that emotionally. I envied the ambulance guys, especially since I pulled that duty from time to time, for they helped people when they could and then the people would be gone. With me, it was getting to know people, love them, watch them slowly die, load their body in a fridge, then help cut them open. I know just enough to know how much I don't know. I have the utmost respect for doctors and nurses for truly it takes a special person to do their jobs, besides a skill set and training. Tj |
This is NOT shock. it is a vasovagal reaction and was due to either the initial stick, or the sight of your own blood flowing into a bag. It occurs in alot of people. I would never use a line placed by a joe blow unless he/she were a heathcare professional due to liability issues. Period! For God sakes, if you have medical services available, don't try to start an IV even if you know how. That is insane; and to suggest that "lay people" should take a course to learn how and to do so even if they don't have fluids available is irresponsible to say the least. Those who state that this shouldn't be done are not doing so to "ensure they will always have work". Hell, if that were the case, they would be ENCOURAGING everyone to start IVs. I think we can all agree that military procedure and civilian practices are not and should not always be the same even on internet survival forums; this being one of those examples. As in most aspects of life, it is not a question of if you "could" do something, it is a question of if you "should" do it, and I simply have not seen any logic or reasoning good enough on this subject as of yet to convince me that it should be done. Buckeye Doc: You forgot to cauterize the vessel and inject all surrounding tissue with Epinephrine just for good measure. |
Though I totally agree the internet isn't the place to learn to hit a vein with a needle, start an IV, or give a shot, I equally disagree having the skill set is not a valuable and even necessary thing every capable American should know. Though I would hope (know many aren't) people would be smart enough to not play doctor, every American should have the right to and enjoy to spend the end of their days at home surrounded by family not in the costly sterile environment of a rest home or hospital. Besides being deplorable way for people to have to end their days, it is a financial drain both on the medical community as well as social welfare. Being able to perform minimal tasks under the direction of a doctor is a major step in taking away the major excuse for not taking care of our own elderly. Having the skill sets is just one step in modern days to restoring the unity of the family. Times have changed and we all want the best care for our family. That should mean people need to change with the times rather than expect society to carry their family burden. I'm not talking when to do these things here but how and if my airhead niece who's only claim to medical professionalism is a lab coat can do it in a major hospital then most Americans should be able to. Just like my niece, they should learn and only do so under controlled conditions. Red Dawn all bets are off. Tj BTW, as a sidebar watching a kid draw blood from me or start an IV and miss a vein I could hit with a dart at regulation distance has been a frustration in my life so I don't post this lightly. |
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What a terrible idea. News flash - if I get a patient with an IV started like that, the first thing I'd do is waste time by removing it. Then I'd place an IV. All you people who have been watching the Borne movies and have stockpiled your turkey needles - please google SEPSIS. The chance of something like this hurting you versus this being genuinely lifesaving are so overwhelming that this thread is pointless and should immediately be forgotten. |