Stephen, although you are right of course, I don't believe getting a large
bore canula into the ACF is so important in a time critical trauma patient.
It is actually relatively easy and far more effective to place a central
line in A&E, or do a cut down. If attended to by a trauma team especially,
as you've no doubt seen - anaesthetist grabs airway control, someone else
does chest drains, someone else does ACF or pedal cut downs almost
simultaneously.
A motorcyclist recently brought into A&E asystolic, and we had four lines in
him within seconds and two chest drains. With four volunteers literally
squeezing blood into him as hard as they could, we got a pulse and output,
but couldn't sustain it. A thoracotomy showed a torn pulmonary artery, and
we came damn close to resuscitating the first trauma asystole (Has it been
done??).
If there is delay to on scene time - where does it occur?? Personally I
think some is due to delaying the Fire Brigade from cutting people out as we
try to put
lines in, put collars on and stabilise people while they are still trapped.
It worries
me a little to see the professional jealosise between Fire and Ambulance
Go on give me a hammering, its only a suspiscion, from my limited experience
so far!!
Jeremy - BASICS
> >I am sure we are right in continuing 14g cannula's but need to justify to
> >myself why?
> >
> Because when they get to A&E, and they start pouring in the blood, I'm
sure
> it will go in much faster through a 14g than an 18g, blood being thicker
> than water. All the flow rates for cannulae are given for water.
>
> I believe there may also be the question of damage to blood cells by
> turbulence and high pressure in the small cannula. I wonder if there has
> been a study of that?
>
>
> regards
>
> Stephen Dolphin
> Paramedic
>
>
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