To Carlos, Rowley and Stephen
THE ORIGINAL QUESTION.
If I infused via an 18g cannula rather than a 14g cannula would there be any
detrimental effects on the patient or problems for the receiveng doctors
because of the choice of cannula. Taking into accout that our arrival on
scene time to arrival at hospital time is usually 20 to 25 minutes which is
enough time to infuse 2000mls of hartmans.
Do you think that introducing a smaller cannula would reduce on scene time?
(see benfits of 18g on original e-mail)
Is there a problem with damage to veins by turbulance (see Stephens e-mail
reply) is fluid go through a smaller cannula at a greater pressure?
Stephen,
We (the group) talk of hypotensive therapy. In this case the pateint may
enter AEU with NO cannula at all. I understand that you may be able to IV
access brown cannula's very successfully, but could you say that about all
of your collegues. If the answer is no then as a comprimise what about the
green cannula's. Easier to get in for most people, therefore hopefully
quicker (reduce on scene times) and you get some fluids into the patient.
One can put them in distally and this leaves the big ACF's free for the
Dr's.
Wot do ya fink?? Garbage? is so why?
If anyone wishes to discuss the subjects below can we make another subject
heading please?
Carlos,
ON SCENE TIMES
Yes, we spend to long on scene. But as you rightly pointed out, we don't
have the training we should. The only insight into ongoing care in the
streets has come via paramedic meetings which we used to have. I and 99.5%
of the ambulance service in my area have had no formal training in trauma
care.
Yes, we are taught how to put a person on a trauma board. Yes, we are taught
how to intubate etc, etc... BUT we do not have any training in how to put it
all together in line with current practice and evidence based medicine.
We apply patient care up to current protocols. If we had more resourses and
the training and the constraints of the protocols were reviewed in line with
emerging evidence based medicine it probably would make a difference.
The (easier said than done) answer, change protocols into guidelines and we
will be able to review what we do on a regualar basis with a peer driven
quality improvement program.
FUNDING
If anyone out there who thinks that my collegues and I need to know and
apply PHTLS concepts I would like to know who is going to pay for it. I'm
not - I've already paid out £1600.00 this year for 'non ambulance'
pre-hopsital related courses to improve myself. My bank manager said that
he's not going to allow my overdraught to get any bigger.
Rowley,
Penetrating vs Blunt trauma. Some in the UK camp say that fluids are good
for blunt trauma. As we get more blunt trauma than penetrating trauma is
fluids good? Paramedics don't know and until such the debate across the pond
is settled then the policy makers will not change our protocols and it would
be stupid for any paramedic to go against existing IHCD or Local protocols.
It opens one up to serious ramifications.
Mike Bjarkoy
Paramedic
Sunny Sussex
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