arteries are not as superficial as veins. also, when palpating (feeling) for a vein, if its actually an artery you'll feel a pulse anyway. i don't know of anyone ever mistaking the two
Wow, if you don't mind me asking, what area do you work in? I know that we are going away from EJ's in preference of IO's, but I still prefer them for someone who is in compensating shock and you can not get a more pereferal vein, over the IO. There seem to be just as many or more possible complications with drilling into someone's bone.
If the patient is laying down the risk of an embolism is very small. Ive seen patients diconnect the IV from their own Central Vanous Catheters (CVK) to go take a piss. No embolism.
@ne014x Yes. Idealy the patient should be laying supine with the head of the bed tilted downward. That way the risk of sucking in air in to the vein by moving or breathing is minimized.
Yes, generally use the biggest appropriate guage possible, but in most situations a 14g EJ isn't indicated, besides the sorter catheter of a 16g flows a significant amount of fluid and as you all know 14's are usually longer and the shorter 16g is less positional. Besides shorter catheters tend to have higher flow rates and less complications. I used 14's more peripherally for trauma's and almost exclusively use 16's for the EJ. My 2 cents.
EJ's are kinda going by the wayside now that the EZIO is becoming more prolific. However, if I'm intubating a Pt and see a big EJ sticking out there that's usually what I'll go for 1st. Those IO's are just so damn fun though, problem is that any fluids have to be infused under pressure, which is why I'll go EJ if I can get it quick.
I know. I've gotten to start a couple IO's in the last year, and they are fun. Thankfully, our county has pressure infusers on all ALS units. I like to get an EJ whenever I can, but I've gotten in trouble for that too. I heard about the sternal IO infusers, but i've never seen them in action. I am really curious to see how those work.
Either that or tell a doctor to start riding squads on a regular basis(oh yeah unless they specialized specifically in emergency medicineor go to EMT/paramedic school,they arent really legally allowed to)so he can start a central line(wait medics in certain areas do that too) instead of you starting an EJ.Thats why I love ER docs,most of them respect and apprecaite medics and EMTS and actually understand why we do what we do.
If starting an EJ is in your protocol and isnot contraindictaed in a specific case and a doc getson your case about starting one,tell him to stick it up his ass,as I have seen a few who have done EJs do before IOs came out and they couldnt get a peripheal line startedelsewhere for anything :)
I heard a fun story about some helicopter jockeys up around Vancouver performing an EJ on an actively seizing patient while in the air. Those guys are cowboys.
Central access is extremely common in Seattle/King County, with some providers using the "Arrow" subclavian central line kit (usually only reserved for hospital use). However, I'm pretty certain our paramedic students don't practice central lines on each other! Ouch!
We don't do central's in the field at all here. Since EJ's are still considered peripheral, we just go straight to an IO. We have the Easy IO drills, and they cut on-scene time on critical calls by a lot. I actually got to do one the other day. Screwed the pooch on the first one, but I got it the 2nd time.
Looked like a medium sized catheter? Is a little bit of lido at the site in order for larger catheters that are being placed on conscious patients?
The medics I work with did this last night to a conscious patient with poor peripheral access. A little bit of lido to limit pain. Interestingly, the catheter produced a positive flash on two occasions, however once the needle was removed (and catheter left in)they couldn't asperate back with a syringe. Got it on the third attempt though.
I don't think I've ever seen lido used on an EJ, even in the ER. The only ones I've done have been in the field on semi-conscious to unconscious patients. My partner is a nurse in Montana, and they have to inject lido on the med surg floor before each stick.
What about the ethical, risk and lawsuit factors about practising IV jugularis at non-patients/paramedic students in the nation that is recordholder in medical lawsuits ?? Next time ET intubation, defibrillation at paramedicstudents e.g. nonpatients .......
Better practise first at succumbed patients or resuscitation/OR patients.
Well I don't know how they do things in the Netherlands, but in the U.S., if someone volunteers to do something ( that is by the way not nearly as dangerous as ET intubation or Defibrillation), and the school has malpractice insurance, it is not setting a bad precedent at all.
Well, I saw an ER doc last night blow 2 perfectly good EJ's because he didn't know how to hold skin tension. So the way I look at it, the exposure that you get to the real thing the better. And that was the director of our program starting the EJ, not another student! If you can't practice in a controlled environment, then what is the point of going to class or clinicals. Christ, I've seen a Doc nasally intubate himself on-stage at a lecture.
O cara é muito corajoso!!! Sou enfermeiro intervencionista no Brasil, trabalho no SAMU . Eu não deixaria....
MrEVGU 1 day ago
heroin injectors running out of veins, please take careful notes
DoctorNewcombe 1 month ago
what would happen if you accidently got the carotid artery
drewnickel 1 month ago
brave soul!! :) you can usually use a bigger gauge... mostly used for burn victims or sorts... they aren't going to complain
bjsmjm03 2 months ago
It aint gotta be sterile just clean right lmao.
dogecnalubma 9 months ago
I just finished their EMT program
daphluvsrickman 10 months ago
What if you hit an artery and not a vein?
Oletos7j 1 year ago
@Oletos7j
arteries are not as superficial as veins. also, when palpating (feeling) for a vein, if its actually an artery you'll feel a pulse anyway. i don't know of anyone ever mistaking the two
salyernuts 11 months ago
id go IO before that.
p2thumper07 1 year ago
Ummm...where do you apply the tourniquet? LOL
aagil23 1 year ago
In my medic class no body had the balls(including me) to step up and get a iv in the ej.
disturbed331 1 year ago
nice!!! haha in my paramedic course nobody got an ej lol but must be brave to volunteer for an ej hahaha.
robthestud2003 1 year ago
she forgot to tie a constricting band around his neck!
summerwoodstars1 2 years ago
@summerwoodstars1 hopefully your joking lol
lordice123 1 year ago
i would bang that.
supertrex2 2 years ago
ACk! sick :)
Starfighter06 2 years ago
what gauge needle is used for Jugular IV's?
boorens18 2 years ago
She is using an 18 here, I think because she is being nice! lol. In reality, I would use the biggest needle I could get away with.
kaoit789 2 years ago
We were not allowed or even shown this skill in any medic class iv taken they always say there is too much of a risk of an air embolism
ne014x 2 years ago 7
Wow, if you don't mind me asking, what area do you work in? I know that we are going away from EJ's in preference of IO's, but I still prefer them for someone who is in compensating shock and you can not get a more pereferal vein, over the IO. There seem to be just as many or more possible complications with drilling into someone's bone.
kaoit789 2 years ago
NC, Id fell better doing an EJ than an IO any day, other than cases of cardiac arrest
ne014x 2 years ago
If the patient is laying down the risk of an embolism is very small. Ive seen patients diconnect the IV from their own Central Vanous Catheters (CVK) to go take a piss. No embolism.
PangOlle 1 year ago
@PangOlle So the risk is there its just minizied by keeping the pt supine while the line is inserted and running?
ne014x 8 months ago
@ne014x Yes. Idealy the patient should be laying supine with the head of the bed tilted downward. That way the risk of sucking in air in to the vein by moving or breathing is minimized.
PangOlle 8 months ago
ER NURSE
Yes, generally use the biggest appropriate guage possible, but in most situations a 14g EJ isn't indicated, besides the sorter catheter of a 16g flows a significant amount of fluid and as you all know 14's are usually longer and the shorter 16g is less positional. Besides shorter catheters tend to have higher flow rates and less complications. I used 14's more peripherally for trauma's and almost exclusively use 16's for the EJ. My 2 cents.
Scotchtwin18 2 years ago
is this american medical response ?(AMR)
831MILKDUD 3 years ago
Nope, it's Foothill College Paramedic Program, on lab day.
kaoit789 3 years ago
EJ's are kinda going by the wayside now that the EZIO is becoming more prolific. However, if I'm intubating a Pt and see a big EJ sticking out there that's usually what I'll go for 1st. Those IO's are just so damn fun though, problem is that any fluids have to be infused under pressure, which is why I'll go EJ if I can get it quick.
medic192575 3 years ago
I know. I've gotten to start a couple IO's in the last year, and they are fun. Thankfully, our county has pressure infusers on all ALS units. I like to get an EJ whenever I can, but I've gotten in trouble for that too. I heard about the sternal IO infusers, but i've never seen them in action. I am really curious to see how those work.
kaoit789 3 years ago
Either that or tell a doctor to start riding squads on a regular basis(oh yeah unless they specialized specifically in emergency medicineor go to EMT/paramedic school,they arent really legally allowed to)so he can start a central line(wait medics in certain areas do that too) instead of you starting an EJ.Thats why I love ER docs,most of them respect and apprecaite medics and EMTS and actually understand why we do what we do.
CyanoticFuture 3 years ago
If starting an EJ is in your protocol and isnot contraindictaed in a specific case and a doc getson your case about starting one,tell him to stick it up his ass,as I have seen a few who have done EJs do before IOs came out and they couldnt get a peripheal line startedelsewhere for anything :)
CyanoticFuture 3 years ago
i didn't even know you could do a jugular I.V. that's crazy
ronnok08 3 years ago
I heard a fun story about some helicopter jockeys up around Vancouver performing an EJ on an actively seizing patient while in the air. Those guys are cowboys.
EvanTeH 3 years ago
Central access is extremely common in Seattle/King County, with some providers using the "Arrow" subclavian central line kit (usually only reserved for hospital use). However, I'm pretty certain our paramedic students don't practice central lines on each other! Ouch!
sirhcdeer 3 years ago
We don't do central's in the field at all here. Since EJ's are still considered peripheral, we just go straight to an IO. We have the Easy IO drills, and they cut on-scene time on critical calls by a lot. I actually got to do one the other day. Screwed the pooch on the first one, but I got it the 2nd time.
kaoit789 3 years ago
Looked like a medium sized catheter? Is a little bit of lido at the site in order for larger catheters that are being placed on conscious patients?
The medics I work with did this last night to a conscious patient with poor peripheral access. A little bit of lido to limit pain. Interestingly, the catheter produced a positive flash on two occasions, however once the needle was removed (and catheter left in)they couldn't asperate back with a syringe. Got it on the third attempt though.
sirhcdeer 3 years ago
I don't think I've ever seen lido used on an EJ, even in the ER. The only ones I've done have been in the field on semi-conscious to unconscious patients. My partner is a nurse in Montana, and they have to inject lido on the med surg floor before each stick.
kaoit789 3 years ago
It's an 18 gauge.
leviathan85 3 years ago
What about the ethical, risk and lawsuit factors about practising IV jugularis at non-patients/paramedic students in the nation that is recordholder in medical lawsuits ?? Next time ET intubation, defibrillation at paramedicstudents e.g. nonpatients .......
Better practise first at succumbed patients or resuscitation/OR patients.
joffryvangrondelle 3 years ago
Well I don't know how they do things in the Netherlands, but in the U.S., if someone volunteers to do something ( that is by the way not nearly as dangerous as ET intubation or Defibrillation), and the school has malpractice insurance, it is not setting a bad precedent at all.
kaoit789 3 years ago
Brave soul...
kd4imu 3 years ago
Here, let me hold my coffee right in the vicinity of a neck stick. Are you shitting me?
Most Medic programs these days won't even let students practice on each other, let alone stab necks.
DPC2 3 years ago
Well, I saw an ER doc last night blow 2 perfectly good EJ's because he didn't know how to hold skin tension. So the way I look at it, the exposure that you get to the real thing the better. And that was the director of our program starting the EJ, not another student! If you can't practice in a controlled environment, then what is the point of going to class or clinicals. Christ, I've seen a Doc nasally intubate himself on-stage at a lecture.
kaoit789 3 years ago
that guy has guts to let her do that haha
tylerd89 3 years ago 8