This month, readers weighed in on a review by Keith Wesley, MD, FACEP, & Marshall Washick, NREMT-P, on a study measuring prehospital IV use and mortality rates (“Study Links IVs to Mortality Rates,” jems.com). Readers also chimed in on Guy Haskell’s article on the not-so-safe driving habits of some EMS providers (“EMS Providers Who Drive Like Maniacs,” jems.com). Finally, a reader comments on the JEMS clinical review feature by Fred Wurster III, NREMT-P, AAS, & Edward T. Dickinson, MD, NREMT-P, FACEP, on inhalation injuries (“Toxic Transport,” May 2011 JEMS).
This study is completely laughable. A few factors I’d like to know is how the patients who received IVs clinically compared to those who did not? I don’t know about everyone else, but it seems to be common knowledge that the worse the patient, the more likely they are to get an IV. Those patients have a higher rate of mortality. Study a group of patients with all other factors being equal, then compare IVs versus no IVs.
I agree that if you’re dumping fluids into a hypovolemic patient, what is your oxygen binding to? Because ringers and saline are both isotonic solutions, after a certain period of time your red blood cells have reproduced, and you have
However, this is a massive amount of fluid, and if you control your bleeding and administer conservative fluid, you would think there would be a reasonable outcome. I say you should control the bleeding and conservatively administer fluids. Your body will create more blood in time if bleeding is controlled and a measure like this is taken. If they have lost too much fluid, then your death rate will be high with or without fluids. I think it’s better to have tried than not try at all.
I say skip the cup test. Simply look in the rearview mirror. You really can’t see traffic out of it anyway, so position it to keep an eye on your partner. You can see when they’re doing a procedure and drive appropriately. You can also see an IV line when hung from the ceiling. Are the IV bag and line flying all over the place, whipping across the patient’s face?
Ninety-five percent of the time we don’t need to be speed racers. Slow down and get you, your partner and your patient there alive and uninjured. It’s our job.
I’ve been wedged in between the driver and patient compartments by a careless driver. I had leaned through the window between the compartments and said, “When you can, I need you to pull over and stop the vehicle.” I didn’t get the chance to say “because the patient needs to be intubated” before the provider driving stomped on the brakes in the middle of the road, and I got wedged by the hips in the aforementioned window.
The result? A patient needing to be intubated and a paramedic needing to be removed from the window.
We’ve all been with someone who is proud to be a “lights and sirens” medic. I think one of the best things to do is feed them a hot dinner, then put them on the stretcher and drive them around the same way you get driven—without the benefit of an anti-emetic.
I wanted to thank you for the thorough and well-written piece on toxic inhalations. It reemphasized the off-gassing exposure from a patient to caregivers (on scene, en route and at the emergency department), a hazard beyond reach of surface decontamination and clothing removal.
The only thing I would also address is the more traditional concern of controlling entry into confined space, particularly below-grade confined spaces where air contaminants or oxygen deficiency may be concentrated and result in multiple rescuer entry and chain of victims. The article well illustrates that it need not be a confined space. Refraining from rushing in anywhere may keep us well in either case.
S. Portland, Maine
In the March 2011 JEMS clinical education feature, “Clandestine Conditions: Identifying diseases that mimic strokes,” the dosages for dextrose were incorrectly listed. The 50 mEq dosage should be 50 ccs, and the 26 g dosage should be 25 g. We regret the errors. JEMS