Bubbles

Chances are, when you were a kid, you loved bubbles. Most kids do.”ž

Grown-ups don_t talk much about bubbles, Life-Saver. But they must be important. I just Googled the word and got 32,300,000 hits. It turns out, life is full of bubbles. Bubbles in the bathtub, bubbles you blow. Spit bubbles. Bubbles at the car wash. Even balloons are bubbles. For 80 years, there_s been a chewing gum called Dubble Bubble, and it_s been a measure of coolness for generations of kids to pop their first bubble-gum bubble.

Of course, you lose some fascination with bubbles about the time you_re old enough to do dishes. That_s when you learn about bubbles in bike tires, too. But your first Coke teaches you that maybe they_re not so bad. Another 10 years, and you discover the bubbles from those noisy latte machines at Starbucks. Soon enough, it_s Budweiser bubbles, and then maybe champagne bubbles.”ž

Of course, we don_t all admit to them, but every one of us learns about methane bubbles. The upper kind, the lower kind, and the kind in between. The silent kind, and the noisy kind. The benign kind, and the kind that can empty a dayroom in two seconds. (They_re flammable, you know. Maybe you_ve run a call or two for the odd young genius who_s just learned that lesson the hard way.)”ž

When you choose a profession, you may learn to regard bubbles as true hazards. Nitrogen bubbles can kill a diver breathing compressed air who surfaces too fast from even a modest depth. Welders go to great lengths to protect their work from the weakening effects of bubbles. Metal in gas (MIG) and Tungsten in gas (TIG) are two techniques of welding in an envelope of inert gas (like argon) to keep bubbles out of welds. Farmers know all about bovine bubbles, and equestrians quickly learn a special kind of difference between north and south bubbles.”ž

As a beginner in medicine, you learned the same lesson: Not all bubbles are benign. One of the risks of cannulating a central vein (or even an external jugular) is the aspiration of airÆ’which, of course, forms bubbles. Hematomatoes are bubbles filled with blood, and so are their deadly cousins, aneurysms.

Bubbles form when you spike an IV bag and allow the fluid to splash down into the open end of that line (especially with a big dripper). Bubbles will keep forming all day, until you eliminate the source.

When you first learn to start IVs, your instructors tell you to be careful not to introduce air into a patient_s veins. The truth is, small bubbles probably won_t do any harm. But who_s to say what_s small? Some people say it takes 50 cc of IV air to kill someone; others say you can do it with as little as 20 cc. No matter. Keep all the air out of an IV line, and you won_t have to worry about it.

Plenty of us struggle to do that, waiting for an IV line to clear before we connect it to a catheter. And waiting, and waiting. That can be awful when you_re a new first responder, and you have a busy paramedic waiting to plug in the line so they can move on to other things.

Fact is, you don_t need to wait. And you never need to worry about bubbles. There_s an airtight technique you can use to save all that time. I_m amazed at how many people don_t know about it, but you don_t find it in EMS texts, and most instructors forget to mention it. It takes no time at all, and it_s so easy even a fuzzy ol_ cave medic can do it.

Next time you open a drip set, uncoil the tubing to its full length. Grab that little roller valve you use to regulate the flow rate, and run it up the tube until it_s”žright at the drip chamber. Now close the valve, spike the bag and pinch the drip chamber to put a fluid level in it. Finally, open the valve and clear the line. You won_t see one bubble, even if you squeeze the bag. The only waiting you_ll have to do will be the time it takes for the fluid to get to the open end. You_ll be so slick.

A side benefit of this technique is, you_ll never have to look for the valve. It_ll be right there at the drip chamber, where you can always find itÆ’again, without wasting time.”žJEMS

Thom Dick”ž has been involved in EMS for 38 years, 23 of them as a full-time EMT and paramedic in San Diego County. He_s currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at”žboxcar414@aol.com.

For more Tip & Tricks:”žwww.jems.com/tips

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