Moderator EMEDPA Posted September 12, 2020 Moderator Share Posted September 12, 2020 Dilt through an EJ. Meth user, totally out of control with afib/rvr and cannabinoid hyperemesis. anxious/dramatic and hyperkinetic. No IV access with 4 attempts by a really good nurse. Figured I would give an EJ a try, and it worked. Next step would have been an IO. Dilt through an IO would have been a first as well. Haldol and ativan through the same EJ. Hospitalist graciously accepted admit. 3 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 13, 2020 Share Posted September 13, 2020 Well done. What other paramedic skills have you drawn on? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 13, 2020 Author Moderator Share Posted September 13, 2020 1 hour ago, ohiovolffemtp said: Well done. What other paramedic skills have you drawn on? all of them. I honestly could not do this job without having been a medic first. 2 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 13, 2020 Author Moderator Share Posted September 13, 2020 still in our ICU. His only access is still my 20G EJ , despite multiple additional attempts by other folks. Quote Link to comment Share on other sites More sharing options...
MediMike Posted September 13, 2020 Share Posted September 13, 2020 13 hours ago, EMEDPA said: still in our ICU. His only access is still my 20G EJ , despite multiple additional attempts by other folks. What's his anatomical hangup for central access?? Stenosed? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 13, 2020 Author Moderator Share Posted September 13, 2020 2 hours ago, MediMike said: What's his anatomical hangup for central access?? Stenosed? scarred. he shot everywhere except his neck and his penis. An IJ would be an option, but this guy doesn't stay still. we had 2 folks holding him down for me to get the EJ. Failing that, it would have been b/l IOs. Quote Link to comment Share on other sites More sharing options...
charlottew Posted September 15, 2020 Share Posted September 15, 2020 10mg IM haldol (or zyprexa if you prefer), then an I/J. I/O would work, too but might be more uncomfortable for an awake patient. 1 Quote Link to comment Share on other sites More sharing options...
MediMike Posted September 15, 2020 Share Posted September 15, 2020 Ketamine! I've heard you ED people have actual blowguns loaded with K-Darts? Now, is it just ketamine or are you required to mix a variety of drugs in it to make a cool new name? Ketofoledex? Dropofolamine? 1 Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted September 15, 2020 Share Posted September 15, 2020 No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet. Definitely a better choice for the wildly out of control than either Haldol or Geodon. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 15, 2020 Author Moderator Share Posted September 15, 2020 8 hours ago, ohiovolffemtp said: No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet. Definitely a better choice for the wildly out of control than either Haldol or Geodon. I gave ketamine to a guy who shook of not one, but TWO IM B52s. chilled him out right quick. Quote Link to comment Share on other sites More sharing options...
Moderator LT_Oneal_PAC Posted September 15, 2020 Moderator Share Posted September 15, 2020 1 hour ago, EMEDPA said: I gave ketamine to a guy who shook of not one, but TWO IM B52s. chilled him out right quick. Not in the ED, but back when doing anesthesia I had to give a guy 400mg of propofol just to start a colonoscopy. If I recall I went through 6 bottles in during that scope. another lady with chronic back pain and methadone use, undergoing some back procedure if I recall, took an entire syringe of sufentanil before intubation. some people are just damn tough Quote Link to comment Share on other sites More sharing options...
kettle Posted September 18, 2020 Share Posted September 18, 2020 On 9/15/2020 at 2:33 AM, ohiovolffemtp said: No blowguns, and I've had at least 2 patients that 500 of IM ketamine only slowed down but didn't make quiet. Definitely a better choice for the wildly out of control than either Haldol or Geodon. I find ketamine IM responses really varied, 500 IM to a full size adult and they are limp with the death stare and 500 IM to another and it was still like wrestling a bear, both from meth use. Personally now that it's making a comeback I like 5 for fighting 10 for biting with droperidol. I find it more consistent. 1 Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.