So, after much practice, I’d finished the supervised mannequin IV sign-off starts on the IV trainer; two ‘flash’ starts (tourniquet, alcohol wipe, catheter insertion, looking just for the ‘flash’ of blood on the catheter injector that means that the catheter has been properly placed in the vein), two full setups (flash, plus IV bag selection, setup, and start), and one ‘bloods’ (same as above, but drawing tubes of lab samples). Tonight, I had no excuse but to move to live subjects. I started three ‘flash’ and had three started on me. One of mine, the second one, didn’t count because I threw the sharp bit into the trash rather than the sharps container, even though I placed the catheter properly. The rule, of course, is ‘give one, get one’, so I had to give myself up in exchange for my make-up poke. The guy I traded with for my make-up flash turned out to be tenative with the needle. He wasn’t able to get a flash. He did manage to give me a major hematoma on the back of my left hand. It didn’t hurt much while he was mucking about but it sure does now. Anyway, now I’ve placed catheters in live human veins three times. It’s pretty weird. By the third time, I had the technique down fairly well and was able to occlude the vein with my ring finger before pulling the needle out of the catheter; my subject didn’t end up covered in blood. Sweet.
For what it’s worth, it’s more difficult on a psychological level than giving sub-q fluids to the cat.
I have one more live flash, one live full setup, and one live bloods to do before the end of the class. One nice thing about moving on to hospital clinicals is that my patient doesn’t get to poke me in exchange for my starting an IV on them.
I’m almost done with the airway lab sign-offs; I have one left to do. I’ve placed endotracheal tubes, laryngeal mask airways, and combitubes into mannequins using various techniques; with c-spine precautions, without, using laryngoscopes, using just fingers to feel the epiglottis(!!!), on the table, on the floor, face-to-face. If you have a sick mannequin with a compromised airway, give me a call. I can’t actually place tubes into human airways in Vermont until I’m a paramedic.
I still have a number of simulated trauma and medical (i.e., sick, not injured) assessments to do before Friday; four each. Those tend to be fairly straight forward; follow the A-B-Cs, treat what you find. I had an interesting medical assessment last Friday where I had to differentiate between asthma and anaphylaxis. It came down to skin tone; anaphylaxis is a systemic condition leaving the patient diaphoretic and pale where asthma is localized to the respiratory system. The simulated patient had multiple allergies and the history I was gathering was leading me to suspect anaphylaxis; he was in respiratory distress on my simulated arrival and not able to speak real well. Conveniently, I picked up on the pink, warm, and dry skin before I pumped the simulated patient full of simulated epinephrine. He’d have survived the epi, most likely, and his bronchiols would have been dilated, but albuterol was what was really called for.
By the way, if anyone says that you have ‘great EJs’, that’s your cue to get up and run.