Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 Ask your mate to go to the Med center and look on the wall, there is a plaque dedicated to the Acton Bridge Preservation Society, if he can tell me what it's about and who's name is on the founder member list! PS the dates on it too. It should be next to the fingers and toes in plastic. .MM gordon scott <gordonscott18@...> wrote: , thanks for your comments. I am aware of protocols. I am also aware of the array of diffent protocols and that they change. They are in the main for first world and not remote medicine, we can not ignore them but we must take everything into consideration. The scary thing is there are some people who follow blindly and do not look at the evidence base. Let's take your comments about the 30 degree headup position from the AHA. I have been taught the CPP=MAP-ICP. There are schools of thought that say a 30 degree head up position affects the MAP and will reduce CPP. There are also those that say a rising MAP will increase a bleed. What do your protocols say about this? As for your comments about " been there seen it and done it " I have phoned someone who is suspicious of your comments and says that I should ask you to supply the date for the up and coming reunion. That if you have as you say been there and seen it you will be able to confirm the date. Not the venue! Regards >> > Gordon, have a read back through what's been said and you see that most >of what has been said relates to possible future new recommendations, not >what we have on protocols. Now if you don't know protocols, where they are >and what they are, pray tell, what are you doing in this job? Gordon maybe >you should think befor you say some of the stuff you just did. It seems >you're not being very diplomatic. >. > > > > > > _________________________________________________________________ Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 , I was only passing on what an esteemed friend of mine told me. Like i said before I also work as a civvilian paramedic and protocols at present are 2* large bore and run in up to 2000ml's. However research in america has shown this to be detrimental to a major trauma patient and there is a big argument for controlled hypotension giving a better prognosis. I think this argument has gone on for long enough now and at least we all agree that to put in a small cannula for the sake of being kind to the patient is a bit wussy so lets all drop it at least until protocols actually change. Toni P.s arguing over peoples background is terribly bitchy, ultimately we are all here to do the same job and maybe even work as a team at spme time so can we leave stuff like that to the playground....... >From: O'Toole <medicroger@...> >Reply- > >Subject: RE: Cannulation and shock >Date: Thu, 14 Mar 2002 16:52:05 +0000 (GMT) > > > SF as in Special forces? Their guidlines say no such thing mate, been >there done that, full on big bore all the way. I don't know of any shortage >of fluids for those boys! They have no chance to do a full on check for >hypotension and control. Just open wide and run like F@#K. Sort out later. >.MM and generally dead 'ard bastard. > Toni Murch <tonimedic@...> wrote: Hi Me again, >Just to let you know after a recent chat with a friend! current SF medic's >guidelines advocate the use of 18g cannula for controlled hypotension in >the >field environment, that is the remote area where fluids are at a minimum. >let me know if anyone else knows of these guidelines? >Toni > > > >From: " Brash, \\ Lines, Gavin (amed2) " <amed2@...> > >Reply- > > " ' ' " > >< > > >Subject: RE: Cannulation and shock > >Date: Thu, 14 Mar 2002 07:11:00 -0600 > > > >Ian, > > > >I assume your talking about Hypotensive resuscitation??. I think the Jury > >is > >still out on this one, Current thoughts are if you can get them up to a > >palpable radial pulse ( + / - 90mm hg) then that is perhaps adequate, I > >would think that perhaps burns may differ a little from trauma as there >is > >plug hole open to force fluids out. > > > >It's a tough one one the experts still cannot agree which way to go.... > > > > > > > > Brash > >Senior Nurse Supervisor > >International SOS \ Cabinda Gulf Oil Company > >e-mail: Amed2@... > >Telephone: CTN. 8 345 2696 > >Via London 020 74878100 Cabinda Ext. 2696 > > > > > Cannulation and shock > > > > > > > > Hi Folks, > > > > Just thought you might find this interesting. I was at > >MRI > > > at > > > > Stonehaven on Monday for a day ( unofficial chat about things in > >general > > > ) > > > > and one of their nurses that trains the medical Aiders on board the > > > rescue > > > > vessels seems to have a different view on cannulation in trauma. At > > > > present all rescue vessels carry sets of cannulas of the usual sizes >- > > > 14 > > > > , 16 , 18. > > > > Tthe training that I have in trauma ( having just done my trauma > > > > management refresher ) states that in shock for adult volume > >replacement > > > > you use 14 / 16 gauge in order to get a rapid flow rate. 18G being > >used > > > > for drug admin etc. This nurse is now telling me that she advocates > >the > > > > use of the 18g cannula alone, even in serious trauma , and that we > > > should > > > > take off the other two sizes of cannula. She does not like the large > > > size > > > > of cannula, saying that it is ' barbaric'. As far as I am aware she > >does > > > > not have any formal pre-hospital quals and was hospital based for >most > > > of > > > > her career. > > > > I checked all my stuff and the JRCALC rules and they all say for > >rapid > > > > fluid admin use 14 / 16 g. > > > > I also met this lady on tuesday at an OPITO meeting where she >tried > >to > > > > get the 14 / 16 g cannulas removed from the equipment lists. This >move > > > was > > > > blocked. I would be interested in your views on this. > > > > Regards to all, > > > > Andy > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 , sorry for the delay. They have said that they have checked back and that according to their records you have not done a tour there. Therefore you would not have recieved an invite. You may however have attempted to go there and not been accepted. You may wish to contact me off list, to give me something more concrete than you were in that building. I am happy to chat off list save boring people. >From: O'Toole <medicroger@...> >Reply- > >Subject: RE: Cannulation and shock >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > Ask your mate to go to the Med center and look on the wall, there is a >plaque dedicated to the Acton Bridge Preservation Society, if he can tell >me what it's about and who's name is on the founder member list! >PS the dates on it too. It should be next to the fingers and toes in >plastic. >.MM > gordon scott <gordonscott18@...> wrote: >, > >thanks for your comments. I am aware of protocols. I am also aware of the >array of diffent protocols and that they change. They are in the main for >first world and not remote medicine, we can not ignore them but we must >take >everything into consideration. The scary thing is there are some people >who >follow blindly and do not look at the evidence base. > >Let's take your comments about the 30 degree headup position from the AHA. >I have been taught the CPP=MAP-ICP. There are schools of thought that say a >30 degree head up position affects the MAP and will reduce CPP. There are >also those that say a rising MAP will increase a bleed. > >What do your protocols say about this? > >As for your comments about " been there seen it and done it " I have phoned >someone who is suspicious of your comments and says that I should ask you >to >supply the date for the up and coming reunion. That if you have as you say >been there and seen it you will be able to confirm the date. Not the >venue! > >Regards > > >> > > Gordon, have a read back through what's been said and you see that most > >of what has been said relates to possible future new recommendations, not > >what we have on protocols. Now if you don't know protocols, where they >are > >and what they are, pray tell, what are you doing in this job? Gordon >maybe > >you should think befor you say some of the stuff you just did. It seems > >you're not being very diplomatic. > >. > > > > > > > > > > > > >_________________________________________________________________ >Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 Sorry if I came across as being angry, that was not the case. As little as 3 weeks ago, I was with the top Doc who was down there teaching, and the same is till being taught. Refined treatments are being done in the field but in a safe environment by medics when the injured bods are brought rearwards. There is no stay and play stuff when out on the ground. The use of swear words was to empahsise what is taught, literally run like F@#K, not I'm angry. I hope this sorts it out. Agree with you wholeheartedly. Behave. . Toni Murch <tonimedic@...> wrote: , I was only passing on what an esteemed friend of mine told me. Like i said before I also work as a civvilian paramedic and protocols at present are 2* large bore and run in up to 2000ml's. However research in america has shown this to be detrimental to a major trauma patient and there is a big argument for controlled hypotension giving a better prognosis. I think this argument has gone on for long enough now and at least we all agree that to put in a small cannula for the sake of being kind to the patient is a bit wussy so lets all drop it at least until protocols actually change. Toni P.s arguing over peoples background is terribly bitchy, ultimately we are all here to do the same job and maybe even work as a team at spme time so can we leave stuff like that to the playground....... >From: O'Toole <medicroger@...> >Reply- > >Subject: RE: Cannulation and shock >Date: Thu, 14 Mar 2002 16:52:05 +0000 (GMT) > > > SF as in Special forces? Their guidlines say no such thing mate, been >there done that, full on big bore all the way. I don't know of any shortage >of fluids for those boys! They have no chance to do a full on check for >hypotension and control. Just open wide and run like F@#K. Sort out later. >.MM and generally dead 'ard bastard. > Toni Murch <tonimedic@...> wrote: Hi Me again, >Just to let you know after a recent chat with a friend! current SF medic's >guidelines advocate the use of 18g cannula for controlled hypotension in >the >field environment, that is the remote area where fluids are at a minimum. >let me know if anyone else knows of these guidelines? >Toni > > > >From: " Brash, \\ Lines, Gavin (amed2) " <amed2@...> > >Reply- > > " ' ' " > >< > > >Subject: RE: Cannulation and shock > >Date: Thu, 14 Mar 2002 07:11:00 -0600 > > > >Ian, > > > >I assume your talking about Hypotensive resuscitation??. I think the Jury > >is > >still out on this one, Current thoughts are if you can get them up to a > >palpable radial pulse ( + / - 90mm hg) then that is perhaps adequate, I > >would think that perhaps burns may differ a little from trauma as there >is > >plug hole open to force fluids out. > > > >It's a tough one one the experts still cannot agree which way to go.... > > > > > > > > Brash > >Senior Nurse Supervisor > >International SOS \ Cabinda Gulf Oil Company > >e-mail: Amed2@... > >Telephone: CTN. 8 345 2696 > >Via London 020 74878100 Cabinda Ext. 2696 > > > > > Cannulation and shock > > > > > > > > Hi Folks, > > > > Just thought you might find this interesting. I was at > >MRI > > > at > > > > Stonehaven on Monday for a day ( unofficial chat about things in > >general > > > ) > > > > and one of their nurses that trains the medical Aiders on board the > > > rescue > > > > vessels seems to have a different view on cannulation in trauma. At > > > > present all rescue vessels carry sets of cannulas of the usual sizes >- > > > 14 > > > > , 16 , 18. > > > > Tthe training that I have in trauma ( having just done my trauma > > > > management refresher ) states that in shock for adult volume > >replacement > > > > you use 14 / 16 gauge in order to get a rapid flow rate. 18G being > >used > > > > for drug admin etc. This nurse is now telling me that she advocates > >the > > > > use of the 18g cannula alone, even in serious trauma , and that we > > > should > > > > take off the other two sizes of cannula. She does not like the large > > > size > > > > of cannula, saying that it is ' barbaric'. As far as I am aware she > >does > > > > not have any formal pre-hospital quals and was hospital based for >most > > > of > > > > her career. > > > > I checked all my stuff and the JRCALC rules and they all say for > >rapid > > > > fluid admin use 14 / 16 g. > > > > I also met this lady on tuesday at an OPITO meeting where she >tried > >to > > > > get the 14 / 16 g cannulas removed from the equipment lists. This >move > > > was > > > > blocked. I would be interested in your views on this. > > > > Regards to all, > > > > Andy > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 15, 2002 Report Share Posted March 15, 2002 As I did not offer you any dates etc, that was amazingly quick, but still alas my question goes unanswered. It will become clear. If your mate goes and has a nose. It's not the fact that I was in the building it's how long I was there, if at all. . gordon scott <gordonscott18@...> wrote: , sorry for the delay. They have said that they have checked back and that according to their records you have not done a tour there. Therefore you would not have recieved an invite. You may however have attempted to go there and not been accepted. You may wish to contact me off list, to give me something more concrete than you were in that building. I am happy to chat off list save boring people. >From: O'Toole >Reply- > >Subject: RE: Cannulation and shock >Date: Fri, 15 Mar 2002 11:37:46 +0000 (GMT) > > > Ask your mate to go to the Med center and look on the wall, there is a >plaque dedicated to the Acton Bridge Preservation Society, if he can tell >me what it's about and who's name is on the founder member list! >PS the dates on it too. It should be next to the fingers and toes in >plastic. >.MM > gordon scott wrote: >, > >thanks for your comments. I am aware of protocols. I am also aware of the >array of diffent protocols and that they change. They are in the main for >first world and not remote medicine, we can not ignore them but we must >take >everything into consideration. The scary thing is there are some people >who >follow blindly and do not look at the evidence base. > >Let's take your comments about the 30 degree headup position from the AHA. >I have been taught the CPP=MAP-ICP. There are schools of thought that say a >30 degree head up position affects the MAP and will reduce CPP. There are >also those that say a rising MAP will increase a bleed. > >What do your protocols say about this? > >As for your comments about " been there seen it and done it " I have phoned >someone who is suspicious of your comments and says that I should ask you >to >supply the date for the up and coming reunion. That if you have as you say >been there and seen it you will be able to confirm the date. Not the >venue! > >Regards > > >> > > Gordon, have a read back through what's been said and you see that most > >of what has been said relates to possible future new recommendations, not > >what we have on protocols. Now if you don't know protocols, where they >are > >and what they are, pray tell, what are you doing in this job? Gordon >maybe > >you should think befor you say some of the stuff you just did. It seems > >you're not being very diplomatic. > >. > > > > > > > > > > > > >_________________________________________________________________ >Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 16, 2002 Report Share Posted March 16, 2002 " They " should not be discussing such things anyway. Ian H Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 Out of curiosity, are you Paramedics allowed to stem blood flow in an open wound ie from a " bleeder " if you can locate the site of the blood loss by using haemostats. This is attacking the problem from the other end to the cannulation I know but I am just curious. JC Cannulation and shock >> > > > >> > > > Hi Folks, >> > > > Just thought you might find this interesting. I was at >> >MRI >> > >at >> > > > Stonehaven on Monday for a day ( unofficial chat about things in >> >general >> > >) >> > > > and one of their nurses that trains the medical Aiders on board the >> > >rescue >> > > > vessels seems to have a different view on cannulation in trauma. At >> > > > present all rescue vessels carry sets of cannulas of the usual sizes >>- >> > >14 >> > > > , 16 , 18. >> > > > Tthe training that I have in trauma ( having just done my trauma >> > > > management refresher ) states that in shock for adult volume >> >replacement >> > > > you use 14 / 16 gauge in order to get a rapid flow rate. 18G being >> >used >> > > > for drug admin etc. This nurse is now telling me that she advocates >> >the >> > > > use of the 18g cannula alone, even in serious trauma , and that we >> > >should >> > > > take off the other two sizes of cannula. She does not like the large >> > >size >> > > > of cannula, saying that it is ' barbaric'. As far as I am aware she >> >does >> > > > not have any formal pre-hospital quals and was hospital based for >>most >> > >of >> > > > her career. >> > > > I checked all my stuff and the JRCALC rules and they all say for >> >rapid >> > > > fluid admin use 14 / 16 g. >> > > > I also met this lady on tuesday at an OPITO meeting where she >>tried >> >to >> > > > get the 14 / 16 g cannulas removed from the equipment lists. This >>move >> > >was >> > > > blocked. I would be interested in your views on this. >> > > > Regards to all, >> > > > Andy >> > > > >> > > > >> > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 What is the current wisdom on rectal infusions as a method of fluid replacement? Ruth Cannulation and shock >> > > > > > >> > > > > > Hi Folks, >> > > > > > Just thought you might find this interesting. I was >> > at >> > > >MRI >> > > > >at >> > > > > > Stonehaven on Monday for a day ( unofficial chat about things in >> > > >general >> > > > >) >> > > > > > and one of their nurses that trains the medical Aiders on board >> > the >> > > > >rescue >> > > > > > vessels seems to have a different view on cannulation in trauma. >> > At >> > > > > > present all rescue vessels carry sets of cannulas of the usual >> > sizes >> > >- >> > > > >14 >> > > > > > , 16 , 18. >> > > > > > Tthe training that I have in trauma ( having just done my >>trauma >> > > > > > management refresher ) states that in shock for adult volume >> > > >replacement >> > > > > > you use 14 / 16 gauge in order to get a rapid flow rate. 18G >>being >> > > >used >> > > > > > for drug admin etc. This nurse is now telling me that she >> > advocates >> > > >the >> > > > > > use of the 18g cannula alone, even in serious trauma , and that >> > we >> > > > >should >> > > > > > take off the other two sizes of cannula. She does not like the >> > large >> > > > >size >> > > > > > of cannula, saying that it is ' barbaric'. As far as I am aware >> > she >> > > >does >> > > > > > not have any formal pre-hospital quals and was hospital based >>for >> > >most >> > > > >of >> > > > > > her career. >> > > > > > I checked all my stuff and the JRCALC rules and they all say >>for >> > > >rapid >> > > > > > fluid admin use 14 / 16 g. >> > > > > > I also met this lady on tuesday at an OPITO meeting where she >> > >tried >> > > >to >> > > > > > get the 14 / 16 g cannulas removed from the equipment lists. >>This >> > >move >> > > > >was >> > > > > > blocked. I would be interested in your views on this. >> > > > > > Regards to all, >> > > > > > Andy >> > > > > > >> > > > > > >> > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 25, 2002 Report Share Posted March 25, 2002 JC, I suppose it's about where you are and the situation with regard to location, type of wound and level of blood loss, trauma support, protocols and transport/time...... In some circumstances I would consider if was happy and confident that what I did would... 1. Improve survivability 2. Confident that not performing would lead to proberbal death. 3. Know I'm doing the best for the patient...and could account for this if it was required. I think circumstances dictate a great deal... not just anywhere and anytime! Regards Tony > Out of curiosity, are you Paramedics allowed to stem blood flow in an open > wound ie from a " bleeder " if you can locate the site of the blood loss by > using haemostats. This is attacking the problem from the other end to the > cannulation I know but I am just curious. > JC > Cannulation and shock > >> > > > > >> > > > Hi Folks, > >> > > > Just thought you might find this interesting. I was at > >> >MRI > >> > >at > >> > > > Stonehaven on Monday for a day ( unofficial chat about things in > >> >general > >> > >) > >> > > > and one of their nurses that trains the medical Aiders on board the > >> > >rescue > >> > > > vessels seems to have a different view on cannulation in trauma. At > >> > > > present all rescue vessels carry sets of cannulas of the usual > sizes > >>- > >> > >14 > >> > > > , 16 , 18. > >> > > > Tthe training that I have in trauma ( having just done my trauma > >> > > > management refresher ) states that in shock for adult volume > >> >replacement > >> > > > you use 14 / 16 gauge in order to get a rapid flow rate. 18G being > >> >used > >> > > > for drug admin etc. This nurse is now telling me that she advocates > >> >the > >> > > > use of the 18g cannula alone, even in serious trauma , and that we > >> > >should > >> > > > take off the other two sizes of cannula. She does not like the > large > >> > >size > >> > > > of cannula, saying that it is ' barbaric'. As far as I am aware she > >> >does > >> > > > not have any formal pre-hospital quals and was hospital based for > >>most > >> > >of > >> > > > her career. > >> > > > I checked all my stuff and the JRCALC rules and they all say for > >> >rapid > >> > > > fluid admin use 14 / 16 g. > >> > > > I also met this lady on tuesday at an OPITO meeting where she > >>tried > >> >to > >> > > > get the 14 / 16 g cannulas removed from the equipment lists. This > >>move > >> > >was > >> > > > blocked. I would be interested in your views on this. > >> > > > Regards to all, > >> > > > Andy > >> > > > > >> > > > > >> > > > Quote Link to comment Share on other sites More sharing options...
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