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How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?
1. It's surprisingly uncommon to have a patient that has a truly serious "sympathetic nervous reaction" to a needle. I've seen a couple of people puke, a couple pass out, etc after being stuck but nothing what I would classify as "serious". Well, except for the one lady who apparently spiked her BP (which was already elevated) and burst a blood vessel in her eye.How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?
1. It's surprisingly uncommon to have a patient that has a truly serious "sympathetic nervous reaction" to a needle. I've seen a couple of people puke, a couple pass out, etc after being stuck but nothing what I would classify as "serious". Well, except for the one lady who apparently spiked her BP (which was already elevated) and burst a blood vessel in her eye.
2. If the IV isn't absolutely necessary, then don't do it. Document the patient refused and was uncooperative.
3. If it is absolutely necessary, then you just have to either talk the patient through it (which works most times) or you have the most drastic option (usually reserved for the intoxicated, the incompetent or the truly critical) of holding them down and doing it. I don't recommend this latter approach be used except in cases where the patient is in extremis because if you do it to the wrong patient, it could theoretically be considered assault.
IMO that is definitely assault if the patient has a GCS of 15, understands the risks of not having the IV started, and is thus capable of refusing treatment.I don't recommend this latter approach be used except in cases where the patient is in extremis because if you do it to the wrong patient, it could theoretically be considered assault.
When I first started as an EMT, I couldn't help but notice that all the medics in our company used approximately the same line regarding IV starts: "All right, you're going to feel a big pinch."
The first time I heard it, I thought to myself that it couldn't possibly go over well-- you're going to call it a big pinch? Why not "a little sting"? But patients seem to accept it well, maybe because it doesn't minimize their anxiety over the needle.
I'm curious what other lines people use for IV starts.
I think it all depends on why they are in your bus.
If they they are a DWI or a pedophile who for some reason ran into an officer's maglight (shi* happens) a little fishing and a big poke is the very least of what they are gonna get. I will find every way possible to make it the most painful, though still properly done, needle stick of their life.
a little fishing and a big poke is the very least of what they are gonna get. I will find every way possible to make it the most painful, though still properly done, needle stick of their life.
Have I ever put a drunk driver's life in danger by sticking him with a bigger needle than I wouldve probably used otherwise....no. Does it make me feel better, naa, it doesnt change anything. Why do people do it? Because there isnt a reason for me to want to make his life comfortable.
You stretching it pretty far by saying actions like those that I have described are unethical, torturous, and unprofessional. How so? Im following protocol, not doing anything dangerous, basically doing my job. I just didnt give him the courtesy of making things a bit more comfortable for him.
Well, I wouldn't call that torture so much as attempted murder.What I would consider torturous is if he told me he was severely allergic to something Im giving him and I give it anyway. Thats wrong, no one can argue.
Your response has led me to wonder whether you have ever actually treated another human being before and whether youve ever experienced any of the emotions associated with medicine. If I had to give an answer, I'd say you have much much much more you still need to learn.
At the University of Virginia, where I am
Caviler you sound like an EMT-B is that your level of training?
yes, that is my level of training. Which would explain why it sounds that way.
So you say you're a paramedic when you're actually an EMT-B, and you start talking to a medical student on proper treatment of criminals in your care from your more "experienced" point of view. So not only are you a dishonest person, you also think it is your place to torture people. You should tell that to the people interviewing you for medical school, I'm sure they'd love it.Come and write back to me after you have a bit more experience treating people. Am I saying its the right thing to do...no, it isnt. Does it happen with everyone in the medical field-you better believe it does.
Well said, jbar. The fact of the matter is people like cavalier shouldn't be working in health care if they cannot maintain professionalism and feel it is necessary to intentionally inflict pain upon patients they dislike. I wonder how many of those awards the state would revoke from you if they found out the things you are admitting to doing while under partial anonymity online.I know Cavalier says he won't respond to this, but I think it's a good point for others out there.
1. I don't agree with the argument that "I've been in the real world, so you can't judge me." When you join a group (ambulance service, the Army etc) you start off with your own values and ideas of how things should happen. Gradually you learn what is accepted behavior, attitudes, and views in that group and most people come to conform to some degree with these common values. Often when you've been doing a job for awhile there are things that you have come to accept as normal parts of the job that it takes an outside perspective to realize, "hey, maybe this isn't right." You really don't years of experience to be able to say that inflicting more pain than is medically needed because you don't like a patient is unethical.
2. I understand the argument that you may not go out of your way to help patients who you don't like. Okay, I'll agree with that. Sure I won't stay 20 minutes past my off time to find a pillow for the patient who just spit on me. But there is a difference between that and making an IV hurt as much as possible before you start it.
3. Any procedure caries some risks, and if you are doing it with a goal other than finishing the task safely you are doing harm. "Fishing around" with an IV cath damages tissue, increases the risk of infection, blowing the vein, delaying having a patient line etc. So you are doing harm.
4. Who are you to judge your patients? Maybe the guy arrested for DUI is really a diabetic, maybe the person accused of child molestation is innocent. You don't know and the reason why you treat patients professionally is so you don't have to find out. It's not your job. Also it's a slippery slope for causing a little more pain to maybe not giving pain meds for a fracture. Or why don't you just say you won't treat prisoners? Or certain groups you don't like? Once you get on that road where you give people different care based on who they are there is not easy stopping.
Even though I don't think you need to match someone in experience to say they are wrong about ethics, and I don't feel the need to fluff my ego by rattling off my experiences, I'll just say that I've worked in EDs, I've worked 911 on ambulances. I'm a medical student and yeah, I have patients I don't like. So I don't think I'm talking from an ivory tower to say trying to cause more pain than needed because you disaprove of a patient is wrong. I'm not saying anyone shouldn't be in medicine, or that you are a bad care provider. I've met plenty of people who have no problem wacking a patient in the head with a radio if they are being a jerk. But I think as professionals we can hold ourselves to a higher standard.
Let me say that I've been working in EDs for the last nine years, and was a full time EMT on a 911 ambulance for almost two years so
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Ive certainly held back on my temper a number of times but other times it gets the best of me. Have I ever hurt someone to the point where the term "torture" comes into question....definitely not. Should everyone be treated the same? Of course, this is a stupid question.
Well said, jbar. The fact of the matter is people like cavalier shouldn't be working in health care if they cannot maintain professionalism and feel it is necessary to intentionally inflict pain upon patients they dislike. I wonder how many of those awards the state would revoke from you if they found out the things you are admitting to doing while under partial anonymity online.
I agree, perhaps that was a bit too harsh. My point was that this kind of behaviour shouldn't be practiced by anyone in any health care profession (doctor, EMT, paramedic, nurse or otherwise). My last post was stating that if he can learn to overcome his anger/control issues, then there isn't a problem.Thanks. Though I would like to make a plea in general to stay away from the whole "this person shouldn't be in medicine/go to med school/would be a bad doctor."
I agree, perhaps that was a bit too harsh. My point was that this kind of behaviour shouldn't be practiced by anyone in any health care profession (doctor, EMT, paramedic, nurse or otherwise). My last post was stating that if he can learn to overcome his anger/control issues, then there isn't a problem.
Glad we can keep this thread positive and a learning experience for everyone then. Yes, we do all make mistakes, and that's OK as long as we learn from them. It was only a week ago that I dealt with an intoxicated patient who had caused a high-speed MVA with a family in the other car. I certainly did not go out of my way to give him A+++ patient care, but I did the job I've been trained to do and no more, no less. Had anyone in the other car been seriously injured, I can see how it would have been hard to remain civil, but that's our job to remain professional.I said I wasn't going to respond, but I want to thank jbar for his post. Very well said.
While Ive never done any significant harm to any patient, I will certainly consider what was said next time I run into a difficult situation.
I dont believe I have an anger issue and I think many conclusions were hastily made by me and others based on a post which wasn't meant to have much value.
What I want the underlying value of my post to be, if nothing else, is that we are all human. Humans make mistakes out there when emotions are high. Control them the best you can and think rationally. Whether we all become doctors, PA's, nurses, EMT's or some other medical professional, we will certainly be placed in a situation where our ethics come into question. Some times we lose control, sometimes we handle it with grace.
Will we always be right? I wish that was the case, but its not...do the best you can when handling with the less than thankful individuals we encounter while trying to lend a helping hand.
I appreciate the replies, and some of the answers were general information that I was already pretty familiar with. Talked it over with a couple of the lead instructors 30+ years a piece in EMS and ER work and the Doc I work for, they all agreed that a patient like the woman who went tachy on me are a stick that I should have passed off to a Doc, PA or ARNP who had ordered the line or tried to get orders for topical lidocaine; as well as talking them down like the Medic/RN and I did.
Again, I appreciate the feedback.
Topical lidocaine works wonders! I have a tube of EMLA cream I use for when I have blood drawn (I'm still a bit uneasy about being stuck. I don't mind sticking others or watching things being done with a needle, just as long as it isn't happening to me), and I can't even feel the needle. The drawback to it is that you have to leave it on for an hour for it to be effective. So its not bad if its for a scheduled procedure or test or if the needlestick can wait for an hour. Doesn't work if there is an immediate need. I have seen people inject lidocaine before starting an IV, but I don't get the point of doing that. You still get stuck for the lidocaine and it burns.
Even though it is not in protocol I do use the lidocaine jelly from the NPA's to numb the region but it is rare.. I don't think they you all need to jump down caviler's throat. I have seen many many times in the ambulance and the ED people put in 14g IV's when an 18 or 20g was all that was needed. I have seen everyone from Doctors to nurses to techs doing this type of behavior. I will say however it is much more rare to see a DR. doing it. I think if you want to be a DR you need to be the one that sets an example and shows how the rest of the staff needs to behave. Caviler if you do become a Dr please leave this type of behavior on the street and don't bring it with you..
tell them you will count to 5 and do it on 1....HA
TITCR.
Those who use this term are generally of high intelligence, but completely overly occupied with the nuances of the admissions process. Most need to get a life and stop wasting their youth posting on anonymous admissions related boards.
How do you deal with the patients who seem unable to remain still or clench up or have a crazy sympathetic nervous reaction to seeing the IV needles?
It's good to remember that there is a reason we carry 14ga needles. A sick patient who is unstable should get the largest IV that you reasonably think their veins can take. Clearly you don't try a 14ga on a 15yo girl with little veins, but it is totally reasonable to start 14ga lines on a guy who is tachy and disoriented. I think what some people on this board are upset by is starting large bore IVs to inflict more discomfort than is medically nessecery. Chest tubes hurt too but sometimes people need them.FutureDrCynthia said:Good Lord! I saw someone get stuck with a 14g needle last week. That looks horrible. I'm not sure why they did it. There was a high level of suspicion that he was on drugs (very disoriented, blood sugar was normal-so that wan't the cause, confusion, pinpoint pupils, heart rate 160). But we weren't sure what was going on with him-he spoke very little English, mostly spoke Korean, so it was hard to get any answers about what was going on from him. But still, that crap looked like it hurt! Sharpened coffee straw is a good description, I said it was like the ink tube inside of a bic pen.