In plane central line

[medicine2wallstreet]

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He literally said they didn't have an IO arch.

 

[lymphocyte]

Let's see, the ascending aortic dissection that comes to the OR after hours with a couple 20 ga PIVs. Starts to decompensate on the OR table.

Or the acute abdominal dissection brought to the OR a couple weeks ago. Stable induction, lines placed, approximately 15-20 min later that dissections extended and we never got control of it.

Again, I'm not here to defend my practice. But it's a little misleading to say we simply never take care of emergencies, and please, take as much time as you want getting that patient ready for this procedure. Or maybe I just work at a place where we get those cases, and you don't. My cardiac surgeons don't like going on pump with an IO. I don't, either.

Brother if you have an acutely dissecting aorta it's not the central line that's going to save you. A good PIVC with a short bung generally has a better flow rate regardless.

Just to be clear, I'm not saying there's NO indication for a central line. I just don't think it ever needs to happen right now with all the other options available.

 

[medicine2wallstreet]

Lymphocyte belongs on a pathology bench. Not in emergent anesthesia situations.

 

[vector2]

Let's see, the ascending aortic dissection that comes to the OR after hours with a couple 20 ga PIVs. Starts to decompensate on the OR table.

Or the acute abdominal dissection brought to the OR a couple weeks ago. Stable induction, lines placed, approximately 15-20 min later that dissections extended and we never got control of it.

Again, I'm not here to defend my practice. But it's a little misleading to say we simply never take care of emergencies, and please, take as much time as you want getting that patient ready for this procedure. Or maybe I just work at a place where we get those cases, and you don't. My cardiac surgeons don't like going on pump with an IO. I don't, either.

I work in a place with all these types of cases. Not only that, we essentially have two horrible techs for a million sites (and none overnight) so I have to grab everything myself. There's pretty much always time to bring an ultrasound to the room, turn it on, put some gel on the probe, and drop a probe cover on my cordis kit.... before the patient comes to the room.

The point being, booked emergencies in the OR are rarely like the highest level traumas that come into the bay where sht is hitting the fan IMMEDIATELY. There is usually enough time to prepare the important things, which in this case is getting your ultrasound, lines, and the necessary drugs ready.

 

[Bertelman]

Brother if you have an acutely dissecting aorta it's not the central line that's going to save you. A good PIVC with a short bung generally has a better flow rate regardless.

Just to be clear, I'm not saying there's NO indication for a central line. I just don't think it ever needs to happen right now with all the other options available.

We can disagree. My Belmont, drips, epi boluses etc needed all the lines I could get.

If this has reached the level of “you don’t really need that central line”, I’ll just see myself to the door.

 

[Simba1711]

I think the thread has railed off my original question and I got enough answers so I’m going to lock the thread.

 

[Arch Guillotti]

He literally said they didn't have an IO arch.

It was a joke🙄