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Resuscitation arterial line

Andrew Brainard abrainard01 at gmail.com
Tue Dec 16 00:51:56 GMT 2014


There are over 2,000 ED in the US, nearly all of whom greet patients without the assistance of a surgeon or anesthetist. All consider themselves competent in placing IVs, most feel competent in placing IOs. However, I suspect there are a large number of them that only occasionally place central lines. Expecting that all these institutions upskill to the point that they can place central lines in seconds with a zero precent failure rate seems fantastical. This magical level of proficiency is even less likely in the 10,000 rural hospitals outside of the US that are staffed with trainees much of the time. 

To paraphrase Donald Rumsfeld of Iraq war fame: “You don’t fight with the army you want, you fight with the army you have."

The question is not: "what should flawless providers do if they have all the skills nescisary to do everything perfectly the first time?” 
The question was: "what should actual providers do if they have a femoral A-line and are temporary unable to get additional access?”

Anyone who has placed an apreaciable number of femoral lines on pulseless patients knows that once you get the pulse back it is not uncommon to find out that your were giving the adrenalin* straight into the leg. It is always a bummer, and, once the BP returns, the femoral "V-line" rapidly gets converted to an A-line while alternative access is attained. 

We can debate the utility of adrenaline in cardiac arrest, but most people still follow the ACLS guidelines. 



Andrew Brainard
abrainard01 at gmail.com
+64 21 246 7423



> On Dec 16, 2014, at 10:10 AM, Jakob stensballe <j.stensballe at gmail.com> wrote:
> 
> I would suggest you collaborate further with your anesthetist colleagues on protocols for advanced iv access, more than depending on a a-line for resuscitation in a patient in extremis.
> 
> 1 IO=150 mL/min. 4 IO=600 mL/min.
> 
> In Afganistan or equal, subclavian v access is part of the primary survey, and takes no time in skilled hands
> 
> All the best
> 
> Jakob
> 
>> On 15/12/2014, at 19.37, "Gross, Ronald" <Ronald.Gross at baystatehealth.org> wrote:
>> 
>> So it is in the extremities as well.
>> 
>> Ronald I. Gross, MD, FACS
>> Chief, Division of Trauma, Acute Care Surgery & Surgical Critical Care
>> Baystate Medical Center
>> Associate Professor of Surgery
>> Tufts School of Medicine
>> 759 Chestnut Street<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2014-December/detectors://0/0>
>> Springfield, MA 01199<x-apple-data-http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2014-December/detectors://0/0>
>> 413-794-4022<tel:413-794-4022>
>> ronald.gross at baystatehealth.org<mailto:ronald.gross at baystatehealth.org>
>> 
>> On Dec 15, 2014, at 1:22 PM, Victor Werlhof <werlhof at me.com<mailto:werlhof at me.com>> wrote:
>> 
>> 
>> " I’ve  never understood why some people have problems using a A-line to
>> briefly  resuscitate through."
>> 
>> How about air or particulate emboli?
>> 
>> That was my concern. Cerebral circulation is pretty unforgiving.
>> Vic
>> 
>> 
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