Called for a possible stroke. Find a middle aged woman lethargic, skin very warm, blood sugar reads HI, which means over 600. Delayed capillary refill. Pressure 76/40. Heart rate on the monitor - 120. Respiratory rate in the low 30's. Can't get a SAT. History of IDDM and a kidney transplant, with subsequent infection problems.
I put her on a non-rebreather and tell the family I will be doing an IV in the ambulance and giving her some fluid. "You won't get an IV," the daughter says. "She has no veins."
I like a challenge. Patients or their family members are often saying they have no veins. Usually that just means they are a tough stick, not impossible. When you get an IV in one, they are very impressed and you are the IV stud, but when you miss after they have told you they have no veins, well, then you're an idiot. I've been the stud and I've been the idiot.
When I check her out in the ambulance as we head lights and sirens to the hospital, I spot a tiny blue vein on her bicept. Can't feel or see anything else. The tiny vein I see will only take our tiniest catheter -- a 24. A 22 is way too big for it. I go into my zen like trance and manage to pop the 24 in and get a good flash. I hook up a bag of Saline, and by the time we are at the hospital I have run in 250 ccs. Not as much fluid as she needs, but better than nothing, and she has access for the IV insulin she needs.
I have patched ahead, and we are quickly hustled to a critical care room, where we are greeted by doctors and staff. Someone says they need to try to get another IV.
"Let a paramedic do it," a flight medic says. "Get me a 18 or a 16."
I am standing there watching as I write my report. This I have to see to believe. Either this guy is the world champion IV stud or he is not just an idiot, but a flamming idiot.
He puts a tourniquet around the woman's forearm, and then getting the 16 needle from a nurse, pats the woman's wrist, then plunges the huge needle in. He digs around. Nothing.
"I'm going to put a central line in," the doctor says.
The medic takes the needle out, then to my surprise plunges it back in -- the same needle. He roots around some more.
"I'm concerned she's really not reacting to your poking," the doctor says.
The medic finally pulls the needle out, and announces, "She's completely shut down."
I guess he was the latter of the two.
