Volume before thought

     I just love it when I have the opportunity to do things that require me to "think outside of the box". In EMS, this can come up pretty often and the more creative you are the more successful you can be. On the flip side, doing something differently just because you can is not a good enough reason most of the time. Putting an IV in a patient's foot just because you could usually doesn't fly.
     However, speaking of odd IV placement and thinking outside of the box, it reminds me of an interesting situation during my days working in the ER while on active duty. I forgot if it was day shift or night shift, but the relevant details still remain in my head.
     The shift was plugging along with nothing really out of the ordinary, until we get a knocking on the ambulance bay doors. I can see an SUV parked in front of our ambulance with an elderly woman waiting impatiently for us. As I walk towards the doors to see what all the commotion was about, I can see she already has the back doors of this modern day "grocery getter" open and there are feet poking out  the back. The first thing that goes through my head is "I really don't want to do CPR right now". So I rush over to find a breathing, circulating, and perfusing man lying in the back of this gas guzzler with an extensive medical hx. And that was just by looking at all the old surgical scars and the trach and old trach scars. I look at the woman that drove the vehicle for answers as a few of the other medics are bringing out a stretcher to get this patient out of the truck and inside. She then tells me "When he gets dehydrated. he goes into A cardiac arrest". Good to know.
     As we get him inside for a better look/assessment you can already tell that he is sick. Breathing fast, no radial pulse, and just agitated. Oh and he was cold too. Great. So IV, O2, and monitor treatment are started. Well the IV part was not successful as of yet. This poor guy was about as vascular as a potato and can only be described as a miracle of modern medicine. His v/s were not exactly great. BP of 70/40, heart rate of 140, and resps at about 30. So we need to do stuff to this guy and fast.
     The search for the elusive vein was turning up diddly in all the usual spots. No AC, EJ, saphaneous, or hand veins. There was a whole lot of nothing. However, as I was looking for an EJ I notice he has a scalp vein. A decent one at that. So I shrug my shoulders in a very "it's better than nothing" kind of way and stick it. Flash, advance, flush, and secure. BAM! We now have access. Just as I put the IV in the spouse of the patient yells out "What the hell is that"! It is an IV that is desperately needed and a crucial part of the care and resus for this poor patient. Thankfully the MD was right there to explain why it was acceptable practice and not medical blasphemy and she calmed down.
     The 20g in the right forehead allowed us to give a liter or two of fluid tank up our guy enough to get normal vital signs and a significantly more comfortable looking patient. Securing this line in place made the guy look like he was wearing a "foam dome", you know the beer dispensing helmets. Minus the beer. So all's well that ends well, right?
     Well the ICU called down to have a few words with me later on. They used phrases like "you can't do that" and "what are you trying to pull". My answer was it was either that or an I/O. This line can stay in for 3 days, per hospital policy while an I/O can only stay for 24 hours. Additionally, we do scalp lines on kids all the time. What is the difference between doing so on an 8 month old v/s an 80 y/o? The line went quiet and then was quickly hung up on by their end. I guess I made my point. I decided not to call them back to say that before they increase their volume that they should put some thought into the issue at hand.
     The point of this story stresses what I was taught from day one as a medic. You get a line where ever you can. It may not be text book and you damn well sure it is not going to be pretty. As long as it is in a vein and it works, we can address the finer details later. I have to say I was quite proud of that line. Even if it was only a 20g.