Punitive Procedures
I submit for your vote the following:
Obnoxious drunk MVA refusing to cooperate with anything; which is the most satisfying- the punitive 14 gauge or the punitive 18 French?
(And any of you who might feel the urge to respond with some comment about punitive procedures being unprofessional, shut the hell up in advance. They were both clinically indicated.)
22 comments:
Are you freakin kidding???? Duh----- LIKE BOTH!!!!!!!!
John :-)
Where I roll, we put system abusers on notice that they will be getting large bore access on both ends if they don't stop the abuse.
Which body part is gonna be skankier to hold, his arm or his Johnson?
I'd shy away from the 14 gauge IV because drunks always self-pull their IV and try to escape, and you'll have to clean up a greater amount of blood with a 14 gauge.
When they pull their own Foley (balloon intact), they won't bleed as much and it'll hurt more.
You don't want to punish yourself too.
I'm sorry; I should add that if the patient is in 4-points and the risk of pulling one's own IV or Foley is low, the 14 gauge is the better choice.
18 Foley - Dry insert
As long as everything goes in cold, what matter?
Do both. In the same place. 18 Fr in the urethra, 14 gauge in the corpus cavernosum. It's an easily accessed vascular space, it's non-positional and you only need one Betadine swab to do both things.
You can also argue that there is arguably less risk of complications, because you're using a sterile technique instead of a simple aseptic technique.
I'm all about economy of technique, baby. That's just how I roll.
And if AD's placement leaves side effects- tell him to cum back and see a couselor--tell his dorcus cavernomorso to come Cialis!!!
And if it last longer than 4 hours - call Guiness Book of records for longest dumbass with a fr catheter in and no trouble peeing out the 14 ga.!!!!
John
oh, 14 gauge definitely!
you can't die from losing too much pee, but the look on their faces as they're hosing out blood while you're getting the bung on is just priceless! plus the potential for a dude barring up while you're shoving in the foley is fairly unappealing. what's a punishment if it starts with a boner?
is it just me, or does everyone else pretend to be beavis when you get out a bung ... i am cornholio!
I have absolutely no idea what this all means. I only presume that it involves some sort of insertion, purely for medicinal purposes you understand. Perhaps both would be advisable, just to be on the safe side. Does it hurt ?
If they're both clinically indicated, how can you lose?
Remember when your mom used to say "shut up or I'll give you something to cry about?"
AD said...14 gauge in the corpus cavernosum.
I know a little place where that's actually been done. Not by me, but I do know of its placement.
whichendbites, a 14g IV needle is big. And it feels like a horsefly bite. The 18g Foley refers to a size of a tube inserted through the usual route to get to the bladder. Although 18's pretty standard, when they would insist that they "can't" pee for their drug screen I'd just nonchalantly toss a 30g onto the stretcher with them and tell them, "I'll be back in a minute."
Never failed. Always came back to a full cup.
Replace "Fr" for "g" on the foley and forgive my addled mind...
Don't forget the medically indicated punitive NG tube.
I was gonna say add a side order of undiluted phenergan, but it all doesn't matter - he's drunk, he unfortunately won't give a shit what you do.
If they were clinically indicated, than you had no choice. Hopefully, your ED was out of lube that day, too!
Between a foley and an angiocath?
Punitive wise, I'd think "Foley". Just thinking about it makes me cringe...
I get 16g's shoved into my antecubes on a bimonthly basis - they don't hurt much ;)
Love the blog, by the way :-)
The largest bore angiocath I've ever even seen was a 16g, and it scared me, so I have to think that a 14g might scare even a drunk guy. I dunno... I'd begin behaving myself PDQ if someone showed me one of those garden hoses and even insinuated that they were going to stab me with it.
I hope you did both. And then, because you weren't sure which "toxins" he ingested, and NGT full of charcoal, just to be on the safe side.
ekg. monitor. 5mg inapsine iv. ah, silence (except for the snoring, then you get to put in a nasal trumpet which is a huge bonus).
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