What are you doing here?

I’m with a young-looking medic in the back with a young woman in seizures. I know her because I’ve transported her many times. Too well. She has impressive* status epilepticus. My last report to the ED was maybe one sentence beyond, “You guys know [insert patient’s name]?” Six people in the room said yes before it turned into a benzodiazepine convention.

We’ve already given her intranasal Versed. The young guy is looking for IV access in her extremities. I know she has no veins but I don’t stop him. I’m easy that way. It doesn’t hurt to look for a bit. He doesn’t find anything, as expected, because she has nothing.

“You want this EJ?” I say to him, figuring a young guy would like the experience of doing one. I mean, it’s even more infrequent than an intubation. I’m sitting at her head, manipulating her head and her body to make things advantageous for me. EJs are easy and difficult both at once. If you’ve done an EJ, you know exactly what I mean.

I once worked with this guy who would start EJs unnecessarily, in my opinion. In his mind, it was practice. In mine, it was disrespectful, even to cardiac arrests, especially when there’s no need for “a second line” or there’s obvious extremity access.

I don’t start any IVs if I don’t need to. I don’t start them “as a precaution” or “just in case” or “because we may need it.” I start them because there is a legitimate complaint. Yes, nurses love medics for starting IVs so they don’t have to do it, but they also hate medics for starting IVs when they want to send someone to the waiting room instead.

Anyway, he hesitates, and makes no move indicating that he’s at all interested in this EJ. He apparently doesn’t want to do it for whatever reason.

That’s like saying a firefighter doesn’t want the nozzle.

So I do it.

And of course that means I can’t fail.

A couple of months later, we go to this patient’s house again. I’m riding with a different young-looking medic to the hospital. After I tell him she has no veins without stopping him, he looks and looks, as if staring at her arms would magically summon something.

I look at her neck again. The same EJ is staring right back at me. I tell him the story of the the last medic who didn’t want to do the EJ, and I wonder out loud why he didn’t want to do it.

“I wouldn’t want to do it either.”

WHAT?

Who are these new medics and what the FUCK are they doing here?

*For medics to be impressed, you know she’s fucked up.

3 thoughts on “What are you doing here?”

  1. To play devil’s advocate, (and as one of the new generations of medics), I certainly wouldn’t want to start an EJ on an actively seizing patient (especially one whose seizure activity is described as “impressive”). The benefit of having IV access (vs, say, an IO) is not nearly enough for me to chance transecting the carotid, causing a pneumo, etc etc. to head you off at the pass, I’m not an idiot and can identify landmarks, and have done more than a few EJs. But an actively seizing patient is the last person whose neck I want to stab. Why not do an IO?

    1. The point of the post is not to discuss the merits of different types of access, even if I think people are too quick to go to IOs without thinking things through. The EJ was easy enough on this particular patient. Even actively seizing patients tend not to have wild seizure activity around the head and neck.

      However, the concern is that these guys simply appeared to want to do neither EJ nor IO, judging by the fact that they made no move to even consider doing either. It was not like they were holding the drill in their hands debating with me which was the better option to use.

Leave a Reply