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If EMS in your area is starting IVs and pushing fluids on scene, then yeah, that's an issue. Plenty of time to do that in the truck. My primary goal is to gathe

If EMS in your area is starting IVs and pushing fluids on scene, then yeah, that's an issue. Plenty of time to do that in the truck. My primary goal is to gather all clinically relevant information I can, establish any needed access (airway, IV, or otherwise), and stabilize any life threats. In short, to set up the ED doc with the best chance of success (a patient with all the 'prep' taken care of, and a good, clear picture of what's going on. I do think you're focusing too much on the dying/not dying distinction. There is a pretty wide range in the middle, and much can be done to help those patients (even if it's only to improve their comfort and reduce anxiety). There are a lot of patients who aren't going to die in the next couple hours who would still benefit from one or more of the interventions available on an aircraft (including a 500cc bolus). "Lots of fluid" really isn't generally the standard of care for severe hemorrhage anymore. 500 mL may indeed be enough (if it's not enough, they're gonna bleed out anyway). I agree 100% that any provider dealing with a medical emergency on an aircraft (or anywhere else) should be looking at the patient, first and foremost, and not rummaging through a medical kit...

paviva 10y ago
> focusing too much on the dying/not dying distinction. Well, my point is that if they aren’t so bad, they don’t need IV fluids, and you can give them some juice with pretty much the same effect (I expect normal GI function). > improve their comfort and reduce anxiety The Lufthansa kit is great in that respect. Lots of Valium and Haldol to make plenty of passengers calm and happy. > "Lots of fluid" really isn't generally the standard of care for severe hemorrhage anymore. I know. That’s been the usual swinging pendulum through the years : give fluids, don’t give fluids, give just a little bit. I highly doubt all this matter except in a few situations in which the patients is pretty much assured to die on the plane: septic choc, severe bleeding, severe fluids loss (on flight cholera?). Seriously, I’ve never seen an acutely sick patient who needed 500 of saline now. They either can wait till next week, or need 2L STAT. Now, the situation is completely different with the chronic/elderly patients slowly deteriorating during the course of many hours/days, and arriving in extremis, and being resuscitated with a little bolus. However, you don’t see those patients in planes because they don’t let them fly!
- JshWright 10y ago
  Alright, I'll concede the fluid point (maybe this is an argument after all ;). It is very unlikely you would find a patient on an airplane that would benefit from a relatively small amount of fluids, but would also be unable to take those fluids PO. No idea why your posts are getting down-voted. This has been a mutually constructive discussion, in my opinion...

paviva 10y ago

> focusing too much on the dying/not dying distinction. Well, my point is that if they aren’t so bad, they don’t need IV fluids, and you can give them some juice with pretty much the same effect (I expect normal GI function). > improve their comfort and reduce anxiety The Lufthansa kit is great in that respect. Lots of Valium and Haldol to make plenty of passengers calm and happy. > "Lots of fluid" really isn't generally the standard of care for severe hemorrhage anymore. I know. That’s been the usual swinging pendulum through the years : give fluids, don’t give fluids, give just a little bit. I highly doubt all this matter except in a few situations in which the patients is pretty much assured to die on the plane: septic choc, severe bleeding, severe fluids loss (on flight cholera?). Seriously, I’ve never seen an acutely sick patient who needed 500 of saline now. They either can wait till next week, or need 2L STAT. Now, the situation is completely different with the chronic/elderly patients slowly deteriorating during the course of many hours/days, and arriving in extremis, and being resuscitated with a little bolus. However, you don’t see those patients in planes because they don’t let them fly!

JshWright 10y ago
Alright, I'll concede the fluid point (maybe this is an argument after all ;). It is very unlikely you would find a patient on an airplane that would benefit from a relatively small amount of fluids, but would also be unable to take those fluids PO. No idea why your posts are getting down-voted. This has been a mutually constructive discussion, in my opinion...