Back to the pigs again, this time for ribs. Practice locating the correct spot and then spiking the “chest” with a 14g 2-inch catheter. It seemed a bit grisly, but if someone has a pneumothorax, this is how you relieve the pressure. Add in a 3-way valve and you can selectively open/close the decompression vent.

Ok…IV therapy was interesting.  IO therapy rocks!   Injecting fluid into the bone marrow.  Sounds a trifle harsh, doesn’t it?   The really awesome part of IO is that it is fast.  It doesn’t seem to take nearly as long to get an IO line established compared to an IV.   Clean the site (arm, knee, sternum), position the correct IO tool (BIG, Bone Injection Gun, FAST for sternal, etc) and pull the trigger or press the button.  You’re in.  Flush the port and hook up the bag of fluids.  Ron told us that many EMS agencies are looking at stopping IV and going with IO instead.  It’s faster and has a better success rate.

The only IO method that seemed really intimidating was the FAST that goes into the sternum.  It’s the nasty looking thing with 8 needles.  It was designed for the military, since the sternum is usually protected by body armor.

Ok…what can be better than playing with sharp things?   How about sterile sharp things and sticking them in hands and arms (albeit training aids and not “live tissue”)?

IV practice…a trifle intimidating to get everything together, do things in the correct order and maintain sterility the entire time.   Now, why does a dive medic need to know how to provide an IV?  The most common is probably to rehydrate the injured diver.  Funny thing–divers tend to be dehydrated, dehydration impacts circulation and increases the risk of DCS and can complicate treatment.  So, for rapid fluid replacement, time do put in an IV.

After a bit of practice, it seemed easier.   Then again, they’re just training arms & hands…not real.   Just wait until IV part II–I found out “live tissue” is a different story altogether.  I’ve new respect for all of the pros that have stuck my vein the first time.

At last! I’ve been practicing knots for months and we finally get to suture some tissue: pigs feet.

Pig skin is tough—really tough. It took a lot of work to get the needle through to close up a laceration. After a few stitches, the needle was dull and it became a lot more difficult. After about 20 stitches, my technique was starting to look better. Still, I need to keep practicing.

Lots of interesting things happen as you descend in a chamber. You can’t whistle at 60 feet. It gets warm as you’re pressed down. It’s awfully loud as the air flows in, and after about 100feet, you starting acting funny. Nitrogen narcosis, rapture of the deep, Martini’s law. For me, I have to really focus on one thing at a time. If I am trying to do something and someone starts talking, it’s hard to focus. To complicate matters, your voice changes. Everybody sounds like a chipmunk or Donald Duck. I was excited to make the trip to 165 feet, which didn’t help matters. By the time we arrived at 165 for our ten minutes of bottom time, I was giggling and I still had to perform some skills. First, was drawing some saline to fill the cuffs on a combitube. 100mL through a 25 gauge needle is hard; when you’re narced, it’s harder. Still, I got the saline drawn, pushed the airway and filled the cuffs. Next up: drawing meds. That was easier, only 1.5cc for an IM injection. Brooks and Frank were trying to take vitals on each other during the dive and were just being goofy. As we started the ascent, Ron had me try to push an ET tube. The chamber isn’t big to start with. Trying to get a good position, using a laryngscope to visualize the trachea was damn near impossible. The combitube or a King tube would be a lot better.

All in all, though, it was an interesting experience and I learned that I need to focus on one thing at a time if I’m working at that depth.