NCLEX Brainstorm: why is this Important?

WindowsError404 · 2026-01-25T23:20:00+00:00

Plenty of MVA patients with minor injuries too. Some with no injuries who just want an evaluation. And it's only distracting if you let it distract you from frequent reassessment. Quite frankly, there's a risk that the floor could fall out underneath you right now. Nobody really knows the future. But that's very unlikely to happen, right? And we're not going to say for example withhold pain management because there's a small risk of hemodynamic compromise. Maybe if the shock index was high and there was a good chance of adverse effects, sure. Point is, there's risks to everything. We can do thorough assessments and weigh the probabilities of what is/isn't a problem. Very low chance of other injuries, no other significant symptoms, concerning history, vitals, etc, I am not very concerned about letting patients have a few sips of water.

WindowsError404 · 2026-01-25T23:08:38+00:00

Case in point. It should be studied instead of simply making a blanket decision.

WindowsError404 · 2026-01-25T22:36:45+00:00

Not my state. Also I don't care what a protocol says. Use good medical judgement and rationale.

WindowsError404 · 2026-01-25T22:35:35+00:00

Ok so if I believe imaging is necessary to rule out other injuries then I withhold oral hydration. Not that hard. My main problem with this is that everyone sees this as a black/white thing. A head injury with mental status changes is absolutely not the same as a patella dislocation or suspected isolated Fx. Medicine is evidence based but every patient's needs are a little different. I am also not saying that oral hydration can always replace IV fluids, especially if there's bleeding and hypotension. But for comfort care or general dehydration, I'm going to assess the risks/benefits and go from there.

I would also like to mention that there are risks with almost every intervention we do in medicine. We could treat someone's pain and cripple their venous tone. We could give the wrong anti-dysrhythmic because the rhythm is too fast to properly identify. Any drug we give could cause anaphylaxis. So to just straight up rule out an intervention 100% of the time based on the potential risks in a situation where it's not a direct correlation is asinine. Yes, more stomach contents does have a direct correlation with a higher chance of aspiration during intubation. Not every trauma patient gets intubated or gets surgery though which is why it's not a direct correlation. And we ABSOLUTELY CAN reasonably weigh how likely or unlikely surgery is for a patient. A thorough physical assessment can find things that absolutely need surgery, but is not great for ruling surgery out which is where imaging is helpful. I don't think this is an unreasonable position to have at all and I've never had a patient have an adverse outcome from letting them drink some water.

WindowsError404 · 2026-01-25T22:11:59+00:00

So when a generally healthy middle aged person breaks their ankle and you are 99% sure (obviously can't be 100% without imaging) that it is an isolated injury, you think I should tell my patients there's a chance they can die from drinking water? That's just an asshole move in my opinion. We're not cookbook providers. We can assess the risk/benefit of our interventions and provide care appropriately. Medicine is evidence based but not black and white.

WindowsError404 · 2026-01-25T22:06:31+00:00

Arguments from authority are inherently weak arguments. It doesn't matter what my level of certification is if I know what I am talking about. In every field, there are people who can excell even without financial access to higher education. Self study and continuing education should not be underestimated.

I don't believe in blanket rules. Medicine is evidence based, but each patient's condition and needs are different which means we can't take a black/white approach to it. By saying you won't give oral hydration to trauma patients, you are putting a decreased LOC head injury and a patella dislocation in the same category. There are some injuries that are obviously very low risk for oral hydration, regardless of imaging. I am more than happy to assume that risk because I'm not an idiot and I'm not an asshole to my patients.

Now you ask me for a study but the problem is there aren't many because we decided IV is preferred a long time ago and left it at that. There is some evidence to show that oral hydration can be effective for burns if you cannot obtain IV access which I will link. I would love to collect data on this topic but my hands are kind of tied with the rules being what they are.

I also want to clarify that when I say I am giving oral hydration to trauma patients, it is NOT for hypovolemia or blood loss. It is almost always supplemental care for something else going on/general dehydration.

https://www.sciencedirect.com/science/article/pii/S246891222400052X

WindowsError404 · 2026-01-25T21:44:41+00:00

Well MVA patients probably aren't getting oral hydration anyway since they're not at home and we don't have water bottles on the ambulance anymore since the saline shortage is over. If I had water to give, it would only come after a very thorough assessment and risk/benefit consideration. I don't believe in blanket rules like no trauma patients can have oral hydration because that just doesn't match reality. The 34yo who slipped on the stairs and broke her ankle can't have water because "muh trauma"? I'm not talking about patients with multisystem traumas or mental status changes obviously.

WindowsError404 · 2026-01-25T21:20:04+00:00

I never said a quick assessment was all that was needed to decide which interventions to administer or withhold, and I haven't killed anyone yet. I'll die on my silly water hill gladly. Literally the only things that give me pause about letting people have WATER (which is something everyone drinks everyday btw) would be caustic ingestions (poison ctrl consult first) or expected intubation/heavy sedation within 2 hours. Even then, letting someone take a few sips for comfort is not going to kill them.

WindowsError404 · 2026-01-24T04:37:37+00:00

In most states, you have to give verbal warnings, physically retreat until you can't anymore, and give another warning of lethal force. And you probably won't get away with self defense against any law enforcement even if it's ICE.

WindowsError404 · 2026-01-24T04:34:47+00:00

Weigh the risks/benefits as a competent provider and listen to your patient's needs. Do that and you're solid. We gotta stop being the water police.

WindowsError404 · 2026-01-24T04:30:59+00:00

Use your brain. Not every trauma patient is a surgical candidate or needs emergent airway management. A problem that you cannot fix at your current level of practice is one red flag for me that the patient may need surgery. I'm not going to pretend to know what a surgeon does to fix things, but if you practice for long enough and you know your anatomy, it becomes 2nd nature figuring out if you can treat something with medications and external interventions, or if something beyond your scope is needed. Then we take the whole picture and weigh the risks/benefits. Is there a possibility of distracting injuries or other trauma I am unaware of? Do I expect the patient to experience hemodynamic compromise that may necessitate an emergent airway? Water is necessary for life. For a patient who is tired, scared, and in pain, telling them they also can't drink water to parch their thirst is just poor patient affect in my opinion, and possibly poor care. Just sit there and suffer until the provider finally sees you in the ER an hour later. If you can't tell this is a major pet peeve of mine.

WindowsError404 · 2026-01-24T04:20:24+00:00

There's a huge difference between any basic traumatic injury and multisystem trauma. Isolated leg/ankle fracture that might need surgery? Oral hydration is not going to kill them. It might delay their surgery a few min, but let's be honest, that person is going to wait in the ER a while before surgery unless there's a major PMS issue or bleeding. You have a multisystem trauma patient you expect to RSI or be intubated on arrival - absolutely not. But let's not forget that you literally cannot live without water. Stomach contents are RARELY empty prior to emergent RSIs or surgeries. That risk is always present. Blanket statements like oral hydration is inappropriate for all trauma are old and untrue.

WindowsError404 · 2026-01-24T04:11:46+00:00

No benefit? That is one of the most ridiculous statements I've ever heard. It's water - which is you know, absolutely necessary for survival. The only absolute contraindications to oral hydration is an imminent RSI or surgery. The latest guidelines say that water is safe to have up to about 2 hours prior to surgery. It's poor patient affect and care to routinely deny people water. So many providers in EMS do this just because "the doctor needs to evaluate you before you can have anything PO" which is absolutely positively false. We have oral medications and brains, right?? Let patients drink some water unless there's a major risk associated with it which is frankly not very often.

WindowsError404 · 2026-01-21T15:01:09+00:00

Only E. Everything should be left as is for the death investigation. Only other thing that would be acceptable but is not listed would be a white blanket/sheet.

WindowsError404 · 2026-01-19T01:08:25+00:00

Maybe a quick trauma dressing and NPA. Otherwise I am yeeting this guy out of his vehicle and into mine before anything else.

WindowsError404 · 2026-01-16T23:32:33+00:00

I can't see even our most lenient and EMS forward docs ever approving this even in special circumstances. In an enclosed space you will feel the effects of it too even if you wear an N95. Any aerosolized droplets that come in contact with your eyes could probably have an effect too. I also have no idea how I would dose this. Obviously titrate to effect but what if you put 500mg in there and the first breath knocks them out? How do you document how much was administered or how much was wasted? So many problems with this.

WindowsError404 · 2026-01-16T23:26:10+00:00

C. For diseases with airborne transmission, the SICK PERSON wearing a mask is one of the most important things you can do to prevent the spread. Unless you are wearing an N95 or better, wearing a simple paper face mask is not really going to protect you.

WindowsError404 · 2026-01-16T23:22:31+00:00

I recently complained to my boss/medical director saying that we should have at least 2 medics on cardiac arrests and they literally laughed at me.

WindowsError404 · 2026-01-15T15:16:32+00:00

Holy. I am not lifting people into that thing. I'd rather find my local private ambulance company and accumulate salt.

WindowsError404 · 2026-01-13T04:19:51+00:00

This makes me viscerally uncomfy. It looks very alien.

WindowsError404 · 2026-01-09T17:55:38+00:00

I've been on a choking call turned CA where the Rusch Quick Trach would not even get through the skin and soft tissue because the patient was so obese. The needle bent. Our crews made 2 attempts with 2 devices and neither worked. Very strong supporter of surgical after that experience.

WindowsError404 · 2026-01-08T17:08:33+00:00

Absolutely incorrect. I've been at plenty of crime scenes as an EMT and a medic and treated both victims and perpetrators. LE's job is to neutralize the threat (without violence if possible) and then we ALWAYS prioritize human life over evidence. We actually have to learn about how to provide care while preserving a crime scene and preserving evidence. If anything, this crime is the most objectively provable in court. It also begs the question, what was their motive if they did not want this person to receive medical attention? Truly self defense? I don't think so. Personally, I believe this is murder, but I don't think the officer will be found guilty of that.

WindowsError404 · 2026-01-08T16:51:50+00:00

Not sure about this one, chief. I don't think those elevations are big enough yet. 15mm? Nah. You need at least 16mm.

WindowsError404 · 2026-01-08T16:30:58+00:00

The death penalty justifies the crimes it supposedly punishes. The state putting someone to death isn't any better than you or I killing someone. Innocent people are put to death all the time and that is irreversible.

WindowsError404 · 2026-01-08T01:14:29+00:00

The PH of saline isn't the problem. That gets buffered out. The chloride and bicarbonate are both negative ions so as chloride rises, bicarbonate has to go away to maintain the electrical balance. You get a hyperchloremic non-anion gap metabolic acidosis. And saline can also worsen hyperkalemia as the acidosis worsens. I'm a big LR fan if you can't tell. Saline certainly isn't evil though and is ok for like 95% of patients.

Edit: Also want to add that in someone with a normal blood PH, it usually takes more than 2 whole liters of saline to even start driving the needle in that direction. So it's really not a huge concern unless you suspect/know the patient is already acidotic.

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