Handtevy Minute - 5 Ways to Have a 3-Way

Hello everyone, this is Peter Entebbe. And welcome to another edition of the Entebbe Minute. Today I wanted to talk about five ways to have a three way. So the three way stopcock is something that I really feel has utility in ems. And the first two we've already covered. So use of adenosine with a three way stopcock. We talked about that already. And push dose pressors. You can go back and check out the hence heavy minute for those too. The other three we'll talk about today are push, pull, IV fluids, medication dilution, and then the poor man's jet ventilator. Okay, so the first thing let's talk about is push, pull, IV fluids. You have a child who's in shock, their blood pressure's low and you don't want to just run that IV fluid in slowly. We want to get it in quickly. So let's take a look at the setup. First we have our IV bag, our IV tubing, and here's our three way stopcock. So we're going to go ahead and we're going to attach it to here, we're going to attach this to the patient and then we're going to attach our 60cc Luer lock syringe. And now we're going going to be off to the patient. And you can see here by opening up the IV bag.

We can pull right into the 60cc syringe.

And then we can turn off to here and then we'll push right into the patient and I'll squirt a little bit and you go right into the patient that way and then you turn it back off here and then you fill up again, you turn all the way the other way and you push into the patient again. And so essentially, in order to get 20cc's per kilo into a child quickly, the only way to do it is with a three way stopcock. Okay, Next we'll talk about medication, dilution. And one of the main medications we'll talk about is fentanyl. So if you think of fentanyl, if you look at the dosing and the volume, typically, for example, for a one year old, the dose will be somewhere around a very small number, like 0.2 milliliters. So what do you do about that for fentanyl? Let's take a look. So here's my fentanyl. I've drawn up 0.2ml. By getting that through, an IV may not be the best idea. So what we'll do is we'll go ahead and we'll Put it onto the three way stopcock. We're going to go off here, we'll take a saline flush, we'll do here. And then simply we're just going to add some more volume to that syringe. So now when we go up to the patient, we can actually give a larger volume of that medication into the iv. Things like ketamine, any of the benzos. I would recommend the same thing.

And the fifth way to have a three way is during the poor man's jet ventilator. So essentially, if you have a needle crike pediatric patient, you cannot oxygenate, you cannot ventilate. Hopefully you'll never have to get to this point. But once you go through the trachea.

You then need a few things. You need the adapter. So this adapter will hook right up to that catheter. Now you're gonna hook this up right to the three way stopcock here. And then you're gonna hook that up to just basic oxygen tubing. So you have to squeeze that on.

Okay, now that you're on and this is going to the tubing, to the oxygen canister. And now essentially you keep the three way off to nowhere. So essentially the entire system is open. You have oxygen streaming through here. And essentially every time you want to give a breath, you just cover that port. Breathe. You can breathe again. Again. This is for higher pressures than you can get from a bvm.

So now that I've told you five ways, I like to have a three way, I want to hear more from you. Let me know what ways you like to use a three way. Thank you very much.