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Nitro with a right sided MI


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#1 EMTgirl84

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Posted 04 March 2008 - 04:01 PM

I am an EMT and I have a partner that does a lot of questionable things. I just wanted to ask for some advice and input. We get called to a patient having chest pressure. We get on scene, pt. is ambulatory. Pt. walks to the cot and we load pt. up and start treatment on scene. Pt. was shoveling the driveway when the pressure starts. Pt. describes it as being in the middle of the chest and a little bit of back pain and it is more of a pressure type feeling than pain. Pts. medical history is high cholesterol and a smoker. Pt. is in late 50's and does have a family history of MI. Pt. is also vomiting. My partner can't hit an IV after 3 attempts. I set up the 12-lead and what I see is not "normal" to me. I am just getting ready to start a medic class so I haven't learned how to read a 12-lead yet, but when I printed off the strip it say acute mi at the top. We are 45 minutes out from the nearest hospital and we do have access to a chopper 1 mile down the road. Pts. vitals are 98/P pulse is running 50-55, O2 sat is 94, pt. has some shortness of breath, as well as vomiting, color looks like crap...grayish, and pt. is clammy. My partner gives her a spray of nitro with no IV line established and then we take off. We go non-emergent. We had sent the EKG to the hospital en route....next thing I know, dispatch is telling me to tell my partner to contact the hospital immediately. The hospital precedes to explain to my partner that this pt. is critical, having a right side MI and needs to go straight to the cath lab. It's almost like my partner didn't even know what was going on or how to read the strip. I then get upgraded to emergent. We get to the hospital and the doctor's are pissed! Pt. goes staright to the cath lab and my partner gets to have a little talk with the supervisor. My partner says that he is "sick" and that is part of the reason he made poor decisions. What are your thoughts?
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#2 brock8024

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Posted 04 March 2008 - 04:13 PM

Did you do a V4R on this pt. IF not then it is my understanding that you cannot tell that they are having a right side MI. I was taught never to trust they writing at the top of the paper. With that BP and heart rate I would not have giving the nitro but I was not there.

Did he ever get the IV started?
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#3 EMTgirl84

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Posted 04 March 2008 - 04:15 PM

Yes, we do have V4R and no he never got a line started.
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#4 JakeEMTP

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Posted 04 March 2008 - 04:24 PM

There really is no excuse for misreading a EKG. I can understand your partner not wanting to give nitro since they couldn't establish a IV line. With a systolic pressure of 98 ( why by palpation?) I might be hesitant to administer it also. Do you not have IO access?

Your patients c/c and presentation would immediately alert me to the possibility of an MI. Sounds like your partner had a massive brain fart. Their action/non-action with this patient would have resulted in our Medical Director suspending their privileges to function until this case was reviewed by the EMS oversight committee. He does not take these sort of things lightly. Immediate remediation is required.
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#5 EMTgirl84

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Posted 04 March 2008 - 04:32 PM

I completely agree and I guess this is why I am so frustrated. This is not this first incident and I really don't think that it will be the last. I continue to get called in the office everytime a call goes wrong because I am technically the only witness. I don't want to be in the middle of it. My supervisors need to take care of it with my partner. I could write a book on all of the things that he has done wrong. I have worked with some fabulous paramedics and I am just sad that some people who call 911 for help may actually end off worse than when they call.
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