ChaseZ

I doubt this would work well. It looks like it would displace the surface tissue but do a poor job of actually applying pressure to a bleeding vessel. Also looks like a good way to create a Pseudoaneurysm or Retro bleed.

1. Haven't experienced this kind of reaction.

2. No

3. 22 RR.. I would think 15 Lpm NRB because of the pale skin and depending on tidal volume... bagging.

What was the change with the Epi?

Sounds like a blood transfusion from someone that has bad seasonal allergies. If the Pt is in/from the Northeast we are currently in a very bad allergy season. Cold spring has led to both a tree and weed/grass pollen season happening at the same time.

Zofran is leading me to Chemo. Also said unknown treatment?!? I would find out the treatment due to the fact you may be looking at a side effect. Might be looking at a drug interaction. Has the patient vomited recently? Could be an aspirated Pt with onset pneumonia.

Can you explain why you feel the need to use a NRB @ 15Lpm or bag this patient? Why do you think this patient has pale skin.....And why do you think more oxygen would fix that?

Aspiration pneumonia does not really fit the scenario and is a far stretch at that.

Sounds like anaphylaxis r/t transfusion reaction. Reaction to platelets is rare but does happen. I think they treated her appropriately. Monitor and transport to the ED

I am surprised they loaded Lovenox along with a Heparin drip. Good luck if it is a dissecting aneurysm. I think a Tridil Drip would have been beneficial until further diagnostics could be obtained.

It seems that a lot of medics are reluctant defer treatment until the ER even with short treatment times. Just because you can do something does not necessarily mean you have to do it. I am not sure if it is just a matter of professional pride or what. There is nothing wrong with waiting until the patient is in a more controlled environment with better equipment or allowing a higher qualified provider to take over. Like systemet stated RSI is a great example of a procedure that should be deferred when ever possible.

We've got several medics who have undergone rehab and returned to the system. I honestly believe that a permanent ban from practise is a heavy handed and unreasonable response.

With nursing it is usually a multi-year suspension/probation with rehab or permanent ban. If you test positive for non prescription meds that could be acquired from the hospital you are almost always permanently banned, even for first offenses.

Agree with the above. Did your mother have any paperwork with her stating who was the POA and primary contact? The Assisted living center "should" have sent a med recon and face sheet when sending her to the hospital. On our quick sheet we have up to 3 urgent contacts and their relationship listed and It is usually assumed that the first person listed is the POA/Proxy but it does not always work out that way. We have to dig through the paper chart to find the admission paperwork and see if there is any POA listed. Not to make excuses for the hospital but your sister should have corrected them or called you.

The ICN Code

• According to the ICN, a nurse’s

  primary responsibility is to patients, and she should treat them with

  respect for their rights, values, customs and beliefs. Personal

  information she learns about them should remain confidential. In addition,

  she should continue her learning because she is personally responsible and

  accountable for good nursing practice and she should take care of her own health so it doesn’t interfere with

  her ability to care for others. She should co-operate with her co-workers

  but, if a patient’s health or safety is threatened by others, she must

  take action to protect them.

The ANA Code

• Like the ICN, the American

  Nurses Association believes that a nurse’s first commitment is to her

  patient, and she should have compassion and respect for every individual

  no matter who they are, what kind of health problems they have, or what

  social and economic background they come from. A nurse also has a duty to

  establish, maintain, and improve health care environments and conditions of employment so that high quality

  health care can be provided. She should work to improve health

  care locally, nationally, and internationally, and she should also work

  through her professional associations to influence social policy

  concerning health care. Finally, she has a duty to maintain her own

  competence and to grow personally and professionally.

Types of Ethical Issues

• Registered nurses responding to

  a 2006 survey reported 21 different ethical issues they faced while caring

  for their patients. These issues included the use of restraints, pain

  management, determining best interest of the patient, organ

  donation, life-sustaining treatment and end of life care, reporting

  errors, dealing with impaired nurses, conflicts of interest, justice for

  people with disabilities, the ethics of research and the use of

  information technology and confidentiality.

Nurse Dissatisfaction

• In a study investigating the

  relationship between ethics and the intent of nurses and social workers to

  leave their profession, researcher Connie Ulrich, Ph.D., RN discovered

  that 25 percent of practicing nurses and social workers wanted to leave

  the field. More than 52 percent of those who responded said they were

  frustrated with the ethical issues they faced. Hospital workers reported

  more ethical stress than caregivers

  who worked in other settings. Nearly 40 percent of hospital workers

  reported they had no organizational resources to help them with their

  ethical concerns, while another 25 percent said they had never received

  any ethical training.

Quoting statements from the ICN and ANA means absolutely nothing. They are both professional organizations that do not represent all nurses nor do they prove any type of legal or ethical obligation aside from their members. As stated earlier many people identify themselves as nurses who are not RNs or even LPNs.

I personally would not throw away my job or my career for one patient, call me heartless.

It sounds like the nurse said "they don't want her resuscitated" meaning the family. I have encountered this a lot where the family will not make the patient a DNR because they are afraid it will lead to inadequate care or neglect but they do not actually want their family member resuscitated. It is a bad situation but it happens.

It also does not sound like the patient was ever in full arrest

I have to work tomorrow morning and I am bringing a small bag with extra clothes, snacks, etc just in case. If my replacement does not show up then I can not leave so it may turn into a long day.

I would suggest go shadowing a RT. Depending on the hospital it can be very mundane and boring. Basically going around giving nebs, treatments, setting up cpap/bipap, etc. while other RTs are in the ICU with vents, drawing ABGs, and responding to codes.

Oh Lord, to be young and gullible again. Scientific studies are no more unbiased than what you politicians tell you. Studies are funded by someone, and often the outcome of the study slants towards whatever drug or technology that the company that donated the money wanted it to produce (not always, but often). AHA has put out numerous scientific studies over the years (I have been at this almost 30), changing the ACLS drugs to whatever was deemed to be the drug of choice after the last ACLS book expired. Guess what, cardiac arrest survival rates have not changed any despite all of those expert scientific studies and STATISTICS that suggested that the old way was stupid and that the new way will save everyone.

ACLS has to change the curriculum every few years to sell more books to us, and that is all this is about. In a controlled setting like an OR, and for a short period of time, a supraglottic airway is sufficient, but in the field, the ETT is king. And to correct the rookie who stated that vomit in the airway is due to over inflating the stomach, I have worked two arrests at buffet restaurants this year (2013) where the vomit was in the airway before CPR was started, not to mention the numerous GSWs to the face (or other facial/head trauma) that put tons of blood in the airway.

I may be young, hell you have been doing this almost a decade longer than I have been alive, but I am not gullible and most certainly not uneducated. But years of experience does not automatically make you an expert. Doing something wrong for 30 years does not really mean much.

Yes, there are some studies that are biased either overtly or through less obvious statistical trickery but for those of us who actually understand research and statistics they are easy to spot.

Medicine is dynamic and ever changing. Many things we swore by years ago have been found to be ineffective or even harmful but that does not in anyway discredit new research and changes. We learn and improve with time.

Actually, In hospital cardiac arrest survival rates have been rising over the past few years. Prehospital cardiac arrest survival rates are tricky and involve many factors outside the control of EMS. We know that early CPR and defibrillation are they key to survival. Regardless of how good our interventions are they are not going to bring back a guy who has been pulseless with no CPR for 10 mins.

If you truly believe that the only reason ACLS changes is to sell books than there is no point in trying to argue with you and I sincerely hope you retire very soon.

Why are you correcting "the rookie"? First of all I am pretty sure he is not a rookie. He is not wrong, that is one of the reasons a patient may vomit during CPR. Obviously not the case in a patient who has vomited prior to arrival but that does not mean it is not correct. Why do you keep using the same anecdotal flawed logic.

And I think everyone will agree that advanced airways are necessary in those rare incidences of excessive blood or vomit in the airway. The study's main focus is uncomplicated cardiac arrests, the most common.

Just have to say it on this one. Your grammar may be the one thing that does get you.

I was thinking the same thing

Have you guys actually ever worked an arrest, and had copious amount of vomit coming up the airway from compressions ? How in the hell could you suggest that an unsecured airway is ever a good thing. I don't care what one study suggests, anyone who has actually worked in the field knows that this is a bunch of crap. As stated earlier, I am sure that I can produce a study that shows anything I want it to.

So much fail in this post.... I am sure you could produce a study showing anything you want but producing one that holds up against academic scrutiny and is publishable in a scientific journal is another story. Wouldn't it be nice if paramedics were required to take statistics, research, and EBM courses.

The risk of aspiration using a LMA w/ PPV is fairly low and is a good compromise to ETI.

What do you think happens to the gross or micro-aspirate that pools around the ET cuff?

Sue them! for all medical bills and gross negligence. their negligence put you at risk of "really dangerous" problems as the other doctor put it. so yeah im sure he didnt document that he called you a hypocondriact. id sue him the doctor over him the hospital and the medschool.

I hope all of your patients treat you with the same courtesy and attempt to sue you into poverty every chance they get. I am in no way discrediting what happened to Dwayne but there is a difference between reporting questionable practices / billing and attempting to sue a provider for financial gain.

This is why so many providers are crippled by fear of litigation

So what would have happened if you tubed the stomach? Would you have just pulled it out? Left it in place? Documented the attempt?

In our hospital resuscitations we have been progressively moving intubation further and further back on the priority list. The official policy is definitive airway at 10 mins. Anesthesia can usually get them tubed while compressions are going.

I personally would not put my real name anywhere on my blog. Everything is searchable and could get you into some trouble. My blog is a place for me to vent about my job and is anonymous, few people know that I have it. I do not really have any advice on increasing traffic. I only have a few hundred views this month. Try to subscribe and follow other similar blogs and leave comments from your blogger.

Regardless of personal feelings about video/photos on scene the Chief acted extremely unprofessional and by touching the camera was legally in the wrong. If I was in charge he would not have a job, regardless of what happened before the clip started.

I would politely ask that the person filming to stop and respect the patient's privacy but if they choose to continue then that is their right. I will do everything reasonable to block their view and cover my patient but never yell, curse, or physically touch them.

I personally would never film anything like this but if I was and you came up and touched my camera/phone I would not hesitate to lay you out. Regardless of how tasteless it may be it is still within the citizens rights to do so.

Being a patient advocate (I hate when that concept is thrown around loosely because the majority of people have no clue what that truly means) does not give you permission to infringe on others rights.

No. You don't get to say that. You...a mentally unbalanced admitted liar who at various times has pretended to be a NZ EMT...NZ Paramedic...medical student...doctor...flight doctor...who knows what else...going by the names Kiwimedic, Kiwiology, MrBrown, Rotors, and probably many more...who's only medical background is the ability to use Google...

You don't get to call anyone an idiot.

ohhhhh now I get it, never put two and two together. I will say it isn't anywhere near as bad as MedicRob

I've seen them call in cardiology and have a trans venous pacer put in place before DCing external pacing.

I will assume you are being facetious

The DOT did a study some years back and the main reason people failed to complete the Paramedic (ALS) program according to its research was lack of basic math and English ability.

Oops. I thought I felt a little resistance

I have owned a Classic II S.E., Cardio III, and Master Cardio. For EMT the classic will probably be the best. They are cheap so you don't have to worry about getting it messed up or lost. The cardios are great but as an EMT you will not be able to differentiate the various clicks and murmurs they allow you to hear so its pretty much pointless. On a side note I loved how all my classmates always charted diminished lung sounds on every patient. They are not diminished you just have a cheap ass stethoscope. Unless your using an isolation stethoscope than your guess is as good as mine.

Haha I just started a blog yesterday and in my first post I said I don't care about grammar or spelling.

Hey I can spell! I am not writing a book so why do I need proper grammar? I am sure that the guy dying on the side of the road will not care very much about my grammar or spelling.

And we wonder why EMS has trouble proving itself as a profession...

Ya in nursing school 80% is a C-, anything lower is a F