Juilin

Thanks Dust, that means a lot. Sometimes certain calls make me wonder. :?

See, this is good, post a new topic and we get some discussion on the boards! My questions were answered and not answered. For the most part, I have to agree with dustdevil. I do not consider myself someone that is horrid uneducated and unfit for the job. But at the same time I am not qualified to make a diagnosis, I am not certified to administer any "definitive care" if I do make a diagnosis, and the hospital staff is going to perform their own assessment regardless of what I say or do and come to their own "diagnosis." At the same time, there is nothing bad and it's probably most beneficial to the patient if the wheel upstairs is turning and you are able to recognize and react to certain conditions. Even if its just "medic" or "drive fast" I think I try to make my job too confusing sometimes and have to remember that all I can do are the ABC's. But hey, I can still be a wizard with the NC and quick to the NRB. :? :roll: And I appreciate the info Ace, I will definitely check out all the website-info you posted. Cheers, Juilin

I apologize for my non-sensical muttering. I was simply trying to convey that I was told some of the most prudent, or easily questioned, concerns for an EMT-B when approaching an altered LOC situation are opiatenarcotic use, diabetes, and hypoxemia. My question was then, what are your most prudent concerns. Another way of phrasing it, what questions immediately come to mind. I suppose I should have clarified that these questions were meant to be a part of history gathering. Sorry if its overly simply, I've been doing this for less than a year. Just trying to make some conversation. :?

In the field, what are the first few questions for an altered patient that go through your head. I was once told by a nurse, opiates, diabetes, and it might of been hypoxemia (cant remember). What are the most prudent considerations and thus questions for the EMT-B to ask. As a caveat, I say all of this knowing that my protocol for any altered patient is immediate transport. I just find that I learn alot from these kind of discussions and the differnt approaches everyone has.

It just came to my attention yesterday that a copy of my patient care report was pulled for an internal audit of the Medic unit and engine company that triaged the patient. Apparently I documented the case well, aka covered my proverbial arse, because I got a pat on the back and was assured by the head of EMS in my county that these guys were to get a talking too. I hope it doesnt ruin any careers, but its nice to know something is being done and it wasnt just blown over.

I recruited some maintenance workers to help us with the lifting, I would have called them back but the patient needed to get out of there and I wasnt going to wait for 4 lazy firefighters to drag their butts back out of bed and come back. I've already filed an incident report and I think the hospital has as well. They were of course surprised and angry to get a patient like that which had been downgraded to BLS. As far as his rhythm, I asked the ER doctor and he said Sinus Brady but then trailed off into something else I didnt understand. My knowledge on dysrhythmias is limited.

"Juilin was killed by a Teleport" I uh, ok. Have to go somehow.

First patient of the day yesterday. Arrive on scene to a 65 y/o m c/o weakness. The Seattle Fire Department had also responded and were waiting for us when we pulled in lights and sirens. The first thing I noticed was that of the four man engine crew, two were outside, one was in the next room (from the patient) with his head stuck out of the window and the Lt. was at least 100 feet out in the hallway. Of course, this left the patient alone slouched against his bed. No surprise he had become incontinent and had a massive bout of diarrhea (and I do mean massive). The fire department gives me a quick report, said that the patient's initial complaint was chest pain and that he had had a stint put in his coronary artery 2 weeks ago. The patient allegedly took 2 NTG 5 min apart which relieved the symptoms but left him feeling weak and unable to walk--to the bathroom. There was supposedly a medic evaluation prior to our arrival but they had since left w/o giving me so much as a report, verification of a 12 lead being run, or even any indication that they had been there other than 'the firefighter told me so.' Well the Lt. hands me my copy of the run-sheet, me and my partner get the patient onto the stair chair, turn around, and they're gone. Thanks guys. Managing to get this 250 pound guy down 4 flights of stairs without hurting ourselves, we place him on the gurney at the base of the stairs. Then the highlight of my day. The landlord of the apartment complex comes up to wish the patient luck and tried to be nice by picking up the dirty linen we used to cover our stair chair. She notices the 3lbs of liquid peanut butter and I wave her off saying that I'll take care of it. She immediately says, "OK," hurries out of the front entrance and vomits at least 8 times in the hedges before running off down the street. Simple amusement. Well guys, we get him into the ambulance and I immediately note that he's alert and speaking in complete sentences, moving good air, L/S are clear, and proceed to the C of the ABC's. Reaching for a quick pulse I note that his skin is WPD, feel the first 'thump' on his radial, wait, wait some more, still waiting...."thump" there's the second one 5 to 6 seconds later. I immediately take a set of V/S, B/P 100/60ish R20 P30 SWPD PERRL. Yes his rate was genuinely 30. I took 5 sets of vitals on a 10 minute transport and he was anywhere from 20-50 with a mean of about 30. The odd thing was that he was completely asymptomatic. No C/P or any Px for that matter. No SOB, Diaphoresis, Anxiety or restlessness, Skin color and quality were normal, also used the Cincinnati stroke scale which he presented negative on everything. Grips were bilat and = somewhat weak. PushPull the same. B/P was a little low but he had just taken two NTG not an hour and a half ago so, correct me if I'm wrong, that seemed within reason. Having already had the medics dump this guy, and being the closest available unit to the hospital I decided to take him in quickly. At the ER, they immediately gave him some atropeine which he did not respond to at all. He eventually was taken up to the Cath lab and I think they started pacing him. I don't really know after that point but at the end of our shift we were able to swing by the hospital and apparently he was still alive. My story of the day. Juilin

EMT-B in Seattle, Washington. 12.00/hr. Fairly average around here.

Cos, I honestly never thought of that and will definetly be doing it on all my patients in the future. I've probably used the thing over a hundred times and this was the first patient who couldnt be coerced with simple verbal remediation. Funny, because I've used the shoulder straps (and restraints) on the gurney to keep patients arms down but never put two and two together on the stair chair. Thanks! Juilin

Thanks for the replies. I already learned some new terms I didnt know about, ie steroid pychosis, in fact I just had this incredibly anxious 21 year old who thought she couldnt breathe while putting together 120 word sentences. She was on Flonase and Prednisone. ^^ Anywho, for this last patient I gather the best thing I could have done was Assess baseline LOC, make sure the ABC's were in order with a quick glance (he was walking around and in no obvious distress) and gather the best history I could. The thing that was difficult was that he would literally not stop moving and would not tolerate VS, O2, an exam, or answer any questions. The best part was he lived up four flights of stairs and everytime we tilted the stairchair back he would scream and flail around as if we were twisting his head off. Eventually we got him to walk down, albeit very very slowly. Thanks for the help! Juilin

Hello, I am relatively new to EMS and just discovered the forums here a few weeks ago. I've been scrounging around and finally thought it would be good of me to maybe contribute to a little discussion, ask a few questions, or at least make a nuisance of myself. I would like to give you guys a little scenario and get some input on it. Me and my partner had some problems. About a month ago we arrived on scene to a 65 year old male ALT LOC. The patient lived alone with hired help that would come and do his laundry, make food, etc. etc. The origin of the call was from his a niece who had been attempting to contact him for some time and were unable to get him to answer his home telephone. Concerned, she called 9-1-1. Upon entering we find him aimlessly walking around in a soiled (food, urine, stool, whole 9 yards) robe. He would repeat the same routine: walk to the couch, sit, ask one of us to help him stand walk to another location of the house, sit, and once again ask one of us to help him stand. It was almost a ghost like trance. Alert only to name. Appeared to be breathing normally, had an incredible amount of edema about mid thoracic down to the feet which was secondary to what we gathered from the niece to chronic liver failure and being treated with meds and routine hospital visits for drainage. Other than that we were not able to get much information at all other than he was normally much more lucid and appeared to be in a significant amount of pain. I work in a tiered response system, so I am normally BLS transport for a patient that has already had the Fire Department on scene for some time. I am still trying to work out the first responder "jitters" (for lack of better term) and would like to see how you guys handle this patient as a first on. Many thanks. Juilin