scubanurse
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Posts posted by scubanurse
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I agree 100% with you ruff, even that first paragraph. I was hoping this would be more of a discussion on field pronouncements, but oh well. Our local protocols have very liberal allowances to call codes in the field, yet it is hardly done and I am trying to figure out why. Are field providers uncomfortable having the death discussion at the home? Is it a CYA situation? I've asked a few of the medics lately and one was bluntly honest and said they needed the practice and he hadn't run a code in a while. I 100% appreciated and respected his honesty. Others have said that there were too many unknowns to call in the field, which I don't really buy.
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That is a special and quite frankly uncommon situation that I agree would warrant a trip to the ED. I'm trying to get more at the grandma found down at 5 in the morning, in asystole and getting transported to the ED with an unknown down time. Those are far more common calls to run than hypothermic arrests.
I'm curious your opinions on this?
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What causes of asystole can be reversed in the hospital? Especially with a downtime of 20+ minutes from on scene to in the hospital?
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I am curious to read everyone's opinions on field pronouncements, and transporting patients with PEA and asystole.
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Welcome!!
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Just sucks, my home state had a LEO LODD just recently, drunk driver hit them. And now in CO we have a DPD officer in the ICU still after being shot at a traffic stop. Too much bad sh** happening right before the holidays.
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I'm with Mike, did they give you any guidelines?
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Why would you need your phone in an emergency situation at work. Isn't that what your radio is for??
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In our ER, in the foothills of Colorado, we have our IV warmers set at 100 F. That being said, we have bare huggers, rangers, and the level 1 infuser to warm fluids more.
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welcome
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Luke presentation ideas? They could each pick a disease less commonly taught and give a 10-15 minute presentation? Or do groups of 2-3?
topics could be:
DKA
Hyperosmolar Hyperglycemic Nonketotic Syndrome
Chemotherapy Side Effects
suicidal patient considerations
Developmental considerations (caring for an autistic patient)
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If he indeed did go with the transporting crew, I would suspend him pending investigation. That is abandonment and not acceptable. Stopping and rendering aid, waiting for another unit, then resuming your initial patient care would be the acceptable decision.
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do you mean I've been being told secrets all along and I've been forgetting them. I wonder what else I'm missing?
Probably! Maybe you should start paying more attention to what your wife says?
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Say what you want about men, but we are the only ones that you should trust with all of your secrets with. We'll never tell anyone because we probably weren't listening in the first place.
My luck they'd miss the part where this is a secret, but hear the secret.
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That's the medical version of the onion satire paper...
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I wish! Between the kiddo, hubby and I both back in school full time and working full time we just don't have time. I'm hoping next year, but in the mean time have to settle for cadaver lab at school.
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Trying to get into chat but it says it's full with 5 members
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I think you are trying to carry too much. Stethoscope and trauma shears have served me well the last 10 years in EMS and trauma nursing.
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Looks like you have to re-take the course then. That's the case in most states that I know of since your chances of passing after a failure and 2+ years out from the course are very slim. Yes your instructors should have notified you of this rule, but it's also part of your responsibility in my opinion to know the rules. You might be able to take a refresher course or completed x number of CEU's and re-take the test but it sounds like the state requires a whole new course to be completed. Sucks and I'm sorry, but I doubt there's much you can do at this point.
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In the Denver area, RM bought Pridemark back in 2011 and now RM has been bought by AMR. Fortunately we have a lot of other small mom & pop ambulance companies that still provide excellent patient centered care so I'm not too concerned about AMR screwing up my patients before they get to us. We also still have quite a few fire based services but that's a different story all together.
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Welcome
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What cliques?
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Thanks doc. Took a drive up to the mountains today with my family and that did me a lot of good. 10 almost 11 years and this is the first time I have truly thought about walking away from medicine. Thanks for listening to my vent guys, means a lot.
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Sorry to hear it's been such a rough road recently.
We see people all the time who choose to ignore or deny their health condition. We see people all the time who refuse to take responsibility for themselves, their own health, their own well-being. Many times they get to leave the ER only to come back again for yet another exacerbation. The uncontrolled diabetics. The COPD-ers with a pack of cigs hanging out of their pocket or purse. The renal players who "missed" dialysis. Again. Hypertension players who don't take their meds. It catches up to them eventually.
You numb yourself to it because if you fought with all of those patients you'd go insane with trying to keep up on people who don't care enough to care for themselves. We're all gonna die some day. If sick patients choose to ignore or deny the means to delay their own death, or at least ensure some semblance of quality of life leading up to their death, that's on them. I'll continue to act in good faith because that's the moral and ethical thing to do. But I'll recognize that if they aren't willing to step up and do their part there's only so much I can do without their help.
We all got into medicine, EMS, nursing or whatever because, on some level, we believe that life is worth fighting for. We have a desire to improve the health status of those with whom we come into contact. Pretty much all of us here will fight tooth and nail to save the life of someone who needs our help. We will do so without prejudice, judgement or reservation. At times, especially prehospitally, we'll find ourselves in dangerous situations (despite our best efforts) to do so. However, there are limits as to what can be done. I feel worse for those who've done nothing to deserve their situation. Those folks will eat at me for days. I'll do what I can to distract myself. I'll run. Read. Blast music. Run some more. Distraction can help. You just have to find what works for you.
For the chronic players, though, those who've had multiple chances to turn themselves around, to do something to improve their own situation, I don't feel as bad. I've learned to let it go.
If this is really eating at you perhaps some professional help with a therapist/counselor who specializes in dealing with heath care providers is in order.
The ones who don't take responsibility for themselves aren't the ones that get to me. Its the guys who do everything "right" with their life and still get the shitty outcomes. Examples from this week:
50'sYM GI bleed 8 units of PRBC and 4 units of Plasma...didn't make it. No previous history and was a marathon runner.
40's YF hx of metastatic colon cancer now with necrotic mets to liver, has 4 kiddos at home.
2yo with non-accidental trauma
It's just been a really long crappy week and I used to be able to run or go work out but lately my own health and joints aren't allowing me to cope the way I was used to before having a kid
Why do we transport dead people?
in Patient Care
Posted
What you're describing is how I imagine it should be. We often bring the family into the room as we're doing our last round with the chaplain and the doc steps back with the primary nurse and describes everything we did and when we get to the next pulse check, we call it and give the family time. We had one family recently get very very hysterical because they thought since the paramedics were taking her to the hospital, we were going to save them and that just isn't the case most of the time.
Do you think most field providers are uncomfortable having that discussion with families, especially those who haven't run many codes in their careers. It seems like we have a lot of new medics lately and I'm wondering if there is a correlation.