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Worst Patient Care Errors


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When I was doing some clinical hours a unit was coming in with a difficulty breathing case. When they did the call up they said they had the patient on 10L O2 per nasal canula. I guess they were wanting blow all the snot out of the guys nose or something.

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When I was doing some clinical hours a unit was coming in with a difficulty breathing case. When they did the call up they said they had the patient on 10L O2 per nasal canula. I guess they were wanting blow all the snot out of the guys nose or something.

My favorite for O2 related mishap is the flow dial says 6 and the pressure guage says 0 either because the tank is empty or not cranked open. Worst is when the BLS/ALS team fails to recognize the empty tank is the reason the patient is still short of breath and tries to get a NRBM to work on the same tank. Or, the Paramedic wants to intubate. I also see ALS teams trying to trouble shoot their vents or CPAPs with an empty tank. And then you have the NRBM let in place on the face from the ambulance to the ED stretcher without a tank attached. Unfortunately this lack of attention is too common place and just accepted as "oh well".

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My favorite for O2 related mishap is the flow dial says 6 and the pressure guage says 0 either because the tank is empty or not cranked open. Worst is when the BLS/ALS team fails to recognize the empty tank is the reason the patient is still short of breath and tries to get a NRBM to work on the same tank. Or, the Paramedic wants to intubate. I also see ALS teams trying to trouble shoot their vents or CPAPs with an empty tank. And then you have the NRBM let in place on the face from the ambulance to the ED stretcher without a tank attached. Unfortunately this lack of attention is too common place and just accepted as "oh well".

Sort of like when they can't get a vent. to work, then you suggest plugging it in. :roll:

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Well, since we're starting up the O2 errors, my favorite is trying to pull a patient out of the ambulance and forgetting to switch from the main tank to the pony.

Yep, happens all the time. But what really, REALLY p!sses me off is when you have someone intubated and the idiot doing ventilations pulls it out while unloading or moving patient off your gurney. :angry4:

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Yep, happens all the time. But what really, REALLY p!sses me off is when you have someone intubated and the idiot doing ventilations pulls it out while unloading or moving patient off your gurney. :angry4:

Perhaps you should be selecting better candidates for ventilating your patients or secure your tubes better. I recommend an entire roll of silk tape if necessary. At the end of the day, its still your fault if the tube comes out, but you already knew that...................

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