More Than Drunk?

[emt322632]

Why not help out a bit more by calling for an ALS intercept? I understand your thinking as far as the high blood pressure goes, but did he really NEED the oxygen?

No apparent respiratory distress, L.S clear bilaterally to auscultation. From the presentation you gave to us it appears that the patient was in no obvious distress whatsoever, save for a few signs that MAY point to something larger on the horizon.

Also, how can you be sure that the recent death of a close relative wasn't the primary cause of the event? Death = grieving. Grieving = depression. Depression = avolition, and substance abuse. Patient may not have cared enough anymore to take his meds, and may have started to use alcohol heavily.

Did his mentation change at all during transport, you're right, the BP of 90/70 in the ER is something to note. Any pallor or decreased LOC on the way in?

[ibemt31]

Im not sure where you work, but where i am is an urban area where we are a hop skip and jump from a hospital. the pt for now is stable, as many people have already said here. perhaps i could have met an als unit in 5 minutes or just gotten to a fully capable appropriate hospital in 7 min......i opted to go to the hospital.

[ibemt31]

As far as the oxygen, am i sure he DOESN` T NEED it? because unless i am sure of that, i will give it to him. I have very little capability to make that determination in the field as a BLS provider, so the only logical thing to do is to err on the side of caution. Why be so selective with oxygen? except for a few rare exceptions, it is generally harmless, and may in fact be helpful. my philosophy has always been be generous with it. ive seen a marked improvement in many pts who most likely did not have any physiologic need for oxygen as far as pain and comfort, simply by administering some o2. it helps psychologically, and like i said is generally harmless. it is not like say, morphine. i am not saying be generous with morphine, what can happen, but o2....why not?

[aussienurse]

Is there a shortage of oxygen where you are? most people requiring an ambulance could benefit from a little O2 every once in a while. dont be sparing lads

[mobey]

Is there a shortage of oxygen where you are? most people requiring an ambulance could benefit from a little O2 every once in a while. dont be sparing lads

Hmmm....

So in following the earlier posts, your saying just throw on an NRB because everyone requiring an ambulance could use a "little" oxygen.

In my experience throwing a mask with O2 whisling through it is hardly soothing. (Remember we are not talking cannulas here).

Patients requiring an ambulance that do not benefit high flow O2:

Isolated fracture of a limb

Hyperventolation d/t anxiety

Most abd pain

headache

I just don't feel well

My car ran out of gas, and I need to get to town

lower limb pain

I can't pee

I can't poo

My hemorroids hurt worse today

Anyone with SPO2 >90, Pink warm dry skin and RR < 30 & non-laboured

[firedoc5]

To me it sounds like a combination of things compounding each other. And/or ETOH or other substance(s) could be presenting an underlying unknown cause. Maybe I'm simplifying it a little but to me, low flow O2, monitoring vitals, and transport. If you're BLS not much else to do. BGL would have been very helpful. Full labs and 12 lead at ER probably best bet at starting to find out exactly what's going on.

[OHMEDIC187]

I will never understand why some basics are not allowed to check a BGL! Whats the big deal? (Im sure its been discussed many times) Anyways, I dont know if I would have gone as far as to give the patient a NRB? But, its your patient, its your call. I dont think it is a big deal that you put him on a NRB. The patient went from 200 systolic to 150 systolic to 90 systolic upon arrival at the ER. All within about 7 minutes? That seems strange to me, although it is possible. With an initial BP reading that high, check and double check those BPs in both arms. With the patient presentation, its hard telling? A BGL may help explain some things. The patient is possibly a chronic alcoholic that has been drinking all day and not taking his meds. Thats why we take them to the ER so they can do their fancy little tests on him.

[ibemt31]

OHMEDIC i agree with you wholeheartedly about the BGL. NJ OEMS can be retarded about alot of little things like that. When i said 7 min, that was tx time to the hospital. the time from the 1st b/p to the third b/p was probably a slightly longer interval, perhaps 15 20 min. still an odd finding, which is why i came on here seeking feedback, but then instead of providing that feedback, everyone jumped down my throat for an intervention i provided to a pt that they did not assess treat or even see........go figure

[ccmedoc]

...but then instead of providing that feedback, everyone jumped down my throat for an intervention i provided to a pt that they did not assess treat or even see........go figure

No one jumped down your throat, young man...Just tried to understand the premise behind the treatment..

[DwayneEMTP]

...everyone jumped down my throat for an intervention i provided to a pt that they did not assess treat or even see........go figure

Actually, I think you did ok...When you don't know what to do, you're right, some Os usually won't hurt.

I think you're receiving some criticism from two fronts, and I explain these to help you progress here and in EMS, not to be rude to you, as I have a lot of respect for, not only your being brave enough to post, but brave enough to stick with it even when it is sometimes not a lot of fun. Good for you.

First reason...And not your fault, is that though 15L/NRB is taught, it is also a little mindless. I'm not calling you mindless, only trying to explain that as you progress through your EMS education you'll find that often, in fact most often, those rules don't apply.

As an almost medic I normally use 3-10L/min of O2 where I was taught as a basic to use 15. Would the other few liters kill anyone? Nah...it's just that I don't get to play by the book any more. I have to make rational, logical decisions about every aspect of my care. Not only the life and death decisions, EVERY, decision.

When a nurse or Doc asks "Did he need 15L/NRB?" I want to be able to say, "I had him on a cannula but his color and mentation seemed a little off and his sats had dropped into the low 80s. I didn't get the response I wanted at 10L either, though at 15 he seems to have pinked up and is staying oriented." (Not a likely conversation, but hopefully it makes my point) Instead of saying, "He might not have needed it, but what difference does it make?"

When I come into the ER with a patient on a cannula I get a completely different initial response than when I come in with someone on an NRB. If I come in with them on high flow O2 it's assumed I am having trouble keeping his sats up and I get much quicker attention. If I commonly brought in patients on high flow that didn't need it, the tiny bit of respect I've managed to gain would soon be lost as no one would be convinced I was a "thinker". See what I mean?

The second place you're having trouble is in your presentation. I'm hoping you're mature enough to take this in the spirit intended....

Your posts appear to be written by a child. To tell you the truth, I've ignored your posts until today, when there wasn't much new to read, because after looking at the first sentence of your first post I was convinced you didn't have anything intelligent to offer. I was surprised to find that you had some good points, but they were lost in the 3rd grade presentation.

Many come here with nothing to offer. They come, and soon leave, to the point that those of us that have been here a few days often don't want to bother trying to help them. Your posts make it appear that you are one of those...though the fact that you continued to fight in your thread leads me to believe that maybe you're not.

Clean up your posts a bit. Give folks a chance to understand what you think, what you mean, and to take you seriously. I for one would like to hear what you have to say.

And try to understand that the posts that offended you came from busy, smart people. They took time out of their day to try and help you be better today than you were yesterday. They were trying to teach you to think, (which you've shown to be capable of with some good logic), not to be an ignorant robot like many...perhaps most, of the people you're going to work with.

Hang in there, don't run away, clean up your posts, but most important? Keep thinking, keep arguing, and keep posting. Every day someone is kind enough to show me a place that I'm weak, but wish I was strong. And then they teach me to be stronger, and smarter. It's well worth the effort. You'll see.

Good luck to you.

Dwayne