GI Bleed =12 lead?

[Fox800]

Holy sheep I step away from this thread for a little while and it blows up :shock:

Let me clarify the following:

-The patient WAS transported

-The transport unit was ALS (all units in our system are ALS)

-The patient was experiencing a considerable amount of rectal bleeding

-The paramedic in question was in an evaluation phase for independent clearance and was "dinged" by his Field Training Officer, not by a supervisor

-A supervisor was never called to the scene or involved with this incident

[spenac]

Guess that means crotch read between the wrong lines. :twisted: No hard feelings crotch enjoyed the banter.

Thanks for the clarification.

[Mateo_1387]

Darn I hate to say something about this to somebody that is helping make my point. I do all those things as an EMT-I. But I am in the minority. Sorry.

I figured someone would dispute what I wrote...but you??? :twisted:

Let me ask you this though, did your EMT-I course require all that darn book learnin'? (not direcly toward spenac, but...) Just as much as the patient needs those skillz...they also need an educated provider.

[spenac]

I figured someone would dispute what I wrote...but you??? :twisted:

Let me ask you this though, did your EMT-I course require all that darn book learnin'? (not direcly toward spenac, but...) Just as much as the patient needs those skillz...they also need an educated provider.

My course was a more in depth EMT-I course but my medical director required additional education as well. But still in my Paramedic studys I have seen that in many ways I was still just a skills monkey. I had pretty good ideas of the whys and why nots but now I have seen a whole lot more. I also have realized that even as I finish Paramedic how little I and in fact any Paramedic knows if not also a higher level medical person.

[crotchitymedic1986]

Dear Spenac and Fox,

I was responding to this post on page 1 of this thread -- not fox's:

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I don't know another way to answer your question without presenting a case study to validate my response.

Patient is a 25 year old female, with a chief complaint of "I just have the flu." Patient presents alert and oriented. Skin is pale, nearly white, including nail beds and lips. She appears to feel poorly and admits to being very tired for the past three days. Vital signs BP 90/50, which is normal for patient, HR 130's at rest, RR 24. Unable to obtain a pulse ox reading. Lung sounds clear and equal bilaterally. Patient is nauseated, however no vomiting, no diarrhea. Rest of physical assessment is unremarkable. Patient was strongly urged by paramedic to be evaluated at the ER. I guess it was a gut feeling based on experience and patient appearance. Patient is goes to the ER as a walkin. Apparently she stated to the triage nurse "I don't feel well" and looked bad enough that the triage nurse nearly set her pants on fire scrambling to find a gurney and a physician. The patient had a Hct of 12 and a Hgb of 3.2. She was also in heart failure secondary to lack of oxygen rich blood. The body can only compensate for so long. The ER performed a 12-lead and it showed ischemia and T-wave changes in every lead. The EGD showed several ulcers and mallory weiss tears in the esophagus, along with a lot of blood in the stomach. I have no idea why there was no vomiting since the stomach isn't a real fan of blood.

Do you need to perform a 12-lead? Probably not, especially if you are a stones throw from the ER. If you have to trek the distance, for whatever reason, a 12-lead may serve to trend any changes in coronary oxygenation and perfusion from start of patient contact until the ECG is repeated in the ER. I know every physician I work with will order an ECG on a patient with that presentation and those labs.

The heart not only needs blood, it needs oxygen-rich blood, and a decrease in hemoglobin that results from a GI Bleed can send a patient into heart failure. It's not a necessity, but I'm a trending type of paramedic.

I know that case study backwards and forwards because I was the patient. The most recent ECG I've had performed still shows ST changes indicative of prior ischemia. I only respond because I keep seeing the age of the patient being brought up as a determining factor in whether or not to perform a 12-lead. After my experience, it cements the fact that heart failure secondary to GI bleed knows no age. You do what you feel is right. Perhaps I'm just a little overly cautious.

[crotchitymedic1986]

With that being said, I just realized that the poster of that thread was the actual patient. So they can clear this up quite easily. So EMS493, did you REFUSE EMS transport, or did the medics tell you that you would be OK to go by car ?

[iMac]

Any more responses on this one?