Gut Feelings?

[emt217]

Long time lurker, new poster. I want to start by saying how much I have learned from all the reading I've done here! You guys are MUCH more intelligent than the boneheads I work around., as well as much more profession oriented. I start Paramedic class in 2 weeks, and am looking forward to leaving the area IMMEDIATELY after.

On to the subject.

I've been an EMT-B for close to 7 years now. Never was much for gut feelings as 99.9% of our call volume revolves around COPD, CHF, ESRD, HTN, or DM. We have a fair amount of ATV accidents, but this centers around med calls. Last night I had a 72 y/o male, wife called 911 stating decreased LOC, possible hypoglycemia. While enroute, 911 informs us pt is more A+O after eating cookies. Upon arrival, pt presents with no distress. No CP,SOB,N/V. initial BS is 65. Wife also states slurred speech. I run a quick neuro assessment. No lateral drift, no facial droop, + PMS all extremities. I go ahead with 15g oral glucose. after 8-10 minutes, BS is up to 95. Pt states he feels better, but is experiencing numbness to L side of face, radiating down L arm. To shorten up, all vitals WNL, BS holds at 95. Pt has PMHx of DM, HTN, TIA x1. Transport to closest ER is 40-45 minutes. As I'm re-assessing, something just keeps nagging at me. I opt for ALS assist. Medcom concurs, and I meet up about fifteen minutes from ER. Monitor shows PAC's, BP slowly rising, HR falling. Waited around for 20 minutes or so, but finally had to run, so I'm unsure of what happened.

Now, all that for this: Anyone ever get that "nagging" feeling something isn't right? The Medic wasn't extremely happy about coming out at 0230, as nothing major showed up. Still, I can't help but feel something just wasn't quite right. I feel I was well within my right to call for ALS, but now I'm begining to question it. Any similar experiences?

Again, wonderful forum with lots of knowledge to share! Hope It's ok to pose questions on occasion while I spend the next year in school.

[fiznat]

You're never in the wrong if you feel "something isn't right" and you want a medic. ...Especially on a 45 minute transport, a lot can happen in that time. I sometimes get frustrated when EMTs make similar decisions around here, but I work in a city and any ambulance can usually make it to the hospital within 10 minutes. That's a different situation.

A medic probably isn't going to do much for this patient as you described it, but hey if he lost his airway or coded enroute it would be a different story entirely, right? And again, 45 minutes is a long time to sit on it if you aren't feeling good about the patient. Trust your instincts. You made a good choice.

[zzyzx]

Sounds to me like you did the right thing.

[crotchitymedic1986]

always trust your gut. And dont back down just because a more experienced medic, nurse, or doctor looks at you like you are stupid.

[emt217]

Thanks. My concern was either A) He was on the verge of a CVA, or correct me if I'm wrong, but with BP increase and HR decrease, I figured something neurological may be taking place. Granted, not alot a medic could've done since WV protocols don't include thrombolytics, but I woulda felt more comfortable with a second set of hands in the back. 90+% of our calls are 45-60 minutes to an ED. All the pt kept telling me was "I just don't feel right". From past experiences, I ALWAYS listen when I hear that!!

[crotchitymedic1986]

could have been, maybe you will get the opportunity to follow up and find out. Could have been a silent MI, or a whole host of issues that go with diabetes. Your gut will save you and your patients many times over your career.

[celticcare]

Hey good work on following your gut, there are some things the paramedic classes or even RN classes teach you and only by taking in all of your senses and the environment around you, will you know more and more to follow your gut. The medic wasn't happy? well Boo Hoo its his job plain and simple, he is for responding for ALS backup as part of his job description. What if the patient needed an IV, or further meds, or those PAC's deteriorated to a Junctional rhythm, a sign of a heart in trouble etc.

You did the right thing, at the end of the day, its about the patient and not individuals egos

Scotty

[crotchitymedic1986]

dont worry what the others think, they will thank you later. But when i was an EMT or a medic on a double medic truck and i wanted to transport someone my medic didnt, i teched the call and did the paperwork.

[spenac]

Long time lurker, new poster. I want to start by saying how much I have learned from all the reading I've done here! You guys are MUCH more intelligent than the boneheads I work around., as well as much more profession oriented. I start Paramedic class in 2 weeks, and am looking forward to leaving the area IMMEDIATELY after.

On to the subject.

I've been an EMT-B for close to 7 years now. Never was much for gut feelings as 99.9% of our call volume revolves around COPD, CHF, ESRD, HTN, or DM. We have a fair amount of ATV accidents, but this centers around med calls. Last night I had a 72 y/o male, wife called 911 stating decreased LOC, possible hypoglycemia. While enroute, 911 informs us pt is more A+O after eating cookies. Upon arrival, pt presents with no distress. No CP,SOB,N/V. initial BS is 65. Wife also states slurred speech. I run a quick neuro assessment. No lateral drift, no facial droop, + PMS all extremities. I go ahead with 15g oral glucose. after 8-10 minutes, BS is up to 95. Pt states he feels better, but is experiencing numbness to L side of face, radiating down L arm. To shorten up, all vitals WNL, BS holds at 95. Pt has PMHx of DM, HTN, TIA x1. Transport to closest ER is 40-45 minutes. As I'm re-assessing, something just keeps nagging at me. I opt for ALS assist. Medcom concurs, and I meet up about fifteen minutes from ER. Monitor shows PAC's, BP slowly rising, HR falling. Waited around for 20 minutes or so, but finally had to run, so I'm unsure of what happened.

Now, all that for this: Anyone ever get that "nagging" feeling something isn't right? The Medic wasn't extremely happy about coming out at 0230, as nothing major showed up. Still, I can't help but feel something just wasn't quite right. I feel I was well within my right to call for ALS, but now I'm begining to question it. Any similar experiences?

Again, wonderful forum with lots of knowledge to share! Hope It's ok to pose questions on occasion while I spend the next year in school.

Good call and you will make a great medic. Never ignore your gut. With education you will be able to do so much for those you treat. Hang in there.

[CBEMT]

Waited around for 20 minutes or so, but finally had to run, so I'm unsure of what happened.

PLEASE don't tell me the medic spent 20 minutes sitting at the rendezvous point. :?