FL_Medic Posted March 16, 2009 Author Share Posted March 16, 2009 Ok, I got a new one. Not a bad call in regards to patient condition... but it did involve some pucker factor. This month I am working on Sanibel island, which is a popular vacation destination in my part of Florida. I responded to a possible cardiac. Upon arrival we find an AAOx4 patient laying on the ground. Friends and family on scene stated that the patient had a syncopal episode. So I do the usual workup, BG, 12-lead, Neuro exam. After the 12-lead prints, this guy that was there, one of the patient's friends who was standing over my shoulder, asked to see the 12-lead. I kinda gave him a funny look, but let him see, figuring he was just one of the local doctors. I say early repol, nothing pertinant, and we get going. On the way to the hospital me and the patient start talking, and he tells me about his friend, the head of cardiology at Johns Hopkins University... Luckily I didn't shun him to much as I have done in the past. I was humbled on a previous call when one of the local cardiologists was on scene of a STEMI. The friend was in the triage area of the hospital before we departed. He was pretty cool about the situation, and actually gave me good praises. Interestingly enough, I learned that he provided the patient with a precordial thump after he couldn't feel a pulse. I didn't ask if he noticed the patient breathing. Link to comment Share on other sites More sharing options...
fiznat Posted March 17, 2009 Share Posted March 17, 2009 Even if you were more forceful with that doc I think you would have still been in the right. Unless you obtain your patient's consent first, HIPPA prevents you from simply showing 12 leads to anyone on scene who asks. A doc probably should have even known better than to ask you first. Link to comment Share on other sites More sharing options...
FL_Medic Posted March 18, 2009 Author Share Posted March 18, 2009 Remember a physician is a higher level of care. He could have taken control of patient care all together since he was treating the patient prior to my arrival anyhow. Of coarse, I'd make his ass ride in if he decided o excersise that option. If he wanted to do something I didn't agree with we would have a problem. Link to comment Share on other sites More sharing options...
FL_Medic Posted April 26, 2009 Author Share Posted April 26, 2009 GSW TO HEAD: To save or not to save First let me explain why I even got this call. My lieutenant was having me meet him at our dispatch center, way out of our zone, so he could fix my key ring. Our narc keys are on a special ring which was damaged, and they have a special tool to fix it. So I was subject to calls out of our zone while on the way. Dispatch Medic 8 respond to possible suicide attempt. Dispatch Notes 65 y/o male unconscious, breathing. GSW(gunshot wound) to the head. We wait for the scene to be secured by law enforcement and head in. Of coarse the address we have is a little off, but we eventually locate the patient indicator lights (cop cars). Scene Size Up The patient is located supine, on the ground, just outside the driver-side door of his pickup truck. The police officer stated that he found a 0.22 caliber rifle about 5 feet away from the patient. The patient was found by a friend of his, and by our arrival the patient's adult son and daughter were both on scene. This road is on the patient's property. Assessment Obvious hemorrhaging from the patient's head; unsure exactly where from. The patient was breathing about 8 to 10 times per minute with blood in his oropharynx. My first impression was to control the patient's airway. I have heard of the calls where the bullet misses the brain somehow. I do, however inspect for brain matter. The patient had an obvious skull fracture indicated by bilateral periorbital ecchymosis. The patient had a good radial pulse and HR of about 70. I called trauma alert. Plan Control the bleeding, get the patient packaged and into the ambulance. We needed room to work, and I didn't want to work this patient right in front of his family. As we are placing the patient on to a backboard I notice it, the wound was proximal to his frontal lobe, dead center of the forehead. We were assisting ventilations at the time via bag-valve mask. I noticed what appeared to be brain matter oozing from the wound. I had never seen brain matter before, and always thought it to be grey, but this was yellow. It was like slime, what else could it be? At this point I had made the decision that this patient was obviously not going to make it. Our protocol states that if a patient has injuries incompatible with life, resuscitation is unnecessary. In addition, as we were rolling the stretcher towards our truck, the daughter stated that the patient has a DNR. I told her to get it, because we were going to need it. This patient subsided rather quickly, leaving me with an uneasy feeling as I watched him die. I know the patient's outcome wasn't going to change. I took into consideration that the patient obviously didn't want to live, and this helped me cope with my decision. Postmortem By moving the patient to my ambulance, I successfully turned my rig into a crime scene. We had to await the medical examiner's arrival. Once there, he did in fact confirm the presence of brain matter. Here's the unusual part. He identified the wound on the forehead as an entrance wound. I presumed that the blood in the mouth possibly indicated an entrance wound with the exit wound on the forehead. His finding meant possible homicide. Fortunately, with further examination, this was a confirmed suicide. When the ME checked the patient's wallet, he identified the label "organ donor" on the patient's driver's license. This thought never entered my head. He was an old guy, and I didn't think anything would be viable. The ME explained how his kidneys and liver could have been used. I will never forget this call. I think I did the right thing. I believe this is what the patient wanted, and I don't feel organ harvesting would have been appropriate. Guess that is a matter of opinion. What do you think? Link to comment Share on other sites More sharing options...
CBEMT Posted April 26, 2009 Share Posted April 26, 2009 By moving the patient to my ambulance, I successfully turned my rig into a crime scene. We had to await the medical examiner's arrival. And here I thought New Jersey was the only state to have that stupid, asinine rule. Link to comment Share on other sites More sharing options...
FL_Medic Posted April 26, 2009 Author Share Posted April 26, 2009 It's funny how it becomes the crime scene even when it's not the scene of the crime and wasn't present at the time of the crime. I understand that they don't want us to move the deceased any more than we have to. Link to comment Share on other sites More sharing options...
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