lazy nurse or maybe clueless

[tamaith]

absolutly right vent. chalk this day as a learning experience. just like everyday i learn something new may not be much everyday but i do learn something on every shift. the pt. last vitals that were taking by my partner. b/p was 110 / ? ( not sure) pulse i believe was 40 something and wk resp: 22 i believe. to be honest i forget the vitals exact numbers. and im not going to make them up . vitals were monitored during transport. transport time 6min. pt was following my partners comands during transport. 2 sets of vitals were taking by ems. but again i forget the exact numbers. pt started to decline a little bit about a block from e.r. about a min or so while waiting to be seen by staff my couldn't find a pulse and with that thats when the one doc came over and he/she couldn't find a pulse. staff said to put pt on bed and then they took over. could als taken pt instead? possible. pt status didn't change from the time we got to dialysis until about a block away from hospital. then pulseless about a min or so in the e.r..

[letmesleep]

I'm not trying to pick on you, because as Vent stated, this is a learning experience for you. I have always told EMTs that working on a "basic transport truck" (for lack of a better term) is NO reason to be.......lazy. I'm not saying you are, just the mentality as a whole, just relax. This is an example of why every pt should be treated based on a clean slate, not just another transfer. Transfers can turn on you just as easy as the glory calls (<-----sarcasm) that come in 911. In this case you realized that the pt was in poor health by stating that the BP and HR were "low", that should tell you and/or your partner that monitoring this pt needs to be HARD CORE, and treat ALL changes correctly. Even if this pt had been stable all the way through the transfer, there is NEVER a reason to kick back and play solitare on your lap top or iPhone. I can't stand stories of EMTs and Medics that start their shifts by prewritting PCAs ect. Basic trucks/ transfers are ways to gain knowledge and experience, and should be treated as such. Take that BP with a real cuff, count the seconds when you check that HR and RR, heres an idea.....figure out SAO2 by checking cap refill and skin tone. Take the time to learn and be better at you career which will lead to respect that ALL of us demand we get.

If we don't act like professionals, how in the hell can we expect to be treated like professionals?

end rant!

[tamaith]

thanks tni. i don'tknow can anything reverse it? i read vitamin k may help. not 100%if pt died but im guessing er staff had a full suction container of blood. when we left. so im guessing pt did but .....

[VentMedic]

pt coded and was bleeding internal. er staff suctioned a lot of blood out of pt.

thanks tni. i don'tknow can anything reverse it? i read vitamin k may help. not 100%if pt died but im guessing er staff had a full suction container of blood. when we left. so im guessing pt did but .....

Did they get this blood from an NG tube? Did they place it in the ED or did the patient already have one? Or was this a suction catheter that someone tried to clear the airway by NT suctioning?

[tamaith]

to be honest i have no idea what those are. the only tubes i know about for suctioning are rigid and flexable . from what it looked like they baged the pt. then had a tube down the throat. i couldn't get a good look cause the amount of ppl i just know the container was full of blood.

[medic_texas]

Why would you want a lab value lesson from a nurse when you have an obvious critical patient? The "INR is 6", wtf can you do about it, especially since you have no idea what INR is, start treatment and rapid transport then pass that information along. The patient comes first.

If you don't have radio communication with the hospitals, why the hell are you running pre-hospital calls? That should be reported or brought up. If a jackass crew brought me a patient like this without a radio or phone call, I'm raising hell. Especially a trainwreck like this.

Info regarding PT/PTT/INR

http://www.labtestsonline.org/understandin...es/pt/test.html

Chalk this up to experience.

[tniuqs]

I'm not trying to pick on you, because as Vent stated, this is a learning experience for you. <snip>

Take the time to learn and be better at you career which will lead to respect that ALL of us demand we get.

If we don't act like professionals, how in the hell can we expect to be treated like professionals?

end rant!

Pfft thats not a rant (cough, splutter hack) some good philosophy here ... BUT SaO2 aint going to help with low perfusion states and loss of RBCs to this degree, its content and capacity funny the most amazing discoveries in medicine are based on excellent observational skills and asking WTF ?

thanks tni. i don'tknow can anything reverse it? i read vitamin k may help. not 100%if pt died but im guessing er staff had a full suction container of blood. when we left. so im guessing pt did but .....

Ok first spell tniuqs ass backwards

Again that thorn in my foot, Vent and chbare and firemedic given one chance will turn this ito a good teaching scenario sooo answer the question posed.

Quoting VENT:

Did they get this blood from an NG tube? Did they place it in the ED or did the patient already have one? Or was this a suction catheter that someone tried to clear the airway by NT suctioning?

cheers

Edited August 28, 2009 by tniuqs

[VentMedic]

Again that thorn in my foot Vent

Just your foot?

[chbare]

A good point. You can have a "normal" pulse oximetry reading; however, be experiencing significant hypoxia. If you have low amounts of circulating red blood cells, yes the remaining cells may be well oxygenated; however, there may in fact not be enough oxygen reaching the tissues. This is known as hyphemic hypoxia.

Another consideration. Pulse oximetry tells us nothing abut tissue oxygenation. Hemoglobin may be well saturated; however, if hemoglobin has a high affinity for oxygen, AKA a left shift on the oxyhemoglobin curve, it will be reluctant to release oxygen to the tissues. Of course, abnormal states of hemoglobin are always a consideration.

One more point to nit pick: SaO2 & SpO2 are not exactly the same concept.

Take care,

chbare.

[tamaith]

thanks for your input texas. first of all the chief complaint was shortness of breathe. when the dialysis unit calls for a private bls company to take their pt to the e.r. they believe its non life threating. otherwise they would call 911 when we were asking what inr meant we were assessing the pt. of course the pt comes first. when we assessed the resperations at the time we arrived the resp were 22 not to say that that can't be anything . cause anything can turn into something. pt didn't start deteriating until a block from the hospital. as far as the communication problem yes i know its a problem. my partner and myself didn't have the e.r. number in our cell phones and we can't call hospitals with our radio's so what we do is have our dispatcher call for us and or the pick up location calls it in for us. thats the system they ve been doing for years not a good one obviously . sad to say thats one of the very few out of many hospitals i don't have in my cell.. its over with. its a learning experience and thats it .