tniuqs Posted January 26, 2011 Share Posted January 26, 2011 No mobster .. the 12 lead would have saved this patients life .. you killed him ! and cost taxpayer lots of money ! Ok before I get the wrath of the khan(s) ... we did just chat on the phone ... its just a joke guys and girls. A couple of queries ; What was pt.s Hemoglobin ... in regard to oxygenation content and capacity idea. Was his "oral" temp 35.8 ? Why was he on MS po prn ? LD svp. Was this calcification on mitral or vegetative and was it verbal report or documented ? Was the patients anxiety level high when you admitted ? Was this patient supposed to be a wait and return or direct admit ? Last but not least his respiratory fungal infection most curious as this can be a very strong indication of a lack of an immune response. OR an knowing this receiving facility VERY well, Did the receiving hospital do or gave something to this patient to precipitate an event ? That's where I would put my money .. the treatment in ER is very questionable. RUFFEM: I know that I don't care about insurance but more than likely the insurance company would kick this bill back and say "what was the medical necessity of said 12 lead?" I never do anything based on insurance but I'm curious as to this being a routine transfer was it medically necessary? more and more that I think about it I probably would have done one but it would have been down on my decision and treatment tree. RUFF: Well you would love to practice where we do ... there would NEVER be a charge for a 12 lead, no justification required to do anything diagnostic ... ever. cheers Link to comment Share on other sites More sharing options...
Bieber Posted January 28, 2011 Share Posted January 28, 2011 I have a question. You said this guy was being transferred for a diabetic foot issue? I assume this was a code green (or I, depending on where you are)? If this was a low priority patient, why did you put the monitor on him at all out of curiosity? I don't know how it is for you, but unfortunately for us an IV or a monitor automatically makes a patient a yellow (code II) where I work, though I assume you may have more freedom to place the monitor on a patient without having to upgrade their status. I'm not sure how my treatment would have differed if at all, because like I said where I work if we put the monitor on someone we automatically have to make them a yellow and stick them with an IV, but I will say that if I'm putting the monitor on an older person (>35 years of age) I feel that a 12 lead is almost obligatory. But you've already recognized that, and I'm no one to criticize you. I don't know if anything you could have done would have changed this patient's outcome. People die, and for all the treatments we can provide we're all really pretty powerless (all of us, not just paramedics) to do much to stop the Reaper. Tough call, man. Link to comment Share on other sites More sharing options...
mobey Posted January 28, 2011 Author Share Posted January 28, 2011 I have a question. You said this guy was being transferred for a diabetic foot issue? I assume this was a code green (or I, depending on where you are)? If this was a low priority patient, why did you put the monitor on him at all out of curiosity? I don't know how it is for you, but unfortunately for us an IV or a monitor automatically makes a patient a yellow (code II) where I work, though I assume you may have more freedom to place the monitor on a patient without having to upgrade their status. I'm not sure how my treatment would have differed if at all, because like I said where I work if we put the monitor on someone we automatically have to make them a yellow and stick them with an IV, but I will say that if I'm putting the monitor on an older person (>35 years of age) I feel that a 12 lead is almost obligatory. But you've already recognized that, and I'm no one to criticize you. Your system sounds waay different than how we operate. The only thing that upgrades my patient is my differential diagnosis. The reason I put a monitor on at all is because it is part of my routine assessment of the elderly, even on "green" transfers. I reserve the 12 lead for people whom are sick. So I agree with your 12 lead assessment. If I am upgrading a call, the 12 lead is a standard assessment. However, basic non-sick pts get the standard 3-4 lead. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 28, 2011 Share Posted January 28, 2011 (edited) Yeah Bieber, I've not heard of such a system either. You HAVE to start an IV if you use a monitor? I've often placed the monitor or run a 12 lead to document a pertinent negative for my report. (50ish year old woman, chest pain, bilat arm pain, began when she had a walking cast removed from her foot and began using a walker. Husband states it's gotten worse each day as she refuses to put weight on the foot as instructed and carries her body weight on the walker. Chest/arms tender to palp, l/s full/clear bilat, pulse full/regular, vitals all well within acceptable limits for situation. ASA, just in case, 12 lead so that I could later justify not running the chest pain protocol, see?) So would you not use the monitor in this way? Or is you do, are you then forced to start an IV on a pt that most likely won't benefit from it? But as Mobey says, it's a diagnostic tool most often used to verify what I'm already confident that I know, either positive or negative, but still just a small part of an assessment. If you choose to use your SPO2, are you then required to put on O2? And you know what brother, in writing this may come across as me bagging on your system, but that's absolutely not true. As one of the brightest new providers we've had here in a while I wouldn't do that. But I am curious, as I've not heard of this before. Maybe if you place the monitor you have to stick them as the two combined upgrades the billing in some way? Interesting though.. Dwayne ...I'm putting the monitor on an older person (>35 years of age)... Edited to try and clarify that my post was meant literally and not tongue in cheek/sarcastic. Edited January 28, 2011 by DwayneEMTP Link to comment Share on other sites More sharing options...
akflightmedic Posted January 28, 2011 Share Posted January 28, 2011 if I'm putting the monitor on an older person (>35 years of age WTF?!?!?!? "Older"...seriously....? Link to comment Share on other sites More sharing options...
JakeEMTP Posted January 28, 2011 Share Posted January 28, 2011 WTF?!?!?!? "Older"...seriously....? Wow! I must be closer to placing one foot in the ground then I originally thought. At minimum, I place a 3-lead on most pt.'s even though it doesn't tell you much. If I have any inclination that something else is going on, a 12-lead. I don't think Mobey's treatment is any different that what I'd do. Sometimes, people just die. Try not to dwell on it to much brother. If the hospital couldn't save him, it was his time. Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 28, 2011 Share Posted January 28, 2011 WTF?!?!?!? "Older"...seriously....? That's like.....240 in Yeti years, isn't it? Link to comment Share on other sites More sharing options...
DartmouthDave Posted January 28, 2011 Share Posted January 28, 2011 Hello, Sure, I guess by that standard one a patient would need a pair of depends by 40? =) LOL Link to comment Share on other sites More sharing options...
DwayneEMTP Posted January 28, 2011 Share Posted January 28, 2011 We're having a little fun at your expense, but I'm guessing that what you mean by older person is "no longer a child or teen" not as in geriatric? Good post, and logical choice for that age group in my opinion. Dwayne Link to comment Share on other sites More sharing options...
HERBIE1 Posted January 28, 2011 Share Posted January 28, 2011 Older? Damn young 'ins. By this standard, that means I'm already worm food... <Sigh> Link to comment Share on other sites More sharing options...
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