Jump to content
mobey

Routine transfer goes wrong

Recommended Posts

Older? Damn young 'ins. By this standard, that means I'm already worm food...

<Sigh>

I'm with you Herbie ... lets don those pampers, hoist the geritol .... THEM IS FIGHTING WORDS !

35 old bhaaa haaa ha !

Share this post


Link to post
Share on other sites

Haha! Whoops, sorry everyone. Open mouth, insert foot. If it makes you feel any better, a nurse once asked me how old I was and I asked her, "How old do I look?" and she said, "I'd say eighteen, but that's only because I assume you have to be at least eighteen to be a paramedic." And my (apparently) youthful appearance doesn't always inspire the greatest confidence in my patients, so it's somewhat of a double edged sword. No offense intended, guys! I call everyone under 21 a "kid" and everyone over 35 an "older person".

As for the monitoring = IV, yeah, unfortunately my system isn't the most progressive in the world. I disagree with it, because in all honesty I can find almost any reason to place a patient on the monitor (and very few reasons NOT to). The explanation that was given to me was that if you think the patient needs the monitor then you think the patient is ALS (i.e. more than just code green) and all ALS patients get IV, O2 and monitor. I don't like it, but I don't have very much say (see, none) in how things are run around here. We just got a new medical director and I heard we're going to have a protocol revision the second half of the year, so hopefully we'll have a little more flexibility with that as well.

Dwayne, no, I don't have to place O2 on a patient unless their SpO2 is under 95% (well, sort of, everything above a green is supposed to get at least an NC though it's not the worst offense if you don't put it on them as long as their sats are above 95% and you're not giving a respiratory depressant), but you mentioned a patient complaining of chest pain and how you would just give aspirin and document no 12 lead changes. Unfortunately, around here, we HAVE to run the full protocol once we've started it unless we get online medical control involved. And pretty much ANY patient who complains of atraumatic chest pain (and sometimes even patients complaining of chest pain following trauma, such as a car crash, under the idea that the start could have given them a heart attack) gets the full chest pain protocol (ASA, nitro if not right wall MI, and fentanyl if no response to nitro x3) regardless of what the 12 lead shows.

Seriously, I've had to go through the whole chest pain protocol on patients that, in my humble (and then still student) opinion, were NOT complaining of cardiac type pain. Including a patient with a history of panic attacks, stated they felt just like they always did during a panic attack, had the numbness/tingling in their fingertips, recent stress at work; and also a patient involved in an MVC who had chest tenderness to palpation, stated they had hit the steering wheel with their chest, no radiation or crushing type sensation. Neither patient had 12 lead changes, but they said the magic words "chest pain", so it was out of my hands. And I'm not trying to say that I'm so good that I shouldn't err on the side of caution if there's ever ANY doubt that a patient's chest pain might be cardiac in origin, but I also don't feel too stupid to not be granted at least a LITTLE bit of slack when it comes to distinguishing cardiac chest pain from any other kind.

I would much rather work in a more progressive and liberal system where protocols were "guidelines" as opposed to strict rules, but unfortunately until I finish my Bachelor's I'm kind of stuck here.

Share this post


Link to post
Share on other sites
, but I will say that if I'm putting the monitor on an older person (>35 years of age) .

Be very careful insulting us old farts young Jedi.

We are the ones making the schedules , that could find you spending your day & nights doing the granny shuttle or the dialysis two step.

Besides : I have boots older than you young whippersnapper!

:-}

  • Like 1

Share this post


Link to post
Share on other sites
...I would much rather work in a more progressive and liberal system where protocols were "guidelines" as opposed to strict rules, but unfortunately until I finish my Bachelor's I'm kind of stuck here.

I have no doubt that you are going to be frustrated, but not damaged by that system. You won't allow it to make you weaker, I'm confident of that...

What I can't figure out is how a medic like you, smart, progressive, educated, political, was ever created there in the first place? Get out of there! You're taking up a spot a fireman should have!!

You know what brother. I know you've been here long enough to know how many of us feel about working such systems, and how hard it must be to talk about the rules you have to follow. But for what it's worth, I've learned something new from nearly every post you've posted here, so I have nothing but respect for the fact that you've chosen to become a medic that doesn't really belong there yet are unafraid to allow us to see inside of it as well as "get" the fact that sometimes you just have to get paid to meet your goals. And how friggin cool is it that you've chosen to go beyond just getting paid and turned all of your experiences into something more positive than most would see...You so much remind me of a young basic/hosemonkey I worked with in Colorado....And I mean that as a compliment.

Thanks for participating man...

Dwayne

Share this post


Link to post
Share on other sites

I have no doubt that you are going to be frustrated, but not damaged by that system. You won't allow it to make you weaker, I'm confident of that...

What I can't figure out is how a medic like you, smart, progressive, educated, political, was ever created there in the first place? Get out of there! You're taking up a spot a fireman should have!!

You know what brother. I know you've been here long enough to know how many of us feel about working such systems, and how hard it must be to talk about the rules you have to follow. But for what it's worth, I've learned something new from nearly every post you've posted here, so I have nothing but respect for the fact that you've chosen to become a medic that doesn't really belong there yet are unafraid to allow us to see inside of it as well as "get" the fact that sometimes you just have to get paid to meet your goals. And how friggin cool is it that you've chosen to go beyond just getting paid and turned all of your experiences into something more positive than most would see...You so much remind me of a young basic/hosemonkey I worked with in Colorado....And I mean that as a compliment.

Thanks for participating man...

Dwayne

Thanks, man. I really appreciate that. Like I said, once I get my Bachelor's (somewhere between two and five semesters left) I'm definitely going to start looking around for someplace that's a little better fit for me, though hopefully we'll have some good changes here in the not too distant future. I get a lot out of talking with everyone here, and I only wish more paramedics and EMTs would take advantage of the internet to come together and learn from each other and each other's systems. THIS is how EMS will grow and evolve and change.

Share this post


Link to post
Share on other sites

Well Mobey, the what would you do if... question is often a bag of worms to try and answer, but I'll give it a shot.

In your place I probably would have put a 12 lead on. Mostly because its a long trip, I agree, you most likely would have seen little to nothing of value, but something might show up. O2? Meh, maybe, there is a chance it could have helped bring the rate down, but no chest pain, no SOB? Im pretty happy with an sp02 of 94%. Fluid? Again maybe a small bolus.

In the end I don't think you witheld any Tx that would have greatly influenced this mans outcome. As for the worry about what the sending facility may say about your interventions, who cares? They already talk behind your back anyway.

Share this post


Link to post
Share on other sites

Something Bieber said really struck a chord with me. He mentioned that he wishes more of us would become involved in sites such as this- coming together, sharing, bitching and moaning- and most importantly, learning. Many of us tend to become myopic in our views- whether they be professional, political, or spiritual. A place such as this allows us to vent our spleens, and more importantly realize that whatever problem we have, chances are another provider has either dealt with it or will deal with it at some time.

(Here comes the geezer part-)

I can't believe I am saying this but when many of us started in this business, the internet as we know it did not exist, and computers had the same processing power as today's wrist watch. Often times I wondered what it would be like to work in another area- what their system would be like, and would they have the same problems we had. I had neither the inclination, nor the means to actually explore my questions, so I just dealt with the problems we had. First I helped organize a union at our company, become disillusioned with that after awhile, then I took a management job because I wanted to change things instead of bitching and moaning. Both efforts were marginally successful because I learned that middle management is a horrible place to be, and only slightly better than being on the bottom rung of the food chain.

Here we have a great resource, and I gotta say- Bieber is wise beyond his years. He gets it, and it makes me feel good that someone like him is the future of the profession. I see so many guys become frustrated and end up becoming a FF or getting out of the business altogether. They get beat down and figure if you can't beat 'em, join 'em. I get that, but I'm too old for that road now.

Keep up the fight, dude. I wish you luck-and great resolve- you're gonna need both.

  • Like 1

Share this post


Link to post
Share on other sites

Dont beat yourself up, everyone in this room has a call somewhere in their past that they would probably do different in hindsight (except for the rookies who havent run enough calls yet), but your story makes a good point about not letting your guard down, on even routine patients. I remember one of the Doctors I worked with in the ER was a part-timer, who was really a podiatrist by day. Because he was so uncomfortable in his skills, he was known for ordering way too many lab tests for the stupidest things, and of course every patient with a bump on the head got a CT. But you know what, about once/twice a month, he would discover something odd, that made him admit a patient that the normal ER doc would discharge. Thanks for sharing.

  • Like 1

Share this post


Link to post
Share on other sites

×
×
  • Create New...