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Sanity Check Needed


neoboi

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The nice thing about EMS forums is to find about diversity. What a lot of people find out is that ALS is not always available and the difference in operations.

To blame the dispatch and physician is not a likely story at some places. Chances if you blame or criticized a physician on how an ambulance was dispatched the EMT might be finding another job. Believe it or not, most places this would not be be an ALS call (diffused abd pain, treated with analgesics). Especially for a 2 mile transport, stable patient.

Personally, I don't even see the necessity of an EMS unit, unless it was because she had been given medication and IV's. From just the picture that was painted, a 33 year old with umbilicus pain, no rebound pain, and had hx of shivering, and sinking feeling after receiving Demerol and Phenergran.... is really pretty normal with about >90 % of gastroenteritis. Although, it could be a ton of problems from appy to ovarian cyst...

Sounds like the Doc wanted to get a more in-depth study he was not able to provide and have the ER physician rule things out. The patient appeared to be stable .. a pulse of 150 is really not that big a deal when you are in pain. (By the way a rate of 154 should not be labeled S.T.) The pressure was maintained... oxygen, shock position ( trenlenburg ? I am supposing ?) hmm that sounds like increasing pain on abdominal wall as well as it proven it really does no good either. I am asking why the suspicion of shock?... other than a slightly elevated pulse. What was indicating to you this patient was going to crash.. or was there such? From the picture you painted, it sounds like a simple transport made into a big event.

EMT's should be able to handle medical calls, and transport appropitately. Yes, error on the side of the patient when you are clueless.....

R/R 911

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i agree with Rid

doesn't sound like a big emergency to me. Heck, that's how I felt with demerol and phenergan.

Running hot for a 5-7 minute transport time - I don't agree with especially at 2am in the morning. LIttle traffic but I'll say this

I was not on the call, I was not teching and I don't have a video of the patient nor their actions.

But I'm one who didn't run hot back to the ER with a code at 2am in the morning with a 8 minute transport time - we saved the guy and I got my rear end reamed for not running hot. There was nothing that the ER did that I did not do except have 12 extra nurses and 3 docs there to argue about what to do with the patient.

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I was under the impression that pain meds were a big no-no for abdominal pain, unless they are in the ER. An urgent care center, at least around here, is like a large doctors office. You can get an X ray, labs, cardiac intervention, but they transfer all the more serious cases to an outside facility. I'd never question a doctor, but how easily can they diagnose the pain, if it's gone?

Other than being tachy, the BP is okay. Tachycardia isn't that bid of a deal, unless there is some underlaying cause. People that are upset get tachy. I'd be concerned if it was SVT, but with the BP and respiratory rate, it doesn't concern me. Phenegran can give you a spaced feeling, as with most antiemetics. But chances are, the 25 of Demerol is the cause of her sinking feeling, the right combinations of meds have set this course. I'd like to see the outcome, because it sounds vague, possibly a UTI?

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the doc at the er (saw him today) said that the tachycardia was caused by a panic attack secondary to the sedative effects of the meds. he further explained that she had a simple gallstone. he however said that it was a good thing at a heartrate we brought her in quickly and didnt wait for als and we expedited transport since we had limited means.....but he also said that the doc at urgent care shouldn't have dumped the Pt on us, she could have broke the tachycardia and wait for a non emergent paramedic ambulance to take her to the er.....

but he gave us a pat on the back *shrug*

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Question: What is the difference between a saline lock and a regular IV clamped down? Why could BLS transport with a lock but not an IV? I'm trying to read up on IVs but what I've seen so far doesn't address this.

I have recieved no formal training but from what Know for sure...

A saline lock is when there is some type of fluid lock on the iv and nothing is running into it. One would be able to inject meds through the port still, or attache a drip.

An IV clamped down.... I'm confused by what you mean. I think saline locks have a clamp on them, but it sounds like you may mean an iv with fluid that is clamped closed. I'm not sure. A search should give you some more info on the subject though. That and I'm sure one of the medics will correct anything I'm not sure of and tell you more...

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I have recieved no formal training but from what Know for sure...

A saline lock is when there is some type of fluid lock on the iv and nothing is running into it. One would be able to inject meds through the port still, or attache a drip.

An IV clamped down.... I'm confused by what you mean. I think saline locks have a clamp on them, but it sounds like you may mean an iv with fluid that is clamped closed. I'm not sure. A search should give you some more info on the subject though. That and I'm sure one of the medics will correct anything I'm not sure of and tell you more...

If I read correctly, and i think I do, your right, nothing different between a Saline Lock and Clamped hanging bag of solution. Nothing different. Most regions dont allow it because its too easy to just "open the clamp" when u need it.

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Saline Locks or formerly called Heparin Locks, are basically an IV route, that is easy accessible route for later use. After initiating an IV a lock type device is attached with a flush of 3-10 ml of NSS. The tubing is clamped of to prevent back flow of blood thus clotting the IV site.

We have almost totally eliminated IV fluids in the field. The only occurrence for fluids is of course hypovalemia, (any fluid loss) and maybe continuous medications such as cardiac arrest etc...

Most patients do not require additional fluids and the extra costs, accidental "over loading", and of course carrying of additional supply etc. As well the patient has less tangling and moving of extremity is easier on the patient.

Meds are simple to administer with flushing the site and administer med's through the port, and re-flush with closure of tubing.

R/R 911

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Thank you, Xselerate and Rid. I've been trying to research before asking a question :D .... I know the ALS in my area are using locks much more frequently now. The ERs certainly seem to appreciate it.

Neoboi, I don't see anything you did that was wrong. You got your patient to the hospital quickly and safely, and communicated with everyone. There will always be other opinions and other ways of doing things. If someone suggested something you like, save it and use it going forward. If not, don't worry about it. Everybody's ok. I hope you feel better after everyone's support...

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I was under the impression that pain meds were a big no-no for abdominal pain, unless they are in the ER.

That's old skool thinking. The most current research disproves the whole theory. And, although old habits die hard, analgesia for abd pain is becoming the standard, even in the field.

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