Sanity Check Needed

[zippyRN]

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

showing your age there - the only analgesia contraindicated in abdo pain in Inhalationals if you think the patient is (bowel) obstructued

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?

you can still illicit all physical findings with an analgesied patient - tif anyrthing they'll be better able to localise th pain

Other than being tachy, the BP is okay.

becasue she's tachy - do we know this patient is not in compensated shock? woithout a FAST USS /DPL or lparotomy we don't know for sure

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.

150 should be raising red flags - if it was 120 maybe

[Ridryder 911]

I disagree... if you were to do USS etc .. on every abdominal pain because the rate is just 150 I would have to have 5 U/S machines in my little ER. Treat the patient not the numbers.. and after a detailed examination then to rule out (if needed) then do aggressive work up. Why run up a ER bill into the thousands of dollars..?

I would had suggested a green lizard or GI cocktail prior to the Demerol... with epigastric pain, run a liter of fluid in and see if her rate goes down and allow the analgesics to work. Get a better H & P then go from there. You probably just scared the hell out of the girl...and running hot didn't help.

R/R 911

[lfdrescuediver]

Been in this situation. Happened to be ex-coworker and next door neighbor. 68 m c/o diarrhea. Hx of CVA and blood clots. Smokes like a chimney, drinks like a fish. Late at night. Get there, he is c/o leg pain. Lying on that side on floor. Get him loaded on to stair chair, and able to palp leg. No signs of cramping. Clot broken loose? ALS is approx. 10 - 12 min. away, in same direction as ER. Then with added time for loading their equip. in our rig, looking at 15 - 18 min. Our trip will take approx. 8 - 10 min. to ER. Decided not to call ALS. Pt did have circulating clot. Also had septicemia. Died in less than 48 hrs. At least he had a friend to look at on his last trip. :?

[cosgrojo]

If you decide as a BLS provider that you need to go code 3, or priority 1, you should consider calling ALS just for CYA. Call them, even if you know that you will get to the hospital before they intercept with you. Ask them their ETA, when it's more than your transport time, cancel and say you are going to the hospital. You made the right decision, just didn't cover your bases thoroughly enough. It's sad that we have to justify our decisions like this, but we are constatly under scrutiny, and we need to accept this and play the political game along with everyone else. I know I've done this same thing before. I still feel to this day I made the right decision, but was yelled at just the same for not calling ALS (we were less than 1/2 mile from hospital). Just cover your a$$ and when you get questioned, you'll have an acceptable explanation to the people who ask.

[Dustdevil]

That's very true, Cos. The problem is, it's easier for them to blame the situation on the EMT than to simply admit that their dispatch protocols and tiered response system -- which led to this SNAFU -- suck arse.

[hammerpcp]

According to me, if the pt's condition has changed since they were last evaluated by the sending doc, they need to be reevaluated before the transfer. Also, if I am not comfortable with a transfer for whatever reason, I will tell the sending doc my concerns (doc's are people too *gasp* they are not infallible and pt's condition do change). When the pt is in your rig it could be your ass if something goes south. Stand up for yourself, and if you don't know ask.

[cosgrojo]

Dust- Agreed, on every level.... arse suckers....