Dustdevil Posted December 26, 2006 Share Posted December 26, 2006 HELL YES! Plus 5 for an excellent post. Going against the conventional wisdom is hard enough, but explaining it intelligently and convincingly is admirable. Link to comment Share on other sites More sharing options...
dgmedic Posted December 26, 2006 Share Posted December 26, 2006 YEAH!!! my semester is over so mom said I can come out and play!! Been a while - hello all... Yup, tapy tapy - I would. It is in our guidelines though. If you screw it up and pop a lung...just say you were decompressing the chest and hit a bump or something. It is a simple procedure and medically acceptable, it is all good. My feelings on this is not the procedure itself, but whom is the directing physician on the other end. Are you speaking to a family physician that just happens to be picking up an ED shift at a small hospital, are you speaking to a board certified or trauma surgeon? And, at that point, to whom are you responsible? On the basis of medical acceptability, the procedure is appropriate, but at what point does the blind-leading-the-blind fall into the "paramedic PRACTICING medicine?" A competent physician DIRECTING the procedure to a medic is completely different than a physician (ill-wittingly in the ED) practicing medicine over the phone. Although it is cute to say and makes us feel like big boys, we do not practice medicine, nurses do not practice medicine, no one "practices" medicine other than a physician. So, if you are being "directed"....do it. If you are being "asked"....don't do it. If you are comfortable with the procedure, can explain physiologically why that procedure would be life-saving, and based on the risk vs. benefit of the outcome and made best decision possible for the patient.....do it (or not). If you feel that you are not able to follow directions...don't do it. If you can...do it. If you feel that your job is at risk and purely have linear thinking abilities, constantly referring to page 154 of "your protocols" - good use of those opposable thumbs that have been bestowed upon you through evolution.........I turn crying.......dubya, dubya, dubya, dot emedicine dot COME ON!!! Think about it...they're DYING...not dead....do the damn procedure. Street lights are starting to come on....gotta get home - my mom is calling - damn...no it is dispatch...gotta go!! -dg Link to comment Share on other sites More sharing options...
Dustdevil Posted December 26, 2006 Share Posted December 26, 2006 Although it is cute to say and makes us feel like big boys, we do not practice medicine, nurses do not practice medicine, no one "practices" medicine other than a physician. Come spend a day in my aid station before you presume to speak for me. :wink: Link to comment Share on other sites More sharing options...
tniuqs Posted December 26, 2006 Share Posted December 26, 2006 If the medic did perform the procedure and the pt died, the family would more than likely never find out about it because they would be wrapped up in too much other stuff to worry. If the medic did it and the pt survived, the family probably wouldn't care because their loved one was still alive. . ERDOC: I seldom disagree with anything you state, I find I must disagree here just a touch: There was a study undertaken "somewhere" the risk to proceed with a lawsuit or any other actions in the case of a sudden death was markedly diminished to "nodda" when the family was present at an arrest. The Family (in the field) is not asked to leave the room, in fact I leave that desicion up to them now in fact, they observe all the procedures and efforts and this confirms to them that everything humanly possible WAS done to help their loved one, I frankly found this to be a shock. This was explained to me by a most excellent R.N. a George Gow (a female) who put my mind at ease and did change my perspective for transporting critical patients with escorts...... "never the less" I thank god, for not being employed in the state of NY! lol. Oddly enough in my career I have received 2 thank you letters from family's that have had a family member pass on while in my care (one on board aircraft on final "an end stage cardiomyopathy") and (one dissecting AAA that I got to the table but later died) in both cases families had observed first hand what exactly what was involved and understood completely and later both wrote me letters of thanks ........ much to my amazement. [hr:eeb3db5e61] On to dgmedic: The tread and question posed IS: Would YOU do this procedure given the senario presented? Your sounding a bit like a politician ..... "directed v/s asked" this is semantics', dude. Although it is cute to say and makes us feel like big boys, we do not practice medicine, nurses do not practice medicine, no one "practices" medicine other than a physician. Cute big boys? wtf, I do agree with the majority of your statements but we are big boys and big girls, some a "bit cuter" than others granted. But we DO practice medicine, period. What do you call it last aid? please forgive me but a bit off topic. Just what is your definition of not practicing medicine: 1- we make surgical incisions, (some suture skin, lines and tubes.) 2- we do invasive procedures. 3- we give drugs IV that could kill instead of (I hate the word save) 4- we prescribe and deliver drugs (in the majority of instances without direct medical contact) 5- use enough electricity to start a small jet. A competent physician DIRECTING the procedure to a medic is completely different than a physician (ill-wittingly in the ED) practicing medicine over the phone. ill witted ER docs?.... huh? ......I haven't met too many of those in my career! If I were to put myself in ERDocs shoes or any in fact, I would be VERY concerned about the capabilities, observations and competency of that field medic too....! Must take a lot of balls to make that type of call, my hair would be white in one week. If you are comfortable with the procedure, can explain physiologically why that procedure would be life-saving, and based on the risk vs. benefit of the outcome and made best decision possible for the patient.....do it (or not). Just whom IS (again the word) "comfortable" sticking a COOKs needle or any thing else handy and long enough, so close to a heart anyway? and btw I would suggest you stop the gut wagon if you are going to do ANY procedure similar, hit a bump in the road...ee gads man thats an excuse as opposed to a possible complication from an invasive procedure, but I think you were trying to make a joke...I would hope. cheers "Edited and minus 2 for rambling off topic" Link to comment Share on other sites More sharing options...
Ridryder 911 Posted December 26, 2006 Share Posted December 26, 2006 Come spend a day in my aid station before you presume to speak for me. :wink: Ditto Dust; Actually, come and work at any ER/ICU/ or even med. surgical unit from rural to a major trauma center.... Obviously, you have no "worldly experience". Sorry, I consult physicians and inform them of what I have. I am legally bound not to perform a procedure as much as do one, if I know that medication or procedure is harmful to that patient in that current condition. As well, I guess you have never heard of NP's (yes, they are nurses).. And yes, they can practice medicine many states without a "physician" license, so feel like a big boy and read up on what is current in medicine. R/r 911 Link to comment Share on other sites More sharing options...
ERDoc Posted December 26, 2006 Share Posted December 26, 2006 ERDOC: I seldom disagree with anything you state, I find I must disagree here just a touch: There was a study undertaken "somewhere" the risk to proceed with a lawsuit or any other actions in the case of a sudden death was markedly diminished to "nodda" when the family was present at an arrest. The Family (in the field) is not asked to leave the room, in fact I leave that desicion up to them now in fact, they observe all the procedures and efforts and this confirms to them that everything humanly possible WAS done to help their loved one, I frankly found this to be a shock. This was explained to me by a most excellent R.N. a George Gow (a female) who put my mind at ease and did change my perspective for transporting critical patients with escorts...... "never the less" I thank god, for not being employed in the state of NY! lol. Oddly enough in my career I have received 2 thank you letters from family's that have had a family member pass on while in my care (one on board aircraft on final "an end stage cardiomyopathy") and (one dissecting AAA that I got to the table but later died) in both cases families had observed first hand what exactly what was involved and understood completely and later both wrote me letters of thanks ........ much to my amazement. I totally agree with the family being present during a resuscitation. I have them present whenever I can. I even did it once so that a family that would not make their mother, who was going very slowly into multisystems failure, a DNR would realize what they were putting there mother through. Sure enough, after about a minute or two they thankfully changed their mind and the pt was allowed to peacfully pass. I don't think the back of the ambulance is the best place for a family to be during a resuscitation. There is just not enough room back there in most cases and pt care needs to come before the family. I think we are talking about two seperate circumstances here. Again, I feel (and it is totally just my opinion) that in the end nothing would probably come from it. If the pt survives, great, no one is going to know any better. If the pt dies, it was not fully unexpected. Unless someone goes out of their way to tell the family this will probably not even get back to them, and if it does, will they understand what it means? Link to comment Share on other sites More sharing options...
tniuqs Posted December 26, 2006 Share Posted December 26, 2006 I totally agree with the family being present during a resuscitation. I have them present whenever I can. I even did it once so that a family that would not make their mother, who was going very slowly into multisystems failure, a DNR would realize what they were putting there mother through. Sure enough, after about a minute or two they thankfully changed their mind and the pt was allowed to peacfully pass. I commend you, I just wish that the time that I spent in ICU that more MDs would have made that very difficult choice, I bet It was not easy. I don't think the back of the ambulance is the best place for a family to be during a resuscitation. Agreed: Never in the back "of a rig" with seat belt on in the front well unless your on board aircraft. Now that gets Me concerned as I have a unwritten rule "No family escorts allowed to fly" :shock: There is just not enough room back there in most cases and pt care needs to come before the family. I think we are talking about two seperate circumstances here. Yes, totally. Again, I feel (and it is totally just my opinion) that in the end nothing would probably come from it. If the pt survives, great, no one is going to know any better. If the pt dies, it was not fully unexpected. Unless someone goes out of their way to tell the family this will probably not even get back to them, and if it does, will they understand what it means? My opinion too, just brought the topic up for clearity, understanding this has made me more "comfortable" Did I say comfortable? OMG! cheers Link to comment Share on other sites More sharing options...
dgmedic Posted December 26, 2006 Share Posted December 26, 2006 Ditto Dust; Actually, come and work at any ER/ICU/ or even med. surgical unit from rural to a major trauma center.... Obviously, you have no "worldly experience". Sorry, I consult physicians and inform them of what I have. I am legally bound not to perform a procedure as much as do one, if I know that medication or procedure is harmful to that patient in that current condition. As well, I guess you have never heard of NP's (yes, they are nurses).. And yes, they can practice medicine many states without a "physician" license, so feel like a big boy and read up on what is current in medicine. R/r 911 Oh, Rid...you hurt me man!! No worldly experience? okay...... Dust? stick to you aid station then....keep crackin' them chests boy!! you keep on a practicing!! Don't know many nurses that independently open up their own clinics and practice medicine. Yes Rid...I know NP - I was speaking of nurses in general. Your argument is similar to saying that a physician which happens to be a medic too. They are practicing under the advanced degree.... Rid...exactly - you consult physicians - that's what I am saying....don't call 'em...don't work from protocols...just do it - then you are practicing. As far as incompetent physicians in the ED, directing vs. asking, bla, bla, bla. Well, I have gone from a brand new medic in a small rural town in missouri where the ED physician was my family physician, to the streets of Denver working with actual ED docs, and now to springfield missouri. I work both on the ground and fly for the Level I here...so I still see both small and large facilities...see both competent and incompetent physicians, nurses, medics, humans, monkeys. Yes there are folks out there that have no business being where they are......like me right? I work (as we all do) from protocols (guidelines...whatever you want to call them to make you feel fuzzy)...I deviate from the protocols when it will benefit the patient....whether I discuss it with a physician or not...but when I do, I make sure to discuss the case with my medical director. If anyone else has a problem with it, they can pull it to M&M, and I present the case, the research, and my line of thinking on my decision (ops...yup rid...I am somewhat current on "medical stuff"). If I am wrong, the physicians educate me on why I am wrong...otherwise, it's good. Looks as if I stepped on some toes....sorry to hurt some feelings. I know some folks really hang their hat on certain things........ I guess I could have just quoted the best line of this thread........ ERDoc When ego exceeds knowledge, we have a problem. -dg Link to comment Share on other sites More sharing options...
1EMT-P Posted December 29, 2006 Share Posted December 29, 2006 I would not have done the procedure, instead I would have started ACLS & transported the patient to the ED. Link to comment Share on other sites More sharing options...
ERDoc Posted December 29, 2006 Share Posted December 29, 2006 I would not have done the procedure, instead I would have started ACLS & transported the patient to the ED. ACLS dictates treating any of the causes of PEA, so why wouldn't you do a centesis? Link to comment Share on other sites More sharing options...
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