Complex cardioversion?

[firefighter523]

I'm sorry, there it is, it must have just popped up in your title!!! Amazing, I am proud to be one, mine was up a long time ago!

[emt322632]

Firefighter, how many years of experience do you have?

I really and truly doubt that Rid, Ruff, and others here are gloating when they're telling you how many years of experience they have behind them. They're trying to get it through your thick skull that they've been around, they've seen things.

I've been doing this for 3 years, and I know not to upset the big dogs, something you have yet to learn.

But maybe you will when your card gets pulled for assault and battery eh?

[Just Plain Ruff]

OH MY GOD, XXXX(Edited out with apologies to Firefighter) and yes patients can hear you when they are unconscious

I am also not the one who started this.

If you would have read any of my previous posts you would have seen my resume but here we go

I've been a medic for nearly 15 years.

I've worked in rural and urban systems.

How long have you been a medic?

[EMT City Administrator]

Lets keep the name calling and egos in check and keep this on track....

Admin

[Just Plain Ruff]

I don't have to put my title in to prove myself. My posts prove my level of professionalism. Maybe I shouldn't have called you an idiot because I don't like to sink to that level but you are just beyond belief.

If you honestly believe everything that you have stated then there is no hope for you. I just hope that your service recognizes your beliefs and takes appropriate action by remediation or maybe best case scenario - prodding you to leave this profession.

I don't doubt that you are a good person and want to help but EMS does not need renegade paramedics who think that just because they are called to a patient that whatever they the provider says goes, to heck with the patients wishes. That thinking is just dangerous

Maybe you should go to your original medic instructor or better yet, go to your medical control or legal department and ask them the following questions

1. What is implied consent?

2. If a patient tells me not to do something but I know that they need what they said not to do, can I still do it?

Go ask those questions and then come back here with the answers.

And you have not answered my question - how long have you been in EMS?

[Just Plain Ruff]

Admin, you are so right, I did apologize for that though. I realized that I was getting a little bit to wrapped up in this. The line of thinking by this person just frightens me but I promise not to name call anymore even though I want to.

Hope your day is going great Admin? Be safe, god speed and take care.

[chbare]

I am having a hard time figuring this one out.

"You should NOT let them decide, that is what you are there for. You are the professional, and are the one that is supposed to know what to do." I understand this goes against what many of us as medical providers believe; however, if a person is awake, oriented, and can communicate their wishes, you cannot perform care without consent. We do not make decisions for people. We do our best to educate and inform people and let them make the decision. Yes, in some cases a patient may undergo treatment against their wishes. This is usually done under a court order or in a protective custody type situation. I also understand that in some cases implied consent will apply. However, even in a critical patient, you could be charged with battery if they are awake, oriented, and refuse treatment, and you perform treatment against their wishes. In addition, you may face a civil suit in addition to criminal charges. I understand that this is frustrating; however, many civil and criminal cases have been successful against providers who touch or perform procedures on a patient against their wishes.

In addition, it is well known that unconscious people can hear, feel, and have awareness of their environment. Mounds of data exist to back up this well known fact. Case reports from the patient in the OR, to the intubated sedated ICU patient, to the unresponsive brain bleed ER patient exist.

With that said, the whole debate regarding consent is not the point of the case study. As I understand, we are talking about what type of treatment to consider for the patient in this threads case study.

Take care,

chbare.

[firefighter523]

Ok this is really getting annoying now. Let reiterate it AGAIN. I simply stated from the beginning.... If at pt is CRITICAL, UBTUNDED, UNRESPONSIVE, and is ready to die, ie..... Low sugar, high sugar, increased ICP, anykind of shock, OD, unstable tachy dysrhythmia.... am I hitting them all? You then fall under IMPLIED consent!!!!! Not EXPRESSED, expressed being the words NO or YES coming out of the patients mouth. Did I mention that is EXPRESSED!! If before they become unresposive, I guess there is the RARE possibility that they will tell you they DONT want anything done. If that is the case and they don't have a DNR present, you must CALL MEDICAL COMMAND!!! I think I am fully aware of this RARE situation!!! If they DONT state the above mentioned statement and crap the bed, you MUST assume they want to LIVE!!! This is NOT so hard, is it??? This will NOT get you nor I in trouble and is the STANDARD of CARE folks!!!!

Call me whatever you would like, I don't care. I am my pt's best advocate all of the time. I will always tell them what I am doing, NOT ask them what they want, do you know why fellas, because they DONT know!!!!!!!!!!!!!!!!!!! We are the ones that must tell them, not ASK. If you tell them and they don't want it, then they sign the dotted line. Is this ENGLISH understandable.

[chbare]

Firefighter523, I do think I understand your statements. I also think that perhaps communication broke down within the posts of this thread. In reviewing your posts I believe that you were trying to emphasize that you felt cardioversion on this patient was the proper treatment; however, in a round about way we ended up in a brawl.

However, some of your statements were misleading. While, unconscious patients ability to hear was not a point of this thread, this among a few other concepts were thrown out none the less. Some of your language could be interpreted as aggressive and some of the statements were not correct. (I do think you were trying to make a point, it just came out wrong.)

Please believe me when I say I am not attacking you or calling you names. I think things got a little aggressive in the heat of the moment. Sometimes we have to accept that we may have been a little erroneous in the delivery of our information,acknowledge and accept that fact, and move on with life. In some of my posts I have fudged on the delivery of my point, somebody called me on it, I acknowledge my error, and life continued.

Take care,

chbare.

[Just Plain Ruff]

Ok this is really getting annoying now. Let reiterate it AGAIN. I simply stated from the beginning.... If at pt is CRITICAL, UBTUNDED, UNRESPONSIVE, and is ready to die, ie..... Low sugar, high sugar, increased ICP, anykind of shock, OD, unstable tachy dysrhythmia.... am I hitting them all? You then fall under IMPLIED consent!!!!! Not EXPRESSED, expressed being the words NO or YES coming out of the patients mouth. Did I mention that is EXPRESSED!! If before they become unresposive, I guess there is the RARE possibility that they will tell you they DONT want anything done. If that is the case and they don't have a DNR present, you must CALL MEDICAL COMMAND!!! I think I am fully aware of this RARE situation!!! If they DONT state the above mentioned statement and crap the bed, you MUST assume they want to LIVE!!! This is NOT so hard, is it??? This will NOT get you nor I in trouble and is the STANDARD of CARE folks!!!!

Call me whatever you would like, I don't care. I am my pt's best advocate all of the time. I will always tell them what I am doing, NOT ask them what they want, do you know why fellas, because they DONT know!!!!!!!!!!!!!!!!!!! We are the ones that must tell them, not ASK. If you tell them and they don't want it, then they sign the dotted line. Is this ENGLISH understandable.

Fire, you really must think we are stupid.

The statements you made in your posts was inflammatory as well as insulting. I concur that I was insulting to you and I apologize but your statements were just so out there.

Yes, I will concede the point that you are your patients advocate but there are times when you just have to let the patient die.

But actually you really have to ask the patient what they want. If you try to force or tell them that you have to do something and you do not ask them then you run the risk of "assault and battery". I do agree that we have to be our patients best advocate but there is a limit.

You never did answer my question, even though I answered yours with my experience as a medic, you have not addressed that question.

It was asked by at least one other person on this forum other than me.

I would suggest that you read each post that you make and see if there are pieces of that post that might mislead others into believing what I for one as well as at least two others read.

The way you post on these forum's directly affects your credibility. If you post badly or make wild statements then your credibility suffers. I know that you might think that this is just a silly forum and your credibility doesn't matter here but it really does. You never know who you might meet in the future.

I would also ask you to go back to your medical director and ask them what their views on Implied consent are or what their views on providing a treatment to a patient when they have told you they don't want the treatment in the first place.

I could go on and on but I'll stop there.

I think that we should just go our separate ways and agree to disagree on this. You have your firmly held beliefs while I have mine. We just operate differently.

I do apologize for calling you a name and I hope you will be big enough to apologize for your condescending attitude towards me and others on this thread. If not no harm done.

God speed and be safe.

Michael