CRAZY call i went on

[uhbt420]

hey everyone, i've been lurking for a while but registered bcause i have a call i wish to discuss.

i work IFT in Cali so usually nothing big. It was just a routine transfer from dialisis center back to the nursing home with one of our frequent fliers. everything was going as usual till bam! he totally passed out on me. i had my partner pull over to the side of the road so he could come and help me and we sprang into action.

i tried OPA but he gagged, so i went for the NPA. put him on high-flow o2 (protocol) and checked vitals. everything was okay except for BP, which was at 100/56 or something like that. (i don't listen w/ a stethoscope i usually just watch the needle bounce, works better for me that way).

my partner hopped back in the seat and started going code 3 to the nearest ER. we have some ALS stuff in the back of the rig cuz sometimes we do back up for 911, so i started an IV enroute.

why was his BP so low, and what made him pass out? it was crazy!

 

[18G]

We can speculate many causes for why your patient went unresponsive. Did your patient stay unresponsive throughout transport? Was it just a syncopal episode? Did they have seizure like activity?

Was their blood pressure really as low as you claim? Giving the method you describe of obtaining the blood pressure I highly call that into question. Why would you intentionally not use a stethoscope to obtain a proper and accurate blood pressure? You watched the needle bounce? Do you mean you palpated it or just put the cuff on and deflated while watching needle bounce? Regardless, unless you used a stethoscope or NiBP your not going to obtain a diastolic pressure.

What was the patients heart rate?

Differentials are many... what other info do u have?

 

[medicdan]

Dialysis patients are some of the sickest barely-stable patients we as EMTs will ever see-- and most who work IFT shrug them off as BS. A million and one things could have been going wrong re: electrolytes, rate of fluids taken off, cardiac, resp, endocrine, etc. Did the patient have a fistula or a graft? Could they have been bleeding from their access? Did you listen over the access with your scope? When you weighed the patient was the fluid loss normal? Did the dialysis center staff report any problems? Many patients who go back and forth from a SNF to Dialysis have a binder-- what were pre-and post-dialysis BPs, according to the book? Change over time (Is 100 systolic normal for this patient post-dialysis?)

Did the patient regain consciousness any any point during the trip to the ER?

BTW, assessing BPs by only looking at the needle and not auscultating or palpating is going to give you an incorrect reading-- the jumping indicates a higher systolic then can be auscultated. While this may be a trick taught for determining what is a pulse and what is not, it is inaccurate for assessment of true BP.

Do you know a pulse? Resps? BS? Pulse Ox? PMH? Meds? With more information we may be able to provide you with more information.

Does OC allow you to initiate ALS procedures without training, just because the equipment is in the truck?

 

[Aidey]

hey everyone, i've been lurking for a while but registered bcause i have a call i wish to discuss.

i work IFT in Cali so usually nothing big. It was just a routine transfer from dialisis center back to the nursing home with one of our frequent fliers. everything was going as usual till bam! he totally passed out on me. i had my partner pull over to the side of the road so he could come and help me and we sprang into action.

i tried OPA but he gagged, so i went for the NPA. put him on high-flow o2 (protocol) and checked vitals. everything was okay except for BP, which was at 100/56 or something like that. (i don't listen w/ a stethoscope i usually just watch the needle bounce, works better for me that way).

my partner hopped back in the seat and started going code 3 to the nearest ER. we have some ALS stuff in the back of the rig cuz sometimes we do back up for 911, so i started an IV enroute.

why was his BP so low, and what made him pass out? it was crazy!

1. How the heck do you document that? That isn't even really checking a BP, it is basically making a half assed estimate. In my service that would be considered negligent, and it wouldn't surprise me if your employer saw it the same way. Especially in a patient that may actually have a BP problem.

You may also be unknowingly committing fraud since technically Medicare requires 2 sets of vital signs, including BP, for validation for billing. If you aren't actually taking a BP those runs aren't valid.

2. I second Dan's question, just becuase you have the equipment on the truck does that mean you are allowed to use it? Please for the love of all that is good in the world tell me that you did not run fluids wide open into this patient.

3. Um, becuase he just got done with dialysis where they removed a bunch of fluid from his body? If it was actually 100/53 that honestly isn't that alarmingly low.

As Dan said, dialysis patients at their baseline are very sick. There are a hundred different things that could be going on, some related to the dialysis, some not. It is impossible to even guess without more information. Also, at least 1/2 of all people on dialysis have diabetes. Some will experience a blood sugar drop during/after their treatment. Usually these people know this if they have been on dialysis for a while, but it can still happen randomly.

 

[SanDiegoEmt7]

This must be a troll... please be a troll.


OP doesn't take a blood pressure correctly or know that 100/54 isn't an absurdly low BP. Then he starts an IV. ED staff are generally aware that EMT-B's don't start lines on patients. I call BS.

Then again... you never know. If this isn't trolling. This person should have their cert revoked. Major liability.

 

[emtJR86]

My first thought was...WHAT THE HELL was a Basic dropping an IV? (just because its on the rig)

 

[Aidey]

This must be a troll... please be a troll.


OP doesn't take a blood pressure correctly or know that 100/54 isn't an absurdly low BP. Then he starts an IV. ED staff are generally aware that EMT-B's don't start lines on patients. I call BS.

Then again... you never know. If this isn't trolling. This person should have their cert revoked. Major liability.

If it isn't a troll there are enough people here from Cali hopefully someone can do enough detective work to find out what company this person works for.

 

[Prophet]

off topic but what is a troll?

 

[Aidey]

http://en.wikipedia.org/wiki/Troll_(Internet)

 

[clibb]

Wow... Just wow...

Did you try to tap him on the shoulder to see if he would wake up?

What was his GCS?

For god's sake get a :censored::censored::censored::censored:ing stethoscope.

 

[uhbt420]

1. How the heck do you document that? That isn't even really checking a BP, it is basically making a half assed estimate. In my service that would be considered negligent, and it wouldn't surprise me if your employer saw it the same way. Especially in a patient that may actually have a BP problem.

well yea in hindsight it was a bad move, but it was an intense situation and i just wanted 2 asess the pt and find out what was goin on...

2. I second Dan's question, just becuase you have the equipment on the truck does that mean you are allowed to use it? Please for the love of all that is good in the world tell me that you did not run fluids wide open into this patient.

no just got access, i'm a team player and i want 2 make things easier for the ER ppl. (nurses usually dont know anything anyway! lol)

3. Um, becuase he just got done with dialysis where they removed a bunch of fluid from his body? If it was actually 100/53 that honestly isn't that alarmingly low.

well he has hypertention so it was low for him

some of you guys are freaking out, relax... i care about all my patients and only want the best for them. and i dont even know what a troll is, so w/e.

 

[Sam Adams]

no just got access, i'm a team player and i want 2 make things easier for the ER ppl. (nurses usually dont know anything anyway! lol)

Someone else asked, but you tip toed around the question. Are you authorized to "just get access" ? You have more important things to be doing as a basic. Doing a proper and thorough assessment so that people down stream can better do THEIR jobs is at the top of that list.

 

[uhbt420]

This must be a troll... please be a troll.

ok i saw the definition of a troll and i am NOT one... so stop saying that.

OP doesn't take a blood pressure correctly or know that 100/54 isn't an absurdly low BP. Then he starts an IV. ED staff are generally aware that EMT-B's don't start lines on patients. I call BS.

like i said the guy has HYPTERTENTION... so it's low for HIM... And it was an intense situation i should have listened w/ the steth but i didnt, wont happen again.

i did the IV cuz i'm a team player. i know its not in my scope but i practiced for years when i vollied in the ER, using those cool plastic arms... and i didn't run fluids i just got access, i know what i'm doing, i just want the best for my pts. i even intubated with a king once so i know what i'm doing.

Then again... you never know. If this isn't trolling. This person should have their cert revoked. Major liability.

im NOT a liability, im an EMT who CARES. besides i'm just doing this till i can get a job w/ the fire department and become a fire medic, so w/e.

 

[Harvey]

I dont know much, but I'm hoping troll. otherwise i wouldnt want you to be an EMT that "cared" for me

 

[Chimpie]

Enough with the troll comments.

This thread is being watched by the admins.

 

[sir.shocksalot]

like i said the guy has HYPTERTENTION... so it's low for HIM... And it was an intense situation i should have listened w/ the steth but i didnt, wont happen again.

My dad has hypertension, his pressure is normally 120/70 or so, having a history of hypertension doesn't mean their blood pressure will be high since hypertension is almost always controlled to a NORMAL level with medications. Furthermore no situation is too intense for you to take an extra 10 seconds to use a stethoscope and get a real pressure. Also a dialysis pt can have huge changes in electrolytes and blood pressure after dialysis.

i did the IV cuz i'm a team player. i know its not in my scope but i practiced for years when i vollied in the ER, using those cool plastic arms... and i didn't run fluids i just got access, i know what i'm doing, i just want the best for my pts. i even intubated with a king once so i know what i'm doing.

Doing things to be a "team player" isn't justification to preform and invasive procedure. And one should never ever do anything that is outside of their scope, I don't care if you know what you are doing, your inability to follow simple standing orders proves that you don't know what you are doing. If you want the best for your patients you would actually do a real assessment and get a real education before you touch patients. Oh and placing a supraglottic airway isn't "intubation", not even a little bit.


im NOT a liability, im an EMT who CARES. besides i'm just doing this till i can get a job w/ the fire department and become a fire medic, so w/e.

Well I will say that you should stay away from being a paramedic. If you did care you would be able to follow your simple protocols and ditch the attitude of "I will be a firefighter therefor until i get there all rules are beneath me". As a medic you will be given tools that can be the difference between life and death, and disregarding your medical education on the basis that you are a firefighter is negligent and is exactly the reason firefighters should never touch patients. I hope for your patient's sake that someone higher on the food chain sees your breach of scope and puts you in your place before you run through a medic mill and kill someone.

 

[CAO]

This thread is being watched by the admins.

Same here, because I'm afraid to even say anything at this point.

 

[Fbarba123]

I can see that you may have been trying to the best you could in a desperate situation (At least, that's what it seems like), So I don't want to knock you on taking action at all, good move there, on the other hand:

I just don't think you should have even started the line, it's not within our scope (EMT-B), and your can open yourself up to a whole lot of issues later, and possibly dismissal depending on the your employers, etc.

You should have been focusing on EMT-Basic skills, pt assessment, gathering up hx, and rechecking vitals.

If you want to pursue Fire medic, make sure you stay within your scope, and remember BLS before ALS!

Hindsight is 20/20, so don't fret, looking backing we all would change our ways

 

[Shishkabob]

like i said the guy has HYPTERTENTION...

???

i did the IV cuz i'm a team player. i know its not in my scope but i practiced for years when i vollied in the ER, using those cool plastic arms... and i didn't run fluids i just got access,

So you were worried enough about the "low blood pressure" to illegally start an IV, but not enough to you know, correct the perceived hypotension?

i know what i'm doing, i just want the best for my pts. i even intubated with a king once so i know what i'm doing.

Oh thank God you used a King, that makes it all ok. I must not know anything as a Paramedic since I've never used a King on a real person.





Just for the record... did you even get a BGL done? I don't know if EMTs can in Cali, but they can't do IVs either so it wouldn't have been any hassle for you.

 

[uhbt420]

Well I will say that you should stay away from being a paramedic. If you did care you would be able to follow your simple protocols and ditch the attitude of "I will be a firefighter therefor until i get there all rules are beneath me". As a medic you will be given tools that can be the difference between life and death, and disregarding your medical education on the basis that you are a firefighter is negligent and is exactly the reason firefighters should never touch patients. I hope for your patient's sake that someone higher on the food chain sees your breach of scope and puts you in your place before you run through a medic mill and kill someone.

ff's should touch patients, thats why the US is moving towards fire-based ems, because its just better that way. we can extricate, decontaminate, and do ems at the same time. and fyi most medic mills are nremt accredited, if you can read a protocol book and do the skills then you are a good medic in my book. we have doctors for dx and stuff.

???
So you were worried enough about the "low blood pressure" to illegally start an IV, but not enough to you know, correct the perceived hypotension?

i had high-flow o2 and trendelenburg, so i was correcting it, thx.

Oh thank God you used a King, that makes it all ok. I must not know anything as a Paramedic since I've never used a King on a real person.

for the record i did the king after i gave it a spin with a normal et tube (fire medic let me). he told me to take it out and try the king even though it was a good esophageol intubation (his words, not mine). even basics can do this als stuff its no big deal, as long as you have a medic watching you and you want the best for your pateints.

Just for the record... did you even get a BGL done? I don't know if EMTs can in Cali, but they can't do IVs either so it wouldn't have been any hassle for you.

cant do it in cali. i may start ivs and other stuff but scope of practice is serious, i don't screw around with it.


you know what, forget it. all i wanted was answers as to why my pt passed out and you guys freaked. i'll talk about this call with a medic some other time.