140/80 and you're calling for ALS intercept for hypertensive crisis?

[Hockey]

:rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl:


40 year old lady. BP 140/80. HR 82. Complaining of stomach pain after eating taco bell (rated at 2/10)

BLS crew from another company called for ALS intercept for "hypertensive crisis"

They ignored my request to not go P-1 and said that I was too far out to stop and wait.

Met them at the hospital, and thats the explanation I got. Talked to the patients RN at the ER and she started to get on me thinking I told them to roll it in hot.

They cleared before I got the chance to have a return chat with them. Tomorrow should be good

 

[mycrofft]

A co-worker woke a MD at 2AM because an inmate's blood glucose was 120 (over the standard normal 100)....

 

[EFDUnit823]

I don’t care who you are, that’s funny right there!

 

[Amberlamps916]

The more and more I work as an EMT,the more I get annoyed with fellow EMT's panicking when a BP is slightly elevated from the normal range. I don't know what it is, but it is becoming increasingly evident to me that some providers rush to make judgements based on numbers and not actually taking the patient's condition into consideration. I had a partner panic and wanted to refuse transport the other day because a patient who was being discharged had a bp of 156/72. The patient was completely stable with no signs of distress. He had a history of htn but refused his medication because he didn't want to have a headache during transport. Am I wrong in thinking that this patient was not having a "crisis"?

 

[SoCal911]

Is the patient going to die before or have permanent damage caused before you can drive to the hospital code 2? Than it's not a crisis. Systolic under 90 is not life sustaining per the receiving MD in my area so light it up. Over 200 is high, but if they have a Hx of htn and no obvious distress than its not a light it up transport. Now if it's a chest pain with cardiac Hx and a 230/120 then light it up. But use your brain - just because it varies from 120/80 does not make it an emergency - it makes you a moron.

 

[mycrofft]

Some people need their Daily Drama.
Won't find many of us old Dinosaurs acting like that.

 

[usalsfyre]

Systolic under 90 is not life sustaining per the receiving MD in my area so light it up....Now if it's a chest pain with cardiac Hx and a 230/120 then light it up.

:rofl::rofl::rofl::rofl:

Neither of these in isolation require emergent transport with a medic on board.

If I had a nickel for every ICU patient sitting at 75/40....

 

[abckidsmom]

:rofl::rofl::rofl::rofl:

Neither of these in isolation require emergent transport with a medic on board.

If I had a nickel for every ICU patient sitting at 75/40....

I have noted an average diastolic for our clientele of about 100. Is anyone normotensive anymore?

 

[Handsome Robb]

:rofl::rofl::rofl::rofl:

Neither of these in isolation require emergent transport with a medic on board.

If I had a nickel for every ICU patient sitting at 75/40....

I was just thinking the same thing...

 

[Anjel]

Wow....

I hate basics. They give other basics a bad name. No wonder most medics dont trust us.

Ive called for ALS twice, per med controls orders.

Once was for hypotension,chest pain, and a confirmed AAA.

And the other was syncopal episode with hypertension, and chest pain.

 

[Shishkabob]

I have a better one for you, hockey.


When I was working IFT in Dallas, my ALS unit and an ILS unit were posted at the same hospital, when dispatch sent my ALS unit on a BLS transfer for a psych patient, right next door. As we're coming out with the patient, we see the ILS truck leaving, and as I start driving with my EMT in the back, dispatch says when we get to the psych facility, to send me (the Paramedic) to meet up with the ILS unit due to a hypertensive issue.


So we get there, I leave my partner with the patient, and I go off to find the ILS crew. As I walk in, the Intermediate is doing paperwork while the EMT is hanging out with the patient. The Intermediate looks perturbed that I was there, saying "I can handle it, I don't know why they sent you". I check out the patient anyhow.


BP of 260/140, nausea/vomiting, blurry vision, AMS. And they were sitting there doing paperwork. I told them to get the patient on the stretcher and out the door in the next 30 seconds or I'd be getting a supervisor involved. They finally transport and the patient is whisked off to CT, where an intracranial bleed is noticed.



I had a talk with that intermediate afterward. I made it quite clear he screwed up.

 

[johnrsemt]

Basics that get worried/freak out due to HR of 140-160 while running a fever of 104F. Oh wait that was me, until someone sat down and educated me about things like that.

Speaking to the experienced providers out there; All of us were new at one point, most of us had something that worried us until we were taught or learned better.

I have seen basics freak out because of HTN, htn, hi/lo BGL's, HR, fever induced HR (me), exercise induced HR.

Had a basic that spent a weekend working with me; we had multiple chest pains for some reason: he and his BLS partner got waved down the next week for a person having chest pain at a ball park. They called for ALS, me. When I got there they had the patient on the truck, so I climbed in with them and my equipment. They already had her on high flow O2, and had 4 Baby ASA that the patient was chewing on.
WHen I started evaluating the patient the basic got out the spray NTG and was getting ready to give it when I stopped him and told him it wasn't cardiac: He got upset because as a medic "You can't diagnose patients, and can't make the call if it is cardiac or not". She had already told him where she hurt and when it started.
Patient was a fast ball softball pitcher that took a line drive directly to her ribcage, just under and slightly left of her left breast. She was complaining of chest pain, only in that spot, and started approx 10 minutes earlier approx 2 seconds after she got hit.
Fentanyl did wonders for the pain; and it wasn't cardiac when we got her to the ED.

That Basic is a good EMT; and I sat him down and explained to him that we can and do diagnose patients in these situations.


All of these 'new' and 'inexperienced' and 'lousy' basics that we complain about now, have the potential to be us in 5, 10 and 20 years. If someone like us doesn't scare them away.

 

[FourLoko]

If I had actual non-IFT experience and was encountering "normal" human beings I might be more "scared" about a "hypertensive" reading.

With IFT I'm happier to see a high blood pressure than anything borderline low. It's less scary actually because HTN seems to be in every HX I read.

 

[Shishkabob]

With IFT I'm happier to see a high blood pressure than anything borderline low. It's less scary actually because HTN seems to be in every HX I read.

I have many more things to fix low than I do to fix high...

 

[FourLoko]

I have many more things to fix low than I do to fix high...

I'll remember that for later.

 

[DrParasite]

Ive called for ALS twice, per med controls orders.

Once was for hypotension,chest pain, and a confirmed AAA.

And the other was syncopal episode with hypertension, and chest pain.

than you haven't been in this field very long.

knowing when ALS is needed or not needed is part of being a good provider.

bring proud of never calling for ALS, or always cancelling ALS, on sick person calls or those borderline cases is a sign that you are a poor provider.

I've called ALS for borderline stuff. I've called for sick patients. and sometimes we both arrive at the same time, and I will say "since you are here, why don't you check them out and throw them on the monitor?" which I only do to medics who treat BLS providers poorly.

and on one borderline call, I had a 40 year old with chest pain, and when the paramedic arrived, her first words were "why are we here???" I told her "because I have a 40 year old man with chest pain, I don't know why. I've ruled out anything I can think of, maybe you want to take a look? " and while he isn't acutely dying, I don't know what the underlying cause is. they assessed and M+T to the hospital with us. and if they released to us oh well, I wanted to make sure there was nothing else going on that I couldn't detect.

for those paramedics that :censored::censored::censored::censored::censored: about getting called for BS, who cares??? you are paid by the hour right? show up, do an assessment, find the patient stable, write a chart and release the patient to BLS to take to the hospital, and go back to your couch or TV.

 

[Anjel]

than you haven't been in this field very long.

knowing when ALS is needed or not needed is part of being a good provider.

bring proud of never calling for ALS, or always cancelling ALS, on sick person calls or those borderline cases is a sign that you are a poor provider.

I've called ALS for borderline stuff. I've called for sick patients. and sometimes we both arrive at the same time, and I will say "since you are here, why don't you check them out and throw them on the monitor?" which I only do to medics who treat BLS providers poorly.

and on one borderline call, I had a 40 year old with chest pain, and when the paramedic arrived, her first words were "why are we here???" I told her "because I have a 40 year old man with chest pain, I don't know why. I've ruled out anything I can think of, maybe you want to take a look? " and while he isn't acutely dying, I don't know what the underlying cause is. they assessed and M+T to the hospital with us. and if they released to us oh well, I wanted to make sure there was nothing else going on that I couldn't detect.

for those paramedics that :censored::censored::censored::censored::censored: about getting called for BS, who cares??? you are paid by the hour right? show up, do an assessment, find the patient stable, write a chart and release the patient to BLS to take to the hospital, and go back to your couch or TV.

Ive been doing this a year.

I'm not proud I haven't had to call. But I know when to. I know a lot of basics that call ALS just to get rid of the patient, so they don't have as much work to do.

I work in a system where unless it is an IFT, a basic unit and ALS get.sent together on every call. And AlS can determine if they will take it or we can. We also have a good dispatchers who send the appropriate units per the chief complaint.

I'm not afraid or too proud to call. But I know they are a important resource that needs to be available for priority calls, not BS calls that BLS is trying to pawn off.

 

[medichopeful]

But use your brain

Pretty sure they removed that from the EMT-B curriculum

 

[SoCal911]

Bahaha^^ god I'm glad I have a decent partner

 

[themooingdawg]

this job is all about making mistakes and learning from it, its an evidence based medicine. Being new, everything is scary, you're not sure what you're suppose to do in certain scenarios and you're not sure what is the right or wrong thing to do at that time. Everybody makes it, and if you don't, i sure as hell don't want to be your partner or your patient when you do make that mistake.