Any comments on this one......

EMT--- next time something is done on scene you don't agree with (or as in this case, learn to not agree with), if it's not unsafe to the patient, bite your tongue, do it, and then after the call discuss it with the 'in-charge'.


Don't ever question the person running the call on scene if it's a technical difference... but don't be afraid to question them after the fact. However, if it's a safety concern, question right then and there to your hearts content.
 
emt seeking first job said:
He complied when three EMTs, his wife, daughter and grandaughter all agreed he should have it (mass suggestion).
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This does not sound like he was satisfied with your answer, it sounds like he decided that it would make his family feel better so he played a long.

emt seeking first job said:
So my question his, assuming he was not senile, wouldnt any MD know that it was appropriate to give 02 in that instance ?
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It was not appropriate to give o2 in that situation. But many doctors do not simply call somebody out as being wrong, often they listen to the reasoning and make a decision based on that.

I am willing to bet his decision wasn't that what you were doing was right, but that to comply with people who didn't know what they were doing was going to get him to people who did faster/with less stress than arguing.
 
Linuss said:
EMT--- next time something is done on scene you don't agree with (or as in this case, learn to not agree with), if it's not unsafe to the patient, bite your tongue, do it, and then after the call discuss it with the 'in-charge'.


Don't ever question the person running the call on scene if it's a technical difference... but don't be afraid to question them after the fact. However, if it's a safety concern, question right then and there to your hearts content.
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Thank you.

I will add that everyone at my service is receptive to questions after the call and some even ask me if I have any questions. Some even go farther to quiz me as what to do on the way to the job, or ask me why we did something after it.
 
The REAL Paramedic Cookbook:

Examine the patient.

Initiate accordingly.

Examine the patient.

Adjust accordingly.

Examine the patient.

Adjust accordingly.

Repeat.

Deliver.
 
emt seeking first job said:
One of the cardinal rules of the public safety professions is if you are the new guy, keep your ears and eyes open and your mouth shut.
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There are a lot of things wrong with public safety culture, and that is definitely one of them. Old guys have experience, new guys (hopefully) have the most up to date knowledge. There's also a place for a fresh set of eyes or a new prospective. New guys should be asking questions, sometimes tough questions, and there should always be an answer that never includes "tradition" or "that's how I was taught back when I took EMT class with Galen."

However, there's also a time and a place to question orders. Oxygen is not perfectly safe. Oxygen is, however, one of the most benign drugs that EMS administers. That doesn't mean that every patient should receive oxygen, but I'm not entirely sure if it would be worth getting into an argument on scene. It would be like getting into an argument about saline lock vs saline TKO on scene.
 
No one is saying to argue it or refuse to do it. We are saying to question the "why" you are doing it. If the pt does not need O2, then ask the "crew cheif" why he wants them on it.

If all you are going to do is sit back and blindly follow orders, you will never be a very good provider. This is not the military, the police dept. or the Fire service. You have the right and justification to question why a treatment is being done, if it is not needed.

This man mostly likely gave in, to keep his family happy. The fact that an MD is questioning your use of O2 should have made you step back and think about why you were doing it.

We are not public safety. We are a medical provider. Please lose all that garbage that they are filling your head with.
 
Seeing the age of the patient would make me think there is something more underlying going on. If the patient is senile then he is not dependable to give accurate information. Asking a few questions you should be able to see if he can be reliable. O2 can never hurt with just a couple of liters on a nasal cannula.

They key being that his BP has been varying. I would be more suspicious of cardiac issues. I noted that his pulse is 42. Is he on beta blockers that may be causing the bradycardia since his BP tells us he's perfusing? Then again he could be fine while at rest but as soon as he moves around or walks the bradycardia may be much for him causing his bradycardia to worsen and the BP to drop and thus the syncope. There could be a chance he could be come hypoxic from poor perfusion and have seizures.
 
emt seeking first job said:
Well if god forbid, the patient has a bad outcome, I would want to be that guy who can defend his actions with the protocols.

I dont want to be that guy who has to explain why he did not follow the protocols.

Seven years in insurance claims left me with the impression that its best to follow what the standard procedure is.
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I'd rather be the girl who could defend her actions with education and knowledge rather than "Oh he told me too.."

"Why didn't you put the patient on oxygen?" "Based on my assesment the patient was not exhibiting signs of hypoxia, and oxygen wasn't indicated."

"Just following orders" is not a good defense at all.
 
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Sasha said:
"Why didn't you put the patient on oxygen?" "Based on my assesment the patient was not exhibiting signs of hypoxia, and oxygen wasn't indicated."
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He may not exhibit signs while at rest. I would bet once he gets up and starts moving he may due to decreased cardiac output during exertion. It's not a respiratory problem.....it appears cardiac. My suspicion due to varied blood pressures with bradycardia. To know for sure you really need more info. I've had patients look fine and still code on me later...it's better to over treat than under treat. Just as long as you remember....Do Not Harm....you can never go wrong.
 
Seeing the age of the patient would make me think there is something more underlying going on. If the patient is senile then he is not dependable to give accurate information
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Just because he's old, doesn't mean he's senile or that there's "more underlying going on". I am working on a book about WWII veterans and a lot of these guys are in their 90s and in better health than a lot of 30 to 40 years old I know. Apparently the patient in this scenario is sharper than the OP because he was able to accurately frame his concerns and bring up issues the young folks didn't know about.

Just as long as you remember....Do Not Harm....you can never go wrong.
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Yeah....giving oxygen never does harm. *rolls eyes*


There could be a chance he could be come hypoxic from poor perfusion and have seizures
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Any idea how infrequent convulsions (true convulsions, not just twitching) actually occur as a result of hypoxia? It seems like you're trying to piece together what little you know about cardiac and respiratory physiology to fit the need of the OP to justify the administration of oxygen to this patient.
 
volparamedic said:
it's better to over treat than under treat.
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Over treatment is just as bad as under treatment.

"The delivery of good medical care is to do as much nothing as possible."
Law 13. The House of God.
 
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it's better to over treat than under treat.
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I love when people put that one out as a defense. It gives me plenty of work as an expert witness.
 
^
Make House of God required reading for all EMT students. The Laws of the House of God are more widely quoted in EMS than many people realize.
 
I finally red House of God earlier this year, and it is a little scary how applicable it is, all these years later.

I rather liked the rule that you can't find a fever if you don't take a temperature. I think the EMS corollary to that is the pulse ox.
 
That was 9 pages of interesting, head shaking reading! The entire BLS crew on that call sounded like a bunch of idiots who had no clue what was going on with the patient. So the patients heart rate was in the 40's.... was the patient symptomatic of the low HR? It sounds like the patient was pretty stable to me.

I had to laugh when I read that the most experienced EMT didn't want to move the patient out of fear that his heart may stop... really?

Here is some more reading on the dangers of high-flow oxygen when not indicated: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1809170.

EMT Seeking... I get you want to be liked and you think your doing the right thing... but it sounds like you are being taken advantage of. Let the Medic clean their own mess. Its not your job! They made it, they clean it.

So what did the Medic think was causing the Bradycardia? Did the Medic provide any ALS tx?
 
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