Did this warrant Lights and Sirens?

[TransportJockey]

With my company (and soon as I type what I'm about to people in this area will know the company) we don't always run EMT/EMT. In my situation today, I was with a driver only. He's not an EMT so I was the only one there.

Wait... Do you work for Capitol? They are the only agency in the metro I can think of that doesn't run EMT/EMT all the time as a minimum

EDIT: And I might be wrong, but I thought to do a CBG, you had to have your IV cert?

 

[JPINFV]

DM with neurological manifestations, Type II

[Socratic method, engaged]

What's the basic pathophysiology behind type 2 DM?

 

[Aidey]

Under the Denver/Metro EMS protocols, we're not equipped for a call like that. If they called us (which they better not if they're worthy of being a nurse), our boss would still send us and on scene, I'd have to call for an ALS unit.

No one worthy of being called a nurse should have called for a BLS transfer for this patient. Even though the facility didn't get a temp as high as you did this patient is very sick. I'm not kidding when I said this is analogous to calling for a BLS transfer for an active MI. Sepsis, and specifically septic shock, have very high mortality rates.

 

[JPINFV]

EDIT: And I might be wrong, but I thought to do a CBG, you had to have your IV cert?

It could be the, "Hi Mrs. Nurse, could you get an updated BGL for the ED please while we get the patient packaged?" game.

 

[Medic29]

Wait... Do you work for Capitol? They are the only agency in the metro I can think of that doesn't run EMT/EMT all the time as a minimum

EDIT: And I might be wrong, but I thought to do a CBG, you had to have your IV cert?

I do lol...I'm looking for an out atm but so hard being so new to Colorado. So I'm getting my BLS experience that I can take elsewhere with me. Like I put in a post about them not too long ago down this category, I'm not gonna let a company with a bad rep destroy me. I'm going to do what I'm trained and make a name for myself. I'm taking this company as a learning experience.

If by CBG you mean a blood glucose, now you got me wondering too. Cause in SD as an EMT I could and I haven't heard otherwise out here. So now I gotta look before I did my self into a hole I'm gonna regret.

 

[FLdoc2011]

Did you get any followup on the case?

 

[Medic29]

Did you get any followup on the case?

I can't get a hold of the EMS coordinators at St. Anthony's atm so I will try again later if not tomorrow morning and I'll place my update here.

 

[Medic29]

[Socratic method, engaged]

What's the basic pathophysiology behind type 2 DM?

I wasn't sure so I had to look it up:

The pathophysiology of Type 2 diabetes mellitus is characterized by peripheral insulin resistance (insulin insensitivity), cell damage, impaired regulation of hepatic glucose production, and later on: declining beta (ß) cell function, eventually leading to possible ß-cell failure.

Taken from http://www.deathtodiabetes.com/Diabetes_-_Pathology.html

 

[TransportJockey]

I do lol...I'm looking for an out atm but so hard being so new to Colorado. So I'm getting my BLS experience that I can take elsewhere with me. Like I put in a post about them not too long ago down this category, I'm not gonna let a company with a bad rep destroy me. I'm going to do what I'm trained and make a name for myself. I'm taking this company as a learning experience.

If by CBG you mean a blood glucose, now you got me wondering too. Cause in SD as an EMT I could and I haven't heard otherwise out here. So now I gotta look before I did my self into a hole I'm gonna regret.

Yep Cap Blood Glucose. And I just looked at Rule 500, it's service discretion for non-IV basics to do it. I know ACA only let IV-Basics do it

 

[JPINFV]

No one worthy of being called a nurse should have called for a BLS transfer for this patient. Even though the facility didn't get a temp as high as you did this patient is very sick. I'm not kidding when I said this is analogous to calling for a BLS transfer for an active MI. Sepsis, and specifically septic shock, have very high mortality rates.

I've been dispatched on chest pain calls when I worked in So. Cal, but my threshold for calling 911 for medics is very low. I agree that it's wrong to dispatch an EMT crew to something like that, but unless the local government regulation agency (be it state or regional) places limitations on what levels can accept what calls, you aren't going to see it go away.

 

[FLdoc2011]

But I agree with the others above. Either at the nursing home level or the company's dispatch end someone should've intervened for an ALS/911 transport.

Especially with the temp you found during transport, that introduces several other serious conditions into the differential.

How was the physical exam... Diaphoretic? Muscle rigidity? Rash/mottling? Bleeding?

On any psych meds?

EKG? Just sinus tach?

 

[Medic29]

Yep Cap Blood Glucose. And I just looked at Rule 500, it's service discretion for non-IV basics to do it. I know ACA only let IV-Basics do it

I'll check with my EMS coordinator then. Cause all our rigs are stocked with it and only a few of us can do IVs. My trainer (who now works for ACA) told me it was ok for me to do during the first emergency I ran while under her care. Granted, listening to her doesn't make up for not checking with my coordinator, it was a trust thing and that's where I could be wrong.

Man I've got so many things I have to re-learn again since my scope is much different than in SD.

 

[JPINFV]

Especially with the temp you found during transport, that introduces several other serious conditions into the differential.

The problem is once you get there it also becomes a question about ETA. However if I decided that I needed to go L/S, then every action after that involved moving towards the ambulance. If I don't have a full set of vitals before I reach the hospital, then so be it, they weren't going to change anything at the EMT level anyways (provided, of course, that the vitals are present). I've had one call where my on scene (not even patient contact) time to arrival at the hospital was 7 minutes with a 0.25 mile transport (funky DNR wording, patient expired a few hours later).

 

[Aidey]

I've been dispatched on chest pain calls when I worked in So. Cal, but my threshold for calling 911 for medics is very low. I agree that it's wrong to dispatch an EMT crew to something like that, but unless the local government regulation agency (be it state or regional) places limitations on what levels can accept what calls, you aren't going to see it go away.

I know, I'm just in a mood and not very tolerant of crappy decision making right now.

But I agree with the others above. Either at the nursing home level or the company's dispatch end someone should've intervened for an ALS/911 transport.

Especially with the temp you found during transport, that introduces several other serious conditions into the differential.

How was the physical exam... Diaphoretic? Muscle rigidity? Rash/mottling? Bleeding?

On any psych meds?

EKG? Just sinus tach?

I doubt they got an EKG...as a BLS agency they probably only carry an AED.

 

[JPINFV]

I doubt they got an EKG...as a BLS agency they probably only carry an AED.

There's always what the hospital got on the monitor.

 

[Medic29]

But I agree with the others above. Either at the nursing home level or the company's dispatch end someone should've intervened for an ALS/911 transport.

Especially with the temp you found during transport, that introduces several other serious conditions into the differential.

How was the physical exam... Diaphoretic? Muscle rigidity? Rash/mottling? Bleeding?

On any psych meds?

EKG? Just sinus tach?

Nothing other than his BGL, respirations, and pulse (outside of his temp) were abnormal. He has a solid normal skin color, full control of muscles, no rash nothing. No bleeding. Normal pupil response. Clear lungs on both sides. It was very odd. The call we had this morning (that my normal partner ran) was a sepsis call from a personal residence and had a temp of 10x and vitals were unstable. This guy went unconsious during transport to Porter. They were close enough to the hospital that at his judgment it would have taken longer for an ALS unit to get there than it would for him to just go. We had complete opposite patients.

 

[FLdoc2011]

The problem is once you get there it also becomes a question about ETA. However if I decided that I needed to go L/S, then every action after that involved moving towards the ambulance. If I don't have a full set of vitals before I reach the hospital, then so be it, they weren't going to change anything at the EMT level anyways (provided, of course, that the vitals are present). I've had one call where my on scene (not even patient contact) time to arrival at the hospital was 7 minutes with a 0.25 mile transport (funky DNR wording, patient expired a few hours later).

I agree. He was already there and what was done was done. I am also not an EMS expert and the current system here in my county is basically a single tier all ALS systems so that's what I'm more familiar with.

 

[the_negro_puppy]

Do we know what medications this patient was on?

 

[Achilles]

Where you take a temp at? Oral or axilary or rectum ???

 

[Medic29]

Do we know what medications this patient was on?

The list the nursing home gave me I left with the hospital. I don't need to put them in any of my reports so I don't keep them. I only keep for my report purposes are a list of allergies.