If im not mistaken, sometimes nausea and vomiting could be the only symptom of myocardial infarction. Especially in older populations where there may be little to no pain at all
Cardiac problems can present with nausea?
Oh my. I guess everyone who is nauseous does need an EKG then.....
While we are at it I suppose we better CT every headache, spinal tap every stiff neck, and culture every cough.
And just to be safe, let's give everyone oxygen and use c-spine precautions for all trauma.
Don't put too much faith in the training levels listed in our members' profiles. They aren't always updated, accurate, and sometimes people choose a student level because they believe they are always learning in this field.
That's a pretty poor outlook to have as a healthcare provider.
And yes, N/V can be an anginal equivalent.
This.IV goes in when I need to give an IV med or reasonably think I will need to give one / pt is at risk of deteriorating.
I do not think he was arguing that N/V can be an anginal equivalent but rather that every N/V complaint should get a 12 lead. A 60 y/o Diabetic female smoker complaing of N/V? Of course.
Just as a new LBBB can be a STEMI equivalent not every patient is getting an emergent cath.
We keep drifting back and forth here, but I think we should focus a little because the OP's original question was an important one.
- Yes, starting an IV when not indicated IS fraud, if you bill for it. It is the very definition of fraud, in fact. That isn't my opinion, that is how CMS and the insurance companies and the courts see it. People - usually physicians but not always - are sued and fined and have their CMS "privileges" revoked for medically unnecessary procedures all the time.
- Starting an IV (or performing any other procedure) without a true indication, even if it doesn't rise to the legal definition of fraud (perhaps because you don't bill for it), is still wrong any way you look at it. You will not find a professional association that endorses exposing patients to the discomfort and risk of unnecessary procedures for "practice", nor would you likely be able to argue that you were following the standard of care or acting in the patient's best interest if some serious complication were to arise from a procedure that you performed just because you hadn't done one in a while. Not to mention the fact that it requires you to falsify the medical record, that is unless you actually document "IV started just because I need the practice".
- As far as what constitutes whether or not an IV or other procedure is indicated, well that is obviously up for debate. I think it is silly to do something in the field just because "they are gonna do it in the ED". I disagree that nausea is an indicator for an EKG for instance, but obviously there are those that disagree with me. I don't think most patients should be back boarded or have a NRB placed, but there are those who disagree with me. So that's the real question here, I think.
I think this whole discussion may be moot. With the Affordable Health Care Act in affect, EMS may see big changes, one being accountability. For EMS companies, I see a big change looming and every penny spent will need paperwork. By 2018 I foresee a whole new practice in the US EMS system. In other words, you drop an IV, better have a reason. Just my prediction/opinion.
I also believe big changes are coming for EMSBy 2018 I foresee a whole new practice in the US EMS system.
I also believe big changes are coming for EMS
Such as? I've heard very little about how the ACA might affect EMS.
Emergency/Trauma Regionalization – Law directs the Secretary of HHS, acting through the Assistant Secretary for Preparedness and Response (ASPR), to award at least four multi-year contracts or competitive grants to support pilot projects that design, implement and evaluate innovative models of regionalized, comprehensive and accountable emergency care and trauma systems.
Trauma Centers – Law requires the Secretary of HHS to establish three programs to award grants to qualified public and Indian trauma centers that would assist in defraying substantial uncompensated care costs; further the core missions of trauma centers (including addressing costs associated with patient stabilization/transfer, trauma education/outreach, coordination with local/regional trauma systems, essential personnel and other fixed costs, and expenses associated with employee/non-employee physician services); and provide emergency financial relief to ensure the continued/future availability of trauma services.
Emergency Medicine Research – Law requires Secretary of HHS to support federal programs administered by NIH, AHRQ, HRSA, CDC and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine, including: (1) the basic science of emergency medicine; (2) the model of service delivery and the components of such models that contribute to enhanced patient health outcomes; (3) the translation of basic scientific research into improved practice; and (4) the development of timely and efficient delivery of health services. In addition, the Secretary of HHS is required to support research to determine the estimated economic impact of, and savings that result from, the implementation of coordinated emergency care services.
This from the ACA. This could be a good thing in some ways and bad in others. From the driving routes we take to hospital x, to the non-emergent patients we routinely transport. Affordable health care will change EMS as we know it. Again just my prognostication.
all that stuff and more is probably enough for it to justify its own thread. I think there are a lot changes coming down the pipeline. Looking forward to it.
Quite Possibly if your ambitious start the thread I would be looking forward to hear how this going to work and elaborate a little bit better