Silly things your instructor said

[EMT91]

Misrepresenting what you are giving your pt is unprofessional, unethical, and if caught could mean you lose your license. You are doing your pt no favours by being dishonest with them. It blows my mind how little integrity some EMTs and Medics have.

Agreed. I never thought I would do it, nor did I say I would. If the pain is caused by being dehydrated, then I might explain that giving saline, which is not a pain killer, MAY help to relieve the pain.

 

[Medic Tim]

Agreed. I never thought I would do it, nor did I say I would. If the pain is caused by being dehydrated, then I might explain that giving saline, which is not a pain killer, MAY help to relieve the pain.

I wasn't singling you or anyone else out. Just an observation from being on here for a bit and past experiences.

 

[Hunter]

Stupid instructor tricks:

"Treat the patient not the monitor"

"A radial pulse means a pressure of at least 80"

"Always have a line before NTG"

This is all stuff I've heard from instructors in the last year.

But the first and third is really good advice for a paramedic right out of school so, wether they annoy you or not

 

[CritterNurse]

Just after Michael Jackson died, my grandmother had to go under anesthesia for minor surgery. She had had Propoflo before without any problems, but she was terrified that she would die if the doctor gave her "what killed Michael Jackson". I was with her when she met with the doctor since she is a bit hard of hearing, and sometimes needed medical terms explained in plain English. When he said she would be given Propoflo, I saw her get a bit of a panicked expression as she asked the doctor to repeat himself. I stepped in and said that she'd be getting Propofol (the generic name). She then nodded and said that would be alright. The pronunciation was different enough to relax her. She was scared enough about having to go for surgery.

 

[usalsfyre]

But the first and third is really good advice for a paramedic right out of school so, wether they annoy you or not

It has nothing to do with annoying me and more to do with the gross misunderstanding of medicine they promote.

 

[airborne2chairborne]

Misrepresenting what you are giving your pt is unprofessional, unethical, and if caught could mean you lose your license. You are doing your pt no favours by being dishonest with them. It blows my mind how little integrity some EMTs and Medics have.

Integrity doesnt just apply to what you say it applies to doing what's best for the patient. If your patient is against saline because he thinks its not enough (despite his medical knowledge ending with bandaids) and you know that's what he needs, I dont see any ethical discrepency with saying "ok, then how about NaCl?" Unless there is a med out there called norma sal in I dont see a difference, you're just pronouncing it goofy. saying you'll give him LR when you actually hook up NS would be unethical.

 

[Handsome Robb]

Integrity doesnt just apply to what you say it applies to doing what's best for the patient. If your patient is against saline because he thinks its not enough (despite his medical knowledge ending with bandaids) and you know that's what he needs, I dont see any ethical discrepency with saying "ok, then how about NaCl?" Unless there is a med out there called norma sal in I dont see a difference, you're just pronouncing it goofy. saying you'll give him LR when you actually hook up NS would be unethical.

That's when I tell them there's a reason I'm the one sitting in the chair while they are on the gurney.

I'm with Kyle on this one. If you are misleading them intentionally it's unethical.

Just like I don't tell people or their families that they are OK. I tell them the truth and what I think, then I tell them I'm going to take good care of them and get them to the help they need. I'm not a doctor and I'm not gonna be the guy on the receiving end of a company's wrath when a patient dies and the first the the family says is "The paramedic said he was going to be fine!!!"

 

[JakeEMTP]

"Treat the patient not the monitor"

This should depend on the context of the discussion.

The values of a well functioning monitor should definitely be considered as part of your assessment.

However, there are situations where the what you are seeing on the monitor and the appearance of the patient are not in sync. You might have a patient with crushing chest pain and diaphoresis but have NSR in 3 leads on the monitor. In that case further assessment should follow and more diagnostics if available to you for the treatment.

You could also have varying results on a pulse oximeter. Some will turn their attention away from the whole patient and focus just on getting an SpO2 reading by repeatedly squeezing and warming each finger until they get what they think is a satisfactory reading while wasting several minutes not performing other assessments.

You could also have the 3 pk a day cigarette smoker or nonsmoker bartender in bar that still allows smoking who is short of breath but has an acceptable SpO2 of 98%. His actual blood saturation value might be closer to 88%.

Sometimes you might get a patient which seems to be an inbetween size for all of your BP cuffs and you get strange numbers with each one. Even with a palpated systolic the surrounding tissue gives you a problem with feeling a brachial or radial. You could try the leg or you may just have to rely on mentation and cap refill.

I think also some instructors want to emphasize the use of all the senses and not just the technology to make decisions on a plan of care. That doesn't mean the monitor should be disregarded. But neither should the statement mentioned above in certain circumstances.

 

[EMT91]

Agreed about treating patients. The medic I did my basic ride a long with really disliked the pulse ox reader.

 

[airborne2chairborne]

Can ANY EMT/paramedic honestly say they've been 100% truthful with all patients? This includes worrying about your own safety with psych patients or telling a patient you don't think he'll last to get discharged from the hospital. I'm all for honesty, unless it makes a patient's condition worse. The "the patient had a heart attack because the paramedic stressed him out" isn't a recieving end you want to be on either

 

[Handsome Robb]

Can ANY EMT/paramedic honestly say they've been 100% truthful with all patients? This includes worrying about your own safety with psych patients or telling a patient you don't think he'll last to get discharged from the hospital. I'm all for honesty, unless it makes a patient's condition worse. The "the patient had a heart attack because the paramedic stressed him out" isn't a recieving end you want to be on either

I didn't say stress them out. I said be honest with them. Doctors are honest, why shouldn't we be? It's their body, their medical condition, they have a right to know.

 

[EMT91]

I will never lie but I will never say 'hey kids your dad here on my gurney is a goner. Say goodbye.' I would tactfully and lovingly say 'I am doing all I can to help.'

 

[airborne2chairborne]

There was a study done recently that showed that patients with chest pain were more likely to code during transport where the siren was blazing because of the added stress. Maybe this is just my opinion, but if I was on a gurney I think the words "I don't think you're gonna make it" or even the paramedic saying "they'll do all they can for you" (which might as well be saying "i don't think you're gonna make it") when I ask if I'm going to be all right or not would stress me out more than a siren. that's just my $0.02, everyone is different though.

 

[Achilles]

Did you guys know there's a new method for choking infants? You lay the infant on its back and move the legs up and down, this moves the diaphragm and air is exhaled out! It's really cool!

 

[airborne2chairborne]

I've just been letting them play with small snack-sized objects, is that what I've been doing wrong?

 

[usalsfyre]

"Treat the patient not the monitor"

This should depend on the context of the discussion.

The values of a well functioning monitor should definitely be considered as part of your assessment.

However, there are situations where the what you are seeing on the monitor and the appearance of the patient are not in sync. You might have a patient with crushing chest pain and diaphoresis but have NSR in 3 leads on the monitor. In that case further assessment should follow and more diagnostics if available to you for the treatment.

You could also have varying results on a pulse oximeter. Some will turn their attention away from the whole patient and focus just on getting an SpO2 reading by repeatedly squeezing and warming each finger until they get what they think is a satisfactory reading while wasting several minutes not performing other assessments.

You could also have the 3 pk a day cigarette smoker or nonsmoker bartender in bar that still allows smoking who is short of breath but has an acceptable SpO2 of 98%. His actual blood saturation value might be closer to 88%.

Sometimes you might get a patient which seems to be an inbetween size for all of your BP cuffs and you get strange numbers with each one. Even with a palpated systolic the surrounding tissue gives you a problem with feeling a brachial or radial. You could try the leg or you may just have to rely on mentation and cap refill.

I think also some instructors want to emphasize the use of all the senses and not just the technology to make decisions on a plan of care. That doesn't mean the monitor should be disregarded. But neither should the statement mentioned above in certain circumstances.

I've seen one or two patients and can't say I've ever seen a pulse ox OVERstate SpO2.

All the above falls under the category of "clinical correlation". If an instructor can't teach this concept appropriately than I question if they have the knowledge base to instruct at the advanced level.

 

[usalsfyre]

There was a study done recently that showed that patients with chest pain were more likely to code during transport where the siren was blazing because of the added stress. Maybe this is just my opinion, but if I was on a gurney I think the words "I don't think you're gonna make it" or even the paramedic saying "they'll do all they can for you" (which might as well be saying "i don't think you're gonna make it") when I ask if I'm going to be all right or not would stress me out more than a siren. that's just my $0.02, everyone is different though.

Citation on the research?

It's about having the ethical fortitude to be honest. The patient is going to have to know. Sooner is better than later. Early in my career I took the easy way out. I've been 100% honest with my patients the last several years and have yet to have a problem.

 

[JakeEMTP]

I've seen one or two patients and can't say I've ever seen a pulse ox OVERstate SpO2.

The SpO2 number is a combined reading. Unless you have a Rad57 equipped for the other 2 values you will not know the break down. In other words, that number does not mean the actual oxygen saturation. There are other components such as Carboxyhemoglobin and Methemoglobin which make up the total saturation measured by a pulse oximeter. If a heavy smoker has an SpO2 of 98%, 10% of that could easily be Carboxyhemoglobin. This is the same as someone exposed to smoke inhalation in a fire. The Carboxyhemoglobin may give you an SpO2 of 100% but that is not the actual saturation of the blood. The combination of the Carboxyhemoglobin plus the hemoglobin saturated by oxygen gives you the total SpO2.

Methemoglobinemia at a very high critical level will also give a higher value on the SpO2 than the actual oxygen saturation. At lower levels of methemoglobin the SpO2 may read fairly accurately.

Various light sources may give you a higher SpO2 than what the patient is.

There are alot of things that must be clinically correlated when using a pulse oximeter.

 

[Aidey]

Methemoglobinemia also causes the pt to be cyanotic, quite dramatically in some cases. If you somehow manage to miss that it is probably time to find a new job.

 

[JakeEMTP]

double post