the 100% directionless thread

[NomadicMedic]

How dare I ask a nurse if 98/60 is normal for the 300lb CHF, COPD, CAD pt that I am taking to a nursing home.

Got my head ripped off.

I got in the habit of ripping back. I'd stand right up and get out my pad, "what's your supervisors name? How do you spell your last name? Whats the phone number I call to speak with your supervisor". I never backed down if that stuff happened. Worked like a champ for me.

However, I'm a rather aggressive Type A who doesn't take to being spoken to like a child very well. So, YMMV.

 

[Anjel]

HA! nice!

 

[Anjel]

I got in the habit of ripping back. I'd stand right up and get out my pad, "what's your supervisors name? How do you spell your last name? Whats the phone number I call to speak with your supervisor". I never backed down if that stuff happened. Worked like a champ for me.

However, I'm a rather aggressive Type A who doesn't take to being spoken to like a child very well. So, YMMV.

Yea I will stand up for myself which I did, but it was better just to walk away then to get a complaint. I am new still.

 

[Handsome Robb]

Back to my seat in the airway chair tomorrow and starting phase 4 of my internship. No help on assessment or skills from my preceptor...unless someone is dying or I'm doing it wrong.

Kinda nerve racking. I'm still having trouble deciding ALS vs. ILS/BLS. My tendency is probably too cautious and I tend to make patients ALS that probably could have been ILS but I guess that's better than missing something big because I dished the call to my I.

 

[adamjh3]

Back to my seat in the airway chair tomorrow and starting phase 4 of my internship. No help on assessment or skills from my preceptor...unless someone is dying or I'm doing it wrong.

Kinda nerve racking. I'm still having trouble deciding ALS vs. ILS/BLS. My tendency is probably too cautious and I tend to make patients ALS that probably could have been ILS but I guess that's better than missing something big because I dished the call to my I.

It's easier to justify instability than stability, so I hear ya. Just pretend the hospital is full of lawyers and you have to explain why you made your decisions to them.

Unless they're dead. Then they're totally stable

 

[Medic Tim]

8 hours into my 12 and only 1 call at the start of the shift. I hate slow shifts, they seem to go on foreverrrrrrrr

 

[ATrain]

I got to write on internship paperwork yesterday, "R/O implanted defibrillator firing secondary to vigorous masturbation".

 

[Anjel]

Was just attacked my a 93 yr old women. Scratches on my arms and.chest and bruises on my boobs where she latched on and wouldnt let go.

Took two men to get her off me.

 

[titmouse]

Was just attacked my a 93 yr old women. Scratches on my arms and.chest and bruises on my boobs where she latched on and wouldnt let go.

Took two men to get her off me.

Thats one strong 93 yo lol

 

[bigbaldguy]

Was just attacked my a 93 yr old women. Scratches on my arms and.chest and bruises on my boobs where she latched on and wouldnt let go.

Took two men to get her off me.

I don wunna go gramgrams house her snuggles hurt.

 

[usalsfyre]

The worst @ss kickings you will receive are from old women and kids, because it's impossible to fight back.

 

[Shishkabob]

How dare I ask a nurse if 98/60 is normal for the 300lb CHF, COPD, CAD pt that I am taking to a nursing home.

Got my head ripped off.

And you didn't rip right back? Said nurse would be regretting her decision to :censored::censored::censored::censored::censored: at me after I got done. Wouldn't be the first time I corrected their ill-placed abger. And several times, a doctor was right next to us and backed me on it.


Oh the look on a nurses face when a doctor tells them to be quiet because the lowly ambulance driver is right... priceless.

 

[adamjh3]

Was just attacked my a 93 yr old women. Scratches on my arms and.chest and bruises on my boobs where she latched on and wouldnt let go.

Took two men to get her off me.

http://www.youtube.com/watch?v=l-Yl_kAE4eg&feature=youtube_gdata_player

 

[FourLoko]

Yea I will stand up for myself which I did, but it was better just to walk away then to get a complaint. I am new still.

Sucks doesn't it? I'm not really new anymore but I know the quickest way to get fired. Already lost one partner.

We got a call yesterday to take a PT from an assisted living facility to the ER. Closest ER is literally two blocks away. Oh but her doctor is at the other hospital 15 - 20 minutes away.

My partner points this out and the first sentence out of the "nurses" mouth includes the name of the OWNER of our company. I ran away.

Such politics. All about that paper!

 

[exodus]

The most appropriate still would be the other ER. That dr knows the patient. Also, was it really an emergency that needed to go to the closest? Or do you go to the most appropriate here?

 

[Aidey]

How often does a patient see their own doctor for an EX visit? Around here the short answer is statistically never. Everyone has an on call doc that does their admitting. The only time you would see your personal MD is if they happen to also be the on call person.

There is also the question of what type of doc are they talking about? If your pulmonologist is at Saint Anne's 20 miles away and you fell down and hurt your knee that doesn't make Saint Anne's the automatic choice.

 

[Epi-do]

But, if you are taking the patient for an issue that is going to require admission, and the patient's doc has privileges at hospital B, but not hospital A, the second hospital most likely is going to be the best one. Granted, you aren't going to know if the doc has privileges, but if he is specifying a particular hospital, there is a very good likelihood that they do.

 

[exodus]

Only reason to not go 15-20 mins away is laziness if theres not an emergency.

 

[Shishkabob]

How often does a patient see their own doctor for an EX visit? Around here the short answer is statistically never. Everyone has an on call doc that does their admitting. The only time you would see your personal MD is if they happen to also be the on call person.

There is also the question of what type of doc are they talking about? If your pulmonologist is at Saint Anne's 20 miles away and you fell down and hurt your knee that doesn't make Saint Anne's the automatic choice.

I mention that to patients all the time when they say their doctor is at a hospital.

"Yes, but your gasteroenterolgist is not going to be in the ER at 3am on a Friday to come see you for a leg that's hurt you for 5 days" But alas, getting common sense and correct information out to the general public is all but impossible when they're set in their ways.

Only reason to not go 15-20 mins away is laziness if theres not an emergency.

"Policy dictates in an emergency, to transport to the closet appropriate facility"
"But this isn't an emergency"
"And yet you called 911"

 

[Aidey]

Honestly we run into this one most often with pulled J-tubes. The local EDs have made it VERY VERY clear they do not reinsert them in the ED. Period. End of discussion. They put in a foley to keep the site open and send the pt back with instructions to schedule an appointment with interventional radiology.

Only reason to not go 15-20 mins away is laziness if theres not an emergency.

There is actually one very good reason. Medicare/Medicaid pay mileage for the closest appropriate hospital. If you have a simple issue that can be dealt with at the closest hospital they will not pay the mileage difference to go to the further away hospital. There is an exception to this if the hospitals are close together (I think it is within a mile, but I'm not 100% sure). Depending on what a company charges for mileage that can get expensive fast.

And I will admit to overruling patients very rarely because of this. We had an older lady with a classic UTI presentation. She had just moved from one side of town to the other a couple weeks previously, and was confused and believed she was still living 4 blocks from hospital A, when really she was now 16 miles away, and only 4 blocks from hospital B. It would have been a nearly $300 charge if we had taken her to hospital A. Since the hospitals records systems are linked we knew there would be no issues there. Staff also told us that she moved there to be closer to her family (who they couldn't get a hold of) and I have a suspicion they would have been pissed if we had taken her to the further away hospital.