the 100% directionless thread

[DragonClaw]

Ofc not. She’s still in the mindset of CPR “saving the patient” because it’s the most radical intervention she’s legally allowed to do, but hasn’t done enough of yet since she doesn’t work a 911 response. Once she work a code a few times, she’ll learn that even without PPE it’s a sysiphean task in most cases.

As previously stated, yeah I have done CPR. And, I mean you don't do CPR to kill them. At least I don't. I know CPR means there's a pretty good chance they're not coming back and even if they do the chances of them being like they were is like nil, plus the quality of life is low and disability is high.

But without a DNR, what are you going to do? "Not feel like it"?

Edit: And isn't our whole job "Sisyphean"? We do the same things. Transporting sick and injured and then those who don't even need it and then AMAing those who do.

The human condition is terminal. Do you really think you're going to grant anyone immortality?

 

[DesertMedic66]

As previously stated, yeah I have done CPR. And, I mean you don't do CPR to kill them. At least I don't. I know CPR means there's a pretty good chance they're not coming back and even if they do the chances of them being like they were is like nil, plus the quality of life is low and disability is high.

But without a DNR, what are you going to do? "Not feel like it"?

In a lot of areas if the resuscitation is considered futile providers may stop. Also in this current time with COVID you have to assess risk vs benefit.

 

[DragonClaw]

In a lot of areas if the resuscitation is considered futile providers may stop. Also in this current time with COVID you have to assess risk vs benefit.

Okay well not in my protocols. There's a lot of people we take home on hospice without a DNR (cringe every time) and if any of them code, I'd work them in a heartbeat. That's our protocols and if it's that terrible, I can leave the company and go find a new medical director. But this is the job I signed up for.

Maybe medics get more leeway. But I don't.

Edit: And by "Feel like" I don't mean there's some protocols that allow you to stop. I mean you literally don't care so won't be bothered. You guys seem to really dodge this scenario.

 

[Qulevrius]

As previously stated, yeah I have done CPR. And, I mean you don't do CPR to kill them. At least I don't. I know CPR means there's a pretty good chance they're not coming back and even if they do the chances of them being like they were is like nil, plus the quality of life is low and disability is high.

But without a DNR, what are you going to do? "Not feel like it"?

Edit: And isn't our whole job "Sisyphean"? We do the same things. Transporting sick and injured and then those who don't even need it and then AMAing those who do.

The human condition is terminal. Do you really think you're going to grant anyone immortality?

I don’t know how you manage to miss the point, every time. Like, whoosh-whoosh, 100 ft over your head. And then coming up with cliches. But here, let me explain this again:

This isn’t an ordinary situation. We are healthcare providers during a pandemic, who have the already difficult procedures being complicated. You aren’t doing anyone any favours by doing everything by the book, only because that’s the “right thing to do”. There are times when something that could work in a regular situation, will absolutely NOT work because of added comorbidity. But this knowledge is beyond your scope and your level of training. You simply do not know what you do not know, as it’s been repeatedly pointed out.

 

[CALEMT]

 

[DragonClaw]

I don’t know how you manage to miss the point, every time. Like, whoosh-whoosh, 100 ft over your head. And then coming up with cliches. But here, let me explain this again:

This isn’t an ordinary situation. We are healthcare providers during a pandemic, who have the already difficult procedures being complicated. You aren’t doing anyone any favours by doing everything by the book, only because that’s the “right thing to do”. There are times when something that could work in a regular situation, will absolutely NOT work because of added comorbidity. But this knowledge is beyond your scope and your level of training. You simply do not know what you do not know, as it’s been repeatedly pointed out.

I would say the point is missed by you equally and oppositely.

Doing things "by the book". You mean what the dr with more clinical experience than you or me that decides how to handle things during a pandemic or otherwise? You mean following protocols that keeps me within the guidelines and allows me to keep my job?

You've missed my pretty straight forward question to add variables that weren't required to then say now it's too complex to say I'm wrong on a question that hasn't been answered.

But okay.

 

[DragonClaw]

View attachment 4870

Me too little buddy.

They called me salmonella growing up because is go catch all the reptiles and take them home as pets.

 

[GMCmedic]

Okay well not in my protocols. There's a lot of people we take home on hospice without a DNR (cringe every time) and if any of them code, I'd work them in a heartbeat. That's our protocols and if it's that terrible, I can leave the company and go find a new medical director. But this is the job I signed up for.

Maybe medics get more leeway. But I don't.

Edit: And by "Feel like" I don't mean there's some protocols that allow you to stop. I mean you literally don't care so won't be bothered. You guys seem to really dodge this scenario.

Are you suggesting were not empathetic and that's why we wouldn't work certain things? It's not a lack of empathy, it is experience. Under normal circumstances were not just going to ignore our duty. We will work that prehospital code knowing that at best they have a ~10% chance of living a normal life again.

Were not living normal circumstances, All arrests should be getting full PPE right now and donning that properly is going to eat precious time. Welcome to our new reality.

You are correct, Medics do have leeway. Is that hospice patient going home to die and they just dont have the DNR completed yet? One phone call to the ER and problem solved. No local Doc is going to ask me to work that, and not working it is the appropriate thing to do, but here is the kicker......you can also make that phone call.

 

[DragonClaw]

Are you suggesting were not empathetic and that's why we wouldn't work certain things? It's not a lack of empathy, it is experience. Under normal circumstances were not just going to ignore our duty. We will work that prehospital code knowing that at best they have a ~10% chance of living a normal life again.

Were not living normal circumstances, All arrests should be getting full PPE right now and donning that properly is going to eat precious time. Welcome to our new reality.

You are correct, Medics do have leeway. Is that hospice patient going home to die and they just dont have the DNR completed yet? One phone call to the ER and problem solved. No local Doc is going to ask me to work that, and not working it is the appropriate thing to do, but here is the kicker......you can also make that phone call.

I'm suggesting that sometimes people do get lazy, empathetic and complacent. Yes. But be clear, I am not accusing you of such as I'm sure y'all have reasons. And if it was a matter of laziness I doubt anyone here would refuse to act.

Most of the time the family refuses a DNR and the pt no longer can make decisions for themselves. It's not an "Oh the family wasn't informed or forgot".

And sure, I'd be okay with asking medical control but until I get something other than standing orders that say to work the code, I'll work it.

 

[Qulevrius]

I would say the point is missed by you equally and oppositely.

Doing things "by the book". You mean what the dr with more clinical experience than you or me that decides how to handle things during a pandemic or otherwise? You mean following protocols that keeps me within the guidelines and allows me to keep my job?

You've missed my pretty straight forward question to add variables that weren't required to then say now it's too complex to say I'm wrong on a question that hasn't been answered.

But okay.

I think I identified your problem. You’re in such a rush to talk back, that you skim over the posts you’re quoting, without actually taking time to process them.

I understand that your medical director is a God figure for you, and I also know why. But try to remember that he isn’t in the field with you, and your guidelines were written in a VERY broad spectrum, on purpose. Therefore, your dilemma shouldn’t be whether to follow or circumvent the SOP, but to UN-DER-STAND what’s happening and to provide effective care in every given situation. But for that, you need to educate yourself beyond the “I’m doing exactly as I’m told” level, that you seem to enjoy so much.

 

[DragonClaw]

I think I identified your problem. You’re in such a rush to talk back, that you skim over the posts you’re quoting, without actually taking time to process them.

I understand that your medical director is a God figure for you, and I also know why. But try to remember that he isn’t in the field with you, and your guidelines were written in a VERY broad spectrum, on purpose. Therefore, your dilemma shouldn’t be whether to follow or circumvent the SOP, but to UN-DER-STAND what’s happening and to provide effective care in every given situation. But for that, you need to educate yourself beyond the “I’m doing exactly as I’m told” level, that you seem to enjoy so much.

Sir, if you think anyone is a God figure but God, you don't know me. Now, I'll allow your analogy, but are you implying you're above standing orders? Is there something else , some power you're granted for that? You might retort "thinking" and I love to think and analyze

Which leads me to, you say I'm in a rush to talk back (but apparently not in a medical setting of my own?) But then you say I refuse to do anything on my own.

Which is it?

Even if I question a protocol (had a 45 minute conversation with my FTO about how exactly to measure medication) that she couldn't answer (yes I don't give meds often anyway, but the question remained). I got with our clinical guy and he answered it in about 5 minutes. But I refused to accept the answer given because it wasn't logical and the literal math didn't check out.

Believe me, I have my share of questions and then some.

But on the truck, I do fall back to protocols, especially given my scope and experience

 

[SandpitMedic]

Re: CPR on a hospice pt?

If they’re on hospice it means they’re on a DNR.
And if they’re not, because the papers haven’t been “filled out” then you should get creative to abide by the patient’s wishes.

 

[SandpitMedic]

Sir, if you think anyone is a God figure but God, you don't know me. Now, I'll allow your analogy, but are you implying you're above standing orders? Is there something else , some power you're granted for that? You might retort "thinking" and I love to think and analyze

Which leads me to, you say I'm in a rush to talk back (but apparently not in a medical setting of my own?) But then you say I refuse to do anything on my own.

Which is it?

Even if I question a protocol (had a 45 minute conversation with my FTO about how exactly to measure medication) that she couldn't answer (yes I don't give meds often anyway, but the question remained). I got with our clinical guy and he answered it in about 5 minutes. But I refused to accept the answer given because it wasn't logical and the literal math didn't check out.

Believe me, I have my share of questions and then some.

But on the truck, I do fall back to protocols, especially given my scope and experience

Your posts indicate you are so far beyond your depth that it’s not worth anyone even trying to help you anymore. You have the emotional maturity of a 13 year old. Please just stop and understand you are new to all of this and the people talking to you are not.

 

[DragonClaw]

Re: CPR on a hospice pt?

If they’re on hospice it means they’re on a DNR.
And if they’re not, because the papers haven’t been “filled out” then you should get creative to abide by the patient’s wishes.

They are going home or to a facility with an acutely terminal condition. It's not uncommon that they don't have a DNR even though some barely make it where we're taking them and are in the active process of dying.

If we don't have a properly signed DNR on hand, I have to work them.

Usually they're not AOx4 and not GCS15

 

[SandpitMedic]

If we don't have a properly signed DNR on hand, I have to work them.

Yes, I am familiar with what protocols say. Like I said, get creative.

 

[DragonClaw]

Your posts indicate you are so far beyond your depth that it’s not worth anyone even trying to help you anymore. You have the emotional maturity of a 13 year old. Please just stop and understand you are new to all of this and the people talking to you are not.

Of course I'm new to this.

And if I'd taken things into my own hands I'm pretty sure most of y'all here would be barking at me to use my protocols.

 

[SandpitMedic]

Of course I'm new to this.

And if I'd taken things into my own hands I'm pretty sure most of y'all here would be barking at me to use my protocols.

Bark bark!

 

[DragonClaw]

Yes, I am familiar with what protocols say. Like I said, get creative.

What does that even mean. Let them finish dying and hope the family doesn't sue?

 

[SandpitMedic]

What does that even mean. Let them finish dying and hope the family doesn't sue?

You’ll figure it out with some experience. Or maybe someone else can help you out with this one.

 

[DragonClaw]

You’ll figure it out with some experience. Or maybe someone else can help you out with this one.

Are you alluding to lying on an official report.

"Yeah we worked her. No dice. Sorry lol"