# Damn that's hot



## vquintessence (Apr 21, 2009)

Tx 63 Y/O female c valid DNR from nursing facility to ED.  The woman had a plethera health problems, was in facility due to UTI.  Well we're dispatched for sudden resp distress:

Thick, coarse bilat rhonchi c poor tidal vol, RR < 8, BP 60/P, "Ah, show us DNR right now... thanks".  The womans obviously septic and going toward the light but just wanted to share this:

ED _rectal temp was 107.3_  Poor womans brain must have been cooking.  ED immediately called for neuro consult.  Heatstroke can get much higher, but still, I've never seen a septic pt get that febrile.


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## Jon (Apr 21, 2009)

"thats hot".

Gotta love the nursing home that will sit on a patient this sick for long enough to let it build. Awesome.


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## medic417 (Apr 21, 2009)

Actually many times if sepsis has been present long term they become hypothermic rather than remain hyperthermic.


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## DV_EMT (Apr 21, 2009)

I was actually admitted to the hospital a few weeks ago for bilateral pneumonia... PO fever was 104.3 which was pretty damn hot for me. I've hit 103.5 before and knocked it down with APAP, but at 104.3, i decided it was time to take a ride with my beautiful fiancee (who's also a neuro nurse). 

and man.... did my vitals compensate like a ped's patient. went from bp 130/90 (ish) and P 94 to bp 82/40 P 130 just from driving from the house to the ED. apparently I was goin into shock pretty quick. glad I decided that 104.3 was too hot!


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## Stewart1990 (Apr 21, 2009)

Jon said:


> "thats hot".
> 
> Gotta love the nursing home that will sit on a patient this sick for long enough to let it build. Awesome.



I pity the people who think putting their loved ones in a nursing home thinking that they will get better care....


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## lightsandsirens5 (Apr 22, 2009)

I hit 104.9 this winter when that flu like thing hit. That was miserable!


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## VentMedic (Apr 22, 2009)

medic417 said:


> Actually many times if sepsis has been present long term they become hypothermic rather than remain hyperthermic.


 
Agreed. As well, the patient's oral and core temps can be vastly different. The higher the core temp, the cooler the skin may feel. Rectal temperatures are not routinely taken. Sepsis can present and deteriorate quickly. 

I have seen countless EMS patients come in with "BS fever call" comments made by the crew in the ED only to see the patient being prepped for intubaton and a central line before they can finish their paperwork. What is even more amazing is these EMT(P)s can not provide a number for the "fever" or a time it was taken. It is also difficult to determine how long it may have taken the ambulance to free up a truck for an old person, who is probably a DNR anyway, in a nursing home which is just a "BS fever call". Unfortunately for the patients, DNR always means Do Not Treat to some in EMS.


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## Sasha (Apr 22, 2009)

Stewart1990 said:


> I pity the people who think putting their loved ones in a nursing home thinking that they will get better care....



In some nursing homes they are.

Of course, we don't see those nursing homes very often because their patients are taken better care of, but old people do tend to get sick.


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## medic417 (Apr 22, 2009)

VentMedic said:


> Agreed. As well, the patient's oral and core temps can be vastly different. The higher the core temp, the cooler the skin may feel. Rectal temperatures are not routinely taken. Sepsis can present and deteriorate quickly.
> 
> I have seen countless EMS patients come in with "BS fever call" comments made by the crew in the ED only to see the patient being prepped for intubaton and a central line before they can finish their paperwork. What is even more amazing is these EMT(P)s can not provide a number for the "fever" or a time it was taken. It is also difficult to determine how long it may have taken the ambulance to free up a truck for an old person, who is probably a DNR anyway, in a nursing home which is just a "BS fever call". Unfortunately for the patients, DNR always means Do Not Treat to some in EMS.



Sad that the lack of education and lack of motivation by many in EMS is killing so many.  No matter how BS I think something is I always treat the patient like they were someone I loved.  If I would do something for my loved one I will do it for this stranger.  

Now I do fault nursing homes for failing to dial 911 when they have someone seriously ill and instead wait on the contract ambulance.


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## VentMedic (Apr 22, 2009)

medic417 said:


> Now I do fault nursing homes for failing to dial 911 when they have someone seriously ill and instead wait on the contract ambulance.


 
They are darned if they do and darned if they don't.  Have you ever witnessed a 911 EMS team blast nurses, and forget about the patient, for calling for a "fever"?   The nurses may recognize the signs and symptoms of sepsis by the trend in the vital signs log including the I/Os but some of these things may mean little to Paramedic who "run only emergencies".    And, the nurses will also have to justify their call to their superiors who are equally critical.  Unfortunately, the nurses are also very limited without a lot of diagnostic data availabe to them when they make the determination to call an ambulance.   

Considering the thousands of patients in nursing homes in some areas, the percentage of ambulance calls to nursing homes is relatively small and their trips to the doctor/hospital may be not much different than if they would living at home by themselves or with family.   Residents in nursing homes are usually elderly, frail and very medically compromised.   It is a tall order for even loved ones or the best of nursing homes to keep their bodies going.


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## medic417 (Apr 22, 2009)

VentMedic said:


> They are darned if they do and darned if they don't.  Have you ever witnessed a 911 EMS team blast nurses, and forget about the patient, for calling for a "fever"?   The nurses may recognize the signs and symptoms of sepsis by the trend in the vital signs log including the I/Os but some of these things may mean little to Paramedic who "run only emergencies".    And, the nurses will also have to justify their call to their superiors who are equally critical.  Unfortunately, the nurses are also very limited without a lot of diagnostic data availabe to them when they make the determination to call an ambulance.



And?  I mean they know the patient needs immediate medical care if they follow the orders and call contract service and are told an hour surely they should know that the patient is in need of care sooner than that and should call 911.  If the 911 medics give them grief report the idiots.  If your boss gives you grief for doing whats right for the patient explain why, if they still give you grief you need a new job.  I do understand the nurses are caught in a bad place but just as you always say it is about what is right for the patient not us.  That applys to nurses just as well as EMS.


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## VentMedic (Apr 22, 2009)

medic417 said:


> And? I mean they know the patient needs immediate medical care if they follow the orders and call contract service and are told an hour surely they should know that the patient is in need of care sooner than that and should call 911. If the 911 medics give them grief report the idiots. If your boss gives you grief for doing whats right for the patient explain why, if they still give you grief you need a new job. I do understand the nurses are caught in a bad place but just as you always say it is about what is right for the patient not us. That applys to nurses just as well as EMS.


 
Many EMT(P)s do get reported for attitudes and it will reflect when contract negotations come around. 

Just like the many threads where EMT(P)s can not figure out whether something is BLS or ALS, the same situation also occurs in the nursing homes. Also, the ambulance services and the EMT(P)s can cause confusion as to the level of care. In parts of Florida, almost everyone is a Paramedic (waiting to get on with the FDs) but are working BLS services. The nurses at the nursing homes get used to seeing all Paramedic patches and may take it that they can function as a Paramedic. 

We recently has another thread to which I posted the requirements the various insurances (private, government etc) have for calling 911. As well, the city or county itself may restrict it. Possibly if more people were aware of some of these contracts, they would be upset. As well, if those in EMS investigated their own company's contract with various LTC facilities, they would have a better understanding as to why the patient is not always the priority in the U.S. healthcare system.

There are now a few hospitals that have their own ambulance services just to do calls with the LTC facilites that use them.  This eliminates alot of problems with the "contracts" with EMS, provides a better understanding and consistency in level of care as medical professionasl speak in similar terms (not ALS or BLS), and improved quality control of the providers.


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## WannaBeFlight (Apr 25, 2009)

In regards to the attitude of medics, I worked in a Fam. Prac setting and I f I had not witnessed it for my own eyes I would never believed this would happen:  We called for a probable Heart Attack for a 84 y/o male pt that was not established with us, just walked in (kinda a rural area), EMS arrives,they *did not bring in the gurney, did not bring in a medical bag or O2, or the cardiac monitor*, then decided to argue with my doc wether the patient really needed to be trasported, they literally said, "this pt does not need to be transported, his wife (82 y/o) can drive him to the ED...pt then went downhill...they were adament not to transport the pt, ended up not having a choice. My doctor made a personal complaint with the ED doc and their supervisor and department chief. Not good. I just cant see arriving on scene with NOTHING in hand!!!! And then want to argue about it in front of the patient. Crazy!


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## WannaBeFlight (Apr 25, 2009)

Oh and they were both Paramedics!


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## Shishkabob (Apr 25, 2009)




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## Sasha (Apr 25, 2009)

WannaBeFlight said:


> In regards to the attitude of medics, I worked in a Fam. Prac setting and I f I had not witnessed it for my own eyes I would never believed this would happen:  We called for a probable Heart Attack for a 84 y/o male pt that was not established with us, just walked in (kinda a rural area), EMS arrives,they *did not bring in the gurney, did not bring in a medical bag or O2, or the cardiac monitor*, then decided to argue with my doc wether the patient really needed to be trasported, they literally said, "this pt does not need to be transported, his wife (82 y/o) can drive him to the ED...pt then went downhill...they were adament not to transport the pt, ended up not having a choice. My doctor made a personal complaint with the ED doc and their supervisor and department chief. Not good. I just cant see arriving on scene with NOTHING in hand!!!! And then want to argue about it in front of the patient. Crazy!



We've called 911 a few times, have always been met with eye rolling, a condescending attitude, "BS call" mentality and disregard. Even towards the doctors. It's turned me off wanting to work on a truck. 

Why don't people understand the only reason that they were called was because we're a clinic and don't transport?


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## reaper (Apr 25, 2009)

WannaBeFlight said:


> In regards to the attitude of medics, I worked in a Fam. Prac setting and I f I had not witnessed it for my own eyes I would never believed this would happen:  We called for a probable Heart Attack for a 84 y/o male pt that was not established with us, just walked in (kinda a rural area), EMS arrives,they *did not bring in the gurney, did not bring in a medical bag or O2, or the cardiac monitor*, then decided to argue with my doc wether the patient really needed to be trasported, they literally said, "this pt does not need to be transported, his wife (82 y/o) can drive him to the ED...pt then went downhill...they were adament not to transport the pt, ended up not having a choice. My doctor made a personal complaint with the ED doc and their supervisor and department chief. Not good. I just cant see arriving on scene with NOTHING in hand!!!! And then want to argue about it in front of the patient. Crazy!



Let me guess, Asheville?


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## reaper (Apr 25, 2009)

Sasha said:


> We've called 911 a few times, have always been met with eye rolling, a condescending attitude, "BS call" mentality and disregard. Even towards the doctors. It's turned me off wanting to work on a truck.
> 
> Why don't people understand the only reason that they were called was because we're a clinic and don't transport?



More reason to work on a truck! Change the attitudes from the inside.


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## Stewart1990 (Apr 25, 2009)

Linuss said:


>



And the thread died a horrible gruesome death.


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## VentMedic (Apr 25, 2009)

I see what the T-Shirt says, but who or what is she referring to?

Surely not herself?   

Not even close to doing the words justice.


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## Stewart1990 (Apr 25, 2009)

VentMedic said:


> I see what the T-Shirt says, but who or what is she referring to?
> 
> Surely not herself?
> 
> Not even close to doing the words justice.



She's just an airhead and says it alot. About everything.
She even tried to copyright it. She wanted money for everytime someone used 'her words'. Its sad. And just tragic.


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## WannaBeFlight (Apr 25, 2009)

reaper said:


> Let me guess, Asheville?



Not Asheville, somewhere around there in the great WNC Mountains!


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## Shishkabob (Apr 25, 2009)

VentMedic said:


> I see what the T-Shirt says, but who or what is she referring to?
> 
> Surely not herself?
> 
> Not even close to doing the words justice.



Please for the love of God, tell me you know her catch phrase?


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## Sasha (Apr 25, 2009)

VentMedic said:


> I see what the T-Shirt says, but who or what is she referring to?
> 
> Surely not herself?
> 
> Not even close to doing the words justice.



While I loathe Paris Hilton as much as the next person, you have to admit if she covers her lazy eye with sunglasses, she IS pretty.


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## VentMedic (Apr 25, 2009)

Linuss said:


> Please for the love of God, tell me you know her catch phrase?


 
Please for the love of God, tell me why I should know this.


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## Sasha (Apr 25, 2009)

VentMedic said:


> Please for the love of God, tell me why I should know this.



Paris Hilton's "catch phrase" is "That's hot!". Because of course, she couldn't think of anything more complicated and needs a default answer for when someone asks her opinion and she's too hung over to think of one. And of course, responding "That's hot" mantains the cliche all blondes are bimbo airheads and of course she couldn't show an ounce of intelligence.

"So, Paris, what do you think about feeding orphans in Africa?"
"That's hot!"

I think she actually tried to trade mark it, as if she's the first one to ever say it....


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## VentMedic (Apr 25, 2009)

And I should know this useless piece of information?


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## Shishkabob (Apr 25, 2009)

VentMedic said:


> And I should know this useless piece of information?



Yes, if for nothing more than to make fun of stereotypical blondes.


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## vquintessence (Apr 27, 2009)

Sorry to attempt resuscitation of this dead topic going on day 3 (whyyy give Hilton any attention?????), but just wanted to clarify a few things on behalf of the nursing home.

_The call came in 911, very rare considering that we provide them the primary transporting contract, and if they'd called for even an emergent transport instead of 911, the facility would have paid $$$ hundreds less._

However on the back side of the coin, the staff didn't take a temp and consequently no tylenol/motrin PR was administered.  *Cannot say why, typically they do and will relay that info to us.*  Complete agreement here with Mrs Vent about how EMS too frequently fails to relay the verbal info given by nursing facilities/clinics.

Despite the DNR bashing, the pt was treated by EMS & ED with everything short of bagging and intubation.


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