# SNF call



## frivera (Jul 16, 2013)

You and your medic partner are dispatched to transport a patient from a SNF to get a catheter replaced and brought back to the SNF. Upon arrival at the SNF your patient becomes unresponsive with a B/P of 80/60 along with rapid shallow breathing. SNF staff is very busy and your medic partner is starting an IV. What, as an EMT, do you do and why?


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## STXmedic (Jul 16, 2013)

*Unresponsive 72F@SNF, "difficulty breathing"*



frivera said:


> You and your medic partner are dispatched to transport a patient from a SNF to get a catheter replaced and brought back to the SNF. Upon arrival at the SNF your patient becomes unresponsive with a B/P of 80/60 along with rapid shallow breathing. SNF staff is very busy and your medic partner is starting an IV. What, as an EMT, do you do and why?



Go tell the nurse that waiting until a patient develops septic shock before you decide to change their catheter is typically frowned upon.


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## NomadicMedic (Jul 16, 2013)

As the EMT? Get the paperwork from the nurse. Hand the paramedic what he needs. Put the patient on the stretcher and then drive carefully to the hospital without throwing everyone around in the back. Your job is done. Clean the ambulance and get ready for the next call


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## hogwiley (Jul 16, 2013)

PoeticInjustice said:


> Go tell the nurse that waiting until a patient develops septic shock before you decide to change their catheter is typically frowned upon.



That's easy enough to say, until you've personally taken care of 30 elderly dementia patients, all of whom have serious diseases and conditions, who are continually developing UTIs and pneumonia, or aspirating everytime they drink something, or need extensive wound care, or are continually falling, and have a mile long list of medications you have to administer. 

Not saying the Nurse wasn't negligent or even incompetent, but the more likely explanation is that she is overworked and the facility is understaffed. 

Telling the nurse how to do a job you personally haven't done is likely to go down as well as the Nurse standing there telling you how to do your job on a call.


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## VFlutter (Jul 16, 2013)

The OP only said "catheter". Don't automatically assume it is a foley. It could be any number of various surgically implanted or sutured in catheters.

That being said, it was probably a foley :rofl:


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## STXmedic (Jul 16, 2013)

hogwiley said:


> That's easy enough to say, until you've personally taken care of 30 elderly dementia patients, all of whom have serious diseases and conditions, who are continually developing UTIs and pneumonia, or aspirating everytime they drink something, or need extensive wound care, or are continually falling, and have a mile long list of medications you have to administer.
> 
> Not saying the Nurse wasn't negligent or even incompetent, but the more likely explanation is that she is overworked and the facility is understaffed.
> 
> Telling the nurse how to do a job you personally haven't done is likely to go down as well as the Nurse standing there telling you how to do your job on a call.



Hey bud. Do me a favor. Take a deep breath, and learn to recognize a comment made in jest (you know, humor?) Thanks


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## hogwiley (Jul 17, 2013)

PoeticInjustice said:


> Hey bud. Do me a favor. Take a deep breath, and learn to recognize a comment made in jest (you know, humor?) Thanks



Yeah it get that it was a joke. I've said similar things myself and nearly got my head bit off(My fiancée works as an RN at an SNF).

 I guess I've been well trained.


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## Akulahawk (Jul 17, 2013)

frivera said:


> You and your medic partner are dispatched to transport a patient from a SNF to get a catheter replaced and brought back to the SNF. Upon arrival at the SNF your patient becomes unresponsive with a B/P of 80/60 along with rapid shallow breathing. SNF staff is very busy and your medic partner is starting an IV. What, as an EMT, do you do and why?


As the EMT? Beyond getting paperwork, last set of vitals... spike and flood a line if not already done, get the patient on the monitor, you set up the gurney for a relatively quick transfer to it, take a second to remember the closest ED facilities, perhaps get another set of vitals if it hasn't been done.

Figure that you'll be leaving the scene in about 8 minutes or less. Keep your mouth shut about the care provided by the SNF while you're there. That's not the place to complain about their care. Your duty is now to the patient. 

Why do the above? Well, your medic partner needs that IV fluid ready to go. Your medic partner is going to need to see heart rate/rhythm. If the monitor has an integrated SpO2, it may also show a pulse rate. The gurney is set up for transfer right away because there's little you or your partner will be able to do on scene that isn't already being done, so it's best to be ready to leave. Don't waste time. Why remember the closest facilities? So you know where to go in case your preferred hospital requires you to divert. Vitals? Sometimes the last set is 2 hours old... or more. 

Why keep your mouth shut? Better to keep the transport contract (and therefor your paycheck) than to jeopardize that. Let the State do it's job and investigate them if need be. Change is usually more likely if it comes from above than below. The folks at the bottom probably already know what needs to change but are powerless to do much about it as they can be replaced too...


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## CodeBru1984 (Jul 17, 2013)

frivera said:


> You and your medic partner are dispatched to transport a patient from a SNF to get a catheter replaced and brought back to the SNF. Upon arrival at the SNF your patient becomes unresponsive with a B/P of 80/60 along with rapid shallow breathing. SNF staff is very busy and your medic partner is starting an IV. What, as an EMT, do you do and why?



This sounds like a question that is asked during a Rural/Metro interview.


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## Clipper1 (Jul 17, 2013)

It sounds like this was a routine call for a catheter change.  Be careful about assuming the SNF was negligent.  You don't know how long this call was pushed back by your company. It could have been several hours.  For routine calls all the proper paperwork must be done between the MD, CM or SW and your company.  Had the SNF called 911 earlier the discussion would be about a BS catheter call.  SNFs just can't win being caught in the middle.

SNF nurses are usually able to change regular Foleys.  Therefore it might be a different type or a medical reason the Foley needs to be changed at a hospital. Also, the patient probably is not in a SNF just because of the Foley. Don't get distracted by just the Foley. Other hx? It also does not have to be sepsis from the Foley. A malfunctioning Foley with distention can cause lots of problems. Bladder scans are another vital sign done by  CNAs and should be recorded.


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## Cren (Jul 17, 2013)

Always assess the ABCs especially in unresponsive patients. Airway doesn't sound patent due to the snoring respirations. You said breathing is shallow. Insert an OPA or NPA and help the patient with his breathing via BVM. Then assess o2 saturation and other vitals and go from there.


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