# Broken fingers with elevator BP



## DrParasite (Sep 15, 2013)

Question from TMIACITW, whic didn't happen to me, but I'm curious what you guys think should be done:

Where I work basics run some emergency calls but there is a medic on the truck. I rode my first one a few days ago.

We were called and upon our arrival there was a 47 y/o man with 3 broken fingers on 1 hand.

Once we loaded the patient up the medic said 'this is a BLS call. You're going to handle it." Which was fine by me. First thing I did was get vital signs. First I used the lifepack for a bp while I checked the rest. When I noticed it was really high I verified the bp manually. Both were almost identical. 180/110. (I know pain will do that but this seemed excessive) This concerned me a lot so I just simply put my head up front told the medic. Then I just continued treatment as protocol.

After the call I had everything wrote down so I could do my report. The medic then came over and gave me a lot of grief about not knowing my protocols and along with irrelevant stuff that has no need to be here. He then took the computer from me and said "I will do this so you don't screw this up too."

Admittedly I am fairly new, however I fail to see what I did wrong other than just point out to him that the pts bp was very elevated. I don't want to cause drama at the company or with him, but since he wouldn't let me see the report on my pt I don't know if he changed things or altered them in anyway. However I have been told by someone that was in the office that my partner decided to call and make a complaint to the supervisor about me because of this.

My questions are what should I do? What about the next time it happens and I have a pt with a 220/150 bp, or any other highly abnormal vital signs, do I just keep my mouth shut? And lastly I know there are people who are burned out and there are paragods, I'm the last person ever to call anyone a P.G. but what should I do when I have him yelling at me for 2 hours after the call? And lastly at what point do other medics upgrade this to an ALS call? No medic that I have ever worked with before has been like this. In fact most of them want me to tell them if there is something "off." Now I'm gun shy and feel that I could end up hurting a pt because he did this. Thanks for your time and help.


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## Carlos Danger (Sep 15, 2013)

DrParasite said:


> Question from TMIACITW, whic didn't happen to me, but I'm curious what you guys think should be done



What I think should be done is that this medic needs verbal and/or written counseling for being hostile to a junior co-worker.


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## truetiger (Sep 15, 2013)

The medic's behavior was completely uncalled for. Did the patient have any other complaints other than his fingers hurting?


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## Akulahawk (Sep 15, 2013)

Halothane said:


> What I think should be done is that this medic needs verbal and/or written counseling for being hostile to a junior co-worker.


I agree. The Paramedic's behavior is unacceptable. You don't triage down to BLS and then verbally abuse your partner for 2 hours about it. I would say that the BLS crewmember should know when it's appropriate and inappropriate for a Paramedic to triage the patient down to BLS. However, the Paramedic should also know and be held accountable for inappropriate triage to BLS.


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## BF2BC EMT (Sep 16, 2013)

He also shouldn't be altering a run sheet that you did as he made the call BLS and was not the lead on the call. Sounds like basically we have someone who got pissed once they realized the elevated BP made the pt ALS and he's covering his tracks (gave report, changed report, and placed you beautifully under the bus)


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## Anonymous (Sep 16, 2013)

BF2BC EMT said:


> He also shouldn't be altering a run sheet that you did as he made the call BLS and was not the lead on the call. Sounds like basically we have someone who got pissed once they realized the elevated BP made the pt ALS and he's covering his tracks (gave report, changed report, and placed you beautifully under the bus)



Exactly, Where I am at a diastolic greater than 100 is an ALS call. Cannot tell you how many times I had blood pressures like you stated and ALS documents over /90


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## Rialaigh (Sep 16, 2013)

Altering the run sheet is a big no no, but also (and to a different point) A bp of 180/110 does not make this call ALS at all. Ive never met a medic that is going to treat that BP without other major underlying symptoms. 

Even a BP of 220/150 does not make me jump (prehospital) in a patient that is otherwise asymptomatic. 220/150 needs to be treated...in a hospital...slowly and controlled....with monitoring....not pre-hospitally. 


BLS call all the way. You did nothing wrong


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## rhan101277 (Sep 17, 2013)

probably elevated BP due to pain from broken fingers.  Pain medication should have been administered here unless contraindicates exist.  This should have been a ALS call.

Also in our protocols a systolic bp of >180 requires cardiac monitoring regardless of history.


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## Wheel (Sep 17, 2013)

rhan101277 said:


> probably elevated BP due to pain from broken fingers.  Pain medication should have been administered here unless contraindicates exist.  This should have been a ALS call.



Agree, ALS for pain management.


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## Handsome Robb (Sep 17, 2013)

ALS for pain management for sure unless they refuse narcs. One broken finger hurts, maybe not fentanyl hurts but hurts. Multiple broken fingers isn't pleasant though, I know from experience. 

The way the medic acted was out of line and I'd bet the way they went about taking the chart from the provider and writing it resulted in a falsified document. 

If I were that EMT I'd be talking to a supervisor about how I was treated as well as the events that occurred involving the chart.


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## NBFFD2433 (Oct 13, 2013)

Rialaigh said:


> Altering the run sheet is a big no no, but also (and to a different point) A bp of 180/110 does not make this call ALS at all. Ive never met a medic that is going to treat that BP without other major underlying symptoms.
> 
> Even a BP of 220/150 does not make me jump (prehospital) in a patient that is otherwise asymptomatic. 220/150 needs to be treated...in a hospital...slowly and controlled....with monitoring....not pre-hospitally.
> 
> ...


I agree.


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## mycrofft (Oct 13, 2013)

My experience with BP in painful situations is the systolic climbs fairly promptly, but the diastolic is much slower to climb if at all.


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## ZombieEMT (Oct 14, 2013)

With the NJ EMS system, this call would not be dispatched with ALS because fracture cases are typically a BLS skill and assessment. I think ALS treat also depends on the severity of pain. I know many medics that will not just administer fentynl just because someone is pain. For that reason, I will probably not request ALS intercept for pain management. If the pain is a 10/10 and patient shows obvious distress, just maybe, and a big maybe... The other thing to take into consideration with a system like ours is transport time. For the most part we are only 10 minutes away from the hospital, with five minutes intercept time in most situations and ALS assessment prior to administering medication. At that point you could be to the hospital.


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## chaz90 (Oct 14, 2013)

HaleEMT said:


> With the NJ EMS system, this call would not be dispatched with ALS because fracture cases are typically a BLS skill and assessment. I think ALS treat also depends on the severity of pain. I know many medics that will not just administer fentynl just because someone is pain. For that reason, I will probably not request ALS intercept for pain management. If the pain is a 10/10 and patient shows obvious distress, just maybe, and a big maybe... The other thing to take into consideration with a system like ours is transport time. For the most part we are only 10 minutes away from the hospital, with five minutes intercept time in most situations and ALS assessment prior to administering medication. At that point you could be to the hospital.



If the patient is in 10/10 pain you'd still consider not calling for an ALS intercept for pain management?? You should have them meet you on scene. 10 minutes away from the hospital still means 10 minutes of exacerbating the pain by bouncing down a road plus an additional time to register, wait for nursing assessment, wait for a provider to come in, place orders, and finally fill the orders for pain management and have it administered. I don't doubt you have medics that refuse to administer narcotics "just because someone is in pain," but this doesn't make it right. Sounds like ALS laziness, incompetence or apathy.


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## Akulahawk (Oct 14, 2013)

If my patient has "just" some broken fingers, I'm probably going to spend a little time on scene and not just immediately transport. I'm going to take the time to splint the fingers and grab something frozen... like peas, carrots, or corn, if at all possible. Why? Cryotherapy works wonders, if it's used correctly. If the pain is still too intense, I will then probably start a line and provide some pain medication. I'm absolutely OK with giving morphine, but I also prefer to try non-pharm methods first because I know how well some well-placed ice packs work.


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## Handsome Robb (Oct 14, 2013)

HaleEMT said:


> With the NJ EMS system, this call would not be dispatched with ALS because fracture cases are typically a BLS skill and assessment. I think ALS treat also depends on the severity of pain. I know many medics that will not just administer fentynl just because someone is pain. For that reason, I will probably not request ALS intercept for pain management. If the pain is a 10/10 and patient shows obvious distress, just maybe, and a big maybe... The other thing to take into consideration with a system like ours is transport time. For the most part we are only 10 minutes away from the hospital, with five minutes intercept time in most situations and ALS assessment prior to administering medication. At that point you could be to the hospital.



That is :censored::censored::censored::censored:ing terrible.

Analgesia is one of the few things that we can make a difference for that patient right here right now.

Why not give them? What good do they do anyone sitting in your pocket and Pyxis until they expire? 

If I was somewhere out of my county and messed myself up enough to need to call 911 and the medic refused to give me narcotics you can damn well bet I'd be sitting down with their supervisor, manager and medical director as well as filing a report with the OEMS. Pain is a huge cause for EMS activations, they might as well take a taxi if all you're going to do is take them to the ER. With that said I agree with Akula about splinting and ice.


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