# Stupid Parents



## al.emt (May 29, 2012)

dispatched to house for unresponsive 13 month old not breathing. en route dispatch advises us that pt is breathing just excessive drooling and unresponsive. i get there and family states the pt was having a seizure and the grandmother was told by mother over the phone to give the rectal valium family was prescribed. mom never read directions, neither did gmaw... PT got 2 FULL tubes of rectal valium... enough to sedate a full grown man... and parents were wondering why pt was not responding... ill just say it was the quietest ride to the hospital with a child ever.

 PT was fine tho. sp02 of 75 when we get child in the truck. but 97 when we get to hospital. other than that no other complaint. half life of valium as you all know very short so didn't have to do anything


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## usalsfyre (May 29, 2012)

al.emt said:


> dispatched to house for unresponsive 13 month old not breathing. en route dispatch advises us that pt is breathing just excessive drooling and unresponsive. i get there and family states the pt was having a seizure and the grandmother was told by mother over the phone to give the rectal valium family was prescribed. mom never read directions, neither did gmaw... PT got 2 FULL tubes of rectal valium... enough to sedate a full grown man... and parents were wondering why pt was not responding... ill just say it was the quietest ride to the hospital with a child ever.
> 
> PT was fine tho. sp02 of 75 when we get child in the truck. but 97 when we get to hospital. other than that no other complaint. half life of valium as you all know very short so didn't have to do anything



Diazepam is one of the longer acting benzodiazepines actually. What was the dose in mgs?


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## al.emt (May 29, 2012)

5mg in 2.5ml.

we bagged and suctioned to hospital. wasnt gonna do a BID.


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## abckidsmom (May 29, 2012)

al.emt said:


> 5mg in 2.5ml.
> 
> we bagged and suctioned to hospital. wasnt gonna do a BID.



5 mg PR in a 13 month old is not ridiculous.

What's a BID?

How was his respiratory effort once you got him kick started?


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## Handsome Robb (May 29, 2012)

abckidsmom said:


> 5 mg PR in a 13 month old is not ridiculous.
> 
> What's a BID?
> 
> How was his respiratory effort once you got him kick started?



I'm thinking he meant blind insertion airway device or BIAD but I'm not sure. 

So the tyke got 10 mg PR? I'm guessing 2 tubes x 2.5 mL each correct? That's not a totally unheard of dose.


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## WolfmanHarris (May 29, 2012)

This is more a medical fail than a parental one. While certainly there seems to be a trend of decreasing accountability, especially where parenting is concerned (see calling Police to discipline 8 y/o) I don't think the blame here should rest entirely with the parents but with the Physician who prescribed the medication.

Consider informed consent, we as providers have an obligation to facilitate informed consent with our patients, in an emergency situation this is mitigated so we don't give it much thought, but the obligation is still there. If you are sending new parents home with a medication to administer, under stress during an emergency, time must be taken to properly instruct the parent on administration. While it should be reasonable to expect the parent to ask questions and seek clarification to ensure they can competently deliver the med, the onus to ensure this remains with the provider.

How many of us have had to instruct a patient on the proper use of their salbutamol because they were never taught and cant figure out why it isn't helping?

That being said I did have a patient who for no reason that we could determine whatsoever, drew up a med he was supposed to take prior to a DI procedure (don't remember which) and inject it into his stomach when it was supposed to be PO. So maybe we just can't fix stupid?


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## Hunter (May 29, 2012)

WolfmanHarris said:


> How many of us have had to instruct a patient on the proper use of their salbutamol because they were never taught and cant figure out why it isn't helping?



Doing IFT and discharges our company has a contract with one of the biggest hospice providers in the area. I have patients all the you're who are discharged with a new prescription for O2 at home and once we get there they don't know how to use the concentrators do I usually have to explain and show them.


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## abckidsmom (May 29, 2012)

Hunter said:


> Doing IFT and discharges our company has a contract with one of the biggest hospice providers in the area. I have patients all the you're who are discharged with a new prescription for O2 at home and once we get there they don't know how to use the concentrators do I usually have to explain and show them.



This is good customer service.  Especially in hospice, everybody's role is educating the patients and their families in self-care.


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## Veneficus (May 29, 2012)

WolfmanHarris said:


> This is more a medical fail than a parental one. While certainly there seems to be a trend of decreasing accountability, especially where parenting is concerned (see calling Police to discipline 8 y/o) I don't think the blame here should rest entirely with the parents but with the Physician who prescribed the medication.



I agree with this without condition.

Physicians have a duty to take the time and properly educate patients. 

If they do not have the time for whatever given reason, the patient should not suffer because of it.


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## medicdan (May 29, 2012)

With decreasing reimbursments, what is the role of printed educational materials and pharmacist education?


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## Veneficus (May 29, 2012)

emt.dan said:


> With decreasing reimbursments, what is the role of printed educational materials and pharmacist education?



An ineffective dodge of responsibility.


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## heatherabel3 (May 29, 2012)

A crappy way to keep from being sued when they can say they gave you the info. 
An example:
My son is T1 Diabetic and was 4 when he was diagnosed. After spending 3 weeks in the hospital it was time to go home and I was terrified to have to do it by myself. I had done the Diabetes education in the hospital and got the usual....this is how you test, this is how you give a shot, here's a chart with his ratio's on it so you know how much insulin to give based on what his BG is when you check it....all the basics. Then when we go to leave they hand me the Glucagon, some of the stupid pharmacy paperwork, and told me that because his sugars were still unstable that if his sugar ever dropped below 30 to give it to him immediately and call an ambulance. Sure as :censored::censored::censored::censored:, 3 days later he started acting all drunk so I checked, his sugar was 24 so I grabbed it and gave the ENTIRE shot. Now I had a very angry little boy who was vomitting all over the place. The medics acted like I was trying to kill him and the docs at the hospital actually called CPS on me for medical neglect. After they got his sugar back down and everything sorted out his Endo came in and said he was sorry, that normally in a child his age, a BG that low would have caused LOC and the Glucagon would have been neccessary but I shouldn't have given it because he was conscious. I told him I was gonna going to ICE and JAG and filing a complaint because my child had been traumatized due to the incorrect information he had given me. He looked me straight in my face and said "You can try but if you would have read the info the pharmacy gave you, you would have known to only give it when there is LOC, not my fault you can't read" and walked away.
Sorry, that was totally off topic, but I really hate that those pharmacy papers are a way for doc's to have legal coverage for not taking the time to properly inform their patients on how to take a medication or use a decive correctly.


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## Veneficus (May 29, 2012)

heatherabel3 said:


> A crappy way to keep from being sued when they can say they gave you the info.
> An example:
> My son is T1 Diabetic and was 4 when he was diagnosed. After spending 3 weeks in the hospital it was time to go home and I was terrified to have to do it by myself. I had done the Diabetes education in the hospital and got the usual....this is how you test, this is how you give a shot, here's a chart with his ratio's on it so you know how much insulin to give based on what his BG is when you check it....all the basics. Then when we go to leave they hand me the Glucagon, some of the stupid pharmacy paperwork, and told me that because his sugars were still unstable that if his sugar ever dropped below 30 to give it to him immediately and call an ambulance. Sure as :censored::censored::censored::censored:, 3 days later he started acting all drunk so I checked, his sugar was 24 so I grabbed it and gave the ENTIRE shot. Now I had a very angry little boy who was vomitting all over the place. The medics acted like I was trying to kill him and the docs at the hospital actually called CPS on me for medical neglect. After they got his sugar back down and everything sorted out his Endo came in and said he was sorry, that normally in a child his age, a BG that low would have caused LOC and the Glucagon would have been neccessary but I shouldn't have given it because he was conscious. I told him I was gonna going to ICE and JAG and filing a complaint because my child had been traumatized due to the incorrect information he had given me. He looked me straight in my face and said "You can try but if you would have read the info the pharmacy gave you, you would have known to only give it when there is LOC, not my fault you can't read" and walked away.
> Sorry, that was totally off topic, but I really hate that those pharmacy papers are a way for doc's to have legal coverage for not taking the time to properly inform their patients on how to take a medication or use a decive correctly.



"But American doctors and healthcare are thew best in the world..."

:rofl:


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## mycrofft (May 29, 2012)

Not to sound disrespectful, but COULD they read the instructions?
Language issues, eyesight (product enclosures are legalese on tissue paper printed < 1 mm tall), lack of vocabulary, lots of issues.

But, they could also have been stupid.

And maybe no-money for medical care? So they inter-use Rx?

EIther way, our is not to get irritated*, ours is to tx the pt. The family needs a visit or three from a community health nurse to asses and teach about used meds, expired meds, eyeglasses, and to call the pharmacy dispensing about not properly educating their customers.

(side note: at a local pharmacy one clerk at the pick up window customarily reached over and pressed "NO" when the machine asked if the customer wanted medical counseling. I turned her in).


* I say this but I used to ALWAYS get irritated at family bystanders.


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## abckidsmom (May 29, 2012)

Veneficus said:


> An ineffective dodge of responsibility.



A. Men.

Anybody who reads those things either (a) already knows what they say or (b) can't understand the text.

And duh, the med might cause headache, nausea or diarrhea.  Lets get a few less words on there, eh?


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## abckidsmom (May 29, 2012)

heatherabel3 said:


> A crappy way to keep from being sued when they can say they gave you the info.
> An example:
> My son is T1 Diabetic and was 4 when he was diagnosed. After spending 3 weeks in the hospital it was time to go home and I was terrified to have to do it by myself. I had done the Diabetes education in the hospital and got the usual....this is how you test, this is how you give a shot, here's a chart with his ratio's on it so you know how much insulin to give based on what his BG is when you check it....all the basics. Then when we go to leave they hand me the Glucagon, some of the stupid pharmacy paperwork, and told me that because his sugars were still unstable that if his sugar ever dropped below 30 to give it to him immediately and call an ambulance. Sure as :censored::censored::censored::censored:, 3 days later he started acting all drunk so I checked, his sugar was 24 so I grabbed it and gave the ENTIRE shot. Now I had a very angry little boy who was vomitting all over the place. The medics acted like I was trying to kill him and the docs at the hospital actually called CPS on me for medical neglect. After they got his sugar back down and everything sorted out his Endo came in and said he was sorry, that normally in a child his age, a BG that low would have caused LOC and the Glucagon would have been neccessary but I shouldn't have given it because he was conscious. I told him I was gonna going to ICE and JAG and filing a complaint because my child had been traumatized due to the incorrect information he had given me. He looked me straight in my face and said "You can try but if you would have read the info the pharmacy gave you, you would have known to only give it when there is LOC, not my fault you can't read" and walked away.
> Sorry, that was totally off topic, but I really hate that those pharmacy papers are a way for doc's to have legal coverage for not taking the time to properly inform their patients on how to take a medication or use a decive correctly.



A. Men.  Case in point.  

I don't know how many times I've been for an unconscious diabetic who'd received glucagon from the family without dissolving the medication in the solution.  

This is MEDICINE!  It isn't full-on rocket science, but we are expecting quite a lot out of people who really don't have a clue.


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## medichopeful (May 29, 2012)

al.emt said:


> PT was fine tho. sp02 of 75 when we get child in the truck. but 97 when we get to hospital. other than that no other complaint. half life of valium as you all know very short so didn't have to do anything



Actually the half-life of diazepam is from 20-50 or 30-60 hours, depending on your source.  And the peak for rectal is about 1.5 hours, so the kid may have gotten worse soon afterwards if the timing was bad.


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## JakeEMTP (May 29, 2012)

al.emt said:


> dispatched to house for unresponsive 13 month old not breathing. en route dispatch advises us that pt is breathing just excessive drooling and unresponsive. i get there and family states the pt was having a seizure and the grandmother was told by mother over the phone to give the rectal valium family was prescribed. mom never read directions, neither did gmaw... PT got 2 FULL tubes of rectal valium... enough to sedate a full grown man... and parents were wondering why pt was not responding... ill just say it was the quietest ride to the hospital with a child ever.
> 
> PT was fine tho. sp02 of 75 when we get child in the truck. but 97 when we get to hospital. other than that no other complaint. half life of valium as you all know very short so didn't have to do anything



There is not alot of info in this.  This dose is not that far fetched either if you compare it with your own protocols. The package probably said 1 application up to a max of 2 which is how I have seen most of these pedi valiums. Did you take the packaging with the script on it with you along with the child?

There is alot more to assess before you determine if it was the fault of the parents. PR Valium is not that fast acting and does not just cause a kid to quit breathing immediately and if they do quit breathing they probably won't restart again as the valium gets more into their system if they are infact OD'd.  

What was the heart rate, heart sounds, skin color, termperature and moistness of the mouth?  Having valium on hand probably means the child had a seizure history but that does not mean something more serious is not going on which may have needed to be addressed. The SpO2 could have been low for some reason and initiated the seizure especially in a 13 month.  Getting sidetracked by trying to call the parents stupid may have caused you to miss a lot of stuff.


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## WolfmanHarris (May 29, 2012)

mycrofft said:


> Not to sound disrespectful, but COULD they read the instructions?
> Language issues, eyesight (product enclosures are legalese on tissue paper printed < 1 mm tall), lack of vocabulary, lots of issues.
> 
> But, they could also have been stupid.
> ...



This isn't disrespectful, it's diligent. We need to consider these factors when providing care.

Say you push D50, tell the patient to have a good meal and sign them off. Leaving aside the fact that you should stay long enough to make sure they've eaten before clearing, what if they have an empty fridge? Language, finances, intelligence, disability, etc should all be considered as part of the patient's history. I'm not suggesting discrimination; sometimes a perfectly level playing field is the most unfair, I'm suggesting that we need a realistic impression of our patients and their limitations to provide them with the best possible care.


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## Brandon275 (Oct 30, 2012)

This is why family and people that have no medical training in general need to stop self medicating.  These people have no clue how much actually goes into these medicines and if you give the improper dose to someone or god forbid they have an anaphylactic reaction to the medication then it will do much more harm then good.  Oh well, stupidity keeps us in business.


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## Veneficus (Oct 30, 2012)

Brandon275 said:


> This is why family and people that have no medical training in general need to stop self medicating.  These people have no clue how much actually goes into these medicines and if you give the improper dose to someone or god forbid they have an anaphylactic reaction to the medication then it will do much more harm then good.  Oh well, stupidity keeps us in business.



You realize this is prescribed for a reason?

We cannot hospitalize every patient that takes a medication at home in order to avoid the dangers. 

People on digoxin, opioids, and B-blockers, and warfarin to name just a few, would be in the hospital for life.

Sometimes bad things happen. It is life.


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## Medic Tim (Oct 30, 2012)

Brandon275 said:


> This is why family and people that have no medical training in general need to stop self medicating.  These people have no clue how much actually goes into these medicines and if you give the improper dose to someone or god forbid they have an anaphylactic reaction to the medication then it will do much more harm then good.  Oh well, stupidity keeps us in business.



So we should hospitalized every pt who has to take a medication because something "bad" might happen?

How do you propose this be done?   

The argument you use here can also apply to basics and some intermediates. How can a course a couple hundred hours long give you enough information/education to administer some of these medications. The family could actually do more than the basic in the scenario you give. I may be wrong but benadryl is a medic drug most places and not all basics can give epi. (ems regardless of level would have the upper hand in airway....hopefully)

I don't want to bash basics or turn this thread into that but wanted to point out that the family can actually do more.


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## mycrofft (Oct 30, 2012)

I'm guessing Brandon was thinking about families trying to figure out stuff rather than  strictly following instructions and calling (calling whom?) if they forget or things look or seem wrong.

Had two sisters in their late sixties who were taking care of their invalid mother , chronically obtunded and diabetic. The mom was around 450 lbs of comatose loose flab and bones because the two could not organize their care, missing meals (sitting pt up and sponfeeding, and later feeding NG tube), and then doubling the feeding, and doing the same with *insulin*. (My partner injured his back when we and two firefighters had to carry her on her side to make it down the narrow hall with a 90 deg angle).


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