the 100% directionless thread

[ffemt8978]

This is very true. In some ways, we used to. Now many mental health patients get dumped on the ED for "medical clearance" and then the ED ends up boarding these patients until an appropriate bed opens up. The ED is a HORRIBLE place for mental health patients.



People that get very loud and aggressive do often end up being sedated and/or restrained. Most patients of mine do OK as I make it clear that it is THEIR behavior that drives how they are treated. If you're being restrained and your my patient, it is because you are a current and continuing danger to yourself or to others because of the things you are doing. If you're just being loud, I don't really care about that until you start escalating beyond that.

Agreed. Patients can be as loud as they want provided they are not disturbing or upsetting other patients. As security, patient care was not our focus. Staff and patient safety was. This would occasionally cause problems with staff in the unit because we handled issues in a different manner than what they wanted. Our response always was, "Well you're process wasn't working, so you had to call us. Why should we do the same thing that you've already tried and that didn't work?"

 

[Peak]

I don’t do loud. It is disruptive and interrupts other patients and can escalate others. It isn’t okay to escalate other patients because you can’t control yourself.

 

[DesertMedic66]

I don’t do loud. It is disruptive and interrupts other patients and can escalate others. It isn’t okay to escalate other patients because you can’t control yourself.

This. Sure you can be loud inside a closed room to where no one can hear you but yelling inside the ED where everyone can hear is going to create issues with other patients and family members.

 

[DragonClaw]

I don’t do loud. It is disruptive and interrupts other patients and can escalate others. It isn’t okay to escalate other patients because you can’t control yourself.

I had an involuntary throw a strap back at me once, gave me a small bruise. She threw it out of rage and protest, but didn't mean to hit me with it. I was collateral. She then apologized to me. She was AOX4 GCS15, she apparently threatened suicide by pills or alluded to such things. Her daughter convinced her to go to ED. She apparently is a counselor or psychologist and was freaking that she was going to a facility that she sent a lot of her patients to. She made the very logical (imo) comparison of a cop in prison. My partner had no sympathy, saying she placed people in bad facilities (He didn't like the ones she frequently sent people to. I don't think she's being malicious in this or how she decides who goes where. Could be insurance or anything else, yeah?). She made a decent amount of fair points about how she was stupid to go to the ER for this and now how she's involuntary and such. I really was not sure if she was right to be sent to a facility and have that on her record. I don't think the hospital made the right call. I think it was just a dumb thing she said in the heat of the moment. She was screaming and yelling and making a scene. The Dr was like 6'6 and stood in the door so she didn't escape like she announced she was gonna just leave. They ended up giving her versed (She agreed to it. But if she didn't, they can't legally give it to her, right?)

But at the same time, if they didn't admit her and EPOW her and then she did legit try or actually kill herself, are they liable for refusing treatment? I dunno. Maybe it is purely CYA or profits they were looking at? Or maybe they really did think she was a nutter butter.

They originally told her she'd be going to a different psych facility she didn't really mind going to (in comparison), confirmed they had a bed for her and all. Then some muckup happened and they no longer did. So she was mad about being lied to (Understandable), talked about suing the hospital and whatnot. I bet she got a lawyer.

With the psychs I've had so far, most EDs aren't equipped to handle it past trying to make sure they don't hurt themselves or others in an acute sense. Which makes sense, they aren't rehabs or whatever. I don't know why people go to the ED for "feeling sad" (With no other complaints or threats, just didn't feel right). Is it wrong to think this? I just think there are more effective options that won't result in the same hassle or treatment.

So many patients stay longer in the hospital because poor or no insurance and the only facilities that will take them are full and there are no beds, so they wait.

The mental health system is so wack.

Had a fella the other day, he was pretty chill. I think he also was attempted suicide or SI. But he was one of the most chill dudes ever. Voluntary. He wanted help, I truly think he did. He just looked pretty depressed and really wanted to smoke a cigarette. He wanted to walk to the ambo but we can't let them. Liability and all. He just had this look about him like he was just kinda done living. Like a burned out fire that went cold, but you knew it was supposed to be lit. He chatted a little, not much. He was quiet and polite, one of the most polite patients I had.

We checked with the facility and they let him smoke outside. Wished him the best. He wasn't that old either. It's kinda sad when you see people so much of an empty shell, a shadow. Light is barely on, someone's kinda home.

It hurts me to see people so hurt. And maybe I guess for me I should limit that. Not that I go home depressed, but it's a heck of a (not so great) thing to see people of all kinds. Some went through the wringer and are as chipper as all get-out. Some are so scared they don't know what's going to happen to them, they feel so distanced and alone, some are apathetic to whatever, and in one case, one was in tears begging us to kill her and throw her in the garbage/ditch. I have seen things (Not to pretend suddenly I have a ton of experience) that I really didn't expect. It's nice when you have a discharge and the person went from not great to better or getting there, that they're on their way and much better than they were.

We had an MVC patient that was in the hospital for like 9 months, she was going to an LTAC because she was finally stable enough. She had been bounced from IMU to ICU for most of that time. She'd been eviscerated, basically gutted and nearly torn in half in the wreck. Still had a lot of lines and tubes, meds, pain. She was very anxious and scared to leave the hospital and just wanted to go home. We encouraged her the best we could. She got pictures with all the staff and her drs, she didn't want to leave the hospital. She had a trach and could barely speak. They closed off a certain line or tube in her abdomen, and upon arrival, it was leaking dark green kinda mushy stuff. Was it a PEG or JP drain or something? I cannot remember the line. Made a note of it to the nurse, but he didn't seem that concerned. I dunno if it was low priority or they just were not attentive staff.

She was just... it was kinda bittersweet. She was getting better but still had a long way to go.

I just wish I could fix people. And maybe I'm getting too attached. I don't always think of these people, but when I sit back and see all the ups and downs, victories and pain, it's just kinda... a window to humanity that sometimes I wish I didn't see. But that sounds like some ignorance is bliss bullcrap, because even if I didn't have a view, it still happens. I just wish I could do more. At the very least, I do all I can for the patients I do have. Try to be sympathetic and reasonable, listen to them, but not patronizing. Be a person to them because a lot of times, people aren't to them.

We had a patient that was a doctor. I assume she helped a lot of people. But at this point she was basically nonverbal, managing weird grunting noises and something that sounded like "Oh my god". She was contracted and had a DNR. Her vitals weren't great, but were stable. She'd had a CVA or something and had dementia. I bet she used to be really smart, but now she couldn't even care for herself. Pressure ulcers and not being able to communicate very well, it was just another "This used to be a very different person". She's still very much a person and should be treated with respect. Her time would be soon, I assume. She was going to a hospice care facility. She would scream like a siren at everything. Being startled, being moved,being touched, getting a BP, and seemingly for no reason.

I wonder what it would be like to meet these people when they were younger, more healthy, etc. What would they be like on their best days?

I feel like people very quickly don't see them as people anymore. Just a burden or an annoyance that society deems we keep.

I kinda went on a tangent, but that's kinda my current thoughts on this.

 

[Akulahawk]

I don’t do loud. It is disruptive and interrupts other patients and can escalate others. It isn’t okay to escalate other patients because you can’t control yourself.

There are definitely parts of the ED that I won't tolerate "loud" because there's no way to muffle the noise... and I'm not referring to application of pillow to facial region of a patient... I'm referring not being able to shut a door because there is no door. Most of the psych patient we get are placed in a specific area of the department that does have doors that we can close. I also generally close those doors because it muffles noise pretty well both ways. I also do let them know they don't have to get loud to be heard and I'm willing to listen as long as they're not loud about it (and if I have the time).

 

[Aprz]

Our mental healthcare system makes me sick.

 

[DragonClaw]

Our mental healthcare system makes me sick.

That's why I kinda just mind my own business and don't go looking for "help".

My last counselor thought guns kill people. Black gun bad.

Anyone who knows me knows I'm not the type to hurt anyone, including myself. But if you say the wrong thing, suddenly you have no rights, nobody will listen to you, and your life is over as you know it.

I feel confident in my ability to make it alright without the crutch of that, meds, etc.

Sure try and eat right, sleep, de-stress appropriately, etc, but don't go knocking on doors you don't want opened.

 

[DragonClaw]

Not that I think I'm unstable and refusing help, but stress and adversity is kinda a mind game at this point.

It's a willpower thing and I'm just gonna keep going no matter what.

 

[NomadicMedic]

The fact that NREMT is going to allow proctored at hone cognitive testing has infuriated the mouth breather EMTs on Facebook.

Pretty funny to watch.

 

[DragonClaw]

The fact that NREMT is going to allow proctored at hone cognitive testing has infuriated the mouth breather EMTs on Facebook.

Pretty funny to watch.

How do they stop cheaters

 

[PotatoMedic]

How do they stop cheaters

They record the entire season and they require a webcam. So they watch you. You have to show them the entire room before even where you are sitting. There are no breaks at all. And then someone watches the test to make sure you didn't cheat.

 

[DragonClaw]

They record the entire season and they require a webcam. So they watch you. You have to show them the entire room before even where you are sitting. There are no breaks at all. And then someone watches the test to make sure you didn't cheat.

That's a lot of... a lot.

Do you think this is a good idea?

Surely someone will get around it. But that's an inevitable percentage and now people don't have to wait for the Rona to end for NREMT.

I just remembered I took my NREMT in Louisiana. Texas didn't have any tests soon enough. But I wasn't gonna let that stop me

 

[DragonClaw]

I just remembered...I killed an animal with the ambulance yesterday. Nvm arrest me now. Put me with the other despicable creatures.

I'm sorry. I must atone.

If I'd been in my POV I'd have slammed on my brakes, but not pt loaded in an ambo/ with my partner in the back.

Let the execution be in the darkness of midnight, I do not deserve to see the sunrise like I have so violently taken from another.

 

[CALEMT]

I once smacked a coyote with my truck at 60mph. Sent his *** flying into the bush... he dead.

Then there was the time I tagged a turkey, he went spiraling into the median.

Theres a reason why I have a aftermarket bumper on my truck...

 

[DesertMedic66]

That's a lot of... a lot.

Do you think this is a good idea?

Surely someone will get around it. But that's an inevitable percentage and now people don't have to wait for the Rona to end for NREMT.

I just remembered I took my NREMT in Louisiana. Texas didn't have any tests soon enough. But I wasn't gonna let that stop me

It’s actually a fairly common process now. Several online college courses do it and so do some pre-employment exams.

You have to also give them access to your computer screen so they can see what applications and websites you have open. They also turn off features like Bluetooth.

 

[Aprz]

Personally, I think NREMT skill testing are a huge waste of time, and it's just an excuse for them to collect more money. We were just talking about the paramedic who punctured the liver and heard air wooshing out. I blame things like NREMT where we verbalize what findings we expect to the point that verbalization matters more than what we really hear, see, or feel. I see it all the time; Not just with with pleural decompression. Other good examples or visualization of endotracheal tube going through the vocal cord, imagining rise and fall of the chest when there isn't (whether intubation, bag-mask ventilation, or using a supraglottic airway), what we find during our assessment (lung sounds, people saying they hear wheezes when it's really rhonchi or rales, hearing clear sounds when they heard nothing). I feel like the skill sheets make us more like robots that will go down the checklist regardless of what happens, and they don't set us up for success.

 

[DragonClaw]

Personally, I think NREMT skill testing are a huge waste of time, and it's just an excuse for them to collect more money. We were just talking about the paramedic who punctured the liver and heard air wooshing out. I blame things like NREMT where we verbalize what findings we expect to the point that verbalization matters more than what we really hear, see, or feel. I see it all the time; Not just with with pleural decompression. Other good examples or visualization of endotracheal tube going through the vocal cord, imagining rise and fall of the chest when there isn't (whether intubation, bag-mask ventilation, or using a supraglottic airway), what we find during our assessment (lung sounds, people saying they hear wheezes when it's really rhonchi or rales, hearing clear sounds when they heard nothing). I feel like the skill sheets make us more like robots that will go down the checklist regardless of what happens, and they don't set us up for success.

Would blood, rather than air, come shooting out during a botched needle decompression? Or nothing? Or would it just kind of ooze out?

 

[Tigger]

AMR is the largest private company. I'm sure they have a way to do this legally. Otherwise if anything happens they'll be sued and have no leg to stand on.

I assure you that AMR being a large private company does not mean that local operations will not do sketchy things. I work for supposedly the crown jewel operation and while most things are above board, crews have certainly been put in bad places by management.

 

[Aprz]

Would blood, rather than air, come shooting out during a botched needle decompression? Or nothing? Or would it just kind of ooze out?

I would say blood, nothing coming out, or being unable to advance the catheter or needle are signs that it wasn't successful. It's not always the provider fault. In ITLS, they teach you to look at the neck veins and resonance (eg knocking a solid wall vs a hollow one, it makes a different sound) to tell the difference between a hemothorax vs pneumothorax, but those are not sensitive findings in my opinion. In my pneumothorax patient's, I've never seen distended neck veins and I imagine those are a late finding or subtle finding just like tracheal deviation. I wouldn't know what it is suppose to feel like trying to feel for resonance. I don't think those type of things happen frequently enough to really get a feel for it.

I've never tried midaxillary placement. Every time I've heard people try midaxillary, they've placed it into the liver. It makes me afraid to try it. I heard midaxillary is a spot that we are taught because of police officers or soldiers wearing body armor and not having quick/easy access to the chest to decompress. I've personally always done it midclavicular. That being said, even feeling the intercostal space, I've still managed to hit the ribs and not be able to get around it. I think the ribs are a little bit more angulated than what we feel on the surface of the chest. I've reproduces this problem on a cadaver before. It's weird to go in like a cm without issue and then just hit a solid wall... You can try to angle it or shimmy it to get by. I've also misplaced midclavicular ones before, and I think contributing factors was chest compressions being done and the fact that I was doing it from the patient's side. The chest compressions I feel like gave me a poor idea of what midclavicular was, and since I was at the patient side, I did both towards me instead of actually midclavicular. I had put the right sided one too medial towards the sternum and the left sided one too far lateral towards the shoulder. After that happened, I now prefer to do it at the head of the patient's where you manage the airway so it's easier for me to assess what is midclavicular.

I've personally never had blood come out either, but maybe that's because I've never tried midaxillary or never had a significant hemothorax?

 

[CALEMT]

I've personally never had blood come out either, but maybe that's because I've never tried midaxillary or never had a significant hemothorax?

My last one had blood. 4th intercostal midaxillary line. It didn't spurt out, just more oozed. GSW to the chest.