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A Rookies tragic mistake. Paramedics this one is for you

Discussion in 'EMS Talk' started by fishyfish, Jun 12, 2018.

  1. fishyfish

    fishyfish Forum Crew Member

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    Hello everyone I want to share with you all a tragic series of unfortunate events that changed the life of 18 year old female forever. 0620 am rual EMS service was dispatched for a 18year old female, who passed out in the shower presenting with slured speach drooping face,numbness on the right side and inability to move that side. A recently certified paramedic, is not phased and states the fallowing " your just stressed, young people do not get strokes". Vitials taken, everything seems normal BP just a little high, no medications or allergies, only hormonal birth control. no code FAST started, iv or o2. Transport is a non emergent, hospitial was told she was sutiabel for triage.Not until 4 hours later was it found by the hospitial. The 18 year did have a stroke, damage was permenant. The cause prolonged use of hormonal birth control. Don't let a blunder like this happen again guys.
     
  2. fishyfish

    fishyfish Forum Crew Member

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    Note also the hospital was never told, of the stroke symptoms. only A stressed 18 year old female and the vitals. This time it was my loved one. Tommarow it could be yours...
     
  3. wanderingmedic

    wanderingmedic RN, Paramedic

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    While a sad scenario, this one does not fall entirely on EMS. The patient sat in the ED for 4 hours. If those were really the assessment findings, the ED certainly could have and should have triaged this patient as a possible CVA. Realistically, there is not much that EMS can do for a stroke other than early notification of the ED. Even transporting Code 3/Priority 1 does not save that much time.

    Also, spell check is your friend.
     
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  4. DrParasite

    DrParasite The fire extinguisher is not just for show

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    What blunder? not recognizing that it was a stroke? the non-emergency transport? leaving the patient in triage? I would think that even if EMS did screw up, the hospital triage nurse (who is more educated than EMS) would have noticed the error, and activated the stroke team, if he or she felt the situation warranted it.

    hormonal birth control can lead to clots (it is a known side effect), but the person is 18 years old.... what made it prolonged? meaning, how long was she on it, to make her high risk? Shouldn't this be much more common, that BC leads to strokes in young healthy people?

    sounds like the new medic was thinking it was bells palsy, which can show similar signs as a stroke. Think of it this way..... how often do 18 year olds have strokes? it isn't common, especially in healthy people. slim minority. your loved one just happened to be one of the unlucky ones.

    Sorry to hear about your loved one, but this seems to be more of a case of bad luck (genetics + BC resulting in an unusually young and healthy individual presenting with stroke like symptoms). If you do think an error was made (and take the whole hindsight is 20/20 out of the picture), file complaints with the appropriate agencies so they can investigate and take corrective action, if necessary.
     
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  5. marian

    marian Forum Crew Member

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    From what I have been told by my doctors, it doesn't even have to be prolonged use of birth control to increase a woman's risk for stroke.

    And, maybe it's because I am a woman and have looked at birth control both from the perspective of an prehospital provider as well as from the perspective of a potential user of hormonal birth control, but I hear hormonal birth control and I instantly think blood clots/strokes/DVT/PE.

    Furthermore, cigarette smoking, bad diet, being inactive all increase risk of stroke on their own and more so when a person is also taking hormonal birth control.

    And there are conditions that increase a person's coagulability that are relatively mild and go undiagnosed until it's too late (e.g. Factor V Leiden, prothrombin whatever).

    It's a bummer for that paramedic and even more so for the patient that this diagnosis was missed. I'd also like to echo wanderingmedic in that patient care was transferred to an ED. Paramedics are not trained to diagnose, we are trained to treat symptoms based on algorithms and transport. Diagnosis and definitive treatment of medical conditions is the purview of higher level providers.

    The main takeaway me is the minute I hear hormonal birth control, I think clots. Secondarily, for all the women out there who are looking for a nonhormonal method of birth control, there are options (e.g. the copper IUD).

    edit to add: sounds as if patient care was also transferred at +/- 0700 to the ED. Most of the EDs I transport to have shift change at 0700.
     
    Last edited: Jun 12, 2018
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  6. epipusher

    epipusher Forum Asst. Chief

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    How would the iv and o2 changed this scenario?
     
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  7. wanderingmedic

    wanderingmedic RN, Paramedic

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    Exactly.
     
  8. RocketMedic

    RocketMedic Fancy Book Learnin'

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    Eh, that's not that tragic. Try watching some poor dude asphyxiate in front of you because you can't get the line to give the drugs to RSI him, but not being obtunded enough to take an SGA, and with an airway that gives nightmares. With a massive internal hemorrhage going on simultaneously.

    That's tragedy.
     
  9. DrParasite

    DrParasite The fire extinguisher is not just for show

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    That's what I meant.... it does increase the risk, but the OP says that was the cause.
    It's not just because your a woman; I'm a man, and that's one of my red flags to, esp if the condition that is presenting could be clot related.

    Sucks that it happened, but I'm not really sold that this was a rookie paramedic mistake in how the patient was treated
     
  10. Bullets

    Bullets Forum Knucklehead

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    That this patient was not evaluated by anyone from the hospital for 4 hours is the real issue. Even in smashed inner city hopsitals, ive rarely had a patient wait that long for initial triage by an RN who would have caught it and sent it for a Stat CT.

    Even with that, the stoke window is 24 hours, so while its unfortunate, she was still well within treatment time.
     
  11. Gurby

    Gurby Forum Asst. Chief

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    Probably by making it worse with regards to the O2. Though I guess maybe the hospital would have paid more attention to her if she had an IV in place.

    y u no IO?
     
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  12. rescue1

    rescue1 Forum Asst. Chief

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    Hormonal birth control does increase your risk of stroke, but the risk is still very small (unless you smoke or are fairly obese). However, stroke in pediatrics/young adults is more common than people (even doctors) think it is, and it should be on your differential for young people with neuro deficits as opposed to jumping to Bell's palsy or intoxication.

    That being said, this is definitely also on the ED for missing classic CVA signs for 4 hours, even if EMS told them it wasn't a stroke.
     
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  13. NomadicMedic

    NomadicMedic EMS Edumacator

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    io
     
  14. mgr22

    mgr22 Forum Asst. Chief

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    I haven't heard of a 24-hour stroke window (vs.3-4.5) for tPA. Where is that being done?
     
  15. rescue1

    rescue1 Forum Asst. Chief

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    I think endovascular clot retrieval is 24 hours.
     
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  16. mgr22

    mgr22 Forum Asst. Chief

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    I thought that maxed out at 6 hours.
     
  17. rescue1

    rescue1 Forum Asst. Chief

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    Check out the DAWN and DEFUSE 3 trials, which looked at retrieval presenting 6-24 hours after onset (DEFUSE 3 was 6-16 hrs). It's pretty new stuff, but many of the big academic hospitals are doing it.
     
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  18. Remi

    Remi Forum Deputy Chief Premium Member

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    Folks go on and on about how paramedics get no respect and how ED personnel should have more faith in our assessment......then they hear a story about a paramedic who misled the ED staff about a critical condition (misinformation which the ED apparently relied on) and all people can say is “meh, it’s the ED’s fault - there’s nothing we can do for strokes anyway”.
     
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  19. NomadicMedic

    NomadicMedic EMS Edumacator

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    It's hard to determine the validity of this story when all we have is the patient's mom telling her side.
     
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  20. rescue1

    rescue1 Forum Asst. Chief

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    Probably an unpopular (and cynical) opinion on this site, but while I'd like to live in a world where paramedic assessment is something valued and important, there are too many poorly educated medics for me to say that providers in the ED should have lots of faith in a paramedic assessment, especially of an atypical patient like an 18 year old with hemiparesis.
     
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