Even if they are on blood thinners they can be on their way.
You can not make them sit because they are SOB, nor can you force oxygen and ALS on people.
If you are not exaggerating about this place you work, it sounds down right ridiculous.
To me, this looks like dehydration, heat exhaustion, and a potential electrolyte deficiency at the very least.(Based on a scenario or two I have seen, scrubbed to prevent identification; I would like your thoughts).
It's a hot dry day without a cloud in the sky.
A family comes up to you asking for a bottle of water. You send your partner to grab some water and notice a male about 12 y/o who just doesn't look good. He is sweaty, flush red, in a slouching / tired posture, and has one hand on his abdomen. You offer him a seat and he takes it.
The parents advise you that their son was not feeling well so they wanted to get him some water. With their permission, you start asking a few questions. The pt is having a headache (3/10) and sharp abd pain (5/10) with nausea and dizziness. The headache is new and the abd pain, nausea, and dizziness have been worsening since morning. He had a hot dog to eat and hasn't drank much all day. The pt takes no medications and nothing like this has ever happened before.
Examination of the abdomen reveals a diffuse pain, unable to be located by the patient. Palpation does not affect the severity of the pain.
You suggest that the patient be evaluated by paramedics for possible transport, but they end up refusing care. You suggest that the pt be seen by his MD, but he does not have an MD. The parents say that they will take him to urgent care but don't want EMS/hospital because they don't have insurance.
How okay are you with this refusal? Your gut instinct wanted an ALS evaluation / transport unit to be called to the scene, but your partner and supervisor both seemed perfectly okay with this as an ordinary refusal.
Similar to most 911 systems in this regard.Here is my concern with this scenario. This place is hiring people that are expected to be able to determine if someone is sick and make a recommendation about treatment/transport, yet they are hiring people that lack the education/experience to make such decisions. This is no offense to the OP, but this is a bad/dangerous set up for you as the provider and for the patients. It makes me wonder what kind of medical direction they are operating under.
Do you guys ever suggest to patients that they go to an urgent care over the ED? A lot of times, a patient will refuse transport after calling (or after their someone else calls for them) with something that seems non-acute. I often want to say, "if it was me, I'd go get checked out at an urgent care", but always feel guilty about it, like I should always advise them to just go straight to highest level of care to CYA.
This place is hiring people that are expected to be able to determine if someone is sick and make a recommendation about treatment/transport, yet they are hiring people that lack the education/experience to make such decisions
I had a patient who was coming in with sharp epigastric pain after eating a gas station burrito. He had an aortic aneurysm. Of course being meth positive could have contributed.What would you do if you had a stomach ache that was sharp? Call an ambulance? Or stop eating ****ty hot dogs that are giving you gas and drink some water?
The CT scan that the senior resident threw on because something didn't feel right. Also with that hospital's patient population, patients are assumed to be meth positive until proven otherwise.Was that the ultimate Dx by the MD, or was there some clue in the field that told you that?
(The "pulsating mass" that the textbook talks about...)
nah, honestly how they describe pain half the time is completely inconsistent with what they have (not just kids)Maybe EMT class scared me a bit much, but isn't sharp abd pain supposed to be worrisome?
Here's a good article looking at the sensitivity/specificity/likelyhood ratios of classical signs and symptoms associated with appendicitis.