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EMT.Hart

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I have been an EMT for about 6 months and a paid one for just over a month.
... I work at a private ambulance service and have done many "emergency" transports. But today we just got back from a call and here's how it went.

Got called out to a nursing home where an elderly female chocked on a Tylenol pill just over an hour prior to ems arrival. Pt had acid reflux hx and was spitting up " dark maroon blood ". My medic had ruled that it was an esophogeal varesice( spelling? ). Any rate. The obviously went into compensative shock.

As we rolled up into er and dropped the pt on the er bed she crashed. Er called code and pushed us out of the way.

Now... Don't get me wrong. I'm glad we got her to the hospital on time but if the nursing home would have waited 6 more minutes. I would have been able to run my first code 3!

- hope she does well.

Thread question. -- what was your first code 3 like? --
 
Why would you have driven code if she crashed? Most companies I know about have a protocol where if your pt crashes while being transported, you stop the truck, call it in to dispatch and go help your partner.

There almost nothing a hospital can do in a code that we can't do in the field.



Plus I doubt your medic would gave been too keen being the only one in the back doing CPR while you drive like a bat out of hell.
 
I dont even like to drive. Not looking forward to Code 3. :wacko:
 
Linuss said:
Why would you have driven code if she crashed? Most companies I know about have a protocol where if your pt crashes while being transported, you stop the truck, call it in to dispatch and go help your partner.

There almost nothing a hospital can do in a code that we can't do in the field.



Plus I doubt your medic would gave been too keen being the only one in the back doing CPR while you drive like a bat out of hell.
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Thank for your input an answering my question! It's great to see how time and time again you forum trolls hide behind your keyboards.

Thanks Linuss!
 
EMT.Hart said:
Thank for your input an answering my question! It's great to see how time and time again you forum trolls hide behind your keyboards.

Thanks Linuss!
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?????

Actually, all of what Linuss says is true. Unless you can actually see the hospital, you aren't going to continue to the hospital. You are going to pull over, assist your partner, and call for additional help. If you can see the hospital, you aren't going to drive code 3. There is no need to do so. The 2 seconds (literally) that you might save, just isn't worth it.

That being said, driving code 3, while being a part of the job, is a calculated risk for everyone involved. All it takes is one person on the road to not be paying enough attention to what they are doing (ambulance driver included) and there is a huge possibility that what happens next results in tragic consequences.

The longer you can go without driving code 3, the better.
 
There is something about the lights and sirens that make people drive like complete idiots. First time you light it up you will see what everyone does... the lights make the other drivers nervous or something.
 
ChicagolandIFT said:
There is something about the lights and sirens that make people drive like complete idiots. First time you light it up you will see what everyone does... the lights make the other drivers nervous or something.
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People around here are pretty good about it from what I've seen. I pull as far over as I can go and everyone else does as well as soon as they notice the lights, no matter who's got them. Fire, Medical or LEO. I'm sure that may chance once I'm actually in the ambulance though. :P
 
EMT.Hart said:
Thank for your input an answering my question! It's great to see how time and time again you forum trolls hide behind your keyboards.

Thanks Linuss!
Click to expand...



+1 to Linuss for his answer. If your patient crashes, your place is in the back, not driving fast. Did I read your response correctly? Did you truly wish for the the patient's condition to degrade further so you could run a "Code 3"? Really? In your 6 month career in the field, have you ever seen esophageal varices and what happens when multiple vessels rupture? It's not pretty, it's not fun; it's a critical, life-threatening emergency that usually ends poorly for the patient. The last patient I responded to with varices almost bled out in the back of the unit; we couldn't suction the blood fast enough to keep up. I understand that you're doing IFT and this is all new and exciting; after you've done it for a few years (or decades) and you've had some real experience you will see that the nursing home staff did their job and should get kudos for recognizing the problem was outside their capability and then called for help. You need to check yourself and decide if you are in this job to care for people or to feed your ya-yas. Furthermore, for someone who has four posts to call a member of nearly a year with well over 2400 posts a "troll" is curious at best and rude at worst. Linuss wasn't "hiding behind a keyboard", he was telling you his opinion of proper care for this patient.

Thread answer: My first code three return was a cardiac arrest in a 56 year old woman. She left a husband, several kids, and a grandchild. The call sucked from start to finish, but I'm sure the call would have been a good one in your book, since we did get to run a few red lights on the way to the hospital...
 
OP, are you for real? Linuss has been an EMT and is close to being a paramedic, as well as a long time forum member and that is how you react to his thought out (and accurate) response to your question? Do not expect us to answer your threads if you are going to call us trolls when we give you posts you do not agree with.

BTW, I second what linuss said.
 
daedalus said:
OP, are you for real? Linuss has been an EMT and is close to being a paramedic, as well as a long time forum member and that is how you react to his thought out (and accurate) response to your question? Do not expect us to answer your threads if you are going to call us trolls when we give you posts you do not agree with.

BTW, I second what linuss said.
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I second that. Apparently this guy's just a "save the world" EMT on his way to a fast burnout.

I hate driving. I hate driving code 3 even more.
 
EMT.Hart said:
Got called out to a nursing home where an elderly female chocked on a Tylenol pill just over an hour prior to ems arrival. Pt had acid reflux hx and was spitting up " dark maroon blood ". My medic had ruled that it was an esophogeal varesice( spelling? ). Any rate. The obviously went into compensative shock.
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Esophageal varices? Tylenol? Your medic is pulling a diagnosis out of his arse. Cirrhosis of the liver with portal hypertension and venous dilation is the usual cause for esophageal varices. GERD is something different and the bleeding could come anywhere in the GI tract. Since you didn't mention any other hx or medications to determine if other bleeding issues or a need to regulate her bleeding time were a concern, it would be difficult to pinpoint the exact cause of bleeding in the GI tract. There is also too little information to determine if her issues are primary or secondary to something else.

If this person was being given Tylenol it was probably for an increased temperature which could be indicative of an infection. I seriously doubt if the choking on the Tylenol was the cause of this situation but rather an infection that rapidly deteriorated into shock probably from sepsis unless there was copious amounts of blood that she vomited up. If the events had not happened so quickly this would probably be a call some would just blow off as BS fever call.

It is good that you got to see this call and I hope you do understand this was not a simple "choke on pill" call but rather how medically complex nursing home calls are even if they are "routine" IFT.

Did your Paramedic initiate treatment by getting a line with fluids or pressors started especially if he thought it was compensatory shock? What was his thoughts on intubating if this patient actually had esophageal varices?

A good Paramedic and a knowledgeable EMT partner should be able to treat the patient with more than just L&S. Once L&S&speed become the treatment, the other treatment will more than likely have to wait especially with an inexperienced driver.
 
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I second Vent and add some.

Our OP doesn't need any characterizations. Thanks for posting and giving us the chance to respond.

Yeah, dx'ing esoph varices is not done in an ambulance. Nice guess, thanks for playing, but blood from down there means get thee to a hospital...see notes above about "code 3", "Warp Four" or whatever.

Some convos will call you to get a pt who is "obviously" dying to keep the death off their statistics. I've fooled 'em, you can too,. and bring that pt back the same week, or the same day, in good shape!

And about the "There's nothing you can do at a hospital you can't do in an ambulance", that's perfectly right if your hospital has no xray, OR, ICU, gift shop, cafeteria, and is the size of a railcar compartment or smaller.;)
 
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Our OP doesn't need any characterizations. Thanks for posting and giving us the chance to respond.
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What is that supposed to mean? Take a look at Linuss's first response and then what the OP wrote about it.
 
mycrofft said:
Yeah, dx'ing esoph varices is not done in an ambulance. Nice guess, thanks for playing, but blood from down there means get thee to a hospital...see notes above about "code 3", "Warp Four" or whatever.
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Spitting up blood usually doesn't shock me. But, if I never see another Blakemore tube attached to a football helmet in this lifetime, I'll be much happier. I would rather be "Code 3" in the opposite direction from those train wrecks. They give a whole new dimension to the term "pucker factor" on CCT/IFTs and in the ICUs.
 
Yeah, dx'ing esoph varices is not done in an ambulance. Nice guess, thanks for playing, but blood from down there means get thee to a hospital...see notes above about "code 3", "Warp Four" or whatever.
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I beg to differ. Perhaps you have not seen the latest paramedic curriculum? I was taught how recognize upper and lower GI bleeds, form a DDx, and treat them. Now, treatment is really the same whether the bleed is an ulcer in the stomach or a ruptured varice, but I know the pathophysiologies of each and they will both be on my short list.

While I may not have an endoscope, I can safely say if a patient is having a active upper GI bleed, and if on the history and physical it is determined the patient is a chronic alcoholic with liver failure I will have a pretty good idea of what is going on. I do not tell the doctors and nurses "blood is comin up from 'down there'". Unprofessional.
 
daedalus said:
I beg to differ. Perhaps you have not seen the latest paramedic curriculum? I was taught how recognize upper and lower GI bleeds, form a DDx, and treat them. Now, treatment is really the same whether the bleed is an ulcer in the stomach or a ruptured varice, but I know the pathophysiologies of each and they will both be on my short list.

While I may not have an endoscope, I can safely say if a patient is having a active upper GI bleed, and if on the history and physical it is determined the patient is a chronic alcoholic with liver failure I will have a pretty good idea of what is going on. I do not tell the doctors and nurses "blood is comin up from 'down there'". Unprofessional.
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GI bleeds and esophageal varices are different. This is part of a differential dx and can not be sufficiently dx'd in the field. People with a cirrhosis hx may have both situations. They may also be bleeding from many areas. It could also be a problem with their INR and trauma from suctioning or coughing. How about a bleed in the posterior nasal passages? Hours of swallowing blood which doesn't digest well?
There have been some patients we've gone crazy scoping both ends and find out it is a bleeder in the nose. They has all the other risk factors to have a GI bleed. We've also had some patients mistaken for GI bleeds that we ended up doing a full pulmonary workup for a gnarly tumor or TB.

All that bleeds is not what it seems. Treat the symptoms per your protocol from a working dx and don't assume you know the "diagnosis".
 
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VentMedic said:
GI bleeds and esophageal varices are different. This is part of a differential dx and can not be sufficiently dx'd in the field. People with a cirrhosis hx may have both situations. They may also be bleeding from many areas. It could also be a problem with their INR and trauma from suctioning or coughing. How about a bleed in the posterior nasal passages? Hours of swallowing blood which doesn't digest well?
There have been some patients we've gone crazy scoping both ends and find out it is a bleeder in the nose. They has all the other risk factors to have a GI bleed. We've also had some patients mistaken for GI bleeds that we ended up doing a full pulmonary workup for a gnarly tumor or TB.

All that bleeds is not what it seems. Treat the symptoms per your protocol from a working dx and don't assume you know the "diagnosis".
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the point of my post was to say that I know better than to say "there is blood comin from down therr". It was not to imply i could make a definitive dx, but that I can make a ddx and treat based on it, like you had said.
People with a cirrhosis hx may have both situations.
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Good to know.
 
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Wow. Left this post to sulk for a day or two to get some good reading in. I feel as though I need to clearify sone things.

I didn't wish for the pts condition to turn into a code 3 status and I'm pleased to inform everyone that a follow up was done. Surgery was a success and the pt is expected to make a full recovery.

In the haste of my last post I failed to mention the whole situation. Including how my medic figured it to be a esoph v. ( which it was ).

I appologize to everyone on the forum who I may have offended in any way and give a special shout out to Linuss.

Thanks EMS brothers and sisters
 
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