Called for 40ish/M Unresponsive...

[NBfire841]

I used to work for a service that ran a 24 hr truck and a 16 hr truck 7 days a week. I worked Fri/Sat 16s so I just slept in a spare bunk sometimes. Occasionally, I would get up with the 24 hr crew if they might need help.

Anyway, we were toned for a mutual aid call, 40ish male, unresponsive. U/A, found pt laying supine in middle of kitchen floor, cool, pale, diaphoretic, snoring respirations @ 10 RR. I announced that I'll get vitals, EMT & Medic told me no. Thought to myself... ok, 2 EMTs and noone is getting vitals? Wife states Hx of DM type I, awoke, went to kitchen. Evidently to eat something. Crew EMT checks CBG while Medic gets IV kit. CBG = 413. I asked if he used an alcohol prep, he said there weren't any in the glucometer so I got 1 out of the IV kit which he refused to take. Pt seizes for approx 1 min, Medic got a 20ga RAC, we got a sheet under him and moved to stretcher, O2 @ 2lpm via NC, to unit.

Crew EMT drives L&S, I'm back with the Medic. Pt has not improved at all obviously. 4 lead = NSR about 64, NiBP = 80/60 range, SpO2 = 88%. Pt seizes every 2 mins now, lasting about 1 min. RR now 8, I ask "BVM?" "No, OPA, NRB 15lpm" ok.... Medic gets 18ga LAC. Refuses to check CBG again, gives valium for seizures, seizures subside.

We get to the ED, doc wants a CBG reading... 11. 11!!!!! Hmmm... I think maybe someone should have gotten some D50 like 25 mins ago. Pt was up and talking before we ever left the ED. I don't work for that service anymore. No one got reprimanded about that call. No vitals in the house? Trust the glucometer reading of 413 and NEVER checked again? WTF?? What would anyone else have done in my situation? I was still pretty new, but now I think i would handle that differently.

 

[Shishkabob]

Holy hell, I'll make sure to never get sick in that town....


How'd that medic, let alone the basic, get their certs?

 

[Ridryder911]

Appearantly you handled right, you no longer work there.

R/r 911

 

[Sail195]

thats unreal, wtf were they thinking?! I really don't see a way to justify that

 

[NBfire841]

I don't know how/why the call went as it did. There is almost zero accountability at that service, unless the director decides he doesn't like you, normally for things that happen outside of your actual patient care duties. I know several other EMTs and Medics that used to work there and they had similar experiences.

 

[NBfire841]

Holy hell, I'll make sure to never get sick in that town....


How'd that medic, let alone the basic, get their certs?

I don't know about the EMT, but the Medic used to work for a company that did almost no 911 calls, mostly inter-facility transports. That's no excuse though, he had to pass the national registry just like every other Medic. He's the type that will send questionable things BLS, and at least thinks about sending mild SOB, dizziness, N/V, BLS even though the pt could benefit from ALS care. Pure laziness. My goal is to put in 8 or so more months in as a basic and start looking at a Paramedic program. I surely don't want to have that kind of thing happen to me again.

 

[firecoins]

just go for the medic.

 

[MrBrown]

Alcohol wipes have glucose in them!!!!

 

[rescue99]

I used to work for a service that ran a 24 hr truck and a 16 hr truck 7 days a week. I worked Fri/Sat 16s so I just slept in a spare bunk sometimes. Occasionally, I would get up with the 24 hr crew if they might need help.

Anyway, we were toned for a mutual aid call, 40ish male, unresponsive. U/A, found pt laying supine in middle of kitchen floor, cool, pale, diaphoretic, snoring respirations @ 10 RR. I announced that I'll get vitals, EMT & Medic told me no. Thought to myself... ok, 2 EMTs and noone is getting vitals? Wife states Hx of DM type I, awoke, went to kitchen. Evidently to eat something. Crew EMT checks CBG while Medic gets IV kit. CBG = 413. I asked if he used an alcohol prep, he said there weren't any in the glucometer so I got 1 out of the IV kit which he refused to take. Pt seizes for approx 1 min, Medic got a 20ga RAC, we got a sheet under him and moved to stretcher, O2 @ 2lpm via NC, to unit.



Crew EMT drives L&S, I'm back with the Medic. Pt has not improved at all obviously. 4 lead = NSR about 64, NiBP = 80/60 range, SpO2 = 88%. Pt seizes every 2 mins now, lasting about 1 min. RR now 8, I ask "BVM?" "No, OPA, NRB 15lpm" ok.... Medic gets 18ga LAC. Refuses to check CBG again, gives valium for seizures, seizures subside.

We get to the ED, doc wants a CBG reading... 11. 11!!!!! Hmmm... I think maybe someone should have gotten some D50 like 25 mins ago. Pt was up and talking before we ever left the ED. I don't work for that service anymore. No one got reprimanded about that call. No vitals in the house? Trust the glucometer reading of 413 and NEVER checked again? WTF?? What would anyone else have done in my situation? I was still pretty new, but now I think i would handle that differently.

Glad to know someone had a clue. Too bad it wasn't the one in charge!
This medic needs the be taken off the road until his skills have been appropriately evaluated and remediated.

 

[Tiberius]

This is why they say "Treat the pt. NOT the machine!"

Blood sugar should have been checked again. Pt. should have been bagged.

I, too, would have left the employ of that service.

 

[NBfire841]

Alcohol wipes have glucose in them!!!!

I was unaware of that. I've never had an issue with that same glucometer before or after that call, both taking blood from the line and via lancet. I'm thinking that the guy started to eat/drink something (OJ, cookie, etc.) before he went unresponsive, so he had a sugary substance on his finger, thus the crazy reading. No way to confirm it now though.

 

[NBfire841]

This is why they say "Treat the pt. NOT the machine!"

Blood sugar should have been checked again. Pt. should have been bagged.

I, too, would have left the employ of that service.

what scares me the most is that there is a very real possibility that the pt suffered at least some loss of brain cells, and that i wasnt yet sure enough of myself to speak up. I guess I should be glad the wife didn't know any better

 

[bstone]

Alcohol wipes have glucose in them!!!!

They do? I took organic chemistry and I distinctly recall there being no glucose in alcohol. Primary, secondary or tertiary alcohols, methyl, ethyl, isopropyl or tertbutal all had zero glucose.

Am I missing something?

And it seems the nurses at allnurses.com say that alcohol gives a "false low".
http://allnurses.com/general-nursing-discussion/fingerstick-glucose-testing-220967.html

 

[NBfire841]

They do? I took organic chemistry and I distinctly recall there being no glucose in alcohol. Primary, secondary or tertiary alcohols, methyl, ethyl, isopropyl or tertbutal all had zero glucose.

Am I missing something?

And it seems the nurses at allnurses.com say that alcohol gives a "false low".
http://allnurses.com/general-nursing-discussion/fingerstick-glucose-testing-220967.html

The comments suggest that this is only the case if the finger is still wet with alcohol. I prefer to take some blood from the line right before the medic puts a lock on it anyway. 1 less hole in the pt, less garbage to pick up, less restocking too!

 

[bstone]

The comments suggest that this is only the case if the finger is still wet with alcohol. I prefer to steal some blood right before the medic puts a lock on the line anyway. 1 less hole in the pt, less garbage to pick up, less restocking too!

Yeah, I noticed the drying advice. I'm going to start doing that.

 

[atropine]

give these guys a break thier only emt's what else could they do. There was no paramedic on the rig if read the op right.

 

[JPINFV]

give these guys a break thier only emt's what else could they do. There was no paramedic on the rig if read the op right.

You might want to reread the thread and the original post again. There was a medic on board and no one is bashing the Basic.

 

[daedalus]

The comments suggest that this is only the case if the finger is still wet with alcohol. I prefer to take some blood from the line right before the medic puts a lock on it anyway. 1 less hole in the pt, less garbage to pick up, less restocking too!

You shouldn't do that. It is no wonder why we don't let most EMTs take blood glucose! Glucometer you carry on the truck are designed for capillary blood, not blood from a vein. If you do not believe me, check the user manuel for your glucometer, or call the manufacture and ask. They are very explicit and are not accurate with venous blood. I am pretty shocked and disappointed that your medic lets you do this.

MrBrown, why would alcohol wipes have a substance that supports microbial life in them? I do not recall glucose or any other carbohydrate as an ingredient in prep pads.

 

[NBfire841]

You shouldn't do that. It is no wonder why we don't let most EMTs take blood glucose! Glucometer you carry on the truck are designed for capillary blood, not blood from a vein. If you do not believe me, check the user manuel for your glucometer, or call the manufacture and ask. They are very explicit and are not accurate with venous blood. I am pretty shocked and disappointed that your medic lets you do this.

MrBrown, why would alcohol wipes have a substance that supports microbial life in them? I do not recall glucose or any other carbohydrate as an ingredient in prep pads.

I won't argue, I believe you. However, the "no wonder" comment was unnecessary. I was taught that by a medic. I will not continue that practice, but how far off is it? Just curious. Learning things like this is why I joined this forum.

 

[traumamama]

MAYBE SOMEONE SHOULD HAVE CHECKED THEIR BLOOD SUGAR:glare: THEY WERE OBVIOUSLY HAVING ALTERED MENTAL STATUS:excl: