Ever had a partner you can't trust??
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mycrofft
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If I can't trust them, they aren't my partner.
You mean like a co-worker who would throw out my charting then report it as not done, spin all the red pens in a centriifuge so they leak, break my coffee mugs and the fan I brougt in to share, use my password to make an inapproriate entry in a patient medical record, read my email, falsely charge that I was asleep on shft, remove my food from the refrig and leave it on the counter all night before I came on shift, steal my set of work keys from the key safe and keep them when they "retired", or tell each of two third-party agencies the other had sanctioned me so they declared me persona non grata for a month before they discovered the ruse?
Naw, nursing's more civilized than that!
Ambulance was much better.
You mean like a co-worker who would throw out my charting then report it as not done, spin all the red pens in a centriifuge so they leak, break my coffee mugs and the fan I brougt in to share, use my password to make an inapproriate entry in a patient medical record, read my email, falsely charge that I was asleep on shft, remove my food from the refrig and leave it on the counter all night before I came on shift, steal my set of work keys from the key safe and keep them when they "retired", or tell each of two third-party agencies the other had sanctioned me so they declared me persona non grata for a month before they discovered the ruse?
Naw, nursing's more civilized than that!
Ambulance was much better.
Brandon275
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Aidey I am not arguing that boarding people is not all that effective, hence the reason I hate doing it. However, it is in the protocol and we have to do it here. Yes I asked her if she had pain I didnt lead her at all. The first thing she said when I asked her if she had pain is that her back and neck were hurting really bad in the midline portion and that she couldnt feel her baby move. Is throwing someone against a truck enough to break someones spine? More than likely no, but I am not allowed to make that call. Someday I would love to see them remove boarding people almost completely out of the protocol. But for now its there and we have to deal with the fact that it is in fact there.
Thats not to say you cant clear C-spine because I do it often. But if you have someone with spinal tenderness in any portion of the C-spine the protocol calls that an automatic fail and C-spine injury cannot be ruled out. Also emotional trauma such as possibly losing your baby is distracting enough for the patient to not be reliable. If she cant focus and give you a proper HPI and where her pain is and all she is saying between her tachypnic breathing is that her spine is killing her then thats all we have to go on. She continued to go back to her baby everytime we tried speaking to get a more detailed description of the pain she had. I dont like the rules, but they have to be followed and one day if you dont you will get burned, and when you do you have no leg to stand on. Case in point, a crew here(not my company) brought in a woman from an MVA who self etricated and was walking around and she complaied of neck and back pain on the spine and they did not board her, guess what she had a spinal FX. If some of you, NVRob, aidey think we were wrong, so be it. All i know is that if we didnt do it the hospital would have went up one side of us and down the other and would have probably called and complained because technically we violated the protocol. Sorry if I sounded disrespectful, I just dont believe in monday morning quarterbacking someones call if you werent there, period. I find it to be a quite arrogant thing to do to be quite honest.
Thats not to say you cant clear C-spine because I do it often. But if you have someone with spinal tenderness in any portion of the C-spine the protocol calls that an automatic fail and C-spine injury cannot be ruled out. Also emotional trauma such as possibly losing your baby is distracting enough for the patient to not be reliable. If she cant focus and give you a proper HPI and where her pain is and all she is saying between her tachypnic breathing is that her spine is killing her then thats all we have to go on. She continued to go back to her baby everytime we tried speaking to get a more detailed description of the pain she had. I dont like the rules, but they have to be followed and one day if you dont you will get burned, and when you do you have no leg to stand on. Case in point, a crew here(not my company) brought in a woman from an MVA who self etricated and was walking around and she complaied of neck and back pain on the spine and they did not board her, guess what she had a spinal FX. If some of you, NVRob, aidey think we were wrong, so be it. All i know is that if we didnt do it the hospital would have went up one side of us and down the other and would have probably called and complained because technically we violated the protocol. Sorry if I sounded disrespectful, I just dont believe in monday morning quarterbacking someones call if you werent there, period. I find it to be a quite arrogant thing to do to be quite honest.
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VFlutter
Flight Nurse
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Although posting the details of the scenario was not your primary reason for starting the thread you still put up a scenario on a community forum. What did you expect? We are all going to critique and add our input. Also, the fact that you back boarded the patient is directly related to how the call was handled (you said you couldn't move the patient away from the scene until BB'd) so it is worth being discussed.
If you can't take getting "Monday Morning Quaterbacked" then I would be more careful about what you post on this forum and you better hope you never have to do a QA/QI or go to court.
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I find you quite arrogant. You broke patient contact to go engage a drunk guy who anyone with common sense would know wasn't going to listen to a word you have to say.
Protocol is a :censored::censored::censored::censored:ty answer. Where was her neck pain? Midline or lateral? Point tenderness? Any neurological deficits? Pain with ROM? ETOH or drugs on board? Altered? Any deformities or crepitus?
You can get mad about us monday morning quarterbacking but you in the end you asked for our opinion and got mad when we gave it to you.
You still haven't answered the question which has been asked multiple times...how far along was this patient?
You could argue potentially losing her baby is distracting but I'll argue right back that you should have calmed her down and explained the situation. You putting her supine in spinal motion restriction could have very well tanked her preload and potentially killed her and if she dies generally so does the baby, if you want to go down that road.
Last time I checked fetuses aren't constantly active and moving about....they do stay still from time to time...but what do I know, I'm just a stupid paramedic and not a doctor.
Are you a basic? Intermediate? Medic?
There are different types of spinal fractures. Someone self extricates out of a car the generally aren't going to get boarded and if they do more often than not is going to be a backboard on the gurney and a "Sir/Ma'am can you take a couple steps over here while keeping your head still and take a seat right hear for me?" By your reasoning we should board everyone, right? Since the MIGHT have a spinal fracture from falling off the bench at the bus stop or running into that door, or slipping in the kitchen, or falling out of bed.
I agree, the rules have to be followed but in the end good clinical judgment, patient care and ultimately being an advocate for the patient is our job. Ever heard the phrase "do no harm"? How does it apply here? Idk about your protocols but mine say midline neck pain with an appropriate mechanism warrants c-spine.
Spinal motion restriction is a treatment and has indications as well as contraindications. Just like oxygen doesn't fix every problem, despite popular belief.
You came here asking for opinions and were given them. When you didn't like the answer you got you started sniping at people. Don't bite the hand that feeds you.
Protocol is a :censored::censored::censored::censored:ty answer. Where was her neck pain? Midline or lateral? Point tenderness? Any neurological deficits? Pain with ROM? ETOH or drugs on board? Altered? Any deformities or crepitus?
You can get mad about us monday morning quarterbacking but you in the end you asked for our opinion and got mad when we gave it to you.
You still haven't answered the question which has been asked multiple times...how far along was this patient?
You could argue potentially losing her baby is distracting but I'll argue right back that you should have calmed her down and explained the situation. You putting her supine in spinal motion restriction could have very well tanked her preload and potentially killed her and if she dies generally so does the baby, if you want to go down that road.
Last time I checked fetuses aren't constantly active and moving about....they do stay still from time to time...but what do I know, I'm just a stupid paramedic and not a doctor.
Are you a basic? Intermediate? Medic?
There are different types of spinal fractures. Someone self extricates out of a car the generally aren't going to get boarded and if they do more often than not is going to be a backboard on the gurney and a "Sir/Ma'am can you take a couple steps over here while keeping your head still and take a seat right hear for me?" By your reasoning we should board everyone, right? Since the MIGHT have a spinal fracture from falling off the bench at the bus stop or running into that door, or slipping in the kitchen, or falling out of bed.
I agree, the rules have to be followed but in the end good clinical judgment, patient care and ultimately being an advocate for the patient is our job. Ever heard the phrase "do no harm"? How does it apply here? Idk about your protocols but mine say midline neck pain with an appropriate mechanism warrants c-spine.
Spinal motion restriction is a treatment and has indications as well as contraindications. Just like oxygen doesn't fix every problem, despite popular belief.
You came here asking for opinions and were given them. When you didn't like the answer you got you started sniping at people. Don't bite the hand that feeds you.
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Anjel
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mycrofft
Still crazy but elsewhere
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Have we gotten into the reverse-catnip again, have we?
ah2388
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Im seeing both sides here, and I believe that everything I could say has been said.
Effectively, the OP is stating that he elected to collar this pt because the guidelines under which he provides care state that he is required to. At some agencies, those guidelines are a bit flexible. If you have involved medical direction and management who will support you making judgement based decisions in the best interest of the pt, then more power to you. In reading this thread, I find it unlikely that is the case.
Along that regard, the OP shouldn't be crucified for making a decision based on the above, instead I would argue that it is an all to common(and in some cases necessary) breakdown of the system:-(
The attitude and "questionable" decision making amongst the involved parties speaks for itself.
In my experience, if a partner has an issue with something that is said or done, he/she is doing you a favor by coming to you first, as alternative reactions seem to be far more common. Additionally, given that most providers I have encountered have reasonably thick skin, Im fairly certain that there is more to the story, and the statement you made to your partner was not quite as innocent as you make it seem.
Apologies for the spotty grammar/spelling...I'm tired
h34r:
Effectively, the OP is stating that he elected to collar this pt because the guidelines under which he provides care state that he is required to. At some agencies, those guidelines are a bit flexible. If you have involved medical direction and management who will support you making judgement based decisions in the best interest of the pt, then more power to you. In reading this thread, I find it unlikely that is the case.
Along that regard, the OP shouldn't be crucified for making a decision based on the above, instead I would argue that it is an all to common(and in some cases necessary) breakdown of the system:-(
The attitude and "questionable" decision making amongst the involved parties speaks for itself.
In my experience, if a partner has an issue with something that is said or done, he/she is doing you a favor by coming to you first, as alternative reactions seem to be far more common. Additionally, given that most providers I have encountered have reasonably thick skin, Im fairly certain that there is more to the story, and the statement you made to your partner was not quite as innocent as you make it seem.
Apologies for the spotty grammar/spelling...I'm tired
h34r:I've had plenty of partners over the years and some I could trust with my life, some I would not trust with a pencil. It's like all things in life, you have to develop trust in each other. When you see them doing something stupid, the best thing you could do is let them know. If that doesn't work then you take it up the chain of command.
My loyalty is to my family first and if my partner is doing something that jeopardizes my life or my license then I will take action to ensure it stops. The whole "what happens on the truck, stays on the truck" mentality can only go so far.
My loyalty is to my family first and if my partner is doing something that jeopardizes my life or my license then I will take action to ensure it stops. The whole "what happens on the truck, stays on the truck" mentality can only go so far.