First Ride Along w/ Funny Story

[Epi-do]

Why would you take them to the ED otherwise? Unless they were adamant to go themselves. I spose you might have some stupid protocol over there that says all pts go to ED or something...sigh.

Yes, we have some "stupid protocol" that says everyone that requests transport by ambulance gets a ride to the ER. I most certainly have taken pts to the ER that I believed would have been served just as well by getting in one of the 6 cars parked in the driveway and driving to the ER, immediate care center, or the family doctor's office on their own. However, when transporting those patients, I don't do things to humiliate them. I still do my job - monitor vital signs, get as thorough a history as possible, provide comfort measures, etc. I don't provide (nor have I ever) fake treatments to my patients.

 

[JonTullos]

Mind if I put this in my signature?

Go for it.

Melcin - it's a "stupid protocol" to transport someone that requests it and may very well need it? Wow.

 

[Sasha]

For the student, who doesn't seem to realize how dangerous cocaine use is.

Source: http://www.webmd.com/mental-health/cocaine-use-and-its-effects

Cocaine is responsible for more U.S. emergency room visits than any other illegal drug. Cocaine harms the brain, heart, blood vessels, and lungs -- and can even cause sudden death. Here's what happens in the body:

Heart. Cocaine is bad for the heart. Cocaine increases heart rate and blood pressure while constricting the arteries supplying blood to the heart. The result can be a heart attack, even in young people without heart disease. Cocaine can also trigger a deadly abnormal heart rhythm called arrhythmia, killing instantly.

Brain. Cocaine can constrict blood vessels in the brain, causing strokes. This can happen even in young people without other risk factors for strokes. Cocaine causes seizures and can lead to bizarre or violent behavior.

Lungs and respiratory system. Snorting cocaine damages the nose and sinuses. Regular use can cause nasal perforation. Smoking crack cocaine irritates the lungs and, in some people, causes permanent lung damage.

Gastrointestinal tract. Cocaine constricts blood vessels supplying the gut. The resulting oxygen starvation can cause ulcers, or even perforation of the stomach or intestines.

Kidneys. Cocaine can cause sudden, overwhelming kidney failure through a process called rhabdomyolysis. In people with high blood pressure, regular cocaine use can accelerate the long-term kidney damage caused by high blood pressure.

Sexual function. Although cocaine has a reputation as an aphrodisiac, it actually may make you less able to finish what you start. Chronic cocaine use can impair sexual function in men and women. In men, cocaine can cause delayed or impaired ejaculation.

How Does Cocaine Effect The Heart?
Source:http://www.circ.ahajournals.org/cgi/content/abstract/85/2/407

It is clear that cocaine has cardiotoxic effects. Acute doses of cocaine suppress myocardial contractility, reduce coronary caliber and coronary blood flow, induce electrical abnormalities in the heart, and in conscious preparations increase heart rate and blood pressure. These effects will decrease myocardial oxygen supply and may increase demand (if heart rate and blood pressure rise). Thus, myocardial ischemia and/or infarction may occur, the latter leading to large areas of confluent necrosis.

Direct toxic effects on the myocardium have been suggested, including scattered foci of myocyte necrosis (and in some but not all studies, contraction band necrosis), myocarditis, and foci of myocyte fibrosis. These abnormalities may lead to cases of cardiomyopathy. Left ventricular hypertrophy associated with chronic cocaine recently has been described. Arrhythmias and sudden death may be observed in acute or chronic use of cocaine.

Something I recently learned.
Source: http://drugsproject.co.uk/cocaine/

Cocaine may also greatly increase this risk of developing rare autoimmune or connective tissue diseases such as lupus, Goodpasture’s disease, vasculitis, glomerulonephritis, Stevens-Johnson syndrome and other diseases. It can also cause a wide array of kidney diseases and renal failure. While these conditions are normally found in chronic use they can also be caused by short term exposure in susceptible individuals.

 

[marineman]

We all have this grand vision in our heads of what constitutes an emergency. Truth is the patient is the one that matters and if they call it's an emergency to them.

I don't condone making a mockery of patients however I have given a 5cc saline flush and told the patient it was morphine. I would never do that on a patient who is obviously in pain that falls within our morphine administration protocols but there are times the placebo affect works better than the drug itself.

Saying there's nitrous in the oxygen could be excusable if you legitimately thought that the placebo effect would help with the patients anxiety but the aspirin on the forehead is inexcusable no matter how you try to look at it.

 

[Sasha]

I don't condone making a mockery of patients however I have given a 5cc saline flush and told the patient it was morphine.

Do you document that you lied to your patient? Do you tell the nurses?

And you have no right to withhold pain meds if you can give them to a person who says they are in pain because YOU don't think they are in pain. You can't possibly tell me that you know for 100% that your patient is not in pain, and to withhold pain management on personal opinion is cruel and unethical.

 

[triemal04]

For the record, taping an aspirin to the pt's forehead was a bit ridiculous and out of line, and not fully assessing the pt would also have been a fully stupid move. But I wasn't there, so who knows what they did/did not do besides what was originally posted.

But beyond that...say that you do have someone who is having an anxiety attack and your only option is to talk them down...can't give versed, ativan, nitrous oxide, valium, nothing. And you can't talk them down, it's just not happening. Do you just sit back and allow them to continue on as they are, or try something else? The placebo effect is a well document thing and has it's place in medicine. There is no reason not to use it when it's appropriate.

And generally speaking, when someone is refused pn meds, it's not based on a personal opinion, but on the assessment of the pt, their presentation and their complaint...kind of like how the doctors at the ER decide that. And if you think that everyone who steps into an ER complaining of pn get's something for it...wow...

 

[Sasha]

And if you think that everyone who steps into an ER complaining of pn get's something for it...wow...

Not everyone gets narcotics, of course not, but everyone should be entitled to pain management. It doesn't matter if your opinion is that they are in pain or not in pain.

Take the chick in the news section who is sueing 911 because she got shot, no one took her seriously, because she could talk calmly. Not your picture of a gunshot victim, is it?

Not everyone will meet your picture of a person in pain.

Is a drug addict/drug seeker above feeling pain?

 

[triemal04]

Not everyone gets narcotics, of course not, but everyone should be entitled to pain management. It doesn't matter if your opinion is that they are in pain or not in pain.

Take the chick in the news section who is sueing 911 because she got shot, no one took her seriously, because she could talk calmly. Not your picture of a gunshot victim, is it?

Not everyone will meet your picture of a person in pain.

Is a drug addict/drug seeker above feeling pain?

Actually, I don't have any generic impression of what a gunshot victim looks like; it varies from pt to pt. In fact I've had one that was very calm (calmer than me; first I'd ever seen) on scene...very nonchalant in saying, "yeah, I've been shot...here, see." Same as I don't have any generic impression of what someone in pn looks like. Making assumptions about people and their treatement based on personal feelings...rather stupid and immature don't you think?

Yeah, you could say that everyone get's pn management. But that does not mean that everyone gets narcs (not what I meant) or any kind of analgesic at all (which is what I meant). Depending on the pt (and the doc's assessment, the pt's complaint and their presentation remember) the management may be being told "no, we will not give you anything at all," though not always in those exact words.

Like it or not, it happens daily across the country...hell, probably across the globe.

Edit: And you didn't answer the question I posted in the first reply...want to take a stab at it?

 

[Sasha]

Edit: And you didn't answer the question I posted in the first reply...want to take a stab at it?

Try something else, of course, but not something that involves lying to the patient or making an idiot out of them by taping an asprin to their forehead so you can get your jollys too.

We will have to agree to disagree, all throughout my clinicals I have never seen anyone denied pain meds, and brief on the 911 road experience or IFT experience. Narcotics? Sure, but not pain management all together, toradol or even PO tylenol. There are also signs around the hospital informing the patient of their right to have their pain effectively managed.

 

[triemal04]

Try something else, of course, but not something that involves lying to the patient or making an idiot out of them by taping an asprin to their forehead so you can get your jollys too.

We will have to agree to disagree, all throughout my clinicals I have never seen anyone denied pain meds, and brief on the 911 road experience or IFT experience. Narcotics? Sure, but not pain management all together, toradol or even PO tylenol. There are also signs around the hospital informing the patient of their right to have their pain effectively managed.

The aspirin I agree with...bit overboard. The "nitrous in a cannula" though...no problem there. But, again, back to the question, there is nothing else for you to try. Every form of talking someone down you know has been tried to no effect and you have no options left...what do you do? You're just going to let them continue to suffer? Or try something that can be beneficial? Isn't it a bit contradictory that you want everyone who is in pn (real or not) to be given some type of analgesic for it, and yet you'll refuse to use a documented tool to potentially help someone having an anxiety attack?

For the rest...it'll happen, trust me on that. The amount and degree that it'll happen will depend on your area, but at some point...

 

[Sasha]

yet you'll refuse to use a documented tool to potentially help someone having an anxiety attack?

I refuse to lie to my patients. Perhaps you lie to yours, but that is on you. I have already answered your question, it's just not the answer you were looking for.

 

[CAOX3]

Ms Rodriquez is fired up....

I believe the medical field in general is a little twisted and I am sure these actions happen more then we care to admit.

 

[triemal04]

I refuse to lie to my patients. Perhaps you lie to yours, but that is on you. I have already answered your question, it's just not the answer you were looking for.

It's an answer, which is what I was looking for. While I do agree that you shouldn't lie to pt's whenever possible (and that includes lies of ommision), which it usually is, there may be times (and the above situation would be one) in which you aren't going to have a choice if you want to effectively treat them. Basically you have said that your personal feelings on this matter will cause you to allow a pt to continue to suffer without trying all available forms of treatement. Comfortable with that?

 

[Sasha]

It's an answer, which is what I was looking for. While I do agree that you shouldn't lie to pt's whenever possible (and that includes lies of ommision), which it usually is, there may be times (and the above situation would be one) in which you aren't going to have a choice if you want to effectively treat them. Basically you have said that your personal feelings on this matter will cause you to allow a pt to continue to suffer without trying all available forms of treatement. Comfortable with that?

That is not what I said. I said I will try something different that does not include lying to my patients.

Like I also said, we will have to agree to disagree, neither one of us are going to move on this topic and your attempts to try and make me into a hypocrite are tiresome.

 

[triemal04]

That is not what I said. I said I will try something different that does not include lying to my patients.

Like I also said, we will have to agree to disagree, neither one of us are going to move on this topic and your attempts to try and make me into a hypocrite are tiresome.

I'm not trying to make you into a hypocrite. (the difference in treatment/attitudes is interesting, but that's all). And it is in effect what you have said; you refuse to lie to a pt for any reason, which, means that you will not use all available treatements, which means that the problem will continue.

Again though, far as the question goes, let me make it even clearer: you have NO other options, everything has been tried and failed. You're only choice is 1-do nothing and allow the pt to continue to suffer from an anxiety attack, or, 2-tell them something along the lines of "nitrous in a cannula" and see if the placebo effect works for them.

I'm really not looking for hypocrisy, more to see if you can understand why a complete blanket statement of "I will never do that and never lie to a pt" doesn't work, and why giving someone a placebo may sometimes be needed. This doesn't mean that I'm condoning lying to a pt or that it should be a regular thing, just that, in this situation, it may be necessary. Same with a placebo; it shouldn't be a regular thing, or the first, second, or even third treatment that comes to mind, but there may be a time when it is your only option. In certain circumstances to do the above isn't going to be wrong, but an appropriate, albeit not the best, treatment.

 

[Sasha]

I'm not trying to make you into a hypocrite. (the difference in treatment/attitudes is interesting, but that's all). And it is in effect what you have said; you refuse to lie to a pt for any reason, which, means that you will not use all available treatements, which means that the problem will continue.

Again though, far as the question goes, let me make it even clearer: you have NO other options, everything has been tried and failed. You're only choice is 1-do nothing and allow the pt to continue to suffer from an anxiety attack, or, 2-tell them something along the lines of "nitrous in a cannula" and see if the placebo effect works for them.

I'm really not looking for hypocrisy, more to see if you can understand why a complete blanket statement of "I will never do that and never lie to a pt" doesn't work, and why giving someone a placebo may sometimes be needed. This doesn't mean that I'm condoning lying to a pt or that it should be a regular thing, just that, in this situation, it may be necessary. Same with a placebo; it shouldn't be a regular thing, or the first, second, or even third treatment that comes to mind, but there may be a time when it is your only option. In certain circumstances to do the above isn't going to be wrong, but an appropriate, albeit not the best, treatment.

So you're telling me that meds have failed buy you think taping an asprin to someone's forhead (placebo) will work?? If you get to that point than nothing will work and you are up a poo creek with no paddle.

Lie to your patients if you want, I wont lie to mine. It is unethical.

 

[triemal04]

So you're telling me that meds have failed buy you think taping an asprin to someone's forhead (placebo) will work?? If you get to that point than nothing will work and you are up a poo creek with no paddle.

Lie to your patients if you want, I wont lie to mine. It is unethical.

Noooo...not at all:

say that you do have someone who is having an anxiety attack and your only option is to talk them down...can't give versed, ativan, nitrous oxide, valium, nothing. And you can't talk them down, it's just not happening. Do you just sit back and allow them to continue on as they are, or try something else?

Not everyone will have the option of using drugs in that situation. Not everyone can be talked down. What will you do if that happens? I've got your answer, you'll do nothing, maybe this will get others who read this thinking.
And again:

The aspirin I agree with...bit overboard.

(Was agreeing that it was wrong.)

For the record, taping an aspirin to the pt's forehead was a bit ridiculous and out of line,

I guess I should remember to be completely blunt, leave no room for ambiguities and in the future just say that that was a BS move on their part.

 

[TRowe]

Im split here. I agree 100% this story should not have been posted. I also agree that the acts of the medics were horrible and unprofessional and could even result in their licenses being revoked.

However, I will say this... How many of you have done coke. As someone who knows all to well the act of doing coke and said consequences, it isn't that off the wall to think the kid was just reacting to the come down. We dont know enough details either way. Sure it could have been a genuine diagnosed anxiety attack. But chances are, from personal and professional experience, it was just the coming down of the coke. Drugs do weird things to people and make them do stupid things and act equally stupid.

I will cite the incident of the PD who called up dispatch to get fire out there after smoking a couple bowls of weed. He reported that he was dying... The kid was just high... Really high, mind you, but just high. There are some people who shouldn't be doing drugs and some who shouldn't be tending to the care of those who are coked out of their mind. I feel no sympathy for the kid and how he was messed with. The medics should be punished but we shouldn't shed a tear over the kids trauma. Next time, do less coke.

 

[dmc2007]

For the more experienced members of the forum, keeping this incident aside, do you see a place in EMS for placebos (assuming they were prescribed by protocols)? Or is MD/DO level education necessary for determining what patients could benefit from placebos and which require actual medication?

Not having much experience in the matter, I'd imagine telling a patient you were administering medications or interventions when you didn't would open you up to all sorts of liability issues.

 

[Cory]

Simply put:

Neither EMT's nor Paramedics are trained in giving placebos.