mycrofft
Still crazy but elsewhere
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- 48
As I replied elsewhere today, I'm ready to take a large bunch of my co-workers and give them to NASA.
Case in point: man is on the floor vomiting for about five minutes, given Tigan injection. No relief in one minute, a normal saline TKO IV is started and the ambulance called for. Pt is normotensive, gave verbal hx of anorexia for three days and epigastric pain but no objectiv signs until pt seen doing this. Guaic negative on vomitus, has breakfast in it. Ambulance is two minutes out, pt weighs about 180 lbs and is acting unconscious once the IV start is over, supervisor takes him by one arm, looks at me , nods at bed cranked all the way up and says "Let's get him into bed". I asked "Why? What's the benefit?". Pt was on a thick folded blanket and lying comfortably. Pt returned one hour after going out, ER dx was indigestion vesus "?".
Second case: respond to man down call. Pt genuinely down, rapid breathing, lying prone. Airway good, FS WNL, BP good with rapid pulse, pt hot to touch and diaphoretic, has trismus, no significant medical hx except on psych meds and cheeks pills. Eventual provisional dx was he ingested a witch's brew of meds to get high, but in the meantime another supervisor comes to the scene with a third oxygen cylinder after we already have two (left the scene after we had two to get #3), and when pt begins to go Cheynes-Stokes on us and we cannot insert an airway (all we have at our level is Berman OP airways and he's clamped shut), I do C collar, put pt supine and ask her to fold a blanket and put it under his sholders to allow head to hyperextend a little. Instead, puts it under his head like a pillow, causing the head to tip forward and the respirations to turn to snoring. Happily as I tried to correct that the fire EMS arrived. Pt returned two days later looking much better (not blue-gray anymore).
Problem is, with paid paramedics EMS ten to fifteen minutes out, why are so many IV's and cervical collars used when the para's are walking up as we start /apply them, why cart people around just to get them off the floor for no medical benefit? How can you tell your coworkers they need to "take a chill pill"...especially a supervisor with no practical field experience??<_<
Case in point: man is on the floor vomiting for about five minutes, given Tigan injection. No relief in one minute, a normal saline TKO IV is started and the ambulance called for. Pt is normotensive, gave verbal hx of anorexia for three days and epigastric pain but no objectiv signs until pt seen doing this. Guaic negative on vomitus, has breakfast in it. Ambulance is two minutes out, pt weighs about 180 lbs and is acting unconscious once the IV start is over, supervisor takes him by one arm, looks at me , nods at bed cranked all the way up and says "Let's get him into bed". I asked "Why? What's the benefit?". Pt was on a thick folded blanket and lying comfortably. Pt returned one hour after going out, ER dx was indigestion vesus "?".
Second case: respond to man down call. Pt genuinely down, rapid breathing, lying prone. Airway good, FS WNL, BP good with rapid pulse, pt hot to touch and diaphoretic, has trismus, no significant medical hx except on psych meds and cheeks pills. Eventual provisional dx was he ingested a witch's brew of meds to get high, but in the meantime another supervisor comes to the scene with a third oxygen cylinder after we already have two (left the scene after we had two to get #3), and when pt begins to go Cheynes-Stokes on us and we cannot insert an airway (all we have at our level is Berman OP airways and he's clamped shut), I do C collar, put pt supine and ask her to fold a blanket and put it under his sholders to allow head to hyperextend a little. Instead, puts it under his head like a pillow, causing the head to tip forward and the respirations to turn to snoring. Happily as I tried to correct that the fire EMS arrived. Pt returned two days later looking much better (not blue-gray anymore).
Problem is, with paid paramedics EMS ten to fifteen minutes out, why are so many IV's and cervical collars used when the para's are walking up as we start /apply them, why cart people around just to get them off the floor for no medical benefit? How can you tell your coworkers they need to "take a chill pill"...especially a supervisor with no practical field experience??<_<