Just another regular dialysis patient....so it was supposed to be.

[shadowstewie]

I don't think you know any of the facts of this situation.

As far as this Paramedic(?), I think if any of this is true, there is little doubt as to why he is only working BLS.

Because out here, you can only work as a Paramedic if you're hired with Fire. All other companies that hire Medic's aren't hiring at all and are actually laying people off. My cousin is a registered Medic but he works for a BLS Ambulance out here because no one else is hiring but Fire.

 

[shadowstewie]

Sniff...sniff... anyone else smell that? Smells like B.S. or let's change the scenario as we have found out by unanimous opinion of what a case of dumbass is?

Now, the story changes with each post.. ALS working BLS.. BLS w./Paramedic's .. dumb and scared RN from arrogant and an idiot EMT.

Sorry, either you did not post correctly the first time or building (attempting) to dig yourself out of stupidity with a spoon.

It's much better to face the music and say... "You know what? I screwed the pooch" and go on and live to learn not to ever do the same mistake again. Never tolerate such erroneous decision making.

RN upset or not, the EMT did not allow the higher trained (they were able to provide care) to do their duty, as well whom ran in with lights & sirens representing that it was a life threatening emergency? .....

Part of maturing in this business is being able to justify each and every action you perform. Right or wrong! Own up to your decisions and build up to be better each every time. This is how those that become good do so.. they learn off their and everyone elses mistakes on what NOT to do.

R/r 911

Why would I admit that I screwed up on something when I didn't even do anything wrong in the first place?

 

[shadowstewie]

Wow....even as a guy who gets regularly told he's too harsh to the newbies.....wow. However, I do not disagree in the slightest.



You beat me to it.

The blood pressure was taken on both arms multiple times, and also on his thigh. All 3 limbs had same results.

 

[usafmedic45]

Why would I admit that I screwed up on something when I didn't even do anything wrong in the first place?

Uh.....because you did do something wrong? Actually you did something wrong (overreacted) and did it in a manner that pretty much guarantees that nurse, that doc and anyone they talk to about you is never going to take your word at even face value ever again.

The blood pressure was taken on both arms multiple times, and also on his thigh. All 3 limbs had same results.

No, by your own posts, they did not:
134/78 in one arm, and 142/82 in the other and increasing with each remeasurement.....

He starts to tear up because he thinks something could be really bad going on with him when he feel's perfectly fine.

This would be because of you and/or your partner repeatedly asking him if he's OK when he thinks he is. Trust me, if I reversed the scenario, you'd become a little tachycardic and your BP would rise if you were being interrogated more or less. After the second or third time of someone going "Are you SURE you're not having chest pain?", most people are going to start worrying that the "medical professional" is picking up on something they are not. Welcome to the wonderful world of playing mind games with people, even though it was done inadvertently.

I almost had to argue with her that if it went up one more time, I'm taking him Code 3 to the ER

You're extremely lucky you walked away with your job. I've fired people for copping an attitude and/or picking a fight over something stupid. You'd be amazed how much hell a nurse can unleash upon EMTs if she decides to take it to her director of nursing who in turn calls your boss and reports you for basically acting wholely unprofessionally. When the saying "Hell hath no fury like a woman scorned", I'm pretty sure the woman they were talking about was a nurse. You'd be amazed how little your boss values your continued presence as an employee of his company when the phrase "He goes or we barr your service from ever bringing someone to our dialysis center again" gets uttered by a facility administrator. Trust me, I've heard it come out of the mouth of a director of nursing myself.

btw his normal BP is 115/72 and pulse 84.

The thing you have to remember about hypertension is that it is only significant- in the short term at least- if it is causing end-organ symptoms (chest pain, neurologic issues, headache, shortness of breath, etc). Also define "normal": are we talking his "normal" before his treatment, during or afterwards? Laying down, seated, standing? I also suggest you google "white coat hypertension" and see why the very presence of a freaked out health care worker may have been a good reason for the "elevated BP".

One of the tricks to develop in health care is the ability to read or see something and go "Oh ****" inside your head but not show it on your face, in your tone of voice or your mannerisms. This also comes in handy should you ever decide to join the World Poker Tour.

I don't care what anyone says to me, whether a Paramedic, RN, Doctor, whoever...if I feel something is better for the patient that's going to help them, I'm going to do it, plus that's what our company is strongly advising us to do, is to argue and do what's best interest for the patient.

Then may I recommend you learn the phrase, "Hi, welcome to Burger King, would you like to try the new Angry Whopper?" because with that attitude- and an apparent inability to know when/how/why to pick your battles, you're not going to last long in this field or any branch of medicine.

It's one thing if you can prove to the person- especially docs and nurses- that you have a damn good reason for standing up and telling them "I may only have 150 hours of training under my belt, but you're wrong!" (because that is exactly how they are going to view that attitude, not as some righteous savior out for the good of the patient) and an entirely different beast to freak out over something paltry and make yourself look like Chicken Little every time you see something that isn't spot on perfect and you can't reason through figuring it out.

I am not saying this to be mean- trust me, I've got better things to do with my time than to be sitting at 0730 trying to think of a good way to make you cry by crushing your soul and breaking your spirit- but rather to try to keep you from further screwing up your job by continuing with this attitude. If I didn't think there was some value inherent in you, I would just let Ridryder continue to feast upon your entrails until you decide that this forum isn't for you and migrate over to EMTCity.

I know this patient since he's a regular and I've taken him a couple times

You "know" him about as well as I know one of my wife's friends: we talk, I know she's an bleeding heart who thinks she's going to save the world by doing missionary work as an RN, and is an insulin-dependent diabetic with a weight issue, but beyond that....

Chances are the nurse you paint as a bumbling, uncaring piece of work and the doc who didn't respond to your concerns with "Ja wohl mein Herr!" probably know this patient a HECK of a lot better than you do.

just to see him start to tear up and almost start crying every time the machine beeped stating he wasn't in good condition, it kinda killed me after I got off work and I started to feel really bad for him because he's a good guy, really nice, really cooperative, really grateful.

Not to add salt to the wound man, but you and/or your partner pretty much caused most of that because of the way you handled the case. This is why HOW something is said is usually more important than WHAT is said. That said, I know I'm going to hear from the mods on this one about how I need to follow my own advice since I'm know around here as a total raging a**hole who occasionally shows his softer side (like I'm trying to do now).

I know I will get better to not let it bother me or anything but can anyone help me or tell me things they've done to help cope with emotional calls that you feel really bad for the patient or even family members?

It should bother you. That's called having a conscience and there's absolutely nothing wrong with having one. If what you did and the results of it didn't bother you, you would pretty much be a sociopath. Actually if seeing another person in pain, discomfort or fear didn't make you feel for them, I would be very afraid of you.

The problem here is that you're misreading the cues of the scenario and assuming that the problem lay with the patient - for whom you feel badly-and his perceived medical issues but failing to see that your actions made the situation worse. They may not have caused the initial slight elevation in BP and HR but it sure didn't seem to help much.

It's not an uncommon problem in emotionally immature or socially/professionally inexperienced persons (not meant as an insult or degradation and I'm not speaking specifically about you either....these are general statements) to lack the ability to analytically pick apart their actions, to be introspective and to admit fault in a socially or professionally unpleasant situation but these are vital things you have to have to excel in medicine in any way shape or form. The sooner someone lacking these traits works on developing them and not taking constructive criticism- such as is being offered (for the most part) here- without becoming defensive or changing the story to avoid the criticism, the better for everyone involved.

As I said, there's nothing wrong with screwing up in a small way once in a while through plain old fashioned ignorance (we all do it, myself included). What is a problem is when ignorance (simply not knowing any better because you've never been told any different) ends and stupidity (you've been corrected and still persist in your belief that you're right and everyone else is wrong) begins. As the saying goes, stupidity kills, but it tends to kill the wrong people in far too great of numbers and the right people in far too small of numbers.

I sincerely wish you the best in your career.

 

[VentMedic]

Because out here, you can only work as a Paramedic if you're hired with Fire. All other companies that hire Medic's aren't hiring at all and are actually laying people off. My cousin is a registered Medic but he works for a BLS Ambulance out here because no one else is hiring but Fire.

Other medics in similar situations in California have relocated to an area where they can work as a Paramedic.

The fact that he was a Paramedic who understood this patient needed advanced care which he did not have the meds or equipment to even monitor the patient makes this even more irresponsible.

The blood pressure was taken on both arms multiple times, and also on his thigh. All 3 limbs had same results.

Did they not teach you about BP and stressful situations? You look at the patient. The fact that you kept repeating the BP, including the arm with the shunt, was probably arguing with the RN, was rushing with "gotta go to ED real fast" motions and attitude and made this patient cry probably contributed to much of the BP problems or didn't help matters when the RN was in the process of stabilizing the patient. This RN also may have seen this patient for at least 4 hours per day and 3 days per week for several years.

I would suggest you work in a more controlled situation like an ED for awhile, along with continuing your education, until you gain some experience in seeing many different patients and working with other healthcare professionals. You are not ready to be working with patients without supervision. The fact that you don't want to see where you could have handled this situation differently shows you are not willing to learn from your mistakes and will continue to make the same ones over and over. The EMT-B class you took does not teach very much about medical emergencies and it also failed to prepare you in how to handle yourself with patients and other professionals in healthcare.

 

[Aidey]

The blood pressure was taken on both arms multiple times, and also on his thigh. All 3 limbs had same results.

Where is the pts dialysis access?

 

[rescue99]

I'll absolutely argee; this BLS crew was over zealous, under trained and pretty darned disrespectful of their patient's welfare as a whole. There is no doubt a person will worsen when he's constantly asked "ya sure ya don't feel sick", by what is perceived as a medical professional. Don't need 1000 words to say...wow, get a little more skill under yer belts there kiddo.

 

[KillTank]

Good lord sentence structure and paragraphs are your friend.

Had to be a Paramedic...

 

[shadowstewie]

Other medics in similar situations in California have relocated to an area where they can work as a Paramedic.

The fact that he was a Paramedic who understood this patient needed advanced care which he did not have the meds or equipment to even monitor the patient makes this even more irresponsible.



Did they not teach you about BP and stressful situations? You look at the patient. The fact that you kept repeating the BP, including the arm with the shunt, was probably arguing with the RN, was rushing with "gotta go to ED real fast" motions and attitude and made this patient cry probably contributed to much of the BP problems or didn't help matters when the RN was in the process of stabilizing the patient. This RN also may have seen this patient for at least 4 hours per day and 3 days per week for several years.

I would suggest you work in a more controlled situation like an ED for awhile, along with continuing your education, until you gain some experience in seeing many different patients and working with other healthcare professionals. You are not ready to be working with patients without supervision. The fact that you don't want to see where you could have handled this situation differently shows you are not willing to learn from your mistakes and will continue to make the same ones over and over. The EMT-B class you took does not teach very much about medical emergencies and it also failed to prepare you in how to handle yourself with patients and other professionals in healthcare.

Actually there is a lot of registered medic's here in Orange County/LA County that work for a BLS company because they cannot find a job working ALS, and maybe they cannot reside somewhere else at this time due to other issues.

The RN was mostly asking him if he felt fine or not like 5x. My partner and I asked him maybe twice and that was it, and that was in the beginning. No one was arguing with the RN at all, she was running around trying to figure out what was wrong with him. And as for the ER...we weren't near the patient when we were talking about that. Plus the RN was telling us that we might possibly have to take him to the ER but she wanted to wait for the Doctor which took like 20-25 minutes to call her back.

 

[Sasha]

Had to be a Paramedic...

....Did you read the post at all?

 

[shadowstewie]

Where is the pts dialysis access?

If I remember, it's in his chest. That's where she started Saline on him was through that.

 

[VentMedic]

If I remember, it's in his chest. That's where she started Saline on him was through that.

Do you check the arms for working or old shunts before you place a BP cuff? What about for PICC lines or mastectomy patients?

 

[rescue99]

If I remember, it's in his chest. That's where she started Saline on him was through that.

Hey Shadow..take this particular call as a great opportunity to learn. There are a few things you can think back on and do differently the next time. Not a person in here hasn't been a greenie. We've allll....YES ALL, have been where you are. Good luck and never stop asking, listening and learning.

 

[shadowstewie]

Do you check the arms for working or old shunts before you place a BP cuff? What about for PICC lines or mastectomy patients?

I'm not sure. We were just following what the Nurse was telling us to do. She told us to check both arms to see if any of them are normal. And my partner upon himself used a thigh cuff also just because the patient was 380lbs and wanted to see if there was a difference. I know i've stated that the blood pressure kept rising, and another post that the blood pressure stayed the same. What I meant by that is that the BP stayed the same way as it was...that it was elevating, and that the BP wasn't going back to normal.

 

[Ridryder911]

Hey Shadow..take this particular call as a great opportunity to learn. There are a few things you can think back on and do differently the next time. Not a person in here hasn't been a greenie. We've allll....YES ALL, have been where you are. Good luck and never stop asking, listening and learning.

Not quite, yes we all have made many mistakes. I and many others have had FTO's and partners that closely monitored and not allowed such an occurrence and definitely no attitude to go along with it. The reason many of us are upset is that not only you have a newbie but one that is paired up with a screw up.

As you are aware how so many bad habits are formed and many are not aware because no one is out there informing them differently. As well so many educators are beginning to see a clean slate (no experience) is better than those that have already bad habits ingrained in them.

p.s. Why is this call appearing to be totally different than the original post?

R/r 911

 

[Sasha]

p.s. Why is this call appearing to be totally different than the original post?

Because he's back peddling.

 

[KillTank]

....Did you read the post at all?

yes I did. What is your point?

 

[shadowstewie]

Because he's back peddling.

How am I back peddling? People are asking me questions about things and I'm clearing them up. I wasn't completely specific in my first post if that's what you're talking about.

 

[Flight-LP]

I'm not sure. We were just following what the Nurse was telling us to do. She told us to check both arms to see if any of them are normal.

This is back peddling. You now say you are following the orders of the very person you were questioning. QUIT WHILE YOU ARE AHEAD!

Chalk this up as a learning experience and get a little more of that experience before you start strutting around telling folks that you aren't going to listen to them. Otherwise, you will find yourself out of a job, and depending on how badly you piss someone off, maybe a career.

 

[KillTank]

I'm not sure. We were just following what the Nurse was telling us to do. She told us to check both arms to see if any of them are normal. And my partner upon himself used a thigh cuff also just because the patient was 380lbs and wanted to see if there was a difference. I know i've stated that the blood pressure kept rising, and another post that the blood pressure stayed the same. What I meant by that is that the BP stayed the same way as it was...that it was elevating, and that the BP wasn't going back to normal.

Fun Fact... RN, LVN or CNA are NOT trained in Emergency Pre Hospital. Only A doctor can give orders on a scene and that is if medical directive will allow it.