Just broke the seal on an airline jump kit

[JPINFV]

Are you licensed? Or certified?

You know, to be honest, I'm not even sure that most politicians know the difference. As such, anything coming from the government that grants an other wise restricted practice is a license, regardless of the noun used to describe it.

 

[the_negro_puppy]

lol action man, care to tell us what was actually wrong with the pt?

 

[webster44]

Ok so i want to provide some more info.

Pt:
Unresponsive 19 year old male - Adequate breathing, slightly thready pulse, bp 80 by palp. He was with his school group(some sort of honors scholastic team) not responsive to pain. Chaperon was unable to provide any additional medical history - he had eaten earlier in the day.

Medic checked his blood sugar and came in at 60.
So what was wrong with him?... I don't know - i'm just a basic <_<


Ambu bag - The reason i wanted to use the ambu was because I would prefer to have a clear face mask as opposed to the yellow airline thing - I'm not sure what the flow rate was on o2 that I did use as it was just on or off.
I never really considered assisting with ventilation.

The physician asked me to preform a jaw thrust - I thought a head tilt would have been fine - I thought that a sternum rub would be appropriate but the doctor told me to cease - Any reason why it would be inappropriate?
While I recognize that a doctor is alot higher then me on the food chain I am still going to interact with him and make my own opinions known. I don't know him or his skill level. Heck he might by an eye doctor who hasn't been in a hospital and 40 years. (and he does not know me either)
But of course I will defer to his decisions.

I acted within my scope of practice

While I can see how my post has a certain action hero quality to it I was calm and deliberate in my actions - I have been an EMT for many years and worked in multiple major metropolitan city's- I'm used to serious medical and trauma situations alike. I don't think I over reacted or acted outside my scope

From my understanding - I am certified by National Registry, and my state. For my individual municipality, and the location of the airport I am licensed under my medical director.

Any other questions? B) .....

 

[lightsandsirens5]

is that on all delta airline planes? wondeer how the legalities would work there.. as in flight takes off from dublin airport does u.s or irish law apply in regards to patient care?

I would guess this; US airline, US flagged aircraft, US crew = US Law.

But I dunno for sure.

~~~~~~~~~~~~~~~~~~~~

And for god's sake, stop brow beating the guy. Maybe he did a few things wrong, but seriously..........some people on here actually have a heart to help others. To them medicine (however little they know) is actually about caring for people, not just a job.

Now I run like heck to avoid the coming storm.....h34r:

 

[usafmedic45]

To them medicine (however little they know) is actually about caring for people, not just a job.

Actually it's a job that happens to involve providing care to people. You don't actually have to care for them or about them to provide care to them. There are a lot of patients I've crossed paths with that I honestly believe the world would be better off without, but that's a topic for another discussion.

I don't think any of us have a problem with him helping. We have a problem with the quasi-"Trauma", quasi-Jack Bauer style description of how he really didn't do much when it comes down to it. I really can't fault him for anything else. LOL

 

[EMTtoBE]

I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why

 

[usafmedic45]

I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why

It's overkill. You can achieve the same end result with a lot less force and pain. A jaw thrust for example will get the patient to respond if they are going to, plus it can provide an airway. In my book, I'd rather be sternal rubbed than have a jaw thrust done on me, but other's mileage may vary.

There is also some who speculate that sternal rubs could pose a risk of aggravating spinal injuries. I'm not so sure I believe that one, but I've heard it repeated a few times.

 

[EMTtoBE]

Thanks for making it more clear..I don't see how it can affect a spinal injury..but thank you

 

[clibb]

It's overkill. You can achieve the same end result with a lot less force and pain. A jaw thrust for example will get the patient to respond if they are going to, plus it can provide an airway. In my book, I'd rather be sternal rubbed than have a jaw thrust done on me, but other's mileage may vary.

There is also some who speculate that sternal rubs could pose a risk of aggravating spinal injuries. I'm not so sure I believe that one, but I've heard it repeated a few times.

How would it aggravate a spinal injury when the spine is not moved or interfered with at all through the sternum rub? Just a questions. I've been taught to use the sternum rub as the third alternative in getting a response from an unconscious patient.
1) Voice or gentle shake if by-standers can confirm that the patient will not have a spinal injury.
2) Pinching
3) Sternum

I'm still an EMT-B student and we were always told never do a sternum rub...we were taught a gentle shake...never understood why

I performed a sternum rub on one of my buddies when he was my patient for our Critical Exams. I got a nasty verbal response from him haha.

 

[Melclin]

Sternal Rubs are nasty.

This kind of damage is common, or as rare as hens teeth depending on who you talk too. Anyway you look at it, it does not appear to be the favoured method of painifying your patient. The consensus seems to be that if you use the sternal rub properly (rubbing hard for anywhere up to 30 seconds), you will do damage.

The painful stimuli of choice these days appears to be trap squeeze and supra-orbital pressure on account of the fact that they have a greatly reduced potential for causing nastiness.

I've never heard of the spinal injuries argument, though I've nothing for or against it. I have, however, always been a tad concerned about a pt's movement after a painful stimulus if I think they have a spinal injury.

 

[emt_irl]

sternum rubs have been gone for years in ireland.. some people still use it but i reckon it could be classed as assualt. we can pinch the ear lobe(very effective ive found) or try get a pain stimulus from the back of hand or finger.

 

[joeshmoe]

It would seem to me a jaw thrust alone would be a pretty good way to evoke a pain response.

So what was even wrong with the patient? No real information aside from they were unresponsive.

Were there snakes on the plane?

EDIT: oops my bad I missed the post where the OP clarified the situation a little

 

[usafmedic45]

How would it aggravate a spinal injury when the spine is not moved or interfered with at all through the sternum rub?

No clue. Just a rumor I have heard several times.

 

[Veneficus]

No clue. Just a rumor I have heard several times.

I had somebody scream at me then write me up in EMS saying that testing for a Babinski reflex would so the same thing...

We really have to start a petition to make the test harder.

 

[LondonMedic]

Additionally I felt comfortable in immediately responding as I am licensed specifically in the location the plane was landing.

I would have felt particularly uncomfortable with you responding. I think you were very lucky to have that particular doctor there, I suspect many others (myself included) would have suggested that you return to your seat if you behaved in this way.

 

[Seaglass]

You = EMT-B. Physician = someone with better assessment abilities. Your statement is false.

To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone.

Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.

 

[LondonMedic]

To be fair, I've seen some doctors who aren't very comfortable outside of a clinical setting. Maybe they practice in an unrelated specialty, maybe they want to observe before getting involved... it doesn't really matter. They know more, but they still might hang back at first. So I wouldn't call the OP a liar on that alone.

Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.

Agreeing with the rest, though. And the bit about staying in the aisle for landing strikes me as odd on a commercial airline.

Absolutely, unless the patient is in extremis (and salvageable), scene safety would be my first thought. I would at the very least have thought that loose or heavy kit (like a cylinder) should be secured.

 

[usafmedic45]

I had somebody scream at me then write me up in EMS saying that testing for a Babinski reflex would so the same thing...

We really have to start a petition to make the test harder.

No kidding.

 

[Veneficus]

Agreed, but they still hold (or will hold) clinical responsibility and should at least be asked if they mind.

If they are playing with the O2 bottle, they are busy with something other than getting in the way of patient care right?

You know, like a kid, give them something to occupy the hands so you can do what you need without interruption?

 

[usafmedic45]

If they are playing with the O2 bottle, they are busy with something other than getting in the way of patient care right?

You know, like a kid, give them something to occupy the hands so you can do what you need without interruption?

I would always ask them to assess breath sounds or "read" an EKG for me on scene. It makes them look good and keeps them out of my way.