Killing Your Patients

[Lifeguards For Life]

How is nitro benign?

You can definitely do some damage, particularly if someone is having a RV infarction.

Run it as a drip. Hlaf life is about 8 seconds. If the BP starts to fall simply shut off the drip.

While you could knock a bp down with SL or topical nitro, the patient could just as easily do the same with their own nitro.

If the Pt is having an MI with RV involvement, or even taken any phosphodiesterase inhibitors, they are just as likely, possibly even more so, to give themselves nitro, than emergency personnel is.

 

[Lifeguards For Life]

You can definitely do some damage, particularly if someone is having a RV infarction.

Even with RV involvement, Nitro is just a relative contraindication.

 

[Lifeguards For Life]

I witnessed some ER nurses knock a patient's BP down from 130/Something to 30/15 because they apparently applied nitro paste and forgot about it. She was darn near circulatory collapse by the time anybody thought to check on her. Talk about close calls. :glare:

But this was not a fatal mistake?

 

[usalsfyre]

Even with RV involvement, Nitro is just a relative contraindication.

Except the American College of Cardiology says it's a class III intervention for RVI...

 

[Lifeguards For Life]

Except the American College of Cardiology says it's a class III intervention for RVI...

Class III interventions mean no proven benefit or potentially harmful right?

I wouldn't give a pt with an RVI Nitro SL, but do you think doing so is a death sentence?

I would give them nitro as a drip though

 

[usalsfyre]

Class III interventions mean no proven benefit or potentially harmful right?

I wouldn't give a pt with an RVI Nitro SL, but do you think doing so is a death sentence?

I would give them nitro as a drip though

Yep, class III is bad.

Not a death sentence, but not helpful.

Considering NTGs benefit in AMI is dubious anyway, I'm probably going to withhold it for RVI period and control the pain with hemodynamiclly stable opiates.

 

[Lifeguards For Life]

Yep, class III is bad.

Not a death sentence, but not helpful.

Considering NTGs benefit in AMI is dubious anyway, I'm probably going to withhold it for RVI period and control the pain with hemodynamiclly stable opiates.

It's not really that I disagree with you, I just want to explore the idea that it is not as easy to make a mistake and kill a patient as some medics would have you believe.

 

[usalsfyre]

It's not really that I disagree with you, I just want to explore the idea that it is not as easy to make a mistake and kill a patient as some medics would have you believe.

NTG infusions, for all the fear surrounding them, are MASSIVELY safer than SL NTG. It is indeed hard to kill someone with NTG. Although not an RVI obviously, I have been known to give a 1.2 MILLIGRAM loading dose SL and run an infusion of NTG between 50 and 100mcg/min for severe CHF. Never seen an ill effect and patients get better. The ED nurses freak out with a 100mcg infusion though.

 

[mycrofft]

Many people in medicine say the tech caused the death when it was due to the insult.

In the course of impressing upon their students how important it is not to make mistakes (and by extension how important it is for them to listen to and believe the teacher uncritically), they take the opportunity to bully and haze them with this. Typical quasi basic training boot camp frickafrack.

Mostly, you can screw up and the original insult still kills; the insult was inevitably and promptly lethal and they die with you even if you do it right; you take too long or act timidly, and etc etc as above. Sometimes you treat too aggressively, then your measure kills the pt or hurries the insult's effect. Sometimes it is the wrong treatment and it exacerbates the insult or preextant condition, and you kill them. Or you do something that in and of itself is lethal such as the oxygen mask/smothering I described earlier. Most times, the tech didn't do it, but failed to prevent it.

 

[BEorP]

Run it as a drip. Hlaf life is about 8 seconds. If the BP starts to fall simply shut off the drip.

While you could knock a bp down with SL or topical nitro, the patient could just as easily do the same with their own nitro.

If the Pt is having an MI with RV involvement, or even taken any phosphodiesterase inhibitors, they are just as likely, possibly even more so, to give themselves nitro, than emergency personnel is.

I really don't understand what you are trying to prove here.

Nitro is commonly administered SL and is not benign. Just because a patient could do it to themselves or you can propose a safer way does not change the fact that the drug, as commonly administered, can be dangerous.

 

[Lifeguards For Life]

I really don't understand what you are trying to prove here.

That Linuss does not run the risk of making a fatal mistake Every. Single.
Time. he gives a patient a medication


And yes, while it can be harmful, do you really feel as if a provider is likely to accidentally kill a patient with it?

 

[Zodiac]

And yes, while it can be harmful, do you really feel as if a provider is likely to accidentally kill a patient with it?

With the right level of incompetence, anything is deadly.

 

[BEorP]

That Linuss does not run the risk of making a fatal mistake Every. Single.
Time. he gives a patient a medication


And yes, while it can be harmful, do you really feel as if a provider is likely to accidentally kill a patient with it?

I'm not trying to get in between you and Linuss.

In the initial post, you asked: "So, let's hear it. what mistakes can you imagine an EMS provider making in good faith, that could prove fatal to a patient."

Giving nitro to an RVI could do that. I think we're on the same page on that.

Now, could an EMS provider do it by accident? Absolutely. Many paramedics in at least one region routinely give nitro without a 12 lead. And even when a 12 lead is available, it is possible to miss something on it.

Will everyone give SL nitro to an RVI? No.
Will it always kill them if they do? No.
Is this something that I am claiming frequently happens? No.

But it is most definitely a way an EMS provider could accidentally kill a patient.

 

[mycrofft]

Maybe nitro needs a separate thread?

If I was treating an unconscious man in a Las Vegas hotel I'd be very chary about whipping on the nitro, due to the Viagra situation there...h34r:

 

[firetender]

This is going in the same direction as medicine: fixating on the individual modality in an attempt to treat what is essentially a set of symptoms rather than stepping back and seeing the patient as a whole entity.

A call involves treating a past and present with many, many variables. In the absence of willfully administering a therapy that is known to exacerbate a bad situation, what we do to kill a patient is usually contributory, not decisive.

 

[Tigger]

I'm having a hard time trying to figure out what a forgivable mistake is, or one that is made in good faith. Everything that I think of always seems to also be equatable to negligence, and I have to wonder how forgivable negligence is.

The one "mistake" that I can come up with is with the stretcher. You're transporting a patient to the ambulance across a parking lot. Neither you nor your partner see a hole in the pavement ahead. One stretcher wheel get's jammed up, the stretcher tips, and the patient strikes his head and dies.

Admittedly, this a far fetched scenario. But can, and has happened in Newport News and in the Boston area. Not sure what the rules are about posting links to news stories.

 

[silver]

Healthcare associated infections (HAIs) are something that can kill patients as well. Something like MRSA or even a "garden variety" infection could be picked up from skin contact, IV placement, central lines etc. and result in a nasty infection and sepsis.

Even with the best EMTs/Medics some infections can't be prevented.

 

[usalsfyre]

Tigger, not to pick on you, but that attitude does nothing but encourage hiding mistakes.

EMS needs to learn from the medical model of training.

 

[Tigger]

I guess I was looking at things more from a legal perspective, in that regardless of intent, negligence is negligence. That said, that's not how I personally look at mistakes. I absolutely understand that a paramedic could err in drawing up a medication and kill a patient. I understand we are all humans and mistakes will happen. Hopefully such an incident would be correctly managed and would not have to end in the paramedics immediate termination.

I know that differentiating from BLS and ALS is not something that EMS needs, but I guess from the basic prospective, there's not a whole lot I can do to even hasten a patient's death, much less kill the patient.

 

[firetender]

II guess from the basic prospective, there's not a whole lot I can do to even hasten a patient's death, much less kill the patient.

You're young. You'll learn.