last nights call

[emt seeking first job]

Any comments welcome.

This was a direrct call to our service. we did not buff it.

(different crew than the last retired MD patient)

68 year old male, reports numbness and tingling in right leg.

Found in a prone position. pulse 44, bp 140/84, resp normal, pupils normal, ctc normal. No facial drop, normal speech, unable to test arms.

Two years ago victim of an assault (MS-13 gang initiation). Two mini and one big stroke after that. Lost use of right arm, fingers permantly twisted in a half-fist.

He was an MD, forced to retire after the assault.

Crew chief never brought up ALS. Never brought up adminstering 0-2.

Ordered set of vitals when we got there.

Interviewed him history, meds, etc, for about 15 minutes.

Got him into the stair chair, set of vitals.

Got him into the rig on the stretcher, set of vitals.

Crew chief told the driver to drive with lights and siren but do not rush.

Ride about 5 minutes.

Pulled up to ER. set of vitals as we were rolling up.

Discuss.

Got him into triage, set of vitals (with the hospital machine)

 

[Epi-do]

Not real sure what you are wanting to discuss. There isn't really enough info their to work with.

What were the additional vitals? His heart rate seems a little slow initially, but without seeing additional vitals to know how it was trending, it is really hard to make much comment on it. From what little you have provided, I would guess that he was perfusing well despite the rate. Was there a 4 or 12 lead done? Did he have any other complaints besides the numbness & tingling in his leg? What did the leg look like? Was it warm, hot, cool? If it was unusually hot/cool, was it the entire leg, or just a portion of it? What other sort of history did he have? What meds was he taking?

A vague complaint like a numb/tingling leg could be caused by literally anything. It could be something as benign as his leg "fell asleep" to something like DVT, atherosclerosis, MS, shingles, Raynaud's phenomenon, or another CVA.

 

[emt seeking first job]

No ALS = no 12 lead.

The skin on his leg looked normal.

I forget his med list.

 

[Tommerag]

^ Agreed....Any other info?

 

[emt seeking first job]

Not real sure what you are wanting to discuss. .

anything that comes to mind

I am 40+ with no health care experience. I am lucky if my agency gets 1 call in a shift. My intention is to hear as many opinions as possible, even the negative insulting ones.

 

[abckidsmom]

The only comment I can make based on the limited information provided: Why 15 minutes for a history if you're a BLS truck who is just going to race him to the hospital anyway?

Do you realize that whatever time you saved with the lights and sirens was previously wasted chatting in the living room?

Get in the habit of having a mental stopwatch and if you're not moving toward the ambulance at 10 minutes, have a reason. I don't get the feeling that too many people are waiting for your ambulance to get back in service after the call, but wasted minutes are wasted minutes. The other vast majority of wasted minutes are when you're out at the hospital.

 

[emt seeking first job]

The only comment I can make based on the limited information provided: Why 15 minutes for a history if you're a BLS truck who is just going to race him to the hospital anyway?

Get in the habit of having a mental stopwatch and if you're not moving toward the ambulance at 10 minutes, have a reason. I don't get the feeling that too many people are waiting for your ambulance to get back in service after the call, but wasted minutes are wasted minutes. The other vast majority of wasted minutes are when you're out at the hospital.

That is what I was thinking.

This particular crew chief has a tendency to stay and chat. This person was asking questions, etc.

Another crew chief told me that their own style is to load and go in the shortest possible time.

I said nothing because the crew chief was experienced and is a paid hospital nurse so who the eff am I to say.....

Again, I am nobody.

This person actually had a regular crew of newbies that they refused to take out anymore because they 1) would not listen and 2) refuse to do what was said (like take vitals, begin getting info for PCR) and they only wanted to run around lights and siren.....

As far as being busy, it comes and goes, sometimes two calls come in at once........

Most people who call are neighborhood old timers, recallling the days of waiting 1 hour for 911.

THANK YOU FOR REPLYING.

 

[Epi-do]

anything that comes to mind

I am 40+ with no health care experience. I am lucky if my agency gets 1 call in a shift. My intention is to hear as many opinions as possible, even the negative insulting ones.

Ummm......wow! I certainly didn't intend to be insulting, I was just making an observation.

 

[abckidsmom]

That is what I was thinking.

This particular crew chief has a tendency to stay and chat. This person was asking questions, etc.

Another crew chief told me that their own style is to load and go in the shortest possible time.

I said nothing because the crew chief was experienced and is a paid hospital nurse so who the eff am I to say.....

Again, I am nobody.

This person actually had a regular crew of newbies that they refused to take out anymore because they 1) would not listen and 2) refuse to do what was said (like take vitals, begin getting info for PCR) and they only wanted to run around lights and siren.....

As far as being busy, it comes and goes, sometimes two calls come in at once........

Most people who call are neighborhood old timers, recallling the days of waiting 1 hour for 911.

THANK YOU FOR REPLYING.

Humility can be overdone. Nurses are great, but they are not necessarily the best EMS providers out there. I know a nurse who ran the busiest inner-city ER in our area, routinely had a million patients and let a patient sit in SVT at a rate of 180 with chest pain and hypotension because she thought she needed a secong medic present to give him adenosine.

There's a balance between deferring to people with more experience and being a leader in the right direction.

 

[Anjel]

I see a lot of your posts where you are looking back in retrospect on your runs. Where you thought something wasn't right. But didn't say anything cuz you are the new guy.

That is a very bad pt advocate. I know this wasn't life or death or anything. But what if next time someone decides to give nitro to a guy with a bp of 80/50. Are you not going to say anything? Or if a guy having a stroke needs to get to the hospital are you gonna just go with the flow when they guy decides to sit on scene forever.

You are there to care for your pt. If you have the "I am nobody" attitude then that's what you are. Nobody. Just a person being bossed around and taking up space.

Maybe you should look for another company. Once that won't punish you for doing what you signed up for. You and me have the same training. But I'm sure as hell not gonna let my pt suffer because I'm afraid of what others might think of me caring for my pr.

It will get better with more experience. I can tell you really do love the job. Just don't forget why you got into it in the first place.

 

[ffemt8978]

I see a lot of your posts where you are looking back in retrospect on your runs. Where you thought something wasn't right. But didn't say anything cuz you are the new guy.

That is a very bad pt advocate. I know this wasn't life or death or anything. But what if next time someone decides to give nitro to a guy with a bp of 80/50. Are you not going to say anything? Or if a guy having a stroke needs to get to the hospital are you gonna just go with the flow when they guy decides to sit on scene forever.

You are there to care for your pt. If you have the "I am nobody" attitude then that's what you are. Nobody. Just a person being bossed around and taking up space.

Maybe you should look for another company. Once that won't punish you for doing what you signed up for. You and me have the same training. But I'm sure as hell not gonna let my pt suffer because I'm afraid of what others might think of me caring for my pr.

It will get better with more experience. I can tell you really do love the job. Just don't forget why you got into it in the first place.

By the same token, there is a time and place for it. For the most part, it can wait until after the run instead of happening on scene in front of the patient. An approach of, "I'm curious as to why this happened" will often times lead to an explanation that can be instructive.

 

[traumahawk]

Any comments welcome.

This was a direrct call to our service. we did not buff it.

(different crew than the last retired MD patient)

68 year old male, reports numbness and tingling in right leg.

Found in a prone position. pulse 44, bp 140/84, resp normal, pupils normal, ctc normal. No facial drop, normal speech, unable to test arms.

Two years ago victim of an assault (MS-13 gang initiation). Two mini and one big stroke after that. Lost use of right arm, fingers permantly twisted in a half-fist.

He was an MD, forced to retire after the assault.

Crew chief never brought up ALS. Never brought up adminstering 0-2.

Ordered set of vitals when we got there.

Interviewed him history, meds, etc, for about 15 minutes.

Got him into the stair chair, set of vitals.

Got him into the rig on the stretcher, set of vitals.

Crew chief told the driver to drive with lights and siren but do not rush.

Ride about 5 minutes.

Pulled up to ER. set of vitals as we were rolling up.

Discuss.

Got him into triage, set of vitals (with the hospital machine)

Ok first off, 15 mins asking a HX was the first mistake. You can still uptain a HX while moving the PT at the same time. You can write on ur glove. The reason why i would do this is becuz of HR. It would make me step it up a bit.
and instead of taking all vitals, just take a pulse till ur in the back of the bus. rememer in BLS vitials will not help a PT. Definitive care Will. And BTW was this a volly. I ask becuz of the term "crew chief".

 

[Outbac1]

As others have said there is not much info on this call. If the only complaint is numbness and tingling in the leg, you're not going to fix that on scene. The HR of 44 raises questions. I doubt it is normal for the pt and needs to be investigated further.

From the info given there was no need to go L&S. When travelling to the hosp one should always drive gently. No sudden acceleration, braking or turns. You can't do any work to help your pt if all you can do is hang on. The pt should be in dire need of some advanced care to benifit from the little time saved by travelling L&S.

For people here to help you we need more information. More hx, more vitals if available, med list, scene info eg: pt was found prone, but where? Bottom of the basement stairs, bathroom floor with pants down etc. These are all clues as to what may be going on with the pt. Most ER Drs will tell you a high percentage of their dx and tx is based on a good hx and assessment of the pt. It guides them in what tests they want to do and what results of these they are looking for to guide their tx.

There are many posts here on assessment, history etc. Poke around, read and learn. Age by the way is just a state of mind. I was 43 when I started my medical carreer, and that wasn't yesterday.

You are not a nobody. You are someone who cares about the system you find yourself working in and who wants to better their meager medical education (I think you are an EMT B ). This I consider a good thing.

 

[emt seeking first job]

In NYC, Nitro if they complain of chest pains, systolic over 120, and they have it in, we dont carry it.

 

[medichopeful]

Ummm......wow! I certainly didn't intend to be insulting, I was just making an observation.

I'm pretty sure it wasn't directed towards you or anybody in particular

 

[emt seeking first job]

For the record:

Please, don;t hold back, with me at least. Say what you think. Either in a thread or PM me.

If you are passing through NYC, we can meet up for a beer and you can say anything to my face, I will pay for the beer.

This is my profession.

Part of being a public safety person in having thick skin. If anyone gets insulted over a forum thread, he or she has no place in this buisness.

 

[ffemt8978]

Please, don;t hold back, with me at least. Say what you think. Either in a thread or PM me.

If you are passing through NYC, we can meet up for a beer and you can say anything to my face, I will pay for the beer.

This is my profession.

Part of being a public safety person in having thick skin. If anyone gets insulted over a forum thread, he or she has no place in this buisness.

True, but anybody making insults on this forum will become the focus of my attention.

 

[exodus]

Is anyone else curious why the arms couldn't be tested? So was there a stroke scale done?

 

[vquintessence]

Is anyone else curious why the arms couldn't be tested? So was there a stroke scale done?

Probably because of the (R) sided hemiparesis w/ contractures? He did otherwise do an "EMS neuro eval".