abckidsmom
Dances with Patients
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Yeah, sure...it smells like lemonade.
Moron CNA's
- Thread starter ilemtbwantn2bTXEMT-P
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Yeah, sure...it smells like lemonade.
ilemtbwantn2bTXEMT-P
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According to the staff he had been bleeding for about an hour when they called but they had no idea how long before that. There was no way to truly assess his Mental Status other than AVPU or LOC, he only spoke Russian, so ALS wouldn't have really been able to do much more for the guy then we did. The CNA's and Nursing staff had no clue abotu his Mental Status or anything when we asked them, and its safe to note too on arrival at the ER when they asked where he came from and we told them the Doctor just shook his head, and told us later his thoughts on the place, which were far from positive.
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Welcome to EMS.
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Quite possibly the most unprofessional and poorly written rant I have seen in a while.
Please don't bring your poor attitude to my state.
Please don't bring your poor attitude to my state.
Frozennoodle
Sir Drinks-a-lot
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If I truly suspected shock I'd pop an 18 in him and hang NS TKO and monitor pressure en route titrating to 80-90 systolic if it dropped below 80. I'd start a second 18 in the other arm and apply a saline lock. Blankets for warmth and loose dressings to sop up the blood w/o direct pressure. That's if I even had time to do half of that in the 5 minutes it takes to go around the block to the hospital.
wow!
Interesting post. Im thinking an IV would be good preferably 16g with a small bolus 250-500. But the big thing would be oxygen which is a bls skill. The iv size is more for the facility if he needs blood or surgery. A second one would not be a bad idea. Maybe check his blood sugar as well since nobody in a " normal " state would pull out a foley.
Interesting post. Im thinking an IV would be good preferably 16g with a small bolus 250-500. But the big thing would be oxygen which is a bls skill. The iv size is more for the facility if he needs blood or surgery. A second one would not be a bad idea. Maybe check his blood sugar as well since nobody in a " normal " state would pull out a foley.
If you can get it why not? What is the goal of this. The person was stating the patient was in shock. By the limited information we have to assume this is the cause of his problems. And the ability to give rapid boluses of fluid is determined by catheter size and length, and tubing size and length. At least I wasnt activating a trauma alert. ( kind of redundant where im at! lol)
The difference in pain is negligible. If you can't get a line would you put an IO in him? Depending on my pt's presentation maybe. But given the info ( poss hypotensive pt with possible altered mental status and tachycardia. What are your options? Aggressive Tx or passive.
Not trying to start a war, I'm new here. But I believe in good dialogue and exchange of ideas.
The difference in pain is negligible. If you can't get a line would you put an IO in him? Depending on my pt's presentation maybe. But given the info ( poss hypotensive pt with possible altered mental status and tachycardia. What are your options? Aggressive Tx or passive.
Not trying to start a war, I'm new here. But I believe in good dialogue and exchange of ideas.
It is not about the pain.
Most 78 year olds are not 16g material. Which means you may not get the first stick and you may wind up with nothing.
Then you are escalating, when more conservatgive treatment would possibly have succeeded.
You perform medical treatments that are indicated, not because you can. If a 20g works, why use a 16g? A central line works, why not that?
It is overkill.
It is not a question of passive or aggresive. It should be indicated, accurate, and as precise as possible.
"Don't use a cannon to kill a mosquito."
iftmedic
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This is a pointless thread
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Sasha
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I'm still not convinced it was shock. he pulled out his cath, so usually that means one of two things, he's just a grumpy old man who likes to pull at things, or he is normally AMS.
What time was this call? I have had a ton of patients who are normally wakeful and alert but are very somnolent for me. But then we are there at midnight, so it's to be expected.
What is his blood pressure normally? A ten point difference isn't really that big of deal considering or rather assuming your first BP was manual, and this one was a machine.
I wouldn't go with the large gauges. That's unnecessary. Even if he ended up getting a transfusion, they can push it through smaller than that. Instead of "If you can get it, why not?" let's stop thinking in terms of frivilous treatments and think more in terms of "Why do I need it?" A 16ga is going to be more traumatic than an 18 or 20 and you're probably going to end up blowing the only one or two good veins you've got for a line.
If you want to go along with "This is shock!!!!" then why spill blood you don't need to spill by poking a hole with an IV that's too big and blowing it? You're just making the situation worse. Go with the smallest effective appropriate gauge.
He doesn't need fluids. Why? So you can dilute the fluid he has, increase BP when the pressure will make him bleed faster?
What time was this call? I have had a ton of patients who are normally wakeful and alert but are very somnolent for me. But then we are there at midnight, so it's to be expected.
What is his blood pressure normally? A ten point difference isn't really that big of deal considering or rather assuming your first BP was manual, and this one was a machine.
I wouldn't go with the large gauges. That's unnecessary. Even if he ended up getting a transfusion, they can push it through smaller than that. Instead of "If you can get it, why not?" let's stop thinking in terms of frivilous treatments and think more in terms of "Why do I need it?" A 16ga is going to be more traumatic than an 18 or 20 and you're probably going to end up blowing the only one or two good veins you've got for a line.
If you want to go along with "This is shock!!!!" then why spill blood you don't need to spill by poking a hole with an IV that's too big and blowing it? You're just making the situation worse. Go with the smallest effective appropriate gauge.
He doesn't need fluids. Why? So you can dilute the fluid he has, increase BP when the pressure will make him bleed faster?
Sasha
Forum Chief
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Then don't comment on it?
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Brown thinks this "moron" of a nurse has more intelligence than you mate seriously. She is right, some old bloke who pulled out his catheter is not going to be status 1 in need of an RSI qualified Intensive Care Paramedic.
They called you for a ride to the hospital, not your medical opinion.
Now you have not defined what a "large" amount of blood is, remember that every layperson knows head wounds bleed "a lot" but anybody with some anatomical knowledge knows that is not because they have torn a major artery but because of the large capillary innervation of the scalp.
A "large" puddle of blood may only be a few mL but widely distributed in area rather than volume. This old bloke is going to have less physiologic reserve than somebody like Brown who is young and healthy so you are kinda partially correct in that if this guy was pissing blood everywhere its going to be more of a concern than in somebody who is younger.
You obviously failed to keep up with the concept that blood pressure is a poor indicator of the degree of perfusion inadequacy. Did you not learn that in the compensated to early decompensatory stages of hypovolaemic shock the patient may be normotensive. Did you ask about his urine output? How long had he been having this big bad serious bleed?
Brown is shocked you did not call for a helicopter and tell the HEMS Doctor what a big serious emergency was so he or she could pull some gelofusine out of the Thomas Pack, pop on a CAT and airlift him back to the major trauma centre for immediate definitive surgery.
Yes, Brown is taking the piss because don't look now bro but you 100 hour wonder ambo course is showing,
Why is oxygen the most important thing?
Do you think any anaesthetist is going to use your crappy prehospital line to give blood products?
You and the bloke who posted this would be good working together
They called you for a ride to the hospital, not your medical opinion.
Now you have not defined what a "large" amount of blood is, remember that every layperson knows head wounds bleed "a lot" but anybody with some anatomical knowledge knows that is not because they have torn a major artery but because of the large capillary innervation of the scalp.
A "large" puddle of blood may only be a few mL but widely distributed in area rather than volume. This old bloke is going to have less physiologic reserve than somebody like Brown who is young and healthy so you are kinda partially correct in that if this guy was pissing blood everywhere its going to be more of a concern than in somebody who is younger.
You obviously failed to keep up with the concept that blood pressure is a poor indicator of the degree of perfusion inadequacy. Did you not learn that in the compensated to early decompensatory stages of hypovolaemic shock the patient may be normotensive. Did you ask about his urine output? How long had he been having this big bad serious bleed?
Brown is shocked you did not call for a helicopter and tell the HEMS Doctor what a big serious emergency was so he or she could pull some gelofusine out of the Thomas Pack, pop on a CAT and airlift him back to the major trauma centre for immediate definitive surgery.
Yes, Brown is taking the piss because don't look now bro but you 100 hour wonder ambo course is showing,
Why is oxygen the most important thing?
Do you think any anaesthetist is going to use your crappy prehospital line to give blood products?
You and the bloke who posted this would be good working together
Frozennoodle
Sir Drinks-a-lot
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I love you two. XD
Some here might .... but if this bloke was that crook they'd put in a central line
Brown loves you too mate but remember you have to compete with Mrs Brown, however many daughters the Brown's end up having, Brown's home made burritos and guac and sleep.
Um, .... how much did you love Brown again?
Most here would too, but I've seen my crappy prehospital lines
h34r: used to infuse blood while the IJ is set up(or femoral if the ED doc is doing it, which raises the question, why does EM seemingly ONLY do femorals?) many times.
mycrofft
Still crazy but elsewhere
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We done putting the boots to the OP?
Metacommunicatonally speaking, (i.e., off thread) folks using handheld devices tend to exhibit parapgraph and punctuational deficits. Versus us longwinded sitdown keyboarders..:blush:
I consider this to be a ventilation session, and note that the OP hasn't gotten into post/reply fights with the repliers.
Metacommunicatonally speaking, (i.e., off thread) folks using handheld devices tend to exhibit parapgraph and punctuational deficits. Versus us longwinded sitdown keyboarders..:blush:
I consider this to be a ventilation session, and note that the OP hasn't gotten into post/reply fights with the repliers.
Frozennoodle
Sir Drinks-a-lot
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Some here might .... but if this bloke was that crook they'd put in a central line
Brown loves you too mate but remember you have to compete with Mrs Brown, however many daughters the Brown's end up having, Brown's home made burritos and guac and sleep.
Um, .... how much did you love Brown again?
Depends on how many burritos you're making ;p
safety