New EMT, don't understand a couple of calls.

[VirginiaEMT]

Hello,

I am new here to the forum and to being and EMT. I need some help, maybe I am just a gung-ho rookie EMT, maybe I don't understand, or maybe I'm right, but I have a couple of questions about calls I recently ran with anothe AIC.

1.What is hyperglycemia? It is my thought that it simply means an excessive blood gluose level. The patient had a D-stick of 175, he said normal is around 120. He was laying on a bench at Wal-Mart, with an altered LOC, but signed a patient refusal because he was feeling better and didn't want to go with us.

As I was questioning the AIC, who is an EMT-E, he said he wasn't hyperglycemic, that is blood sugar simply spiked because it was originally low, and when he ate it shot up.

I thought anything above a 140, for anyone is considered hyperglycemic?

2. We ran an attempted suicide, female with incisions on both wrist. Very deep blood bleeding was almost clotted upon our arrival, but not completely.

The AIC started asking her questions about WHY she did it, and started telling her that suicide was no way out, and I'm thinking "who gives a crap, let's fix her" first. Here's the questions I have:

A. I controled bleeding on right wrist, and bandaged, no problems encountered. The left wrist was still slightly bledding, not an artery bleed, I place a dressing on it and elevated. I asked the AIC to open another 4x4 because she was bleeding through the original, and I was going to place another one on top, and continue direct pressure. The AIC said no, that I didn't want to do that because I was "over-dressing it", she said she was told by our OMD, to simply leave the original, and push down on the bleed harder, with the thumb. Again. this was venous bleeding. What do you feel is the right answer.

B. The ladies color was still o.k, but her pupils were dialated and very slow(she said she had not taken any drugs). I mentioned that we should put her on 15LPM of O2 with a NRB, number one because of the loss of blood, and her pupils reaction to light as well as being dialated, and she said that the patient wasn't shocky and a nasal with 6LPM would be sufficient.I drove to the hospital, and when we entered the ER, she had completely taken the O2 off. I am under the opinion we should have treated for shock, because it could have only helped, and not hurt her in any way.

Any thoughts????

 

[Aidey]

Hello,

I am new here to the forum and to being and EMT. I need some help, maybe I am just a gung-ho rookie EMT, maybe I don't understand, or maybe I'm right, but I have a couple of questions about calls I recently ran with anothe AIC.

1.What is hyperglycemia? It is my thought that it simply means an excessive blood gluose level. The patient had a D-stick of 175, he said normal is around 120. He was laying on a bench at Wal-Mart, with an altered LOC, but signed a patient refusal because he was feeling better and didn't want to go with us.

As I was questioning the AIC, who is an EMT-E, he said he wasn't hyperglycemic, that is blood sugar simply spiked because it was originally low, and when he ate it shot up.

I thought anything above a 140, for anyone is considered hyperglycemic?

There is a difference between a clinically significant number and an elevated but relatively insignificant number. A totally healthy person could hit 175mg/dl by eating a large meal with a lot of carbs in it. I have a hard time thinking of a situation where a chem of 175mg/dl would concern me.

2. We ran an attempted suicide, female with incisions on both wrist. Very deep blood bleeding was almost clotted upon our arrival, but not completely.

The AIC started asking her questions about WHY she did it, and started telling her that suicide was no way out, and I'm thinking "who gives a crap, let's fix her" first. Here's the questions I have:

A. I controled bleeding on right wrist, and bandaged, no problems encountered. The left wrist was still slightly bledding, not an artery bleed, I place a dressing on it and elevated. I asked the AIC to open another 4x4 because she was bleeding through the original, and I was going to place another one on top, and continue direct pressure. The AIC said no, that I didn't want to do that because I was "over-dressing it", she said she was told by our OMD, to simply leave the original, and push down on the bleed harder, with the thumb. Again. this was venous bleeding. What do you feel is the right answer.

B. The ladies color was still o.k, but her pupils were dialated and very slow(she said she had not taken any drugs). I mentioned that we should put her on 15LPM of O2 with a NRB, number one because of the loss of blood, and her pupils reaction to light as well as being dialated, and she said that the patient wasn't shocky and a nasal with 6LPM would be sufficient.I drove to the hospital, and when we entered the ER, she had completely taken the O2 off. I am under the opinion we should have treated for shock, because it could have only helped, and not hurt her in any way.

Any thoughts????

I'm not sure what your medic meant by overdressing. The only thing I can think of is that adding more gauze doesn't really help if you aren't applying any pressure.

As for the O2 this patient likely didn't need any oxygen. Dilated pupils is not enough reason to put someone on O2. Was she tachy? Hypotensive? Breathing fast? The pts pupils were likely dilated from an activation of her flight or fight response due to the high emotions of the situation.

If her vital signs were within acceptable limits I highly doubt she was in shock. Doing things "just because it won't hurt" isn't a good idea. If the pt wasn't in shock, she didn't need to be treated for shock.

Generally patients must pass the "blue test" to get 15lpm via NRB, ie, they must be blue in order to get it. There are some exemptions to this, but for the most part unless a patient is blue they get a cannula first (that is if oxygen is indicated at all).

 

[johnrsemt]

fix her first

It doesn't hurt to talk to the patient while you are stopping the bleeding and dressing the wounds;
In fact the more you talk to them the better. let them know what you are doing: makes the patient more comfortable and helps them to relax. helps them the think that maybe you know what you are doing.

I have had patients that the only thing I did for them on the run is hold their hand, and talk to them

 

[Fox]

Hello,

I am new here to the forum and to being and EMT. I need some help, maybe I am just a gung-ho rookie EMT, maybe I don't understand, or maybe I'm right, but I have a couple of questions about calls I recently ran with anothe AIC.

1.What is hyperglycemia? It is my thought that it simply means an excessive blood gluose level. The patient had a D-stick of 175, he said normal is around 120. He was laying on a bench at Wal-Mart, with an altered LOC, but signed a patient refusal because he was feeling better and didn't want to go with us.

As I was questioning the AIC, who is an EMT-E, he said he wasn't hyperglycemic, that is blood sugar simply spiked because it was originally low, and when he ate it shot up.

I thought anything above a 140, for anyone is considered hyperglycemic?

2. We ran an attempted suicide, female with incisions on both wrist. Very deep blood bleeding was almost clotted upon our arrival, but not completely.

The AIC started asking her questions about WHY she did it, and started telling her that suicide was no way out, and I'm thinking "who gives a crap, let's fix her" first. Here's the questions I have:

A. I controled bleeding on right wrist, and bandaged, no problems encountered. The left wrist was still slightly bledding, not an artery bleed, I place a dressing on it and elevated. I asked the AIC to open another 4x4 because she was bleeding through the original, and I was going to place another one on top, and continue direct pressure. The AIC said no, that I didn't want to do that because I was "over-dressing it", she said she was told by our OMD, to simply leave the original, and push down on the bleed harder, with the thumb. Again. this was venous bleeding. What do you feel is the right answer.

B. The ladies color was still o.k, but her pupils were dialated and very slow(she said she had not taken any drugs). I mentioned that we should put her on 15LPM of O2 with a NRB, number one because of the loss of blood, and her pupils reaction to light as well as being dialated, and she said that the patient wasn't shocky and a nasal with 6LPM would be sufficient.I drove to the hospital, and when we entered the ER, she had completely taken the O2 off. I am under the opinion we should have treated for shock, because it could have only helped, and not hurt her in any way.

Any thoughts????

In class they teach you to give EVERYONE a NRB at 15LPM. In fact, if we didn't do it every check off we failed.

But look at it this way. If a patient only needed 5mg of medicine to feel better, would you give them 15mg? No. O2 is considered a drug, so give it as the patient can tolerate and use it when it's needed, not overkill. Sometimes a NC is more appropriate for the situation.

That's just how I view it.

As for the dressing, I really couldn't tell you. That seems weird to me. If you were using pressure and she bled through, the I would've added another dressing.

I've had a PCP tell me to not worry about blood sugar til it hit 180-200. I think it depends on the patient and the activities that led to the sugar spike. And the doctor.

 

[TransportJockey]

About the diabetic call:
I've had a few patients that were frequent fliers that a 'low' CBG was in the 200's, they normally stayed at 3-400. Not everyone is text book for 'normal vitals'

 

[medic417]

About the diabetic call:
I've had a few patients that were frequent fliers that a 'low' CBG was in the 200's, they normally stayed at 3-400. Not everyone is text book for 'normal vitals'

Exactly. Treat the patient not the text book. Many patients with medical problems know what the normal vitals for them are. Listen to them. If you are in a good system you can provide care based on patient norms not some numbers in a protocol book. If you are in a bad system that requires everything match the protocol numbers then you may need to call medical control and ask to treat the patient based on their norms, which will probably be denied because any system that requires call med control is garbage.

 

[VirginiaEMT]

It doesn't hurt to talk to the patient while you are stopping the bleeding and dressing the wounds;
In fact the more you talk to them the better. let them know what you are doing: makes the patient more comfortable and helps them to relax. helps them the think that maybe you know what you are doing.

I have had patients that the only thing I did for them on the run is hold their hand, and talk to them

We weren't doing any interventions, simply asking questions at that point. I am very glad to see that I can actually get answers to questions I may have, on this forum. I really appreciate it.

 

[medic417]

We weren't doing any interventions, simply asking questions at that point.

What you will learn is often one person will be talking to the patient while the other starts treatment. Your partner probably thought you would start bandaging the wounds while they calmed the patient.

 

[VirginiaEMT]

What you will learn is often one person will be talking to the patient while the other starts treatment. Your partner probably thought you would start bandaging the wounds while they calmed the patient.

You're probably right. I did well in my EMT-B class, 96 average, and passed the state exam with a 90, I guess now it's time to get into the real world and learn street smarts.

 

[CSLEMT]

EMT Question... What Would You Do?

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

 

[Akulahawk]

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

In my case, I'd want to know what role I'm in... Why? Simple. Some roles I can fill will limit what my response would be for our fallen batter.

In an EMT role, once you're called onto the field, your options are quite limited. You're going to basically start running the Head Injury/C-Spine protocol and that batter will likely end up being transported to the ED on a LSB. As a Paramedic, your options might improve a bit if you're trained and authorized to clear C-Spine in the field. Otherwise, the Paramedic will have to follow the same basic C-Spine script the EMT follows.

An ATC has more options than that... but you're not going to be using those options if you're working as an EMT or Paramedic.

 

[clibb]

Hyper means excessive. So yeah, high blood sugar. 175 isn't scary high. 80-120 is the normal range for a non-diabetic adult.

I had a patient that was on a insulin pump and was DKA and her blood sugar was 477. She was NOT feeling good.

With the oxygen, that totally depends on your protocol. Where I did my ride-alongs, you had to put oxygen on nearly every patient. It was more of a courtesy then anything else.
Do happen to know what her SP02 was at? That should be what you would determine if the patient needed oxygen or not.

 

[medichopeful]

The pts pupils were likely dilated from an activation of her flight or fight response due to the high emotions of the situation.

Dilated pupils can also be caused by loss of blood (hypovolemia).

 

[JPINFV]

As an EMT, what would you do?

Depends on the assessment and level of play. Sorry, but being hit in the helmet by a 10 year old throwing a fast ball doesn't concern me.

 

[usafmedic45]

she said she had not taken any drugs

Any thoughts????

Other than she was probably lying? Especially given that most suicides have something on board, even if not in toxic or lethal dosages.

175 isn't scary high

Unless it is <100 or >400 I don't get concerned in the field.

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

Off duty? Absolutely nothing.

a nasal with 6LPM would be sufficient.I drove to the hospital, and when we entered the ER, she had completely taken the O2 off. I am under the opinion we should have treated for shock, because it could have only helped, and not hurt her in any way.

Actually a nasal cannula at 2 LPM would be my only consideration, if I gave O2 at all. Not giving O2 in this situation would not have set off any alarm bells in my book and I used to do chart review for several EMS systems.

BTW, we don't do things because they "aren't going to hurt", or at least we shouldn't be. We should only do things that are going to help. It's called evidence-based practice and it is worth learning, looking into and being proactive in regards to when it comes to EMS protocol development.

Dilated pupils can also be caused by loss of blood

So far as I am aware, that only happens in massive, uncontrolled shock. Do you have a citation for it occurring otherwise?

 

[VirginiaEMT]

Recently watched a Little League baseball game when a batter was hit by a fastball on the left ear side of helmet.

Batter immediately dropped... he remained conscious.

Players coach waved off people on field as he approached the batter and attended to player.

As an EMT, what would you do?

I guess this is directed at me. First, since I saw what happened that would eliminated the need to ask what happened.

Tell the coach who I am and my qualifications. call for EMS
1.have someone maintain c-spine
2.then I would check AVPU.
3.I would check to see if his airway was compromized due to blood, teeth.If so, if so, carefully log roll(recovery position), to allow for drainage so the airway is maintained.
4.I would also apply ice to the damaged area to reduce swelling
5. maintain airway and be prepared for changes until EMS arrives, also maintain conversation with the boy
6. I would watch his pupils for changes, check any vitals I can without equipment, skin color, watch for symptoms of shock, and gather as much info as I can SAMPLE,OPQRST,ETC. for the EMS personnel.

This is assuming I am just sitting there with no ambulance or equipment. I have a small first aid bag, with general equipment. Still working on it. If you want my treatment with an ambulance handy, I do that too.

 

[JPINFV]

2. We ran an attempted suicide, female with incisions on both wrist. Very deep blood bleeding was almost clotted upon our arrival, but not completely.

The AIC started asking her questions about WHY she did it, and started telling her that suicide was no way out, and I'm thinking "who gives a crap, let's fix her" first.

While I question the ability of EMS providers to provide proper counseling, fixing the psych issues is just as much fixing the patient as wrapping the wrists.

B. The ladies color was still o.k, but her pupils were dialated and very slow(she said she had not taken any drugs). I mentioned that we should put her on 15LPM of O2 with a NRB, number one because of the loss of blood, and her pupils reaction to light as well as being dialated, and she said that the patient wasn't shocky and a nasal with 6LPM would be sufficient.I drove to the hospital, and when we entered the ER, she had completely taken the O2 off. I am under the opinion we should have treated for shock, because it could have only helped, and not hurt her in any way.

Any thoughts????

Research the oxygen content equation.

 

[JPINFV]

Here's something to chew on for the new EMTs.

Which is worse, taking a baseball to the head or taking a baseball to the chest?

 

[adamjh3]

It depends on the force behind the ball, where on the body part the victim was hit, and the protective gear the victim is wearing.

Because a fast ball thrown by Randy Johnson that pegs you in the head with no helmet on could certainly cause some sort of brain injury - if not a skull Fx. - depending upon where it hits.

And that same fast ball hits you in the thorax, it could probably break ribs, no?

 

[TransportJockey]

Here's something to chew on for the new EMTs.

Which is worse, taking a baseball to the head or taking a baseball to the chest?

Can I answer? I know this one