NRB Flow Rate

[usalsfyre]

A patient can also "pass out" from acidosis, hypoxia, hypercapnia and cardiac issues. I don't think your advice is very sound.

All of which can be somewhat reasonably removed from consideration of being the presenting emergent condition by careful and complete history and physical exam. Which from talking with Linuss himself and his educators is not an area in which he lacks knowledge or is careless.

One does not always need labs to diagnose a serious medical condition.

 

[usalsfyre]

Okay....I guess "on this forum" are the key words here.

Glad to see you think so highly of us.

There are many pyschogenic disorders that require hospitalization and medication. Too many patients do get blown off because of the "psych" stigma and sometimes even the EDs are easily influenced by something the paramedics have said. We've already seen what has happened to women, the elderly and diabetics when it comes to heart disease and what some "diagnosed" as anxiety or some pyschogenic pain if it doesn't present as the textbook states.

Absolutely, which is why a careful medical provider will assess patients completely. Laying the blame for an ED's failings on paramedics assessments (which we have established are not always reliable) is unfair. Both parties share equal responsibility.

Only the truly ignorant allow the ignorance of those before them to influence their decision making. There's a lot of idiot medics out there, but apparently a lot of idiot ED staff as well.

 

[Veneficus]

Inadequete exams are not limited to EMS.

They are not even limited to any particular field of healthcare.

Around the world I have witnessed providers, some MDs, who are lax in their exams, histories, and even diagnostics, who write off patients they feel are unworthy or uninteresting in some way.

In my experience and it seems to be shared by many of my associates at all levels, nonacademic medical centers are notorious for harboring these types of providers.

I have seen some of these facilities and by extension their providers who are so bad, they should be closed down, the building bulldozed, and the ground salted. The employees forever banished from the healthcare realm in shame.

Many of these providers see nothing at all wrong with their practices.

In some instances a paramedic like Linuss in the back of a rig will be considerably better care then a fair amount of these providers.

I think it is important to remember that not every patient is hovering on the brink of death by some obscure disease. That it is both economically and practically impossible to run every test on every patient.

There is merit in epidemiology as well as clinical usefulness in using it as part of forming a dx.

Specialized providers should not get too caught up in their ability to point out obscure pathology relating to their field as a measure of superiority. For some providers are required to be generalists and provide supportive care until specialists can be engaged.

 

[Journey]

All of which can be somewhat reasonably removed from consideration of being the presenting emergent condition by careful and complete history and physical exam. Which from talking with Linuss himself and his educators is not an area in which he lacks knowledge or is careless.

One does not always need labs to diagnose a serious medical condition.

A serious medical condition does not always have to present with a lot of blood on the ground, no breathing or tombstone T waves. There are many disease processes that can be recognized early, and yes with labs, to prevent them from cascading into a situation that is life threatening.

 

[Journey]

Inadequete exams are not limited to EMS.

They are not even limited to any particular field of healthcare.

Around the world I have witnessed providers, some MDs, who are lax in their exams, histories, and even diagnostics, who write off patients they feel are unworthy or uninteresting in some way.

In my experience and it seems to be shared by many of my associates at all levels, nonacademic medical centers are notorious for harboring these types of providers.

I have seen some of these facilities and by extension their providers who are so bad, they should be closed down, the building bulldozed, and the ground salted. The employees forever banished from the healthcare realm in shame.

Many of these providers see nothing at all wrong with their practices.

In some instances a paramedic like Linuss in the back of a rig will be considerably better care then a fair amount of these providers.

I think it is important to remember that not every patient is hovering on the brink of death by some obscure disease. That it is both economically and practically impossible to run every test on every patient.

There is merit in epidemiology as well as clinical usefulness in using it as part of forming a dx.

Specialized providers should not get too caught up in their ability to point out obscure pathology relating to their field as a measure of superiority. For some providers are required to be generalists and provide supportive care until specialists can be engaged.

You don't seem to have a good opinion of doctors, hospitals or anybody associated with them. EMS is not the end all for all medicine. Linuss who has a certificate as a Paramedic and a few months of experience on a BLS transfer truck is not the highest standard of medicine. From some of the talk on this forum you would think a few would want to get past that level.

In my remark I was referring to the hospital ED staff actually trusting what a Paramedic might have assessed and put the patient in a back hall unmonitored for awhile. True, it is the ED staff's fault by not doing an assessment themselves to make their own determination. Just taking the word of a Paramedic could get them into serious trouble. As licensed health care providers they should be aware of their responsibility and liability. Sometimes we just need reminding of that responsibility and not all who are not EMTs or Paramedics should be banished. There are many , many good doctors, nurses and hospitals that do enforce a higher standard of care. Again, medicine doesn't just stop with EMS.

 

[usalsfyre]

A serious medical condition does not always have to present with a lot of blood on the ground, no breathing or tombstone T waves. There are many disease processes that can be recognized early, and yes with labs, to prevent them from cascading into a situation that is life threatening.

If you'd payed attention to my post on this and many other subjects you'd realize I'm very aware of this. However, MOST of these conditions also have accompanying signs and symptoms, however stubtle they may be. How do you think medicine is practiced in underdeveloped areas or was practiced prior to diagnostic testing?

Overreliance on technology is poor form.

 

[Journey]

Absolutely, which is why a careful medical provider will assess patients completely. Laying the blame for an ED's failings on paramedics assessments (which we have established are not always reliable) is unfair. Both parties share equal responsibility.

Only the truly ignorant allow the ignorance of those before them to influence their decision making. There's a lot of idiot medics out there, but apparently a lot of idiot ED staff as well.

See my above post and my previous posts. I actually gave Paramedics credit that the ED staff did trust them. You have obviously proved me wrong for that trust by acknowledging we are idiots if we do trust the Paramedics' assessments.

 

[usalsfyre]

You don't seem to have a good opinion of doctors, hospitals or anybody associated with them. EMS is not the end all for all medicine. Linuss who has a certificate as a Paramedic and a few months of experience on a BLS transfer truck is not the highest standard of medicine. From some of the talk on this forum you would think a few would want to get past that level.

In my remark I was referring to the hospital ED staff actually trusting what a Paramedic might have assessed and put the patient in a back hall unmonitored for awhile. True, it is the ED staff's fault by not doing an assessment themselves to make their own determination. Just taking the word of a Paramedic could get them into serious trouble. As licensed health care providers they should be aware of their responsibility and liability. Sometimes we just need reminding of that responsibility and not all who are not EMTs or Paramedics should be banished. There are many , many good doctors, nurses and hospitals that do enforce a higher standard of care. Again, medicine doesn't just stop with EMS.

This is just funny.

 

[JPINFV]

This is just funny.

I was thinking the same thing.

 

[usalsfyre]

See my above post and my previous posts. I actually gave Paramedics credit that the ED staff did trust them. You have obviously proved me wrong for that trust by acknowledging we are idiots if we do trust the Paramedics' assessments.

Don't put words in my mouth.

I trust many of my first responders implicitly, doesn't mean a patient doesn't get a full assesment upon my arrival. Doubly so if I'm not familiar with the medical provider in question, including IFTs from the floor in which approprite care hasn't been started/care can be improved. If EDs are not willing to reassess a patient appropritely, especially if the paramedic in question doesn't have a proven track record, then they share as much blame as the EMS unit.

 

[Journey]

If you'd payed attention to my post on this and many other subjects you'd realize I'm very aware of this. However, MOST of these conditions also have accompanying signs and symptoms, however stubtle they may be. How do you think medicine is practiced in underdeveloped areas or was practiced prior to diagnostic testing?

Overreliance on technology is poor form.

Mortality rate in an underdeveloped country or even in parts of the U.S.?

I would say there are some but I would not say most diseases. I would say you might have been lucky enough to catch something before it developed into something serious.

What would you say is overreliance on technology? Labs should confirm what you suspect.

Your arm might appear to be broken and it might be quite obvious. Would you profer no X-Ray be done and just take your chances on setting the bone to see if it grows back together okay.

I guess if your wife finds a lump in a breast exam you would advise her to wait and see what happens next instead of getting it check out. Would you tell your wife a mammogram is a waste of time since you could diagnose what is wrong without relying on diagnostic tests? Would you be willing to gamble with her life just to prove your point?

If you child appears with seizure like activity but stops after a few minutes, you probably would not want to take the child to a doctor and a CT Scan or MRI would not be something you would ever want since that would be relying on technology. You already diagnosed "a seizure" and that is all you need to know just as you would in the field as a Paramedic. I could rattle off a long list of things that could cause a seizure but to confirm them, some diagnostic tests would have to be done and you wouldn't want to be thought of as relying on technology. It's only a seizure.

I guess if you tore up your back lifting a patient you would just want the surgeon to cut into it without any idea of what the problem might be from a preliminary work up. Definitely wouldn't want any lab work.

Again, some of the most common life threatening injuries or diseases are not always the most obvious.

 

[Journey]

If EDs are not willing to reassess a patient appropritely, especially if the paramedic in question doesn't have a proven track record, then they share as much blame as the EMS unit.

I definitely agree. But then you'll get post after post on this forum that the ED staff "assessed" the patient again after they were just told something and didn't seem to trust what was given in report. However, it shouldn't matter to the ED staff if they hurt your feelings by doing their own assessment.

 

[usalsfyre]

Mortality rate in an underdeveloped country or even in parts of the U.S.?

I would say there are some but I would not say most diseases. I would say you might have been lucky enough to catch something before it developed into something serious.

What would you say is overreliance on technology? Labs should confirm what you suspect.

Your arm might appear to be broken and it might be quite obvious. Would you profer no X-Ray be done and just take your chances on setting the bone to see if it grows back together okay.

I guess if your wife finds a lump in a breast exam you would advise her to wait and see what happens next instead of getting it check out. Would you tell your wife a mammogram is a waste of time since you could diagnose what is wrong without relying on diagnostic tests? Would you be willing to gamble with her life just to prove your point?

If you child appears with seizure like activity but stops after a few minutes, you probably would not want to take the child to a doctor and a CT Scan or MRI would not be something you would ever want since that would be relying on technology. You already diagnosed "a seizure" and that is all you need to know just as you would in the field as a Paramedic. I could rattle off a long list of things that could cause a seizure but to confirm them, some diagnostic tests would have to be done and you wouldn't want to be thought of as relying on technology. It's only a seizure.

I guess if you tore up your back lifting a patient you would just want the surgeon to cut into it without any idea of what the problem might be from a preliminary work up. Definitely wouldn't want any lab work.

Again, some of the most common life threatening injuries or diseases are not always the most obvious.

All of the examples you gave were initally found by physical exam. So you defeated your entire argument about occult disease being found by lab test.

Do you really believe this stuff? Your advising a full ED workup for EVERY, FREAKIN PATIENT. If you hear hoofbeats, think horses...

 

[usalsfyre]

I definitely agree. But then you'll get post after post on this forum that the ED staff "assessed" the patient again after they were just told something and didn't seem to trust what was given in report. However, it shouldn't matter to the ED staff if they hurt your feelings by doing their own assessment.

My feelings are not hurt by this, it's their job.

 

[usafmedic45]

Okay....I guess "on this forum" are the key words here.

Actually he's one of the sharper medics that I've talked to regardless of setting. Maybe not the best, but he certainly is on the upper side of the curve.

There are many pyschogenic disorders that require hospitalization and medication.

Right. Never said that was not the case.

Too many patients do get blown off because of the "psych" stigma and sometimes even the EDs are easily influenced by something the paramedics have said.

Too many people simply continue to beat dead horses when shown that the defense they put up was not necessarily incorrect, but at least incorrectly applied.

some pyschogenic pain if it doesn't present as the textbook states.

Let's not turn this into a discussion about "fibromyalgia". LOL Besides, we are talking about something presenting exactly as the textbook states in this particular case. The only issue was the improper dosing of a drug until it was turned into a debate about differential diagnosis.

 

[Melclin]

I think it is important to remember that not every patient is hovering on the brink of death by some obscure disease. That it is both economically and practically impossible to run every test on every patient.

Beat me to the obvious point.

Journey, mate, are you really suggesting that every person who bumps their head needs to go to CT, every person whose resp rate rise above 20 when they're upset needs to be worked up for a million metabolic disorder etc?

At some stage you've gotta start saying well there is a decent enough probability that ______ has happened to this person and it would be unreasonable to spend ten thousand dollars on testing it.

 

[DesertMedic66]

thats weird. trouble breathing but resp at 12 per min and spo2 at 99% with vomiting. seems weird they would use a nrb. i think the better choice would have been a nc at 4lpm if not lower. just my opinion.

 

[jjesusfreak01]

thats weird. trouble breathing but resp at 12 per min and spo2 at 99% with vomiting. seems weird they would use a nrb. i think the better choice would have been a nc at 4lpm if not lower. just my opinion.

Emergencies are often only what the patients make them. I'll grant that if the pt is happy with a NC that (and an emesis basin) wouldn't be a bad idea.

 

[cmetalbend]

Don't put words in my mouth.

I trust many of my first responders implicitly, doesn't mean a patient doesn't get a full assesment upon my arrival. Doubly so if I'm not familiar with the medical provider in question, including IFTs from the floor in which approprite care hasn't been started/care can be improved. If EDs are not willing to reassess a patient appropritely, especially if the paramedic in question doesn't have a proven track record, then they share as much blame as the EMS unit.

In my opnion they should assume more of it actualy. (the ED) due to the fact patient vitals will and can change in a Heart beat, so to speak. Once I transfer care to the ed, it's now their' patient and my oral report is a STARTING point not the diagnosis and treatment. I get them there ALIVE and thats My job. If an ED doesn't do another assesment then thats on them not me. Now if it is discovered I missed a life threat that could have saved a patient, well thats somthing I have to live with. Sorry if any of this sounds rude, but passing the Buck, or trying to distribute it is not a good practice.

 

[usafmedic45]

thats weird. trouble breathing but resp at 12 per min and spo2 at 99% with vomiting. seems weird they would use a nrb. i think the better choice would have been a nc at 4lpm if not lower. just my opinion.

Yeah, the choice of device and flow rate were the major problems here.