odd call...

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uhbt420

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dispatched to SNF the other day for "sick unknown". turns out to be a patient with pain and mild bleeding from the rectum. 92 yo female, hx of mild dementia, type 2 diabetes mellitus, bowel incontience.

rn says that another nurse attempted to give pt an enema because she hadn't gone in four days. enema attempt didnt turn out so well-- most of the fluid flushed back out and evidenltly there was minor damage to the rectal wall

pt was very angry and combative after the injury. rn says the pt often gets angry when things dont "go her way"

vitals: b/p 138/76, resp 24, 94 bpm, 98.8 tympanic, 97 sp02 ra

we cancelled fire als, gave pt 6 lpm via nc, and tranpsorted in position of comfort.

did we handle the situation properly? it was a bit of a weird call that didn't really fit into our protocols.
 
I think you handled it as well as you could. Not much anyone can do for the patient in the field. Just try and make them as comfortable as possible.
 
I think you handled it Fine, i wasnt there so i cant say for sure. But did you keep an eye on vitals the entire transport? We most likely would have picked up a medic. I agree with amberdt03, keep the PT comfortable.
 
Not much you can do...fluids aren't needed, drugs aren't needed. I prob would have went with 2 lpm, 6 can be pretty uncomfortable and she was at 97%. Position of comfort and diesel.
 
I would have skipped the O2, wasn't called for in this case.
 
Yeah, I would have forgone the O2 also. There really isn't anything we can do except monitor.
 
uhbt420 said:
pt was very angry and combative after the injury. rn says the pt often gets angry when things dont "go her way"

.
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Were someone to probe my anus and draw blood, I too would be combative. Just getting her out of there was appropriate intervention.
 
Minus the 02 that's probably all I would have done. Doesn't warrant IV or any invasive procedures. Just monitor vitals on the way to the ED
 
C.T.E.M.R. said:
I think you handled it Fine, i wasnt there so i cant say for sure. But did you keep an eye on vitals the entire transport? We most likely would have picked up a medic. I agree with amberdt03, keep the PT comfortable.
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my partner wanted to keep als intact and i seriously considered it, but from what i could tell the elevated b/p was more from agitation/combativeness than anything else. it dropped within normal limits shortly after loading the pt in the ambulance.

lampnyter said:
Was she bleeding the whole ride to the hospital?
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bleeding stopped prior to arrival. only concern was that a large amount of the enema's fluid (saline?) had basically washed right back out of the rectum. it was a totally botched enema for sure.

i am aware that o2 was not necessarily warranted in this case, but i sometimes use it for placebo effect. the pt did not become uncomfortable with the 6 lpm and mellowed out a bit, but whether that was due to 02 or just being treated like a human being remains to be seen

thanks for the input.
 
Pass on the o2 Y'all did fine... I can't understand why 911 was called for a "botched" enema. Unless we are talking massive amounts of blood... But you did say the bleeding had stopped.
 
He did say it was a snf call :p do they ever have a reason that makes sense for transfers the majority of the time?
8jimi8 said:
Pass on the o2 Y'all did fine... I can't understand why 911 was called for a "botched" enema. Unless we are talking massive amounts of blood... But you did say the bleeding had stopped.
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jtpaintball70 said:
He did say it was a snf call :p do they ever have a reason that makes sense for transfers the majority of the time?
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Sure they do.

They are incapable and don't want to deal with the patient so they punt to the ED.

Patient giving you a hard time? Find a reason to send them to the ED.

Patient laying quietly for hours in DKA, call ambulance sometime tomorrow.

See the pattern?
 
Veneficus said:
Sure they do.

They are incapable and don't want to deal with the patient so they punt to the ED.

Patient giving you a hard time? Find a reason to send them to the ED.

Patient laying quietly for hours in DKA, call ambulance sometime tomorrow.

See the pattern?
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Yeah this seems to happen all the time here with the SNF because they get fed up with a PT and want to get rid of them for a bit. I hate doing those transfers because it is RIGHT ACROSS the street from their facility to the ED. What a waste of time and resources.
 
Some have said pass on the o2 but I dont see the problem with it. I'm just a student though and I don't know if it causes a hassle or what but our instructor tells us trauma or no trauma you can never go wrong with o2 as long as the patient comfortably takes it.

As you said even if it is nothing more then making the patient think it is helping should be more then enough reason to give them o2 just to calm them down. Atleast thats how I look at it
 
hurt88 said:
Some have said pass on the o2 but I dont see the problem with it. I'm just a student though and I don't know if it causes a hassle or what but our instructor tells us trauma or no trauma you can never go wrong with o2 as long as the patient comfortably takes it.

As you said even if it is nothing more then making the patient think it is helping should be more then enough reason to give them o2 just to calm them down. Atleast thats how I look at it
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There is a group of patients who may be killed that way quite easly...those COPD patients adapted to hypoxia in whom the high level of CO2 is the only stimulus keeping them breathing spontaneously...
 
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RNL said:
There is a group of patients who may be killed that way quite easly...those addopted to hypoxia in whom the high level of CO2 is the only stimulus keeping them breathing spontaneously...
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and I learn a bit more...He has always just told us the exact opposite in that o2 wont kill anyone. So I've just gone off the basis of if you think o2 will help calm the paitent or if you arn't sure if they need it then give it anyways.
 
hurt88 said:
and I learn a bit more...He has always just told us the exact opposite in that o2 wont kill anyone. So I've just gone off the basis of if you think o2 will help calm the paitent or if you arn't sure if they need it then give it anyways.
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When it comes to medicine and medical care, listen to the doctor over the instructor.
 
Realistically In pre-hospital care the Pt contact is not long enough to cause harm using O2. And they would of hopefully been informed by staff at the snf if indeed the pt had copd and most people with copd are on 2lpm or 4lpm via nc anyways.
 
RNL said:
There is a group of patients who may be killed that way quite easly...those COPD patients adapted to hypoxia in whom the high level of CO2 is the only stimulus keeping them breathing spontaneously...
Click to expand...

People with copd do operate with a hypoxic drive but that is low levels of oxygen. In normal circumstances people have a hypercarbic drive, breathing that is regualted by the chemorecepters and are semsitive to high levels of CO2.
 
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