Partners who think they are the hospital.

[CCNRMedic1982]

Sorry meant to say example not term.

 

[Farmer2DO]

He decides, no, we are gonna stay here and let 500ccs of the bag go through to "stabilize" her. He also said he didn't want to move her just yet because with such hypotension if we move her too quickly she could get an arrhythmia. I have never heard that one before.

He's blowing smoke up your backside to try and make himself look like the smart one. Ask him for evidence for this from the literature.

I told him I felt we should go to the hospital, we can just as easily give fluid while we move and get her to a place that can correct the sepsis. He disagreed with me and I left it at that as to not start a scene in front of the family.

He wasn't doing the patient any favors. I would suggest that calling his bluff on scene, even if it is in front of family, is indicated here.

The same thing happened a couple weeks back with an obvious GI bleed. Severe hypotension, he wants to stay on scene because he thinks he can stabilize the patient with his magical bag of normal saline. I just don't get it.

By that logic, he should be doing the same things with trauma patients. Tell him then, the next gunshot to the chest or belly you get needs to wait on scene while you get a fluid bolus in. Who needs a surgeon?

The is a little validity to his arrhythmia statement

Do you have evidence to back that up? Which journal article can I go to to read that?

Acute alteration in mental status is a life threat to me.

That's going to be fixed by staying in the house and watching the fluid drip in?

but if she didn't improve her pressure with fluid resuscitation then I would've thought about giving a vasopressor.

You would have started a pressor after 500 ml? I don't even usually consider a pressor until I'm 2 L in. You need to fill the tank before you start squeezing it. And dopamine is far from my favorite pressor. I prefer levo, vaso, and neo; all 4 of which should go through a central line and should have an art line for titration.

You don't understand how movement would effect cardiac irritability? Yes the heart will always get its blood first but if the amount of oxygenated blood being delivered to the heart is decreased then having the pt. move will increase myocardial oxygen demand increasing workload on the heart to some extent. Heart becomes irritable arrhythmias are possible.

Which textbook did you get this from? This is pulled from some accepted medical source, right?

This guy is a cowboy and a danger to his patients. He thinks he can play God and that he is as good as any hospital. I can guarantee you, in regards to septic shock and surgical emergencies, he most certainly is not. You should take this up the ladder through QA before he causes harm to someone and drags you into it.

 

[the_negro_puppy]

Any chance of DKA or the like with this pt? brought on by an infection?

U have had a similar presenting pt hypotenisve tachy at 140 with ECG showing nearly global s-t depression. BSL high type one diabetic, Decreased blood ph at hospital dx metabolic acidosis.

 

[medic417]

Hard to condemn a person when all we have is the statements of a person that obviously has their panties in a wad.

 

[Farmer2DO]

Hard to condemn a person when all we have is the statements of a person that obviously has their panties in a wad.

So you're saying his statement isn't credible? I actually don't think it sounds like his "panties are all in a wad". I think he sounds pretty reasonable.

 

[medic417]

So you're saying his statement isn't credible? I actually don't think it sounds like his "panties are all in a wad". I think he sounds pretty reasonable.

When one believes one side w/o hearing the other side one shows lack of wisdom. Remember there are at least 2 sides to this event.

The OP made statements that sound like a child pouting when they got caught with their hand in the cookie jar.

 

[Farmer2DO]

When one believes one side w/o hearing the other side one shows lack of wisdom. Remember there are at least 2 sides to this event.

The OP made statements that sound like a child pouting when they got caught with their hand in the cookie jar.

I'm not really sure where your comments are coming from. Panties in a wad and child pouting? I didn't get that at all from the OP. Apparently you have something against him. Fine. Go ahead and be judgmental.

People post scenarios, situations and disagreements on here all the time, without their credibility being attacked. I'm not sure why, all of a sudden, the OP's comments aren't credible. Are you the paramedic that thinks that he can cure septic shock with 500 ml NS?

 

[medic417]

I'm not really sure where your comments are coming from. Panties in a wad and child pouting? I didn't get that at all from the OP. Apparently you have something against him. Fine. Go ahead and be judgmental.

People post scenarios, situations and disagreements on here all the time, without their credibility being attacked. I'm not sure why, all of a sudden, the OP's comments aren't credible. Are you the paramedic that thinks that he can cure septic shock with 500 ml NS?

I have nothing against the OP just stating how the post sounds.

Everyone else is judging w/o facts or the other side of the story so guess that makes me making judgments OK as well.

This was not a scenario this was an attack on a person not here to provide a defense, to provide the other side of the story.

 

[Doczilla]

Got a quick question--- what do your SOP's say about fluid challenges in general? Are they 500ml boluses repeated after serial assessments? If not, forget I asked.

Anyhoo, people in sepsis require MASSIVE amounts of fluids, as much as 8 liters in the first day alone. And that's assuming there's no DIC, ARDS, or anything else nasty that rolls downhill with sepsis. If the're creeping up on endstage, [a few days in might do it] you might actually make them WORSE with crystalloids [read: without pressors, PRBC's,FFP,cryoprecipitate, steroids, antibiotics] by causing dilutional coagulopathy.

As far as the arrythmia --- yeah it can happen, and guess what: there's bigger fish to fry. The only concept behind that [as mentioned before] is the irritable heart from global ischemia. With control measures in place, it's reasonable to say that you'll most likely see some PVC's.

Best medicine for that is diesel--- especially in an urban system where transport times are minimal. But that's the thing, you see alot of that mentaility in urban/metro systems because people KNOW that once you get enroute, there's not much time to do anything. So if you're a "stay and play" medic, the only way to feel like more than a glorified taxi is to mess around on scene.

But I see it this way: I.V fluids don't save lives--- SURGERY saves lives. Definitive care saves lives. Fluids are a stop-gap to buy more time.

 

[RocketMedic]

If you see a change in your patient's condition after 500mL of NS, that change is a sign your patient is probably a little more serious than you think...

 

[Doczilla]

Oh one more thing- I meant the arrythmias (read : PVC's that you would just look at and not treat) would happen if they were gonna happen, not be caused by getting sheeted to a scoop stretcher.

 

[NYMedic828]

Ok so here's a scenario that occurred yesterday.

Late 30s male came in as unconscious at the pharmacy.

Arrive onscene patient severely lethargic and AMS but verbally responsive.

Pharmacist said he was waiting on his insulin script, sat down in chair and went out. She said something sounded wrong when he was talkin to her.

BP 85/60 sitting in the chair
HR 130 sinus tach no ectopy
RR 20 regular
SPo2 98%
12 lead unremarkable
BGL 435 + ketone warning.

Our assumption is possibly DKA on the basis of he probably hasnt had his insulin for a few days now since he's picking up a new batch.

We call for a BLS backup my partner goes out to get the stretcher. The guy had horrible veins but I made an attempt at finding an AC while waiting on my partner. No luck.

My partner is now dead set on getting this IV, again 10 min from the hospital. He attempts twice more on the same arm I just made one attempt on. Then in the bus he fails again on the other arm. Then he fails The left EJ. We pull into the ER bay, and he starts an attempt at the right EJ. Mind you we are at the hospital... And he failed again of course.

He was frantically going about the whole time like the patient was deteriorating when in reality he was in the same condition as when we first made contact. Vitals unchanged.

The ER doc agreed probable DKA and she acquired a left EJ with ease.

Unfortunately there's nothing I can do about it. He has almost 20 years with the agency as BLS and a couple as ALS. My few years doesn't get my voice heard too well.

 

[Veneficus]

Ok so here's a scenario that occurred yesterday.

Late 30s male came in as unconscious at the pharmacy.

Arrive onscene patient severely lethargic and AMS but verbally responsive.

Pharmacist said he was waiting on his insulin script, sat down in chair and went out. She said something sounded wrong when he was talkin to her.

BP 85/60 sitting in the chair
HR 130 sinus tach no ectopy
RR 20 regular
SPo2 98%
12 lead unremarkable
BGL 435 + ketone warning.

Our assumption is possibly DKA on the basis of he probably hasnt had his insulin for a few days now since he's picking up a new batch.

We call for a BLS backup my partner goes out to get the stretcher. The guy had horrible veins but I made an attempt at finding an AC while waiting on my partner. No luck.

My partner is now dead set on getting this IV, again 10 min from the hospital. He attempts twice more on the same arm I just made one attempt on. Then in the bus he fails again on the other arm. Then he fails The left EJ. We pull into the ER bay, and he starts an attempt at the right EJ. Mind you we are at the hospital... And he failed again of course.

He was frantically going about the whole time like the patient was deteriorating when in reality he was in the same condition as when we first made contact. Vitals unchanged.

The ER doc agreed probable DKA and she acquired a left EJ with ease.

Unfortunately there's nothing I can do about it. He has almost 20 years with the agency as BLS and a couple as ALS. My few years doesn't get my voice heard too well.

That is what medical directors are for. Start there.

 

[abckidsmom]

Ok so here's a scenario that occurred yesterday.

Late 30s male came in as unconscious at the pharmacy.

Arrive onscene patient severely lethargic and AMS but verbally responsive.

Pharmacist said he was waiting on his insulin script, sat down in chair and went out. She said something sounded wrong when he was talkin to her.

BP 85/60 sitting in the chair
HR 130 sinus tach no ectopy
RR 20 regular
SPo2 98%
12 lead unremarkable
BGL 435 + ketone warning.

Our assumption is possibly DKA on the basis of he probably hasnt had his insulin for a few days now since he's picking up a new batch.

We call for a BLS backup my partner goes out to get the stretcher. The guy had horrible veins but I made an attempt at finding an AC while waiting on my partner. No luck.

My partner is now dead set on getting this IV, again 10 min from the hospital. He attempts twice more on the same arm I just made one attempt on. Then in the bus he fails again on the other arm. Then he fails The left EJ. We pull into the ER bay, and he starts an attempt at the right EJ. Mind you we are at the hospital... And he failed again of course.

He was frantically going about the whole time like the patient was deteriorating when in reality he was in the same condition as when we first made contact. Vitals unchanged.

The ER doc agreed probable DKA and she acquired a left EJ with ease.

Unfortunately there's nothing I can do about it. He has almost 20 years with the agency as BLS and a couple as ALS. My few years doesn't get my voice heard too well.

I have a form rule for myself. Two sticks and I'm out. Max of three total for the patient. No more than that, ever. If they need it that bad, they can have an IO.

Nothing good comes of multiple sticks by the same, over pressured provider.

 

[medic417]

Invite your partner to join here so we can hear both sides. Perhaps then we can help both of you improve patient care.

 

[NYMedic828]

Invite your partner to join here so we can hear both sides. Perhaps then we can help both of you improve patient care.

Yea that will go over well I'm sure. He wouldn't know a place that could possibly teach him something more even existed.

You haven't been useful for anything in this thread other than making assumptions that for whatever reason i came on this forum to lie about something to make myself feel better. with all due respect, :censored::censored::censored::censored: off.

 

[medic417]

Yea that will go over well I'm sure. He wouldn't know a place that could possibly teach him something more even existed.

You haven't been useful for anything in this thread other than making assumptions that for whatever reason i came on this forum to lie about something to make myself feel better. with all due respect, :censored::censored::censored::censored: off.

I have done nothing but help you and everyone else to remember that there is more than just your side of the story. No need for the rude response. If you are telling the truth you should have no reason not to allow us to hear the other side.

 

[NYMedic828]

I have done nothing but help you and everyone else to remember that there is more than just your side of the story. No need for the rude response. If you are telling the truth you should have no reason not to allow us to hear the other side.

Actually Your only posts in this thread have been to question the validity of my story.

Do you really think it an exceptional idea to tell the person I am forced to sit next to for 30 hours a week that I utterly dispise him and everything he does and want to take it up with him on a public forum?

Thats the last of my quarrel with you. I have no reason to fight with someone behind a keyboard.

 

[medic417]

Actually Your only posts in this thread have been to question the validity of my story.

Do you really think it an exceptional idea to tell the person I am forced to sit next to for 30 hours a week that I utterly dispise him and everything he does and want to take it up with him on a public forum?

Thats the last of my quarrel with you. I have no reason to fight with someone behind a keyboard.

Then choose not to fight as I have not fought, just pointed out we have only one side of the story. In your mind you have presented the facts. If your partner gave their side we would see they are biased towards them being right just as you are biased that you are right. Then those of us on the outside would be able to see that the truth lies somewhere in the middle. That or your partner would come on here hoping to prove to us they are the greatest of all time and we would then agree with you.

No need to get excited just understand we should never pass judgement w/o the facts. Though as those initially grabbing the pitch forks and torches on here proved many are more than willing to join a mob w/o all the evidence. Heck we see it in the media even in todays news.

 

[abckidsmom]

Then choose not to fight as I have not fought, just pointed out we have only one side of the story. In your mind you have presented the facts. If your partner gave their side we would see they are biased towards them being right just as you are biased that you are right. Then those of us on the outside would be able to see that the truth lies somewhere in the middle. That or your partner would come on here hoping to prove to us they are the greatest of all time and we would then agree with you.

No need to get excited just understand we should never pass judgement w/o the facts. Though as those initially grabbing the pitch forks and torches on here proved many are more than willing to join a mob w/o all the evidence. Heck we see it in the media even in todays news.

Or we could assume for the sake of discussion, which is all this is, that what he said was true, fully detailed, and completely accurate. Having assumed all of that, we could then discuss THAT situation, without relevance to the actual situation, I we choose to believe that there is anything wrong with discussing a one-sided scenario.

And in the future, we could choose to contribute our opinion or knowledge on the topic at hand and maybe not question the veracity of posters.