Relatively new EMT basic on a 911 truck under 1 year road experience so still learning a lot.... Dispatched out to ECF facility non emergent for ABD pain.
Arrive on scene find PT In ECF bed, presenting as lethargic. Alert to person and events. Normal baseline is AOX2 per staff - CVA and dementia hx.
Chief complaint per PT is ABD pain X 4 quadrants. Tender to palp, soft, no masses, non rigid.
No apparent onset of new cva per staff there's a deficit, unsure which side.
ABD pain X 4 hours - HX of constipation W/ no recent constipation, bowel movement prior to ems arrival... No blood noted, no emisis.
Per friend who lives in the ECF + nausea. Unsure on accuracy of ECF resident HX on PT due to resident possibly dementia etc.
PT noted to be on vicodin X 4 doses per day, and fentanal.
Noted to have RX of immodium as well.
Presenting W/ possible constipation.
Per physician report paperwork PT presents W/ hypotension.
Vitals obtained on scene W/ ECF BP cuff. BP found normotensive at 128/72.
SPO2 found low on room air at 89%
Pt placed on O2 - 4lpm NC. Corresponding O2 increase noted.
PT presents with secretions, but a patent unobstructed airway.
Lungs clear W/ no adventitous sounds noted for an 80 YO person.
Hr is wnl 86. Bgl slightly hyperglycemic near 300
Temp unable to be assessed. PT skin Presents as pink warm to touch and dry. Not hot cool or clammy. Skin intact no obvious abnormalities. No recent HX of trauma.
PT transferred to stretcher. Loaded to ambulance maintained on ems O2 monitored with no exacerbations or condition changes. Mentation maintained AOX2 lethargic, answering questions on prompting then returning to sleep.
PT presents as at normal baseline but lethargic due to generalized malaise/ABD pain.
No acute distress present.
PT transported to nearest Emergency facility without lights or sirens. Classified as a priority 3 non emergent transfer.
Give hand off to nurse n clear.
Show back up later n get basically called out by the nurse. Nurse Comes up n says you need to check your vitals machine or something. I'm like what?
Nurse says that the PT was a GI bleed, and went to resus because they got a BP in the 60s systolic.
Nurse then goes on to say ya the doc had me print out your run report and highlight some stuff. Nurse says it looks pretty weird when you pick someone up and the paperwork has hypotension right on it but you still get a good BP then get here and we get a low BP.
Basically the nurse insinuated that I made up the vital signs.
Now, in retrospect I should have reassessed vitals with a manual cuff on my own.
The other thing I kinda feel was I maybe should have treated the oxygenation issue more aggressively, possibly with a NRB but the NC at 4 lpm was appearing to raise O2 sats to an acceptable level at or above 90%.
So idk. At the end of it all transportation wasn't delayed. I guess technically definitive treatment was maybe delayed since the PT was initially brought into a regular er room and care handed to a er nurse not a resus staff?
I also kind of wonder if they thought my airway assessment was bs too since I wrote in my report that it presented W/ no abnormalities or adventitous sounds heard - they presented as normal 80 year old lungs in my opinion. I'd have considered the lung assessment a pretty severe alteration if this was a 20 year old patient, but sounded pretty unremarkable for 80.
There was no obvious signs of GI bleed. No Melina or hematamesis per staff, no hx of gi issues...
What do you think? If the doc was asking to have things highlighted on my run etc am I going to be facing some repercussions? Suggestions n comments appreciated.
Arrive on scene find PT In ECF bed, presenting as lethargic. Alert to person and events. Normal baseline is AOX2 per staff - CVA and dementia hx.
Chief complaint per PT is ABD pain X 4 quadrants. Tender to palp, soft, no masses, non rigid.
No apparent onset of new cva per staff there's a deficit, unsure which side.
ABD pain X 4 hours - HX of constipation W/ no recent constipation, bowel movement prior to ems arrival... No blood noted, no emisis.
Per friend who lives in the ECF + nausea. Unsure on accuracy of ECF resident HX on PT due to resident possibly dementia etc.
PT noted to be on vicodin X 4 doses per day, and fentanal.
Noted to have RX of immodium as well.
Presenting W/ possible constipation.
Per physician report paperwork PT presents W/ hypotension.
Vitals obtained on scene W/ ECF BP cuff. BP found normotensive at 128/72.
SPO2 found low on room air at 89%
Pt placed on O2 - 4lpm NC. Corresponding O2 increase noted.
PT presents with secretions, but a patent unobstructed airway.
Lungs clear W/ no adventitous sounds noted for an 80 YO person.
Hr is wnl 86. Bgl slightly hyperglycemic near 300
Temp unable to be assessed. PT skin Presents as pink warm to touch and dry. Not hot cool or clammy. Skin intact no obvious abnormalities. No recent HX of trauma.
PT transferred to stretcher. Loaded to ambulance maintained on ems O2 monitored with no exacerbations or condition changes. Mentation maintained AOX2 lethargic, answering questions on prompting then returning to sleep.
PT presents as at normal baseline but lethargic due to generalized malaise/ABD pain.
No acute distress present.
PT transported to nearest Emergency facility without lights or sirens. Classified as a priority 3 non emergent transfer.
Give hand off to nurse n clear.
Show back up later n get basically called out by the nurse. Nurse Comes up n says you need to check your vitals machine or something. I'm like what?
Nurse says that the PT was a GI bleed, and went to resus because they got a BP in the 60s systolic.
Nurse then goes on to say ya the doc had me print out your run report and highlight some stuff. Nurse says it looks pretty weird when you pick someone up and the paperwork has hypotension right on it but you still get a good BP then get here and we get a low BP.
Basically the nurse insinuated that I made up the vital signs.
Now, in retrospect I should have reassessed vitals with a manual cuff on my own.
The other thing I kinda feel was I maybe should have treated the oxygenation issue more aggressively, possibly with a NRB but the NC at 4 lpm was appearing to raise O2 sats to an acceptable level at or above 90%.
So idk. At the end of it all transportation wasn't delayed. I guess technically definitive treatment was maybe delayed since the PT was initially brought into a regular er room and care handed to a er nurse not a resus staff?
I also kind of wonder if they thought my airway assessment was bs too since I wrote in my report that it presented W/ no abnormalities or adventitous sounds heard - they presented as normal 80 year old lungs in my opinion. I'd have considered the lung assessment a pretty severe alteration if this was a 20 year old patient, but sounded pretty unremarkable for 80.
There was no obvious signs of GI bleed. No Melina or hematamesis per staff, no hx of gi issues...
What do you think? If the doc was asking to have things highlighted on my run etc am I going to be facing some repercussions? Suggestions n comments appreciated.
