Should I have had als on this call

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chickj0434

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68 F at Dana Farber. Just finished chemo treatment. Been having a bad cough for few weeks spitting up yellow phlegm. Could definately hear it in her lungs. Bp 160/100 hr 80 sat 97 on 2 lpm. Was transporting and als was behind us so cancelled them. Hospital is less than 10 min away. Should I have had them evaluate her.
 
If ALS has to chase you to help or evaluate the patient, don't wait.
No reason from what you said in your report to even have called ALS in the 1st place. Patient is stable: her cough and phlegm is weeks old (and so is bad lung sounds). BP is high, but she isn't going to stroke out, so no big deal.
Is she normally on O2? Because she probably doesn't need it otherwise.

Without knowing what she looks like (pale, diaphoretic, cyanotic, etc) there is no reason to have ALS eval her. and Never a reason to wait for ALS to catch up to you.

With her Chemo history, (believe me very few people getting Chemo don't see a doctor every few treatments {my dad gets it 1 time a week, and sees the doctor before every treatment}), she has seen a doctor a few times in the weeks she has had the cough, he has probably heard her coughing and seen her coughing up crap; so doctor isn't concerned about it.
 
chickj0434 said:
68 F at Dana Farber. Just finished chemo treatment. Been having a bad cough for few weeks spitting up yellow phlegm. Could definately hear it in her lungs. Bp 160/100 hr 80 sat 97 on 2 lpm. Was transporting and als was behind us so cancelled them. Hospital is less than 10 min away. Should I have had them evaluate her.
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What’s your clinical concern? Sounds like a fairly stable BLS patient? Is the patient at 2lpm normally?
 
chickj0434 said:
68 F at Dana Farber. Just finished chemo treatment. Been having a bad cough for few weeks spitting up yellow phlegm. Could definately hear it in her lungs. Bp 160/100 hr 80 sat 97 on 2 lpm. Was transporting and als was behind us so cancelled them. Hospital is less than 10 min away. Should I have had them evaluate her.
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I wouldn’t have called for ALS from what you mentioned. What would be warranting for ALS ? Hypertension ? Hypertension isn’t in my protocol to request for ALS unless symptomatic, where I am only hypotension is. Also yeah 160/100 is high but not stroke level high. Is she on 2LPM baseline ? If she wasn’t what was her baseline sat ? 97% even on 2LPM is nothing concerning to me as a BLS provider. Especially if her ling sounds are weeks old. A lot of COPD (not saying she does just an example) pts will have crappy lung sounds as a baseline but that alone doesn’t warrant for ALS.

Seems like a stable pt but I’m not sure what your protocols are. I feel like for most companies/states this didn’t warrant for ALS though. You can always talk to a coworker or FTO/Supervisor with any questions you have about a call. I would never belittle somebody over a questionable call whether its you questioning it or somebody else.
 
Simple answer is no...

more complicated question: what interventions would you have wanted ALS to do?

Would that delay in getting the hospital to definitive care (which is a hospital) have been beneficial to the patient?
 
In my opinion no need for als however that being said when in doubt call them. They can always tell you it’s a Bls call if you are unsure rather be safe then sorry.
 
I have no idea what 68F is or what Dana Barber is....
 
No reason for ALS. I would have BLS it especially if already in back of your rig and hospital is that close.
 
No, sounds like a straight forward immunocomprimised PNA patient. BP is high but, not urgent unless the patient is showing signs of end organ failure along with the HTN.

What is ALS generally doing nowadays for HTN emergencies/urgent hydralazine, labetolol IVP? Cardene drip 🤔
 
Comfort Care said:
No, sounds like a straight forward immunocomprimised PNA patient. BP is high but, not urgent unless the patient is showing signs of end organ failure along with the HTN.

What is ALS generally doing nowadays for HTN emergencies/urgent hydralazine, labetolol IVP? Cardene drip 🤔
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Probably nothing.
 
ALS can always lower BP; start an IV, and don't cap it off with a lock, until you bleed them enough to drop the BP; believe me, sooner or later the BP will drop. LOL, cheaper than leeches
 
johnrsemt said:
ALS can always lower BP; start an IV, and don't cap it off with a lock, until you bleed them enough to drop the BP; believe me, sooner or later the BP will drop. LOL, cheaper than leeches
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Oh I believe you. Way cheaper than leaches, especially if you have that 14g or cordis. Always make sure you titrate to a MAP>65 or SBP >90. 😆 🤣
 
Can that paranedic cure cancer?
 
chickj0434 said:
68 F at Dana Farber. Just finished chemo treatment. Been having a bad cough for few weeks spitting up yellow phlegm. Could definately hear it in her lungs. Bp 160/100 hr 80 sat 97 on 2 lpm. Was transporting and als was behind us so cancelled them. Hospital is less than 10 min away. Should I have had them evaluate her.
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Unless I am missing something on presentation I'd tell my bed relax and lay back I got this one just continue to monitor and transport enroute try to get a good understanding of her history and medications just sounds like a pneumonia or maybe bronchitis not a concerning presentation initially
 
Considering both what I've learned from experienced medics at my full time job and also that the hospital was 10 minutes away, I personally wouldn't have requested ALS. Other than that, I probably would've done exactly the same in this situation. Bear in mind, however, that A). I wasn't on scene with you and didn't see the patient, and B). my paramedics have taught me enough that I'm not scared to exhaust the options my protocols give me before requesting ALS. I've also learned that sometimes the hospital is my closest ALS. All this said, I don't know your thought processes, protocols, available equipment, level of education, or comfort zone; therefore, I can't say if you made the right call, only what I would've done.
 
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