Tell us the Times you've "F***** up" on a call

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mrhunt

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i dunno why this thought popped into my head. Thought it would be interesting. Tell a brief one sentence summary of "**** ups" on calls.
I'll go first.


Applied a Traction splint to a femur fracture with No distal pulse. Cap Refill was restored but afterwards saw a semi-small lac to Thigh and it was most likely an open femur fracture that i applied a traction splint to. At least circulation was restored...

Forgot to check a blood sugar on a traumatic head injury who was altered. He had a VERY obvious brain bleed, but its still a standard of care i missed.

Worst in my department (i didnt do it):
Gave Versed to a Pt with sciatia (meant to give fentanyl) and THEN still gave fentanyl afterwards.


What are yours!
And everyone be nice, And somewhat supportive. Nobody here is perfect. We all **** up.
 
I accidentally gave Midazolam instead of Morphine once. I didn't read the name carefully, I didn't take into consideration the way the vials look (completely different), and I didn't listen to my gut when I thought something was strange about the concentration (5 mg/ml instead of 10 mg/ml). To make things worse, the patient became unresponsive after I gave it, I couldn't tell if they were breathing so I gave Narcan. It obviously didn't do anything, but the patient was slightly arousable afterwards. I didn't realize the mistake until I was doing paperwork after the call.

I think contributing factors was I came into work with the flu, I was working my first night shift in a year, I felt pressured to give the pain med quickly because we were close to the hospital. I didn't want to be one of those medics. In my area, we always said Versed. Nobody called it Midazolam. So I think when I grabbed it, I saw M, and I instantly thought it was Morphine instead of Versed. It was Midazolam.

I am happy I kept my job, but it was humiliating. In the system I was working in, we rarely did dual medic. Like you'd work dual medic if you picked up OT and it was approved by management. Very rare. I had to work dual medic for half a year because of this. I didn't work with FTOs, but regular medics. They were briefed by management why I was working with them. They would treat me like an idiot and bring it up/use it against me during any disageement or problem. Everyone not briefed that saw us posting or at hospital would be like "How did you get so lucky to work dual medic?" I hated it.

So when I do my med rights, I make sure to carefully read the name. On top of that, I take into consideration what the vial looks like, the size of the vial, the color of the cap. I consider the concentration because that could've saved me when I noticed something was wrong with the concentration. Listen to your gut. I check multiple times eg before I draw it up and just before I push it. If someone else is available, I have them confirm. Don't think a mistake like that can't happen to you. I never in a million years thought it would happen to me.
 
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mrhunt said:
i dunno why this thought popped into my head. Thought it would be interesting. Tell a brief one sentence summary of "**** ups" on calls.
I'll go first.


Applied a Traction splint to a femur fracture with No distal pulse. Cap Refill was restored but afterwards saw a semi-small lac to Thigh and it was most likely an open femur fracture that i applied a traction splint to. At least circulation was restored...

Forgot to check a blood sugar on a traumatic head injury who was altered. He had a VERY obvious brain bleed, but its still a standard of care i missed.

Worst in my department (i didnt do it):
Gave Versed to a Pt with sciatia (meant to give fentanyl) and THEN still gave fentanyl afterwards.


What are yours!
And everyone be nice, And somewhat supportive. Nobody here is perfect. We all **** up.
Click to expand...

First of all, I think most of the world has come around to the idea that traction on an open femur fracture is perfectly fine ESPECIALLY when distals pulses are gone.

Not a big one, but I did pound 150mcg of fentanyl in a fellow for procedural sedation prior to small procedure. The order was for 50mcg, and I think I had my thumb on the 1 on the label affixed syringe. The nurse I was working with drew it up and handed it over to me (I was on the IV side of pt).

We might have had to bag him for a little bit. No harm, thank goodness.
 
Aprz...and anyone else. A very helpful tip for ANY medication administration to possibly incorporate into your practice is:

1. Read it OUT LOUD. Not in your head, read it out loud...I am going to give 5mg of versed, this is a 10mg in 2 ml vial, so I will push 1 mL of versed. When you say it out loud, either your partner hears it and corrects if needed OR you hear it, and it just sounds wrong.

2. If my partner is readily available on scene or in back of the truck, do Step 1 above, then hand them the syringe for verification of the amount in it, show them the vial. Any level person, even a 1st Responder can read a name and see an amount in syringe. Sure, they may not know what it is or if it is even appropriate, however you have taken an extra step to possibly identify any concerns.

If my partner is driving, do Step 1 so they can hear you.
 
great idea Akflightmedic on reading it out loud.

And when the person in my company did the med error, We all gave a ton of ****. I went up and was like "hey! What color is that bag your holding? RED?!? Like FENtANYL VIALS?!" Alot of color blind jokes and You cant read jokes. Good times. All in good fun. And that person only had to do retraining with an FTO for 2 weeks and that was it, so pretty minor.
 
mrhunt said:
great idea Akflightmedic on reading it out loud.

And when the person in my company did the med error, We all gave a ton of ****. I went up and was like "hey! What color is that bag your holding? RED?!? Like FENtANYL VIALS?!" Alot of color blind jokes and You cant read jokes. Good times. All in good fun. And that person only had to do retraining with an FTO for 2 weeks and that was it, so pretty minor.
Click to expand...
I was so embarrassed by my mistake, I was not having a good time, and I almost quit over it. I remember being stressed out thinking about quiting, wondering if I am gonna get fired, will I be able to get a medic or even an EMT job? I felt very screwed. Anybody making fun of me, gave me a hard time.... it was not good fun. They may have thought it was funny, but I was not doing good.
 
mrhunt said:
great idea Akflightmedic on reading it out loud.

And when the person in my company did the med error, We all gave a ton of ****. I went up and was like "hey! What color is that bag your holding? RED?!? Like FENtANYL VIALS?!" Alot of color blind jokes and You cant read jokes. Good times. All in good fun. And that person only had to do retraining with an FTO for 2 weeks and that was it, so pretty minor.
Click to expand...
What goes around comes around, bro...all in good fun...
 
Oh trust me. ive gotten plenty of **** too.

Heres another i forgot about!
Gave Versed & went code for a lady having an APPARENT psudo seizure.
She was DAMN good at it, extremely convincing, took sternal rubs like a champ. History of brain tumor's, it all added up. Seemed very straight forward.

Enroute it tipped me off a bit that Her SP02 was high 90's and she seemed to be maintaining her own airway but didnt really think much of it.
Get to the ER and shes still seizing. Im thinking full status obviously at this point. Nurse asks me her weight and estimates....too high of weight apparently.

the Pt WHILE FULL TONIC ACTIVITY Raises her goddamn hand, And does a thumbs down sign to indicate a lower weight than the one the nurse estimated. Wow. Fully unresponsive for me enroute! this lady was a CHAMP.

Apparently she pulled this successfully with 3 other medics, Every one of them treated her the exact same way and gave versed.
 
Aprz said:
I accidentally gave Midazolam instead of Morphine once. I didn't read the name carefully, I didn't take into consideration the way the vials look (completely different), and I didn't listen to my gut when I thought something was strange about the concentration (5 mg/ml instead of 10 mg/ml). To make things worse, the patient became unresponsive after I gave it, I couldn't tell if they were breathing so I gave Narcan. It obviously didn't do anything, but the patient was slightly arousable afterwards. I didn't realize the mistake until I was doing paperwork after the call.

I think contributing factors was I came into work with the flu, I was working my first night shift in a year, I felt pressured to give the pain med quickly because we were close to the hospital. I didn't want to be one of those medics. In my area, we always said Versed. Nobody called it Midazolam. So I think when I grabbed it, I saw M, and I instantly thought it was Morphine instead of Versed. It was Midazolam.

I am happy I kept my job, but it was humiliating. In the system I was working in, we rarely did dual medic. Like you'd work dual medic if you picked up OT and it was approved by management. Very rare. I had to work dual medic for half a year because of this. I didn't work with FTOs, but regular medics. They were briefed by management why I was working with them. They would treat me like an idiot and bring it up/use it against me during any disageement or problem. Everyone not briefed that saw us posting or at hospital would be like "How did you get so lucky to work dual medic?" I hated it.

So when I do my med rights, I make sure to carefully read the name. On top of that, I take into consideration what the vial looks like, the size of the vial, the color of the cap. I consider the concentration because that could've saved me when I noticed something was wrong with the concentration. Listen to your gut. I check multiple times eg before I draw it up and just before I push it. If someone else is available, I have them confirm. Don't think a mistake like that can't happen to you. I never in a million years thought it would happen to me.
Click to expand...
Syringe/vial swaps are epidemic. No way they're not going to happen. Sedation for sedation? Not elegant at all but, in the end, really no big deal. Epinephrine for paralytic? Problem. If you work with more than 5 IV drugs...just get ready for the mistake... because it's coming.... and you're in very good company....
 
MR Hunt, I have never thought of insulting a seizure patient or unconscious patient to see if they are faking. I will have to remember that one.

That isn't a mistake though. LOL

I pulled and spiked a 500mL IV bag for my medic, on a little old lady who was sick, Major Septic shock. Got about 50mL into her, as we were loading cot into the truck and the medic climbed in I pulled the bag off the IV pole on the cot, and was hanging it on the ceiling and screamed "OH ****". The medic thought she died.
I had spiked 500mL of 2grams of Lidocaine. not NS
 
I was doing my FTO time for the 911 side of where I work. First cardiac arrest, I go in holding the AED and asked “ok what do you want me to do?” No idea why I asked that. After that they took me off of the schedule for my next two FTO days.
 
Fezman92 said:
I was doing my FTO time for the 911 side of where I work. First cardiac arrest, I go in holding the AED and asked “ok what do you want me to do?” No idea why I asked that. After that they took me off of the schedule for my next two FTO days.
Click to expand...
Wow, that's ultra lame of them. There really isn't anything wrong with what you did. I imagine that everyone (with or without experience) does the same thing, if they are second in. I usually ask what you asked, but follow up with what looks like needs to be done or what I want to do "Hey guys, what do you need me to do? Want me to handle the airway?" (usually the firefighters would get on IO right away, have already done it or are working on it by the time I showed up). At the same, if you're new, less exposure isn't going to make you better. That's really dumb. You didn't do anything wrong, especially for a new person.
 
Yeah it really sucked because they pulled me from the schedule and didn’t tell me. I found out by double checking the schedule. They called me into the bosses office a few days after the 911 call and talked to me about it but they never mentioned ending my 911 FTO stuff. It really hurt. They’re really hurting for EMTs over there and I was originally hired for the 911 branch. I was told when I asked why I was pulled that they want me doing some ALS transport shifts to get better with pt assessment.
 
Oh yeah, I was always second-guessing myself, often to the point of worrying over my 4 days off (FD 24hr schedule) whether or not I'd have a job to come back to. Just little stuff like, "did I do the right thing?" "maybe I should have done...instead..." It's easy to fall into that trap. We all screw up from time to time. As a matter of fact, one of the last in-service training sessions I attended after returning to ambulance work after serving in dispatch, was a class given by our medical director (a very fine ER doc) about the mistakes he made during his career that negatively affected the patient's outcome or contributed to death. A very brave thing to do, but his point was that it happens and you learn. And if he confessed his mistakes, maybe we might forgive our own errors and learn from the experience. When it came time to lie on his ER gurney (chest pain), I was glad to see that he was the attending physician in the ER.

When I became a fire dispatcher for an urban FD, I did some monumental screw-ups (Dispatching a medical-aid [paramedic engine and ambulance] run to a burn victim whose clothing was aflame after contact with the gas stove. The fire eventually spread to the kitchen cabinets, making it actually a full structural response. We had a "self-dispatch" system where all six stations heard the initial phone call over the station speakers and could respond on their own initiative. Imagine sending a routine medical call out over the air and suddenly have ladder trucks, additional engines, the B.C., as well as the initially dispatched units going "en route." I had my tail between my legs for weeks after that one! The newspaper had a front-page photo of one of the medics carrying out a baby suffering from smoke inhalation with heavy smoke coming out the front door as he was exiting. My shame ran deep.

One thing I will say is that no matter what your particular screw-up might be, it's all in how you recognize and fix the error. There were a lot of my screw-ups that never made the light of day, especially in fire dispatch where I fixed the problem for a good outcome, and no one was even aware of my error. It happens when you're inundated with calls, no units available and the phones are ringing like crazy, the radio's alive and each one is for a different emergency while you're fighting off tunnel vision from information overload because you're the sole dispatcher on duty for that 24-hour shift. But we watched out for each other, (the other city fire dispatchers on our radio net), and if we heard another dispatcher getting himself/herself in deep, we'd pick up the direct line and advise them that we had units available for mutual aid if needed or maybe a simple thing like, "Hey, I just heard your Engine-3 go available on-scene, you could use him..." It helps to know someone has your back.

That said, the most difficult act of forgiveness is to forgive yourself.
 
Recently was on my first pediatric arrest as a paramedic. Wasn’t really a big **** up but forgot how to places straps on backboard so made me look dumb for a minute while I figured it out. After call went back over that skill ( are backboards do not come with straps so have to place them when needed)
 
Jn1232th said:
Recently was on my first pediatric arrest as a paramedic. Wasn’t really a big **** up but forgot how to places straps on backboard so made me look dumb for a minute while I figured it out. After call went back over that skill ( are backboards do not come with straps so have to place them when needed)
Click to expand...
God, I don’t remember the last time I have ever actually put straps on a backboard
 
I failed to put a 5150 in four point restraints. They seemed nice so I just put them in the wrist restraints. About 5 minutes into the ride to the psychiatric facility, all hell broke loose. My partner and I wound up having to both restrain the person's feet in the back of the rig. Fortunately they weren't that strong and we were able to do it.
 
PT job, 1st shift working with an advanced EMT she handed me a drawn up syringe of Versed, said 2.5mg Versed, I repeated yes, 2.5mg Versed, IM. Gave it all. She about had a cow. Turns out she draws up the entire amount and then only pushes what is needed.
I told her that I am used to drawing up what is needed for that dose or push and when she said 2.5 and I repeated 2.5 I thought that is what was in the syringe.
She thought the patient was going to die. Patient was nice and calm for the next hour. He was much easier to get an IV in (he kept jerking before).
She told the ED doctor what happened, he laughed about it.
 
mrhunt said:
Oh trust me. ive gotten plenty of **** too.

Heres another i forgot about!
Gave Versed & went code for a lady having an APPARENT psudo seizure.
She was DAMN good at it, extremely convincing, took sternal rubs like a champ. History of brain tumor's, it all added up. Seemed very straight forward.

Enroute it tipped me off a bit that Her SP02 was high 90's and she seemed to be maintaining her own airway but didnt really think much of it.
Get to the ER and shes still seizing. Im thinking full status obviously at this point. Nurse asks me her weight and estimates....too high of weight apparently.

the Pt WHILE FULL TONIC ACTIVITY Raises her goddamn hand, And does a thumbs down sign to indicate a lower weight than the one the nurse estimated. Wow. Fully unresponsive for me enroute! this lady was a CHAMP.

Apparently she pulled this successfully with 3 other medics, Every one of them treated her the exact same way and gave versed.
Click to expand...
Hahahahahaha.
A laldy once faked a stroke and I called a stroke alert. Seizures yes I expect that but the stroke got me messed up until the ER doctor recognized her, she got 2 IVs and rapid transport well then I felt dumb.
 
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