"That BP is NOT possible"

[BloodNGlory02]

Responded to a call today- 72 y/o male pt found lying in the garage by wife, unknown medical problem. It was by the rescue captains house so she was there right away. 71 y/o man found unresponsive in the garage by his wife. So Angie gets there, said the guy was prone, she rolled him over, he had vomit all over, had an insanely high blood pressure, barely breathing. So we get there, run up to the garage, Angie starts an IV, Marty tries to get an airway in, he wont open his jaw, so we load him up, get in the ambo, in the mean time the cops are trying to calm down his wife, so we try the nasal in the squad, we get it in with a little resistance. I must say thats the first time I've done a nasal. Its so much like stuffing it in the dummies nose! anyways, we get going, this guys pulse is all over the place and his heart rhythm wasnt really a rhythm. this guy was hairy so the leads were fallin off. Well the guy pretty much stops breathing so I suggest we bag him. start that, get another BP, I call the hospital to let them know we're coming in. This is where it gets frustrating.
** me
&& dumb nurse I wanna kill

**St Lukes ER From TCFD 1451
&& Go ahead TC this is St Lukes
**Enroute to your facility with a 72 y/o male patient, unresponsive, assisted ventilations. pt was found by wife in garage, unknown down time. pt has hypertension and takes medication for that, upon EMS arrival pt. prone in slight yellowish vomit. We currently have an IV established, nasal airway inserted and are assisting ventilations. Our vitals at this time are 224/126, pulse of 84 and fluctuating, 12 breaths a minute assisted and pulse ox of 98%, we'll be to you in 5 minutes.
&& TCFD that blood pressure is NOT POSSIBLE
**That is what we've gotten 2 times.
&& Please revital as that blood pressure is NOT POSSIBLE
** Um.. yea 10-4 standby.....
...........
...........
...........
**St Lukes our repeat pressure is (somewhere near what I originally gave)
&& (sigh & snotty) tennnnnnnn four TCFD see you in 3 minutes.

How the hell is a nurse going to tell me my blood pressure IS NOT POSSIBLE? Im not lying. Thats what the screen said. Sure we get some interferance using the machine, but our VERY competant paramedic/RN/loads of experience Rescue Captain took a manual beforehand and also had something in the 200's. I was so pissed off at that. We got to the ER, I continued to bag until the doc was ready to intubate. We stood around for about 10 min before I went to do paper work. Mind you I was still fuming. They hooked him up to their BP cuff and got 230 something over 120 something. So i KNOW my BP wasnt off. So i finished the report and the tech that came into the room was very nice, I asked her who the nurse was that took report. She pointed her out and I told her what happened. She said she does that to a lot of squads. Im contemplating writing a letter to their ER director. There is no reason for her to be telling me that a perfectly obtainable BP is NOT POSSIBLE. I've seen BP's of 200's before it is VERY possible.
The guy ended up having a head bleed. The doc didnt think he'd make it more than an hour. We went back in the room before leaving to hand over paperwork and the guy was bleeding out the nose and one of their IV lines came out and it was like he was on 200mg of coumadin. It was a faucet. So I guess ill find out in a few days if he made it.
So i have a question- im thinking about writting a letter to their ER director just because of the manner in which this occured. When does a nurse have the right to downright argue with an incoming squad with a critical patient? It was just 2 of us in the back so I didnt have time to talk on the radio and bag the pt. I had more things to attend to. Would it be a good idea to alert the ER to this nurses "practices"? Another emt said "you wont last long in EMS if you get all worked up over this" it is a big deal to me when im second guessed. Any thoughts??

 

[Chimpie]

I would bring it up with your liason with the ED, meaning the person on YOUR department that channels info from your department/service to that ED. You jumping over everyone, including your own, and going directly to the ER director may ruffle a few feathers.

If you feel that strongly about it I would let your liason know IN WRITING what happened. Keep a copy for yourself of course.

And yes, things like this happens in every occupation. It's the small stuff like that that sends me through the roof. I have a hard time keeping my cool sometimes and someone challenging me like that, OVER THE AIR, would have... well, it would not have been pretty.
h34r:

 

[shorthairedpunk]

Your hospital likely records the radio and EMS line, I would request a copy of the tape within one week to be presented to your liason, if that has not been made available then bypass our liason and contact the hospital directly, if that doesnt bring results, the governing agency (in Illinois its the Dept of Public Health) that oversses things will have a policy for such an issue to be addressed at a state level.

That nurse needs a good spanking if this is the first time, if it has been addressed more than once then she should be formally reprimanded by the regulating body, or terminated

 

[BloodNGlory02]

im not sure the line I called was taped. Its just the general ER line, aka- our med control line. Maybe ill check into that. The tech I was talking to said this isnt the first time she's heard of this nurse doing something like that. I think I might go to our rescue captain first, shes a paramedic instructor and does a lot of clinicals there, maybe she can get in touch with someone.

 

[rescuecpt]

Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).

 

[Jon]

Originally posted by BloodNGlory02@Mar 24 2005, 10:29 AM
im not sure the line I called was taped. Its just the general ER line, aka- our med control line. Maybe ill check into that. The tech I was talking to said this isnt the first time she's heard of this nurse doing something like that. I think I might go to our rescue captain first, shes a paramedic instructor and does a lot of clinicals there, maybe she can get in touch with someone.

Med control is ALWAYS taped. It is a CYA for the doc to avoid the he said - she said if ever something goes to court.

Sometimes command radios are taped.


Jon

 

[medic03]

Originally posted by rescuecpt@Mar 24 2005, 10:50 AM
Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).

800 is recorded...... :huh:
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all. Big brother is watching :unsure:

 

[rescuecpt]

Originally posted by medic03+Mar 25 2005, 05:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (medic03 @ Mar 25 2005, 05:42 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@Mar 24 2005, 10:50 AM
Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).

800 is recorded...... :huh:
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all. Big brother is watching :unsure: [/b][/quote]
Sorry, I didn't say it clearly - 800mhz is recorded when you call medical control, but not when you call the hospital. Heck, they don't even pick up half the time at HH... damn NSLIJ. UHSB is SO MUCH BETTER!

 

[Jon]

Originally posted by rescuecpt@Mar 25 2005, 05:55 PM
damn NSLIJ. UHSB is SO MUCH BETTER!

English, please.

Jon

 

[TTLWHKR]

We only get recorded if we use telemetry, but sometimes I'd like to let some nurses hear how *****y they sound!

 

[BloodNGlory02]

thanks for all the feed back guys. Our radios are NOT taped. But I dont think its going to matter. The tech I talked to that day knows this nurse does stuff like this frequently so if anything she will let the director know.

 

[SCEMT-B]

Don't fell bad about it, things happen, we a;; run into nurses who question what we give them. It could haev been like my situation tho. I got dispatched to a pt with a bp of over 500 :blink: course I figured the dispatcher ment BGL of over 500 :lol:

I was correct of course

 

[medic03]

Originally posted by MedicStudentJon+Mar 25 2005, 07:13 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Mar 25 2005, 07:13 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt@Mar 25 2005, 05:55 PM
damn NSLIJ. UHSB is SO MUCH BETTER!

English, please.

Jon [/b][/quote]
NSLIJ = North Shore Long Island Jewish hospital
UHSB = University Hospital @ Stony Brook

 

[Jon]

Originally posted by medic03+Mar 26 2005, 03:45 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (medic03 @ Mar 26 2005, 03:45 AM)</td></tr><tr><td id='QUOTE'>

Originally posted by MedicStudentJon@Mar 25 2005, 07:13 PM
<!--QuoteBegin-rescuecpt

@Mar 25 2005, 05:55 PM
damn NSLIJ.  UHSB is SO MUCH BETTER! 

English, please.

Jon

NSLIJ = North Shore Long Island Jewish hospital
UHSB = University Hospital @ Stony Brook [/b][/quote]
Thanks.

 

[rescuecpt]

Medic03 beat me to it. I was kissing up to him, he works at University Hospital, as opposed to the other conglomerate in the area, North Shore LIJ... there's also Catholic Health Services.

 

[emtal233]

Originally posted by rescuecpt+Mar 25 2005, 05:55 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (rescuecpt @ Mar 25 2005, 05:55 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by medic03@Mar 25 2005, 05:42 PM
<!--QuoteBegin-rescuecpt

@Mar 24 2005, 10:50 AM
Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).

800 is recorded...... :huh:
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all. Big brother is watching :unsure:

Sorry, I didn't say it clearly - 800mhz is recorded when you call medical control, but not when you call the hospital. Heck, they don't even pick up half the time at HH... damn NSLIJ. UHSB is SO MUCH BETTER! [/b][/quote]
Thanks recuecpt.....

 

[rescuecpt]

Originally posted by emtal233+Apr 15 2005, 10:08 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (emtal233 @ Apr 15 2005, 10:08 PM)</td></tr><tr><td id='QUOTE'>

Originally posted by rescuecpt@Mar 25 2005, 05:55 PM

Originally posted by medic03@Mar 25 2005, 05:42 PM
<!--QuoteBegin-rescuecpt

@Mar 24 2005, 10:50 AM
Our medical control lines are all recorded, however, our hospital transmissions are not (we call in by either low band or 800mhz to the hospital).

800 is recorded...... :huh:
When you switch to ALS1 on the 800 band, all that conversation is recorded. The county has it all. Big brother is watching :unsure:

Sorry, I didn't say it clearly - 800mhz is recorded when you call medical control, but not when you call the hospital. Heck, they don't even pick up half the time at HH... damn NSLIJ. UHSB is SO MUCH BETTER!

Thanks recuecpt..... [/b][/quote]
Except for you, Alex of course.

 

[emtal233]

It's ok, that particular hospital give me a splitting headache when I walk in to the ED or the CCU or whereever I am removing someone from......

 

[devist8me]

I've got tons of stories about run-ins with nurses like this. Luckily, only a small percentage of them exist. I never probably handle it correctly and tend to blow up without thinking it through. I like the idea of a liason...those usually have good results.

Also, she lacked professionalism plus disrespected you on the radio for all to hear who has that freq. Makes the outfit she works for look bad too.

 

[rescuecpt]

I had a pt yesterday, history of hypoglycemia, hypothyroid, endocarditis, and COPD, c/o difficulty breathing times 12 hours. Picked her up at a clinic. She stopped smoking one week ago and ever since has been week and had difficulty walking, etc. We put her on 15L NRB, per protocol, and I discuss her options for nebulizer treatment (she does not use nebulizers or O2 at home). Because she is over 70 and COPD I have to call for the treatment, we are less than 5 min from the hospital, so after talking to her a little bit she denies treatment as the O2 made her feel much better. I monitor her vitals and keep a close eye on her O2 sats and respiratory rate. Vitals all within normal limits, satting at 90% on room air, 99% on 15L NRB.

At the hospital, the PCA takes her off the O2 to get another baseline sat, and she immediately has difficulty breathing again. After a few minutes, he puts her back on and she improves. The nurse asks me about treatment, and I tell her O2 and monitoring vitals, pt denied other interventions. The nurse asks how much O2, I tell her, and she says "why would you do that?" I said, "that's my protocol." She said "you don't give that much O2 to a COPD patient", so I replied "that's my protocol, regardless of COPD - I monitored for respiratory repression, O2 sats, and pain. If something changed for the worse, I would have taken corrective measures." She again said that that wasn't right, and I was like "well that's what I have to do"... and at that moment was when the PCA took her off the O2 and my originally quiet patient started gasping and wheezing. I was pissed to be second guessed like that, I understand where she's coming from, but wasn't my explanation logical enough?