the 100% directionless thread

[TransportJockey]

I think we are all going to float away. It's pouring.

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[NomadicMedic]

I've had two of those this year so far... Luckily the neb epi helped, but it was still dicey

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Nebulized epi for epiglottitis? Or were these kids with croup?

The thing I learned was leave epiglottitis kids alone. Offer some humidified o2, but otherwise just beat feet to the ED and get ready for a surgical airway.

 

[TransportJockey]

Nebulized epi for epiglottitis? Or were these kids with croup?

The thing I learned was leave epiglottitis kids alone. Offer some humidified o2, but otherwise just beat feet to the ED and get ready for a surgical airway.

**** my bad. I did mean Croup. I can't think today apparently.

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[VentMonkey]

That's everyday 'round my station.

Lo and behold soon as I open my big fat yap...

 

[NysEms2117]

i was thinking the same thing DE, but i wasn't a medic and didn't feel like getting roasted lol.

 

[NomadicMedic]

i was thinking the same thing DE, but i wasn't a medic and didn't feel like getting roasted lol.

It's okay. You can jump in. We don't verify education here.

Bawhahahah. Sorry. I had to.

 

[NysEms2117]

It's okay. You can jump in. We don't verify education here.

Bawhahahah. Sorry. I had to.

glad you did, I now promote myself to Surgeon General.

 

[VentMonkey]

Nebulized epi for epiglottitis? Or were these kids with croup?

The thing I learned was leave epiglottitis kids alone. Offer some humidified o2, but otherwise just beat feet to the ED and get ready for a surgical airway.

That's our treatment tree here as well, neb ep for croupy kiddos, and leave the (suspected) epiglottis be and monitor for transport.

A sudden spike in temp is supposed to be a "classic" giveaway as oftentimes their symptoms may mimic one another, but I am no surgeon general, sooo...

glad you did, I now promote myself to Surgeon General.

i was thinking the same thing DE, but i wasn't a medic and didn't feel like getting roasted lol.

...that's part of the fun.

 

[NomadicMedic]

glad you did, I now promote myself to Surgeon General.

 

[NomadicMedic]

That's our treatment tree here as well, neb ep for croupy kiddos, and leave the (suspected) epiglottis be and monitor for transport.

A sudden spike in temp is supposed to be a "classic" giveaway as oftentimes their symptoms may mimic one another, but I am no surgeon general, sooo...


...that's part of the fun.

The drooling and inability to eat or drink is a big tell. Croup is subglottic inflammation, so they can eat or drink without difficulty. But, if the mom says the kiddo can't drink or control their own secretions, I always err on the side of epiglottitis.

 

[NysEms2117]

The drooling and inability to eat or drink is a big tell. Croup is subglottic inflammation, so they can eat or drink without difficulty. But, if the mom says the kiddo can't drink or control their own secretions, I always err on the side of epiglottitis.

That's ya know what I was going to say


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[Akulahawk]

Looks like it's going to be one of those "hurry up and wait" kind of days.

That was clearly NOT how things went for me the last couple days... Slammed with some generally sick patients. Had a couple of hypoglycemic ALOC patients, both brought in by ambulance. Glucagon worked well for the first one (no IV access, no need for an IO, can't say due to HIPAA details) and the other was definitely "lights out" with an FSBG < 30... I would have pushed the D50 regardless of presence of the doc who ordered the D50 which was in my hands already. Always fun to try to push syrup through a small bore IV...

 

[NomadicMedic]

I also had a ridiculous past couple of days at the Urgent Care. They treat us more as an ER than I had expected. On Friday, I worked as the clinical lead, our equalvent of a charge nurse, talk about trial by fire. In 13 hours we had a syncope in the lobby that took a couple of liters of fluid, a couple of fairly decent trauma patients and a "man down" in front of our clinic. Along with an additional 60+ General sickness "fast track" type patients. The paramedic works up all of the "emergent" stuff before the provider sees them, and in the case of something that is a life threat, we can treat to our full scope. Otherwise, we have to get orders for procedures/meds.

We were staffed with me, a rad tech (who also doubles as an MA), a PCT who can basically just triage and do simple procedures like collecting a UA and a PA.

Oh, and our digital rads went down at around 11am and wasn't working again until after 5:30pm. And everyone needed rads. And we had a brand new NP on her first day who couldn't script or discharge patients due to a computer issue. It was a crazy day.

 

[VentMonkey]

That was clearly NOT how things went for me the last couple days... Slammed with some generally sick patients. Had a couple of hypoglycemic ALOC patients, both brought in by ambulance. Glucagon worked well for the first one (no IV access, no need for an IO, can't say due to HIPAA details) and the other was definitely "lights out" with an FSBG < 30... I would have pushed the D50 regardless of presence of the doc who ordered the D50 which was in my hands already. Always fun to try to push syrup through a small bore IV...

Without giving away much, are a rural ED nurse?

I'd always imagined you have to learn to improvise at these types of facilities as some of the staff at the more rural ED's where I am have to either think on the fly, and/ or deal with physicians who oftentimes lack ED time and experience; seems interesting, and a recipe for frequently high-acuity admissions.

 

[exodus]

I also had a ridiculous past couple of days at the Urgent Care. They treat us more as an ER than I had expected. On Friday, I worked as the clinical lead, our equalvent of a charge nurse, talk about trial by fire. In 13 hours we had a syncope in the lobby that took a couple of liters of fluid, a couple of fairly decent trauma patients and a "man down" in front of our clinic. Along with an additional 60+ General sickness "fast track" type patients. The paramedic works up all of the "emergent" stuff before the provider sees them, and in the case of something that is a life threat, we can treat to our full scope. Otherwise, we have to get orders for procedures/meds.

We were staffed with me, a rad tech (who also doubles as an MA), a PCT who can basically just triage and do simple procedures like collecting a UA and a PA.

Oh, and our digital rads went down at around 11am and wasn't working again until after 5:30pm. And everyone needed rads. And we had a brand new NP on her first day who couldn't script or discharge patients due to a computer issue. It was a crazy day.

Be sure your license bureau is okay with you acting as a full-scope medic while not on an ambulance / on the clock with your licensed agency / MD. Several of our medics just got in trouble for working in an ER with the full scope of a medic when they were not legally allowed to.

 

[TransportJockey]

Be sure your license bureau is okay with you acting as a full-scope medic while not on an ambulance / on the clock with your licensed agency / MD. Several of our medics just got in trouble for working in an ER with the full scope of a medic when they were not legally allowed to.

That's odd? I've never heard of something like that. All the states I've worked in have allowed full scope anywhere you have a medical director.

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[VentMonkey]

That's odd? I've never heard of something like that. All the states I've worked in have allowed full scope anywhere you have a medical director.

One word: California.

 

[EpiEMS]

That's odd? I've never heard of something like that. All the states I've worked in have allowed full scope anywhere you have a medical director.

Some states don't allow EMS providers to function in fixed facilities - at least, under their EMS licensure, so I am given to understand. This could be due to laws or regulatory/rulemaking decisions.

(A decent, if limited, write-up is in Part II of this document from the ASTHO)

 

[NomadicMedic]

Absolutely a valid point, and one that anyone who functions in a role like this should be aware of. We are certainly not independent practitioners and have a full set of protocols to function under while in the clinic and we operate under a medical director. I also should be clear when I say "full scope", I mean the full scope allowed under those protocols. For example, I cannot perform a surgical airway in the urgent care clinic but I can perform assessment, diagnostics and immediate interventions as needed, like D50, Albuterol or the like.

There has been a trend to allow paramedics to work as "advanced scope techs" in Emergency Departments and we've been doing it for years with Remote medicine and offshore posts. If there are clearly defined protocols and oversight of the medics by a medical director or program coordinator, I don't see a huge issue with it.

 

[EpiEMS]

That reminds me...I'd like to see a national model emergency medical services statute if one exists. We have them for so many different things (drug laws, traffic, etc.), EMS would be nice to see!