the 100% directionless thread

P

Peak

ED/Prehospital Registered Nurse
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PotatoMedic said:
She's allowed to be seen as many times as she wants. But there are ways to have patients banned from hospitals including the emergency room. It takes a lot of paperwork. I knew one patient that was only allowed at the county hospital and required a 1:1 sitter that had to be a security guard.
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Technically if a patient has been evaluated for their complaint and is determined to not have a emergency medical condition the patient can then be asked to leave the property and if they don’t either produce a new complaint or leave they can be trespassed and ultimately arrested.

This gets a bit into gray areas. If for example this patient was discharged 10 minutes ago for chronic back pain, was told she can take OTC meds and they had a holler that she won’t leave the hospital until the doctor writes her a prescription for Percocet then it wouldn’t be unreasonable to have PD trespass her.

If she was evaluated 6 hours ago and is back then it would be difficult to argue that the patient had no changes and can be asked to leave without evaluation.

Where this boundary is isn’t well established in statues or case law. Malingering patients do not have the right to occupy the ED and staff time simply because they are in the ED and not another area. A CMS participating (or other federally funded insurance program; and therefore obligated to EMTALA) has an obligation to evaluate and treat emergency medical conditions and active labor, not to be a shelter.
 
Jim37F

Jim37F

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I know when I was working in Willowbrook I encountered at least a couple frequent fliers whom had full on Restraining Orders against them. By the hospital.

I'm not quite sure the legalities, but they were the kind who went to the ER with nonsense and were generally loud and obnoxious types...

I'm believe they would still be evaluated and treated if they had an actual treatable complaint, but otherwise kicked off property. If we picked them up BLS, we were highly encouraged to take them to a different hospital.
 
VentMonkey

VentMonkey

Family Guy
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Jim37F said:
I know when I was working in Willowbrook I encountered at least a couple frequent fliers whom had full on Restraining Orders against them. By the hospital.

I'm not quite sure the legalities, but they were the kind who went to the ER with nonsense and were generally loud and obnoxious types...

I'm believe they would still be evaluated and treated if they had an actual treatable complaint, but otherwise kicked off property. If we picked them up BLS, we were highly encouraged to take them to a different hospital.
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Lol company’s change. Coverage areas, patients, and practices seldom do.

Also, just call it Compton bro. Your street cred will go way up😁...
 
S

StCEMT

Forum Deputy Chief
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Well we've officially pulled intubation due to COVID for adult arrests and we are to use Kings first line.
 
A

Aprz

The New Beach Medic
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My county put out a notice saying to "avoid" nebulizing, intubation, and CPAP, but it didn't prohibit it. They put out some basic recommendation for what to do if we decide to proceed with those procedures or treatment (Pretty much do it outside, don't do it in an enclosed area. Turn on exhaust fan if in ambulance.).
 
Jim37F

Jim37F

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To help avoid those aerosolizing procedures, the "magic number" of SpO2 before providing oxygen has been lowered from 94% to 90%.
 
S

StCEMT

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Jim37F said:
To help avoid those aerosolizing procedures, the "magic number" of SpO2 before providing oxygen has been lowered from 94% to 90%.
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I mean if they're at 94, then why give it? Seems like an insignificant issue to worry about.
GMCmedic said:
Quite a kneejerk reaction this late in the game.
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Yea, I'm not sure why they are doing it now. I've intubated since COVID has been in the city. But the last one was also a regular I knew that it would only be a matter of time before he arrested one time too many and not overly concerned about COVID being the why. I'm not real sure that the BVM ventilations done before an SGA is dropped are really any safer, but.... whatever. Maybe there is some meaningful difference in potential exposure and viral load.
 
E tank

E tank

Caution: Paralyzing Agent
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Aprz said:
My county put out a notice saying to "avoid" nebulizing, intubation, and CPAP, but it didn't prohibit it. They put out some basic recommendation for what to do if we decide to proceed with those procedures or treatment (Pretty much do it outside, don't do it in an enclosed area. Turn on exhaust fan if in ambulance.).
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Ha...someone in need of intubation or CPAP is by definition an "Aerosol Generator". Those two things would only retard the immediate spread of the dreaded 'aerosol'.
 
E tank

E tank

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Jim37F said:
To help avoid those aerosolizing procedures, the "magic number" of SpO2 before providing oxygen has been lowered from 94% to 90%.
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Some brainiac where I am has decided that any supplemental oxygen flow equal to or less than 6 lpm isn't aerosol generating. If you need a brainiac to help you with your protocols, I know where you can get a few....
 
Tigger

Tigger

Dodges Pucks
Community Leader
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NomadicMedic said:
And we're the opposite. No SGAs, intubated them all. The rationale is that there is less chance of areosol from a cuffed ET than from a poorly fitted sga.
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I think this is a better idea all around. Mask ventilations (which are difficult to avoid) are still the sketchiest in my mind unless people are militant about two handed seals.
 
Jim37F

Jim37F

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Standard protocol said to give O2 of they were less than 94%. Now with COVID its don't give them O2 if they're 90% or above. Of course with the "don't withhold oxygen therapy, including aerosol-generating procedures, when indicated for appropriate patient care." disclaimer attached.

Per our official guidelines, Aerosol generating procedures are listed as:
  • Intubation
  • Supraglottic airway placement
  • Nebulizer treatment
  • CPAP
  • Bi-PAP
  • High flow O2 via NRB and/or BVM
Nasal Cannula at 6 LPM or less is listed as not providing aerosole flow.

For us, FD side, basically an A&Ox3 patient with no complaints of SOB, and SpO2 of 90% or greater, No O2.
Alert patient, complaining of SOB, but O2 greater than 90% is NC. Unless inadequate ventilations then upgrade to NRB or BVM based on patient presentation.

Altered patient with SpO2 90% or greater, NC. Less than 90% gets NRB. Or BVM if inadequate ventilations.

Its basically what our guidelines were before, but before it was less than 94% when we started O2 therapy
158993633969970521658593524753.jpg
 
DragonClaw

DragonClaw

Emergency Medical Texan
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Jim37F said:
Standard protocol said to give O2 of they were less than 94%. Now with COVID its don't give them O2 if they're 90% or above. Of course with the "don't withhold oxygen therapy, including aerosol-generating procedures, when indicated for appropriate patient care." disclaimer attached.

Per our official guidelines, Aerosol generating procedures are listed as:
  • Intubation
  • Supraglottic airway placement
  • Nebulizer treatment
  • CPAP
  • Bi-PAP
  • High flow O2 via NRB and/or BVM
Nasal Cannula at 6 LPM or less is listed as not providing aerosole flow.

For us, FD side, basically an A&Ox3 patient with no complaints of SOB, and SpO2 of 90% or greater, No O2.
Alert patient, complaining of SOB, but O2 greater than 90% is NC. Unless inadequate ventilations then upgrade to NRB or BVM based on patient presentation.

Altered patient with SpO2 90% or greater, NC. Less than 90% gets NRB. Or BVM if inadequate ventilations.

Its basically what our guidelines were before, but before it was less than 94% when we started O2 therapyView attachment 4999
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What if they're AO4 with SOB or something?
 
Seirende

Seirende

Washed Up Paramedic/ EMT Dropout
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Is a share pack of m&m's really for two people or is it all for me at two different points in the day?
 
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