the 100% directionless thread

abckidsmom said:
They do get to suggest a lot. If a nurse doesn't approach the doc with at least a vague plan, things don't go as smoothly.
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This is definitely true. What the nurse tells the doc can have a big impact on how long it takes for the doc to get in the room and what care the pt gets in the meantime.
 
Just over a year of medic school and 3 1/2 years working as a medic, and I have never gotten pulses back on a cardiac arrest...
















UNTIL LAST NIGHT!! Now to follow up and see what the ultimate outcome is for this guy.

He's a known diabetic with a feeding tube and a suprapubic catheter who stopped speaking to his roommate midsentence. We found him in v-fib, shocked him once, and had a bounding pulse and a BP of ~140/90. Eventually went into PEA, pushed some epi, and pulses came back.

We get to the ER and the first thing the doc points out is that he isn't intubated. Yeah, about that....he was initially taking agonal respirations, and continued to breath on his own throughout the run, although not adequately enough on his own, so he got bagged anyway. We don't have RSI, so I wasn't able to intubate him.

The doc does RSI to intubate him, and then off he goes to CT. Nothing unexpected showed up there. He did start moving though, so they had to sedate him again to finish the CT. When we left the ED, he was on a vent, and they had to restrain him to keep him from moving too much and pulling a line or the tube. Apparently, they had tried propofol, but it made him too hypotensive, so they were trying to decide what they were going to use instead.
 
Epi-do said:
Just over a year of medic school and 3 1/2 years working as a medic, and I have never gotten pulses back on a cardiac arrest...
















UNTIL LAST NIGHT!! Now to follow up and see what the ultimate outcome is for this guy.

He's a known diabetic with a feeding tube and a suprapubic catheter who stopped speaking to his roommate midsentence. We found him in v-fib, shocked him once, and had a bounding pulse and a BP of ~140/90. Eventually went into PEA, pushed some epi, and pulses came back.

We get to the ER and the first thing the doc points out is that he isn't intubated. Yeah, about that....he was initially taking agonal respirations, and continued to breath on his own throughout the run, although not adequately enough on his own, so he got bagged anyway. We don't have RSI, so I wasn't able to intubate him.

The doc does RSI to intubate him, and then off he goes to CT. Nothing unexpected showed up there. He did start moving though, so they had to sedate him again to finish the CT. When we left the ED, he was on a vent, and they had to restrain him to keep him from moving too much and pulling a line or the tube. Apparently, they had tried propofol, but it made him too hypotensive, so they were trying to decide what they were going to use instead.
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Congrats!

Perhaps a fentanyl drip with a touch of Versed?
 
Linuss said:
Ahhh new grad nurses. It's always fun when you shatter their view that all we do is drive ambulances and not do anything advanced. Just wait till you walk in with an RSI :rofl:


Apparently, ER nurses at our local level 1 can't give Phenergan. We can. :)
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Unfortunately no RSI for us ground medics here... :wacko: hopefully that will change in the near future or I'm going to have to start wielding nasotracheal intubations haha. Never done one though, don't it on a mannequin once but that's about it.

Fast it worked pretty well for me, albeit I did get to sleep till 0930.
 
Well we've been holding the wall for 90 minutes now on an ift to radiology for a scan... We are working on our 4th O2 tank.

Well we only killed one of ours and 2 of the hospitals, now we are on the hospitals 3rd. No big deal.

I love watching the rad techs watch YouTube videos in their empty MRI rooms while we sit in the hallway.
 
NVRob said:
Unfortunately no RSI for us ground medics here... :wacko: hopefully that will change in the near future or I'm going to have to start wielding nasotracheal intubations haha. Never done one though, don't it on a mannequin once but that's about it.
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Never done a naso-tracheal on a real patient, and I've done more RSIs than standard intubations. And my last intubation was in July :sad:


Epi-do said:
Just over a year of medic school and 3 1/2 years working as a medic, and I have never gotten pulses back on a cardiac arrest... UNTIL LAST NIGHT!!
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Congrats! I had my first sustained ROSC several weeks ago, though haven't heard anything about him since. No mention in obituaries or medical examiner website, either.


jjesusfreak01 said:
That's not really fair. You're implying that nurses get to decide what meds the patient gets.
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No, I'm saying even doctors cannot have nurses given Phenergan at that hospital. It's not allowed to be handled by nurses per facility rules. Apparently a bad patient outcome one time when a nurse gave it.
 
Linuss said:
Never done a naso-tracheal on a real patient, and I've done more RSIs than standard intubations. And my last intubation was in July :sad:




Congrats! I had my first sustained ROSC several weeks ago, though haven't heard anything about him since. No mention in obituaries or medical examiner website, either.




No, I'm saying even doctors cannot have nurses given Phenergan at that hospital. It's not allowed to be handled by nurses per facility rules. Apparently a bad patient outcome one time when a nurse gave it.
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That's like banning medics from driving code 3 because once there was a really bad accident and the medic was driving code 3.
 
Sasha said:
That's like banning medics from driving code 3 because once there was a really bad accident and the medic was driving code 3.
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I didn't say it made sense, and infact it shocked me last week when I first learned about it. It then proceeded to cause an argument at the nurses station, as I slowly backed away to the door. :P
 
Linuss said:
Ahhh new grad nurses. It's always fun when you shatter their view that all we do is drive ambulances and not do anything advanced. Just wait till you walk in with an RSI :rofl:


Apparently, ER nurses at our local level 1 can't give Phenergan. We can. :)
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Wait till you give three or four milligrams of NTG to a CHF patient and instead of the doc reaming you a new one like said nurses want all they have to say is "good job" :D.
 
What's the deal with medics giving probies tons of s**t? Srsly.
 
n7lxi said:
Yeah. At my last service I got used to just having me and my partner on an RSI. Now, if I knock someone down and tube them, I'll have 6 people in the ambulance. It gets a little crowded. I've been told to "play nicer" with the BLS crews, because on priority calls when the ambulance starts looking like a clown car, I start kicking people out. "I want one EMT and my partner in here. Everyone else, OUT! Yes Chief, that means you!"
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Yes!! Lol I've made plenty of enemies by "kindly asking them" to get the hell out of my box :D I can't stand when the back gets crowded like that! Our boxes are pretty good size, and I still don't like more than three people back there, including myself :p
 
Mozzarella stuffed meatballs with garlic bread for dinner? I think yes.
 
EpiEMS said:
What's the deal with medics giving probies tons of s**t? Srsly.
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It's even better when there's six fire medics on scene harassing a medic intern
 
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