The Crackhead with Chest Pain

[JVEMT]

Trying to prove a fellow crew wrong. Dispatched for chest pain. You arrive to find one female patient A&Ox3 c/o chest pain & SOB. One can clearly see something more is at play. Patient admits to using cocaine, drinking alcohol and doing taking other medication such as percocet. Patient denies any history. Patient B/P is 150/120. No medics available. Crew responding said “even if there was ALS around the corner, he would cancel them because it’s a bull**** call”. Do you agree or disagree? Note* 1) Cocaine is proven for potential to cause M.I. due to arterial spasm, one of the symptoms being elevated B/P.

 

[firecoins]

Trying to prove a fellow crew wrong. Dispatched for chest pain. You arrive to find one female patient A&Ox3 c/o chest pain & SOB. One can clearly see something more is at play. Patient admits to using cocaine, drinking alcohol and doing taking other medication such as percocet. Patient denies any history. Patient B/P is 150/120. No medics available. Crew responding said “even if there was ALS around the corner, he would cancel them because it’s a bull**** call”. Do you agree or disagree? Note* 1) Cocaine is proven for potential to cause M.I. due to arterial spasm, one of the symptoms being elevated B/P.

disagree. cocain causes MIs. It was an ALS job.

 

[VentMedic]

Since women and drug addicts don't always feel chest pain the same as the text book describes, this woman could already have had an MI previously and didn't know it as well as cardiomyopathy. This can be a very serious problem and some will already have an ejection fraction of 25% by the time they do get help. The fact that there are some in EMS who blows them off as bull**** doesn't help anyone or anything either. What could be an early diagnosis and treatment may now be an extensive ICU and hospital stay.

 

[Scott33]

It would take a very brave (I think that is the word) BLS crew to stand down ALS in a C/P patient who has a diastolic BP of 120.

Crew were wrong, and perhaps they should have a good look at why they are in EMS.

 

[medic417]

Another arguement for always having a Paramedic on every ambulance. These BLS providers could have killed this lady by their inaction.

 

[Sasha]

It would take a very brave (I think that is the word) BLS crew to stand down ALS in a C/P patient who has a diastolic BP of 120.

I don't think brave is the word. I think ignorant, stupid, or foolish may be better alternatives!

 

[firecoins]

I missed the ultra high diastolic. I guess the diastolic was on drugs.:glare:

 

[el Murpharino]

You should prove this crew wrong by bringing this case to the attention of your medical director...see what he/she has to say about it.

 

[BossyCow]

Another arguement for always having a Paramedic on every ambulance. These BLS providers could have killed this lady by their inaction.

I would say its an argument for not having stupid people on the ambulance. I'm BLS and this would have definitely been an ALS call for me.

Its not always the BLS making the mistake. I called ALS for support on an elderly female, ground level fall, she dragged herself to her waterbed where she lay for several hours on an unheated waterbed before calling 911.

She's a familiar fixture in the area, though never called us before. Tough old broad in her late 70's, retired from a career in law enforcement. Drinks heavily, smokes constantly. We backboard her, called ALS and transported. I had an ALS crew respond and tell me to take her in BLS. She was later diagnosed with a shattered sacrum and several fractured Lumbar Vertebra.

It was several years ago and I can't remember the vitals etc. But she was in tremendous pain despite the liquor on board, and mildly hypothermic. I got reamed by the ALS crew for calling them out on B.S. in the middle of the night and accused of being overly cautious because I backboarded her.

 

[medic417]

I would say its an argument for not having stupid people on the ambulance. I'm BLS and this would have definitely been an ALS call for me.

Its not always the BLS making the mistake.

I apologise I should have said properly educated Paramedics on every ambulance.

 

[BossyCow]

I apologise I should have said properly educated Paramedics on every ambulance.

You can't educate away arrogance or personality defects.

 

[medic417]

You can't educate away arrogance or personality defects.

But increased education would weed out more. But as I've said before I do wish we could teach common sense. That may be the only truly impossible dream in EMS.

 

[firecoins]

There are MDs with arrogance and personality defects.

 

[medic417]

There are MDs with arrogance and personality defects.

Just think how many more there would be if they had lax education requirments like we do.

 

[firecoins]

Just think how many more there would be if they had lax education requirments like we do.

Education higher requirements are good. I don't think it has anything to do with arrogance or personality defects. I think certain part of the job just attract such types.

 

[medic417]

Education higher requirements are good. I don't think it has anything to do with arrogance or personality defects. I think certain part of the job just attract such types.

True we even see that here. Shockingly some here even claim I'm arrogant and have personality defects, of course thats nicer than the way they put it.

 

[firecoins]

True we even see that here. Shockingly some here even claim I'm arrogant and have personality defects, of course thats nicer than the way they put it.

I don't know you and can not intelligently assess your personality flaws.

Several members claim to know my personalty traits simply based on this forum. They were grossly wrong in their characterizations. Anyone on this website who thinks they "know" people through the forum need to reassess that opinion.

 

[MRE]

Another arguement for always having a Paramedic on every ambulance. These BLS providers could have killed this lady by their inaction.

As a basic I don't know enough to determine that the call is not worthy of ALS, so they are definitely getting called if this was my pt.

It would be nice to have a medic on all ambulances, but not always possible, especially in my area. Right now I would settle for basics with a decent head on their shoulders.

 

[benkfd]

This is definitely an ALS run in my book. Don't know what happened exactly but is there a protocol or standing order for a Paramedic intercept while they were enroute to the hospital? It's hard to believe that there are services out there that don't have at least 1 Medic on each truck? I would think that would be a liability issue? We run at least 1 Medic on each truck and many times there are 2.

 

[BossyCow]

And again, instead of addressing the OP's question, we deteriorate into the same old rhetoric.