The Good, Bad and Ugly

[RocketMedic]

Wow. Really glad I didn't pursue working there. :/

Rocket, sounds like it's job search time.

I'm getting that feeling myself.

 

[Trashtruck]

You seem aggressive.
Your employer won't let you be.
Other places will.

Go to those other places.
Be happy.

 

[RocketMedic]

SVT corrected!

 

[Carlos Danger]

Better? Sounds like you did fine. He was conscious ("screaming"), and the BiPAP helped, so there you go.

Just because the ED decided to RSI doesn't mean that you should have. They've got better drugs, more staff, back-up anesthesia and surgery. What makes sense doing in a fully-equipped ED doesn't necessarily make sense doing 10 minutes earlier at 50 mph on a bumpy street with (maybe) 1 basic partner.

This is so true. I wish more paramedics understood this.

After talking it over with my dad, I think I should have intubated him. Im fairly uncomfortable with RSI, and all we carry is versed and etomidate to induce, along with fent for pain management. No paralytics.

Am I too timid on airways? Im not great at them yet, and BiPap worked, but intubating would have been better (maybe?)?

I strongly disagree that you should have intubated him, especially if you are "fairly uncomfortable with RSI". From the sounds it, this could have been a tough airway who decompensated immediately after you blunt his sympathetic discharge and respiratory drive with a large dose of a sedative. As the doctor above said, it is one thing to deal with that in a well-equipped ED; it is a very different thing altogether alone in the back of an ambulance.

One important thing to keep in mind is that it actually takes more skill, and in the field setting, I believe it puts patients at more risk, to intubate with sedation alone than with NMB. An intubation that is easy in a patient who has received succinylcholine may be very different if all they've received is a large dose of versed or etomidate.

Knowing your limits is extremely valuable. Admitting that you aren't yet very good at or confident with something is extremely important. It indicates self-confidence, humility, and conscientiousness. We don't see enough of it in EMS.

I can't think of anything I would have done differently in 21 minutes. Good job.

 

[RocketMedic]

yeah...I think I did right by my patient.
Had an interesting night tonight going from awesome SVT conversion to Mr "I just pee in my jumpsuit because its too hard to take off". Really, dude?