Way to go dude. Make me look stupid.

[BLSBoy]

This went down last night, and has been buggin me ever since..

Get dispatched for an assault, scene secure, blah blah blah. Pt was aprox 50 yrs old, +ETOH useage, was struck several times in the head and face, possibly with an unk. object. Pt found supine on ground covered by a blanket by PD. Pt c/o head and back pain, and was bleeding at a good rate from nose and mouth. There was no evidence of clotting, and it was still coming out, so I gave him a 5x9 to hold. Pt had a number of meds, no antiseizure meds were among them. Pt poor historian to PMHx. Placed him on LBB, and C-Collar, but something just felt hinky.

Mind you, he was CAOx3, GCS 14, 1 off for confusion. Coulda been from ETOH, coulda been from blows to head. I didn't know, and since I was working BLS cause NJ is dragging their feet on giving me my Medic cert, I didn't have a lot of options before me.

Anyway, instead if going to the local hospital that was 3 or so minutes from us, I decided to go to the Trauma Center 15-20 min away. I had NOT trauma alerted this pt, but in case something was going on, he would go there anyway, so I wanted to stay one step ahead of the curve.

Initial BP was 86 palp, P 88, R22, SPO2 85 on RA. I placed him on 15 LPM via NRB, and it came up to 99%. About halfway into the trip, he stopped talking, eyes focused dead on the ceiling, arms and upper body began convulsing, and he stopped breathing.

Wonderful :wacko::glare:

No local ALS available, it's John Wayne time.

Pt stopped seizing, was unresponsive to painful stimuli (see knuckle deep in sternum, pen to back of fingernails and titty twister)

Jaw clenched, couldn't drop an OPA, and he stopped breathing. Ventilated with BVM for 2-3 min, then he became awake, in a post-ictal state. Put him back on NRB, sats back up, next set of vitals at 80/60, P 94, Sat 99% on high flow. Pt was alert and oriented by the time we arrived at Trauma Center. Mind you, we decided to call a Trauma Alert en route based on his actions.

We walk in, I give report, and basically get the "Stupid EMT hit the panic button for no reason" look from all in attendance.

<_<:glare:

 

[MedicPrincess]

Mind you, we decided to call a Trauma Alert en route based on his actions.

We walk in, I give report, and basically get the "Stupid EMT hit the panic button for no reason" look from all in attendance.

<_<:glare:

You did good. Freakin' ER Trauma Centers.....

See my TA thread....

Based on his initial BP <90 he would have met "technical" TA criteria for us. But the seizure, AMS, BVM, ect.... I'd have TA'd him.

A seizure pt after a fall that is called the TA on is the reason the trauma surgeon I referred to in that thread attempted to remove my rear end for me..... When she came back for round 2 in the EMS break room, my partner did a bang up job of saving that same rear end she was attempting to have.

In a nutshell she asked me, "So are you telling me all seizure patients should be Trauma Alerts?"
Me: "Well when they fall and then minutes later start with the convulsions that are continuing when I get there 15 minutes after the fall, then Yes."
Her: "Well he is drunk."
Me: "So are you telling me a pt with ETOH on board cannot be a trauma alert? By the way, whats he doing right now?" (Mind you, I knew the answer)
Her: "He was conscious for about 2 minutes and now he is seizing again." (now this is about an hour after the fall)
Me: "So, active seizure for almost an hour. Are you trying to tell me that a fall patient, who happens to have ETOH on board, and is now Status doesn't meet criteria?"
Her: "You need to double check what meets Trauma Alert Criteria."
Me: (now in my pocket, I carry a little yellow card, issued by LifeFlight with the TA criteria listed) "OH, you mean this one. I didn't even need BS Paramedic preference." As I pull it out, show it to her and point out GCS <12/BMR <4.
Her: "Well, where did you get your medical license?" And she turned and walked out of our break room.

At which point, I began gathering up my stuff, looked at my partner and told him to wait there as I headed out the door with her.....

And thats the point my partner got on the radio and put us available and clear, for an immediate emergency call. And as fate would have it, we didn't have another patient to transport to that hospital for the rest of the night.

 

[Airwaygoddess]

Take a deep breath, you gave that patient a fighting chance.

 

[daedalus]

You did good. Freakin' ER Trauma Centers.....

See my TA thread....

Based on his initial BP <90 he would have met "technical" TA criteria for us. But the seizure, AMS, BVM, ect.... I'd have TA'd him.

A seizure pt after a fall that is called the TA on is the reason the trauma surgeon I referred to in that thread attempted to remove my rear end for me..... When she came back for round 2 in the EMS break room, my partner did a bang up job of saving that same rear end she was attempting to have.

In a nutshell she asked me, "So are you telling me all seizure patients should be Trauma Alerts?"
Me: "Well when they fall and then minutes later start with the convulsions that are continuing when I get there 15 minutes after the fall, then Yes."
Her: "Well he is drunk."
Me: "So are you telling me a pt with ETOH on board cannot be a trauma alert? By the way, whats he doing right now?" (Mind you, I knew the answer)
Her: "He was conscious for about 2 minutes and now he is seizing again." (now this is about an hour after the fall)
Me: "So, active seizure for almost an hour. Are you trying to tell me that a fall patient, who happens to have ETOH on board, and is now Status doesn't meet criteria?"
Her: "You need to double check what meets Trauma Alert Criteria."
Me: (now in my pocket, I carry a little yellow card, issued by LifeFlight with the TA criteria listed) "OH, you mean this one. I didn't even need BS Paramedic preference." As I pull it out, show it to her and point out GCS <12/BMR <4.
Her: "Well, where did you get your medical license?" And she turned and walked out of our break room.

At which point, I began gathering up my stuff, looked at my partner and told him to wait there as I headed out the door with her.....

And thats the point my partner got on the radio and put us available and clear, for an immediate emergency call. And as fate would have it, we didn't have another patient to transport to that hospital for the rest of the night.

Oh gawd. I would be frustrated beyond imagination.
You did well MP.

If she had asked me for my medical license, and I was a medic, I would have pulled it out. In California, Paramedics are licensed by the state to preform ALS prehospital medicine. Thats a license right? And it is of medical origins....

 

[Aileana]

Sounds like a good, cautious course of treatment. No need for the hospital staff to be annoyed (though it does happen), the patient arriving in better condition than they were called in as is a good sign .
I would have taken similar precautions, since given the patient's age and a potential history of alcoholism, he's at a higher risk for epidural and subdural bleeds with that MoI.
Sounds like this could potentially have been retrogressive unconsciousness, commonly seen with epidural hematomas.

 

[ChristinaM]

I work for a county in Florida that is at the top of the game for aggressive/progressive prehospital patient care.

Our medical director's philosophy is that he would rather us call 10 trauma alerts that are not true trauma alerts than miss 1 legitimate trauma alert.

I think you acted in the best interest of your patient based on the information you had and the treatment available to you.

I say job well done, and I am sure the patient would feel the same way.