nypamedic43

This patient was going home. Why would you need a narrative and nurses notes? And what would you do with them after you get the patient home? Give it to the family? Put it with your chart so that billing can shred it when they get to that particular chart for the day or week? You knew she has had a stoke in the past and has a deficit from it. You knew why she had been taken to the ED on this particular occassion. You only really need the most basic of information to do your chart and she is only going to be billed for a ride home. And the issue for medicaid can be rectified by writing something like this... " Patient is being transported by ambulance to her residence from the ED. Patient is going by ambulance because of history of past stroke which has left her with deficits that left her bedbound and unable to travel by wheelchair. Paitent was moved to the stretcher with bed linen and secured with 4 straps." You need to state how they were moved and why they are going by ambulance. Those 3 sentences, or something kind of like them are all you need to get your company paid for the transfer. Did you read the whole thread? The OP stated that the patient had had a CT done and was found to be normal. She had some asymptomatic hypertension, which as ERDoc stated above, is usually not treated in the ED and that it would probably normalize after a couple of days, when she gets back into her regular medication regimen. Personally, if my dispatcher tells me to go to the ED, pick up a patient and take them home, that's what I am going to do. As long as that patient doesn't look like they are in distress at the time I make contact and the report that I get from the nurse doesn't red flag anything...I am going to do what I am paid to do....take them home. I dont need a complete history, nurses notes, med list or thier past surgeries. By talking with nurse prior to transport, I can get all that info, and if I cant get it, then I would talk to the family when I got the patient home. I dont second guess DOCTOR's and NURSE's that have years more education and experience than I have when it comes to discharging a patient. I don't need them pissed off at me because I think that I know better than them...because I dont.

I agree with Jake. It is absolutely imperative that they get over this grade school stuff. They have to practice on opposite sex classmates to work this out and get comfortable with the skill. We can't pick real life patients, females assess males and males assess females. They have to be able to do this skill without giggling and being shy. That doesn't do anyone any good.

Unfortunately thats what Medicare wants...a reason WHY she has to go be stretcher. Here in NY, the dementia is enough to warrent it and being unable to ambulate because of past CVA seals the deal. The need for supervision comes from the hx of dementia. You have to stop and remember, other than essential medical information, the ED doesnt have to give you any paperwork. While you may think it was a half-assed H&P, at least you got something to help write your chart. The age of the past CVA is irrelevant, she has a deficit from it and that is enough. We also dont know if the ER Doc, talked to her primary before discharge. He probably did but that wont be in any paperwork that we are concerned with. We just dont know the dynamics of what transpired while she was being treated. If you are second guessing yourself, and thinking that she shouldnt have gone home, then maybe she shouldnt have. Listen to your gut. Learn from it, move on and next time, do it better. ED staff may get a little pissy with you for second guessing them...but if you have the patients best interests at heart, they can't fault you for that.

If she is going home, why do you need anything other than an H&P, med list and a face sheet. Nurses notes dont go home with the patient, they stay with the hospital chart and/or are faxed to thier regular doctor. Discharge papers and follow up appts, if any, should have gone home with the patients family. My only question is this one...why is she going home by ambulance? Is she confused? Unable to ambulate? This patient should have been going home by wheel chair van or family POV if she wasn't confused and could walk. We have to show WHY the patient needs to go by stretcher in order to get paid for the trip, unless the family pays up front. Should she have been discharged? I dont know that answer. But if I was concerned about the elevated BP and she still had a headache, I would have taken her back in and spoken with the Doc in charge. edited for spelling

I started a thread on the national shortage of Valium..cant seem to find it now that I need it. We were given Midaz for seizures but the new protocols ( that we are waiting ohh so patiently to be put into service) also call for RSI. However, at this time, we have nothing to go with it except Morphine. Anyway, I expressed concern over the use of Midaz and was told not to worry about it. So, I am just wondering, if there is a concern over using it for intubation...why isnt there a concern for using it with seizures? Is it because the dosage for seizures is so much lower?

Relax. Take a deep breath. If you dont know the material by now, you won't know it for the test. The NR tests at the minimum level required. Lots of people start the test, get to 80 or so questions and it shuts down and they panic, thinking that they have failed. Not the case. The first questions are a grab bag and if you get X amount right the test assumes that you will get more right and so shuts down. OR, it will shut down because you have gotten ALOt WRONG, as is the case on another thread here. When it shuts down, dont panic, it's just the way its designed.

Welcome to the City and Good Luck on your test!

It really depends on what the patients complaint is. We cover some very rural areas of northern PA, with some transport times going over the 30 min mark. We also cover a medium sized city where transport times are less than 10 minutes. If I'm out in the sticks, I load the patient and go because I have LOTS of time to do my interventions if needed. If I'm in the city, general illness, headaches and the like have short scene times. MI's, strokes, respiratory distress, they get the monitor and O2, I get the IV enroute. Our protocols state that an acute MI is less than 10 min scene time, strokes are the same. For strokes we check a BGL before we put the monitor on, then the monitor and O2 and we are rolling. I guess I'm not sure why you are staying on scene for extended periods of time for any patient, especially with long transport times. I'm not saying you're wrong, I'm just thinking that if you have a long tranpsort time, why not just get moving and do everything on the ride in.

http://www.reuters.com/article/2012/01/11/us-oxygen-patients-idUSTRE80A26A20120111 I was perusing some pages on Facebook and ran across this article. I can see giving too much oxygen to a COPD'r that is normally on 2-3 liters via cannula. I try to keep them at 2-3 liters while transporting to the ED unless more is warrented or more aggressive intervention is needed. I found it interesting and it is just a theory at this time, there isnt any proof...per se.

The company I work for has a policy in place for this. NO food or beverages in the patient compartment. NOW, with that being said, we do lots and lots of IFT's that are long distance, Cleveland, NYC, Pittsburgh, Philadelphia, Boston. Am I going to tell a patient that they cant eat in the back, if they have been waiting for hours for a bed and they havent eaten anything? No I'm not, especially if the trip is going to take 6 or 8 hours. If they want to take a sandwich and a drink with us, I have no problem with that as long as they arent NPO for a procedure at said far away destination. Because we have the policy in place, we are usually very diligent about making sure that the trash is emptied as soon as we can do so. In other words, what the boss doesnt know, wont hurt him, and the patient is a little more comfortable on the trip. On the flip side of this, would you really WANT to eat in the patient compartment? We can't sanitize the patient compartment after every patient, although in a perfect world, we should. Some of these patients have things that Ajax wont get rid of, and I'm just not willing to take the chance. Besides, as was stated before, there is really no proof that someone was eating in the patient compartment, just that the wrappings made it to the garbage can.

I've not done any reading on the subject, but it sounds like it might be something to look into. Just think of the possibilities for our kids...having allllll those people to look after them and give them different views and insights and well....just different life experiences to choose and learn from. WOW!! Would be awesome

Ya Know I've had just about enough. Seth, the fact that you are being called to the carpet on this "project" of yours, should tell you a little something about us, as a whole. We have posers and trolls and TV producers and authors and journalists come on here ALL the time. Needless to say, most of them have gone the way of the dodo. My suggestion to you is this...instead of rising to the bait and saying just whatever the hell comes into that journalist pea brain of yours...think about this. This site has taken YEARS to put together...by people who are a WHOLE lot smarter that you ( and me for that matter). Climb down off your high horse a second. If you want to be taken seriously here, put it out there honestly, take the crap thats going to be shoveled at you for being a person who has ZERO understanding of who we are and what we do. If you cant do that, if you cant be an adult who wants to do this "project" then be gone. You arent gaining any brownie points here, in fact you are losing them every time you insult the FORUM MODERATOR....who can delete every single post and thread you have on here. Bad form dude!!!!

Umm....gas? A hernia? A very large tumor??

I'm pretty sure I missed that lecture myself Toni. This is the story in the New Haven Register http://www.nhregister.com/articles/2012/01/09/news/metro/doc4f0b325a4180c238579975.txt?viewmode=fullstory

NYS has about the same requirements as TX...High school graduate/GED, SS# and picture ID. For the most part, the immunizations will be provided by the organization that you are going to be working with, whether its a paid/volunteer ambulance service or a fire dept that has an ambulance. This the is the NYS website...http://www.health.ny.gov/nysdoh/ems/main.htm. Because every state is different and then every county and town is different, NYS has basic protocols in place. The higher the level, the more protocols are added. NYS currently has 6 levels of EMT from the Certified First responder to CC-AEMT-P ( Critical Care PAramedic) Not all regions use all levels and protocols vary because medical directors want certain things done but not others. You have undertaken a HUGE project. One that I doubt you will see the end of. EMS is constantly evolving and changing. Good luck.

I've been trying to find updates on the story, to no avail so far.

Or Elmira...sounds like an awesome course. However Dayton is pretty close lol. Well about 6 hours

Diagnosis is confirmed by thoracentesis. IV antibiotics given and a chest tube may be inserted. Chest tubes are problematic because the pus is very thick. To improve the chest tube drainage, fibrinolytics and DNA enzyme can be given intrapleurally through the chest tube to break the fibrinous septation and to reduce the pus viscosity. Although these adjunct treatments are proven effective, its administration may cause rare but life-threatening intrapleural hemorrhage and hypersensitivity reaction. If this is insufficient, surgical debridement of the pleural space may be required. This is frequently done using video-assisted thoracoscopic techniques but if the disease is chronic, a limited thoracotomy may be necessary to fully drain the pus and remove the fibrinopurulent exudate from the lung and from the chest wall. Occasionally, a full thoracotomy, formal decortication and pleurectomy are required. Rarely, portions of the lung have to be resected. Sounds painful...not something I want to go through.

It is also called purulent pleuritis or pleural empyema. It is an accumulation of pus in the pleural cavity. It will usually arise from an infection in the lung such as pneumonia and is often associated with parapneumonic effusions. Symptoms vary in severity but include fever, cough, chest pain, shortness of breath and diaphoresis.

Pyothorax (n) Suppurative inflammation of the pleural space. actomyosin (n) a protein complex in muscle fibers; composed of myosin and actin; shortens when stimulated and causes muscle contractions A protein complex of actin and MYOSINS occurring in muscle. It is the essential contractile substance of muscle. found in Medical-Dictionary.cc

Good luck with your classes and welcome to the CIty. Peruse the site...there is a LOT of info here that will help you.

Welcome to the City Ed.

I'm happy being a street medic...no offers from me LOL. Anyhoo, welcome to the City Seth

Whether or not the accusation is true, his life is ruined and his career is over. Just the hint of inpropriety is a hangin offence unfortunately, thats what I meant by giving us all a black eye. Because if its proven that it didnt happen, there was sdtill an accusation. If its proven that it did happen...well then all paramedics are pervs and will eventually do something like this. Its a double edged sword...and nobody comes out unscathed.

As far as I know, it's just an accusation at this point. I'm not trying to hang anyone at this point in time. We just don't Know all the facts yet. Edited for spelling