medic53226

Whats going on is that we are using D50 to reverse insulin shock, and the pt not wanting to go to the hospital. So, we contact Medical Control, and they are not allowing the refusal. Causing the problem of patient refusing, and the doctor saying bring in the patient, but in Indiana that is kidnapping. So, our go is to make it better for the crew,patient and the doctor.

What is your policy on refusal of care, we are changing our protocols and just looking for ideals.

Trauma and OD's is the most common calls in my area, and meth abuse.

I would like for our basic emt's to be allowed to use glucometers prior to admin of oral glucose.

I would like some insight on how you fellow directors or supervisor would handle a problem that came about on a pt in my county. We had a crew respond to a accident, in which the pt was still alive and breathing on their own but shallow. The crew that found the pt decided to intubate, but pt was clinched. We don't have a protocol for RSI, but since he was combative they followed the that protocol and the respiratory distress protocol. However, 3 medics responded 2 on duty on off duty put on by the supervisor. The 1st paramedic on duty choose to have 1 medic give 10 mg of valium, which is in protocol but, the other two medics gave 10 mgs also so this pt got a total of 30 mg of valium. Due to the pts injuries the pt died at arrival to the trauma 1 hospital. My problem accures because as protocol medical control has reviewed, but 2 of the 3 medics have went to rival services, but use the same protocols. This is a vilation of protocol and the state has advised to inform the and we did, but little or no response. I would like your insight on how you may have or would handle this problem.

I'm sorry, It should read: Our narcs are checked at shift change and counted by offgoing and oncoming medics. Then logged in to our narc book. My question to all is how do you account for your wasted narcs, do you have your bls partner or does a nurse or doc have to witness. Thanks

Are narcs are checked every shift change and recorded, and counted in front on offgoing and oncoming medics. I have a question how do you was your narcs, when given and if they expire.

My system carries Fentanyl,Dilaudid,Morphine in our pain managament protocol. It is our choice on of which to give, except in chest pain only MS.

I would like your opions on this subject, and any info you might have. In our system one of the doctors, is saying that you should never use high flow O2 on anything. So, He wants the paramedics and emts to show him with medical documentation, that why high flow O2 is needed. Thank you for your time. Chad

All thank you for your replies and I'm sorry for the grammar, and this is my last topic and reply.

Shelbmedic, I thank you for your comments and I was not trying to say that the pt wasn't worth my time, and that I would check he out I had a new intermediate and that had had many runs since in our system medics take 90% of the run. The pt had no distress, and was AOX3, was evaluated by me before I got out of the ambulance and answer all my questions that I asked and at the present time of the run, I felt she had alot of issues, and that it would be a good run for him to learn on, and I at no time felt she needed monitor, with her intial assesment, because all of her vitals signs was stable and no distress, nothing, and also I don't consider ambulance runs taxi rides, I take pride in my work and I treat everyone with care and compassion, and as you said not to quote, and won't I check all my pts before anyone touchs them.

I was posting for a another unit that had a ldt, and was disp for a possible OD, Enroute as you all we try to asume what we a possible going to be faced with, and in this town meth is bad, and other illegal drugs. So upon arrival I was thinking that it was illegal or script OD. We found a 41 y/o male pt with a friend and she stated that he had taken 10 Lortab 10/500 with 30 Phenergan 25-50mg pills and chased them with ETOH. However, the pt was still AOX3, and said it had been 2 hours since he had taken these meds, so placed on the monitor, IV, O2 by N/C to start V/S stable, with no distress, just I getting back at my wife, so in the ambulance enroute to ER pt started to LOC, so I gave he a 1 mg of Narcan to start, and new full well what was to come, from my action and knowing that we don't have RSI, and have to have orders for intubation in this scenario, He got narcan just enough to keep him breathing, but also knowing that the phenergan is increasing the effects of the narcotic in Lortab. We as I though he woke up and proceed to kick my but while he was vomiting, what a thrill. So we get the pt to the hospital and have all his bottles, we find that he had just filled his lortab the day before and their was 180 lortab missing and with the phenergan, he also had vistaril, neurotin with the other meds so the drs figured that he had ingested the whole bottle he would have ingested 90,000 mgs of Acetamiphen, and 1800 mg of Hydrocodone with the phenergan, That has to be the most I think I have ever seen on pt take. I would like to know what you have seen and done for similar pts, and conditions. Thanks Chad

Thanks to everyone for you time and information, and I hope that this may help you someday, because I know that if you have been in this business for more than one day you have seen stuff that just puzzles the crap out of you. Another pt I had was checked by a EMS Director and passed to me as he is having a stroke he took no V/S, no BGL, just the FD told him the pt had a history of CVA's and that was all he needed. However the pt had a hx of diabetes and multiple other medical conditions, to say the least. By the way the pts BGL was 32 and after reversing the hypoglycemia, he started throwing couplets, and then VT, and he woke was complaing of chest pain. That at that time the wife stated he had been having chest pain all day before what she called his stroke episode. I wanted to drag my EMS Director out of his little office and ask did they teach you pt assement in you medic program, or you just to lazy to do that since you got you promotion. That is why I hope that I never turn into him, or anyone that just goes by what I'm told and not what I find. Thanks Chad

Sorry for the delay I have been swamped the last few days, But anyway This pt I was passing of to my Intermediate Partener and he was more than happy to take the pt, so he asked if he could put her on the monitor, he was a new intermediate and I said you dont have to ask my permission to put her on the monitor, and he did so as I was leaving the back of the ambulance. Because she was AOX3 no trauma, no problems, just stressed out over he family life. So as I was stepping out of the ambulance my partener said hey Chad take a look at the monitor and by the tone of his voice, I knew that I really didn't want to see what was on the monitor. So I looked anyway and found the pt to have Tombstone or Firehelment T waves with no distress so I checked the leads and they were right, so I went enroute with my partner driving, and did everything enroute, Pt is W/P/D and her only complaint is that her right elbow started hurting 2 days ago, and she had recently taken a nerve pill but that was all, so in this system we can do 12 Leads and when it printed it stated that she was having a Inferior MI, but she had no symptoms, so as I turned to call my report in I stated my findings and the pts condition and the Dr though I was a idoit, I for sure, but when I got done in the 1 min or less, I spent calling in my report she has went from W/P/D to PALE, DIAPHORETIC, PRESSURE ON THE in her right shoulder, N/V now I had already gave the asa, nitro per protocol but had to request MS if needed when I called, and her BP drop to 98/64 for 132/86. The pt was taken cath lab were on unblockage of the artery she went into VF was shocked and went hope 1 week later. To this day all I say is what I thought that day, were in the hell was that in the paramedic book.

Ok, This is the run, 60 y/o female that needs take to the hospital to talk to someone, and dosent want to drive herself, and would like a medic unit to come. You find a 60y/o female in the house with a dog that as big as cow and a dovermen pincker, and is helped to the back porch by the pt, before she opens the door. Pt intially says that she has been stressed since her husband had open heart surgery triple bypass, just 2 weeks ago, and her 40 y/o son moved back in and she just can't handle the stress. Ok, what would you like to know other than her V/S are stable, W/P/D.

The problem really is that they were BLS for over 25 yrs and just went medic June 1st, and now the doctor that I told you about says anything that he transfers will go paramedic because he can. Their have been some question the call, but was told that if you don't want to take the call then they will call someone else. The Dr for instance called us for a transfer at 1:00 am in the moring to transfer the pt to Indy, and went to the hospital, and as we were standing their, our supervisor called with a question and this DR response was if you don't want to take the pt then I will call someone else, matter of fact the hospital won't give us drugs that they order for the transfer. But their is no one that will do anything about this matter and it is a bad problem all around, but I was told by my Director of EMS, that if we don't feel comfortable then we don't have to take the run and if they have a problem then they can call him. By the way as for the pt after he got the dopamine, at our arrival at the larger hospital he had his eyes open and was looking around and was breating against the tube.

This run started with a bls unit not asking for a intercept, but got better at the hospital, when the doc was told that the pt was in distress and breathing at 4-6 bpm, by the charge nurse the doc looked at the nurse and I quote " SO " and mind you they are bagging this pt in the ER, and he gets up and walks into another room and takes a pt report, and they had to wait so, before I even got into the mix, we were behind the eight ball, and what made it even better my supervisor, said I would have got help for you, the ironic thing is she was the the one that took the call in the first place, and just found it was a paramedic run and that was it, I never know on all the transfers that I have recently took knew what the pt needed because dispatch is not required to get that info.

I was disp to our local hospital for a emergent transfer to a larger hospital 27-30 miles away. Upon arrival you find a 80 y/o m pt in RM 3 that is intubated and has fluid running at 250 cc/hr, by orders of Dr, however, just before we transfer the pt to our cot the the nurse says that the last bp was 101/50, but just as we get ready to move the pt to the cot, the monitor shows a new bp of 75/30, and the nurse says as she increased the drip to W/O, that the pt has been running in the 80's and that she has been increasing the drip back and forth. To the that response the RT says I have had to suction fluid out of his tube 3-4 times. The orders for the trip are 250cc/hr, and 50% O2, per Dr in the ER. Enroute I suctioned the pt 2-3 times and bagged the pt with the pt breating against the BVM, and no one to help with the BP's but was still able to achieve, BP's hovered around 78-80's and the ER has said he was septic. I know what I did and I want on the info I told how you would have handled this run and remember the ER Doc hates EMS, and has expressed that we as useful as tits on a boar.

I don't know what happened after we delivered her to the larger hospital they treat us at this hospital like step kids, but she had a fever, but during the transfer she was AOX3 and had no troubles, so as far as that thats all I know and I thank everyone for your information and question I learned alot of different medical conditions that could be associated with this presentation.

We never found out about the BM, but I transfered her to a larger hospital about 2-3 Hours later and it was because they couldn't keep her BGL under control, and wasn't for sure why.

AZCEP, I'm not following you when you say I contraindicated by self, about the abd, when pressure is applied she dosen't respond to the area, dosent grab you had or try to guard her abd. The surgery site is by the RUQ, we have to call for RSI, and our MC refused RSI, pt remains combative and a BS is finally achieved, and reading is 21, pt is given D50 25 grams IV that was started in the EJ 18 ga, pt responds within mins and becomes AOX3 enroute to the hospital. Ok this is the first time I got a pt with temp and low bgl, they are usually cool, clammy, sweaty, and have had some seizures with the hypotension. I wrote to see what everyone else would do. Because this was a actual run just a few days ago at our service.

Did he get any new drugs, hx of asthma, family with gall bladder problems or may a is he a tall thin male

Pt remains combative as you leave family says ammonia level was elevated last check 1-2 days, and that is was just sleeping and they heard he start snoring and no can seem to find her meds, This is als unit, and np is nasal airway, pt had 98% on NRB @ 15 Lpm, unable to get glucose, monitor was dropped actually the pt threw the glucose monitor as it was getting setup to check a sugar, pt would be combative for a few seconds - mins stop posture and then without notice become combative again it seemed only stronger. I have me a paramedic, my partener emtb and FD driver. Pt snoring has decreased a little with the NP airway, but still has the snoring. Pt pupils are sluggish to light, but equal, BP is now 148/68, per partner. Pt still has good lung sounds. We are not able to get a temp. No guarding when abd checked and the surgery site has just minor brusing, no obvious signs of infection and whole body is hot. What else

Scene safe, PT is on NRB by FD and is 98% SPO2, PT is very warm to the touch and ashen in color, pt had a stent put in a artery in the liver to help with cirrhosis of the liver, pt is diabetic, pt is also givin NP, pt still snoring, and very combative, Nearest hospital 20-30 miles no helicopter, bad weather T storms. GCS 8 E4/V2/M2. Lungs are clear and no recent falls, no new meds, just liver stent placed 2 weeks ago. Has eaten as far as family knows, and has been checking her own BGL. What else

Dispatch: Medic 2 respond to a rural residence for a pt with ALOC and decreased resp, fever recent liver surgery. Upon arrival you find a 75 y/o female in bed supine with local FD, pt is combative, and it is everything they can do to keep her under control. Pt is having snoring respirations, and hot to the touch. BP 142/68, Resp 30 snoring. Decorticate Posture. What do you want else to know.