Disrespect from doctors

[jjones1418]

Agreeeeeee with 'zilla. Find some other etiology of his unconsciousness if that flumazenil didn't reverse it. It at least means you didn't cause it with 5mg of versed IM. Hahaha. That's not too much versed at all. You did what ya had to do.

Smile and walk away.

J. Jones CC/NREMT-P, FP-C

[Medic26]

"Some docs are just a$$wipes.

Agreed, but Nurses, Doctors, Medics......there is a few in every bunch.

Treat every doctor you encounter like a moody & hormonal woman......but there will still be times when you walk away scratching your head wondering what you did to deserve the comments made.

[fiznat]

hahaha nicely put, medic26, nicely put.

[Dustdevil]

I realise this isn't really a "scenario" for us to ponder, but I'm still kinda hung up on it, myself. A little more insight might help us figure out if there was any real reason for the doc to be upset. What was the patients respiratory rate post ictally? I mean, if you dropped his rate to 2 and shallow, and did nothing to assist, then yeah... there is a legitimate concern here. Not that this would justify him being a dick like that, but at least I could see why he might be annoyed.

I actually did buy a guy a tube last year. When the anaesthesiologist started tubing, the surgeon was like, "Uhhh... WHY are we intubating now?" Anaesthesiologist calmly said, "A little medication overdose." Surgeon replies, "Oh, okay." Discussion over. Nobody freaked out or started screaming and waving their arms. Nobody started pointing fingers or lecturing. We all just went about the business we were there for, and all learned a lesson from it. Amazing how, in the middle of utter chaos, pretty much everybody out here manages to remain professional. Even more amazing that the doc in your case, with one patient to worry about, goes off the deep end instead of just keeping his head in the game. Some people...

The old 'scratch your head with one finger' move is always appropriate in such cases. If you wear glasses, the old 'middle finger glasses push-up' is even better.

[NREMT-Basic]

I had a patient earlier this year that was in full tonic-clonic when we got to him....seizing on concrete and jumpin like he was hooked to a car battery. Mind you none of the rescue personnel on scene was making any effort to do anything. In the process of packaging him he become conscious though not A/O. Someone came out of the building he had just been in (beer and phenytoin...yum) and said that he has smacked his head on fire hydrant as he fell the first time and this matching perfectly with the mongo lac on his scalp. For me, this bought his him some c-spine action with a no-neck and a long board. We transported him to the ER, basic supportive care, med starts a line in left A/C, no meds given per med control while en route. When we rolled in a signed him over, I left the room to write it up, came back and a PA had taken him off the board and out of the collar. When I questioned why this was done without clearing him when we had a known head contact with hard object plus the seizing on pavement, the PA said "I know a screwed up neck when I see it. He's fine." I asked him if I could quote him in my PCR and suddenly he was calling for assistance to re-collar and board the patient. Go figure. I did tell him though that he should use the hospital's board cause the paramedic wanted ours back. I didnt know anyone's face could turn that read without stroking out. He was also upset because the medic had assessed what he believed to be flail chest (though I wasnt so sure) and had written with a black sharpy on the patient's chest "possible right flail chest." They dont like that in the ER I gather from the way the PA questioned the parental lineage of the medic. In the trauma bay and in the box are two different matters, Ive learned. Another seizure pt had two episodes of emesis in our presence and then a third one as we rolled him in to ER. He started gagging, I hollared for some assistance, didnt get it, unstrapped him, log rolled him and let him blow chow on the wall paper. Some times you just have to smile and nod.

[fiznat]

I realise this isn't really a "scenario" for us to ponder, but I'm still kinda hung up on it, myself. A little more insight might help us figure out if there was any real reason for the doc to be upset. What was the patients respiratory rate post ictally? I mean, if you dropped his rate to 2 and shallow, and did nothing to assist, then yeah... there is a legitimate concern here. Not that this would justify him being a dick like that, but at least I could see why he might be annoyed.

I agree, but this wasn't the case (give me some credit!). Vitals in transport were:

BP 100/70

HR 124

RR 26

SPO2 91 (on 15 lpm O2 NRB)

ETCO2 30 with normal waveform

The guy was belly breathing a bit and in general his respirations did look a little odd. They commented about it at the hospital also, but nobody bagged him until right before they intubated (half hour later or so). I chalked his respiratory "difficulties" up to an altered mental status, which I believed would improve as he got farther away from the time of his seizure. Besides, his sat wasn't THAT bad and there seemed to be good gas exchange as evidenced by the ETCO2.

After a half hour and the routine stuff in the ED his sat was down to 87, so thats when they decided to intubate.

I do wonder if perhaps he aspirated something while seizing, or maybe had some other infectious problem going on since he was very hot. Temp read at 102* in the ED.

I will try and follow up today when I go back into work, but I might not be able to since we never got any demographics for the guy. I will try though.

[NREMT-Basic]

I was taught (please correct if I was taught incorrectly) that a elevated core temp is common in post-ictal patients. The two most recent that I have seen were both very hot (in the 102-103 range) with extremely dry skin. The paramedic not so PC referred to it as "shakin and bakin' " and both had O2 sats in the high 80s-low 90s on room air. Both sat and core temp improved in both with 12-17LPM via NRB. Can someone tell me for reference what causes the elevated core temp and low sats? Is it a CNS reponse and is it as common in post-ictal seizure patients as we were taught?

[fiznat]

It could be a CNS thing, or also because people are exerting themselves quite a bit during major seizures. Even still though, these temps were measured a good 30 minutes after the patient's last seizure, and - I believe - he should have come down by then. The low SPO2 is not normal as far as I know.

[AnthonyM83]

I don't know if this is the best way....but I'm starting to figure out that the best reply to criticism to be able to immediately quote a protocol and your patient data.

Doc: It's your fault

You: For pushing the 5 of Versed? (gotta get clarification first, either to find out if THAT was the problem and/or to box him into an answer)

Doc: Yes

You: Nope, protocol's fault. We're not allowed to disregard them.

(a time when strict protocols can actually be good...to defend yourself).

But maybe that's just me being argumentative.

Also, I imagine the tighter knit community, the easier it is to not go off on (perceived) mistakes...if he knows he won't see you again for a month, he might not feel like (what he feels is) wasting his time with another random medic. Doesn't help things for doc, medics, or patients....but I've seen this with FFs interacting with EMTs.

[mrmeaner]

I actually did buy a guy a tube last year. When the anaesthesiologist started tubing, the surgeon was like, "Uhhh... WHY are we intubating now?" Anaesthesiologist calmly said, "A little medication overdose." Surgeon replies, "Oh, okay." Discussion over. Nobody freaked out or started screaming and waving their arms. Nobody started pointing fingers or lecturing. We all just went about the business we were there for, and all learned a lesson from it. Amazing how, in the middle of utter chaos, pretty much everybody out here manages to remain professional. Even more amazing that the doc in your case, with one patient to worry about, goes off the deep end instead of just keeping his head in the game. Some people...

...when they don't know how to fix the problem at hand, they look for a cause that they can blame on someone else?