nursing home nurses

[davidkinback]

i dont mean to be mean but it seems to me, some of these nurses are alittle on the dull side. ex. get called to nursing home. for difficulty breathing. when we get there you can hear the fluid in the guys lungs from across the room. i mean the guy sounded like shit. so i ask the nurse. how long has his lungs sounded wet like that? and this chick tells me ' well we just put a wet towel on him about two hours ago." and she said it with a straight face

[Jyannotti308]

Welcome to the Nursing home side of EMS. Some of these nurses are down right morons.

[Jyannotti308]

Welcome to the Nursing home side of EMS, Some of these LPNs are morons and some but not many of the RNs are dumb.

We have a nursing home that we are contracted with the likes to call us for "respiratory difficulties" all the time, most of these patients have trachs in, mind you im only BLS. I go into the room, the first thing I check is ABC's, the nurse is like "his o2 sats are 70% on 2 litres of nasal cannula" Anyone see a problem with that? LOL. Then I Inspect the trach a little more and low and behold its a mucus plug, grab the suction, suction the trach out with a yankur, remove the plug, apply o2 by peds mask to the trach area at about 10-15 lpm to get him back off on the right start again get his sats up and hes breathing well now. They still want him to go for an eval.

This is the ridicolus shit us "transfer techs" deal with on a day in day out basis. Mind you when Im on duty at the FD we get called to nursing homes to, and I couldnt begin to tell you, there.....

"

[VentMedic]

LOL. Then I Inspect the trach a little more and low and behold its a mucus plug, grab the suction, suction the trach out with a yankur, remove the plug, apply o2 by peds mask to the trach area at about 10-15 lpm to get him back off on the right start again get his sats up and hes breathing well now. They still want him to go for an eval.

"

I would definitely now send him to the hospital for evaluation and possibly some antibiotic coverage. Just curious, was the trach cuff inflated or deflated?

[Jyannotti308]

Okay. Why send him out for antibiotics because of the suction procedure used? In the county I work in BLS EMTs are not allowed to deep suction patients with soft tip, however in the county I run in on the FD (used to work for a private service in the same county) we were. This particular incident happend a while ago and I don't remember if it was inflated or deflated, I am leaning more towards Inflated since we were told it was stable.

JYannotti308

[VentMedic]

I asked about the cuff to see if there was a clue as to what type of airway device it was. There are about 300 different artificial airway devices on the market. Not all nursing homes are certified for certain airways. Some Montgomery stoma devices may be acceptable while others require at least a SNF rating. You stated that it was a NH and the pt was wearing a NC leads me to believe it may have be more of a Montgomery tube rather then an extended cannula device. You also did not mention an available humidification system with a trach collar which one might also believe the patient was able use his upper airway majority of the time. Thus, there could be more than a plugged trach causing the desaturation.

Was the patient able to speak? Did he have a speaking valve?

A cuff is NOT used to stabilize a trach. It is used to make a slight seal for ventilation purposes. Unless the person was on a ventilator at night, cuffed trachs are rarely used for long term. It is also a myth about the cuff preventing aspiration since the cuff is located below the cords.

The diameter of the yankeur can create problems if inserted into a trach. It can create atelectasis and suction trauma on the tracheal wall if the trach is angulated in an awkward direction or just a different anatomical structure is present such as in some of the post radical neck resections.

If the yankeur suction device was just laying around, it is loaded contaminants. They lay on the floor, in the bed,in the butt crack of the patients and are used to suction up just about any mess. Even for NHs and homecare, there are easy sleaved suction devices where you don't even have to know a thing about sterile techique. I always suggest those for transports since they are cost effective with their reuse capabilities.

If the patient did have a Shiley, Portex or Bivona trach with an inflated cuff and was wearing a NC, I would take the patient in for some serious humidification and mucolytic therapy along with a CXR to check for more complications. This would also alert the hospital staff to contact the NH and send some educational material before this happens again.

You mentioned this happened before. Anytime you have patients either at home or in a facility with special devices and equipment if is good to get all the information you can about it. You can have your supervisor request an inservice. Then, you'll be better prepared to quickly assess. You might also be able to make valid points to the physicians so that a followup is done at that facility to improve their system for caring for long term artificial airways.

There are many things to assess with a patient who has an artificial airway. These patients are rarely just a "respiratory" patient but a multi-system time bomb. SpO2 will only give you a small view of the whole picture. Many times healthcare providers do get distracted by a "trach" and forget about all the other systems that are needing a little attention.

Edit note:

Damn, I just realized this post was listed under FUNNY STUFF. Although, I rarely pass up the opportunity to get people thinking about airways no matter what their level of certification or what category the post is in.

[Richard B the EMT]

This seems to be a mention of an error done on the part of the facility staff, not really anything funny.

[itku2er]

Here We go again........ I will defend one of my professions I said it once I will say it again.

There are good and bad in every profession, Why dont you guys for a change do a thread picking on the MEDICS that dont know shit? Or the BLS crew that was gonna put a patient that had fallen on a back board and not strap them down? My personal favorite is the MEDICS that pick up a patient that is bleeding out and never attempted and IV.

Like I said there is good and bad in every profession......its just that some of NURSES are good nurses WE CARE and do the best we can for our patients. Then its people LIKE you all that destroy the good ones and make our jobs harder.

Come spend the day with me davidkinback I will show you how some of us DO that job.

ITK

[kysmokeeater62]

my favorite is when you show up and the pt is DOA and you asked how long they have been this way and they say 10 min.....really Rigormortis sets in little after 10 mins sweet heart

[mobey]

my favorite is when you show up and the pt is DOA and you asked how long they have been this way and they say 10 min.....really Rigormortis sets in little after 10 mins sweet heart

Deathonline.net/decomposition says Rigor sets in approx 3 hrs after termination of blood flow.

Deathreferance.com says 2-6hrs

www.deathreference.com/Py-Se/Rigor-Mortis-and-Other-Postmortem-Changes.html

My personal experience tells me it's definatly not within 1/2 hr, I have transported bodies for the coroner from scenes before and never have seen rigor.

Where do you get your info?