Ridryder 911 Posted December 30, 2007 Posted December 30, 2007 Treat people like they deserve to be treated, you DO NOT decompress a person whose sats and BP are above 90!!!!!! PERIOD!!!! Let me say this, I highly suggest that you either : A) Attend courses such as PHTLS/ITLS/ ATLS to further your education before making grossly and erroneous and harmful statements as you just did without any merit. Re-attend Paramedic school or possibly a refresher, so you understand that clinically significant tension pneumothorax can still have saturation's above 90 and as well maybe normotensive to even hypertensive. If one awaits for the symptomology of decreased saturation rates, tracheal deviation, and blood pressure to fall before taking action, then one will either not have to take any action at all or will be performing resuscitation measure. Please refrain from posting erroneous information and attempt to make sure statements are up to current medical standards. R/r 911
DwayneEMTP Posted December 30, 2007 Author Posted December 30, 2007 Dwayne, you've indicated that his BP was not known. First... That was the crucial vital sign that you missed and before all else, if you suspected that it was a tension, you should have obtained ATLEAST that, as well as a good spo2 reading ON high flow 02. Ok, let's retract our claws for a sec and take a look at this thing. Lord knows I have plenty to learn here... First, did you read the part where this wasn't my call? That it was a scenario I was given? And had it actually been my call I would have boneheaded it terribly? The only way to differentiate a pulmonary contusion, and tension pneumo is a chest x ray,... How about decompression as a diagnostic aid? LET ME SAY THIS TO YOU AGAIN, AND THIS IS WHERE THE POOR HISTORY COMES IN, you have indicated that this pt has a STRONG and FULL pulse, I may have stepped on my weenie here (Ok, if I could actually step on my weenie I probably wouldn't be trying to work for medic wages, but you know what I mean). I need to look into this further. If that was way off in the ditch, there was no vicious intent...It was simply a foolish thing to say, and I'll attempt to be more careful in the future. So until, you can give a better hx of a pt, expect some answers that you don't like in return!! There were no answers that I was looking for. My goal was knowledge. I had no preconceived notions of what form that knowledge would come in. Treat people like they deserve to be treated, I'm not sure where this statement came from. If I have a tension pneumo, I hope you would decompress it. ...you DO NOT decompress a person whose sats and BP are above 90!!!!!! PERIOD!!!! I don't have a lot of experience to argue with here. Do you have a ton of patients with cyanosis and sats in the 90's? I've had at least two patients with sats in the low 70's that were not cyanotic. Perhaps your experience has been different. Dwayne
Ridryder 911 Posted December 30, 2007 Posted December 30, 2007 Sorry Dwayne but this is not a clawful event. The information given to await a drop in oxygen saturation, and for the patient to be hypotensive before decompression is a gross and erroneous statement. If one did such as recommended could be found grossly negligent in patient care. Nothing personal; rather such statements should not had been made. Such actions and recommendations may lead to confusion for those studying EMT programs. Let's keep the forums and posts as medically accurate as possible. R/r 911
DwayneEMTP Posted December 30, 2007 Author Posted December 30, 2007 Back on track please. No name calling. Not sure how to post? Read the rules. http://www.emtcity.com/phpBB2/siterules.php Thanks Admin If this is in reference to firefighter and I...I'm all good. I have a feeling if we can someday pry firefighter away from his belief in 'absolutes' he's going to be first rate... I'm certainly not trying to tell you what to do, only to mention that I think I still have a lot to learn from this thread... Thanks for our great site! Dwayne
firefighter523 Posted December 30, 2007 Posted December 30, 2007 Rid I am sorry you feel that way. SPO2 below 90 on high flow 02 and a BP below 90 indicates, (not always) that the pt most likely WILL be altered enough to tolarate a needle, possibly 2, going into his chest. If he is not altered and his sats and BP are good enough to get him to a hosp before they can get him a cxr to differentiate the two, I will wait, and refrain from placing a needle into someones chest. WE DO NOT DO PROFILACTIC CHEST DECOMPRESSIONS!!!! IT SHOULD BE DONE IN AN EMERGENT SITUATION WITH UNSTABLE VITAL SIGNS!!! You call me a cowboy medic, but atleast I know when IT SHOULD BE DONE IN THE FIELD!!! It is barbaric to place a needle in a chest without sedation while they are sitting up looking at you!!!! Even if they are altered, with vitals above what I have stated, nobody is good enough to totally differentiate tension from contusion!!! BP less than 90 indicates poor cardiac output, Sats below 90 indicates poor oxygenation !!! Couple those two with a history of chest trauma and a person who is altered, then you may think about placing a needle or two. You NEVER cease to amaze me with your STUPIDITY rid!!!
DwayneEMTP Posted December 30, 2007 Author Posted December 30, 2007 Sorry Dwayne but this is not a clawful event. The information given to await a drop in oxygen saturation, and for the patient to be hypotensive is a gross and erroneous statement. If one did such as recommended could be found grossly negligent in patient care. Nothing personal; rather such statements should not had been made. Such actions and recommendations may lead to confusion for those studying EMT programs. Let's keep the forums and posts as medically accurate as possible. R/r 911 I agree completly Rid...My post wasn't aimed at you, I must have still been typing when you posted, so I didn't see your post until later. But, as someone else mentioned also...Would we expect to see the hypotension by the time this patient was cyanotic? Intuitively, I say no...that the pressure wouldn't be that great on the heart yet (Though I haven 't researched it) , or perhaps the hypotension would be secondary to hypoxia? Not sure. Did I bonehead the pulse s/s in the scenario? Dwayne
firefighter523 Posted December 30, 2007 Posted December 30, 2007 Dwayne, I know you are still going through class, don't argue with me, and then when you think I am right, pull the, "Oh I'm just a student yet" card to look for sympathy, and or to try to make me look bad! I see right through you!!
DwayneEMTP Posted December 30, 2007 Author Posted December 30, 2007 Again firefighter, for about the 12th time... Did this person, with sats in the high 90's, show obvious signs of cyanosis? Did you actually read the scenario? Or are you just hell bent on ignorant tantrums? Dwayne
firefighter523 Posted December 30, 2007 Posted December 30, 2007 IF THEIR SATS ARE IN THE HIGH 90S, THEN THEY PROBABLY ARENT GOING TO BE CYANOTIC. Whoever gave you this piss poor senario should wait in line behind you to finish CLASS!!!
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