GI Bleed =12 lead?

[crotchitymedic1986]

Boy, you guys are going a long way to justify poor patient care. Let me clarify it this way: Is there any one in this room that would not have transported this patient, based on the baseline vital signs that were presented ?

There is a reason the supervisor "dinged" this crew, and it was justified ---- IF the supervisor contacted the patient, which i am sure they did, and found that they patient REFUSED transport, I doubt they would have received the "ding". If the OP wishes to come back and tell us that they tried everything humanly possible to get this patient to go to the ER via EMS, then I will accept that the patient refused AMA -- but if the OP is honest, I doubt you will ever read that quote. Maybe they didnt talk her out of going, but i doubt they tried real hard to convince her to go by EMS.

[crotchitymedic1986]

And to the medics who actually ran the call: I am not on a high-horse judging you. We all make mistakes, it doesnt make you evil or incompetent because you made a mistake. All I or anyone else can ask is that you learn from your mistakes, and not repeat them. Thanks for sharing the call, so that others may learn from that mistake. You wont be the first or last to leave a patient at home, that should have been transported.

[spenac]

Boy, you guys are going a long way to justify poor patient care. Let me clarify it this way: Is there any one in this room that would not have transported this patient, based on the baseline vital signs that were presented ?

There is a reason the supervisor "dinged" this crew, and it was justified ---- IF the supervisor contacted the patient, which i am sure they did, and found that they patient REFUSED transport, I doubt they would have received the "ding". If the OP wishes to come back and tell us that they tried everything humanly possible to get this patient to go to the ER via EMS, then I will accept that the patient refused AMA -- but if the OP is honest, I doubt you will ever read that quote. Maybe they didnt talk her out of going, but i doubt they tried real hard to convince her to go by EMS.

First and fore most you need to watch accusing someone of trying to justify poor patient care. I have never justified poor care and I do not stand for poor care. I give and insist those that work with me give the best care. Would I have transported this patient, yes unless patient refused to let me which is what it sounds to me happened. Op never said they did not want to transport. Did OP or his partner talk patient out of going, does not say so we do not know. Thus you are using speculation and claiming a fact.

Second I have never seen a supervisor contact a patient to ask what happened to base discipline on. In fact I bet in most services they don't as it might give patient reason to think something was done wrong and lead to a lawsuit. In fact I bet the owners of most services would fire any supervisor that did.

You by your words have proven you are assuming a whole lot of things when very little was actually stated. Honestly it makes you sound arrogant and sadly ignorant. I am not trying to insult just to help you realize that when you present like a fact something that is not to be found really borders on well never mind. Now had you left it at a statement such as in my experience often I have seen this or that, but you have made it sound like you have a lot more facts by saying they did or did not do something.

[crotchitymedic1986]

We shall see ............................. Supervisors dont typically "ding" innocent medics --- if the patient refused to go, there is nothing to ding them for. I am not assuming, just reading between the lines. If I am wrong, I will be the first to admit it -- hope you will do the same.

[spenac]

We shall see ............................. Supervisors dont typically "ding" innocent medics --- if the patient refused to go, there is nothing to ding them for. I am not assuming, just reading between the lines. If I am wrong, I will be the first to admit it -- hope you will do the same.

Actually some supervisors do. Sounds like you have only dealt with perfect supervisors. I have seen supervisors go around trying to get people to write up fake incidents on employees they don't like so they would be able to discipline them. So there are supervisors that do ding just to ding, maybe it makes them feel important.

I'm not reading between the lines only commenting on the few facts we have unless I prefaced with something that showed I was giving opinion rather than fact.

There is no problem expressing your opinion or even thoughts on how it may have gone down just make it clear that is what you are doing. State well reading between the lines it would seem....................... Then we all read its your thoughts not some fact that we missed.

[Mateo_1387]

Mateo, I realize you are new, but unfortunately lazy medics leave patients behind all the time. It is easy to see, although the OP will deny it, that this patient was talked out of going to the hospital via EMS.

I think you should go back and read what the OP said. Nowhere did the OP state anything about transport. Now, the original thread is about the usefulness of 12 leads with patients who have GI bleeds. EMS49393 gave a good write up as to why a 12 lead would be applicable to a patient having a GI bleed.

...they should have realized that this patient was very sick with just the basic vital signs that they had.

Agreed

Note the OP did not say that the patient refused EMS transport after several minutes of us begging her to go, and getting a supervisor involved.

In fact, he never said anything about the patient going to the hospital at all. Its a moot point. From what I can tell, EMS49393 did not go via ambulance to the hospital. Why, we do not know. It is a waste of time to hash this out.

The OP wrote the question as if, "we did everything we could, do you think a 12 Lead would have showed us how critical the patient was ?" You didnt need a 12 Lead to see that.

Lets say the 12 lead shows ischemia in the heart, then the 12 is showing you that your patient is even more sick than you probably realized. I agree that your senses should be used, but when given the tools, I think you should use them when indicated. That is one of the reasons this is not a basic call, which is what I thought was an ignorant statement on your part.

But typically, a GI bleed can be handled by any EMTI that can start an IV. If your system wishes to use an ALS unit (which would have also just started the fluid bolus), so be it.

No NoNoNoNoNoNoNoNoNoNoNoNoNoNo!

You do not get it. I realize you have been doing this for a long time, but unfortunately, an EMT-I cannot give the same assessment and care that a paramedic can give. Shoving these calls on basic and intermediate units is going to cause people to fall through the cracks. That, to me, is lazy. These patient may beneift from treatments such as fluid boluses, ECG monitoring, a 12 lead ECG acquisition and interpretation, NG tube, pain meds, and an antiemetic. I am not aware of any intermediates that can do all of these treatments.

Boy, you guys are going a long way to justify poor patient care.

On the contrary, we have advocated quality patient care, where you have stated that a 12 lead is at the bottom of the list for GI bleeds and these patients do not deserve paramedic treatment en route to the hospital.

Thanks for sharing the call, so that others may learn from that mistake. You wont be the first or last to leave a patient at home, that should have been transported.

I still have not seen a big mistake made. You are assuming a mistake was made with no evidence.

[spenac]

You do not get it. I realize you have been doing this for a long time, but unfortunately, an EMT-I cannot give the same assessment and care that a paramedic can give. Shoving these calls on basic and intermediate units is going to cause people to fall through the cracks. That, to me, is lazy. These patient may beneift from treatments such as fluid boluses, ECG monitoring, a 12 lead ECG acquisition and interpretation, NG tube, pain meds, and an antiemetic. I am not aware of any intermediates that can do all of these treatments.

Darn I hate to say something about this to somebody that is helping make my point. I do all those things as an EMT-I. But I am in the minority. Sorry.

[crotchitymedic1986]

again, you are misreading what i typed --- i never said that this patient should not receive ALS, I merely pointed out that a EMTB-I should be able to recognize compensatory shock. My point was that even in a BLS system, this patient should have received EMS transport to the hospital. And for the record, a BLS unit that transported the patient during the initial 911 call and only started an IV and O2, would have been preferrable to an ALS transport hours later, after the patient deteriorated to having CHF.

[WolfmanHarris]

I just grabbed the EMT-B text I was required to buy (not sure why as we never referenced it in class, only Bledsoe) Brady's "Emergency Care: 10th edition" by Limmer and OKeefe. There are a total of 3 pages on shock and not written in any real detail. And I quote:

"Compensated shock: The body senses the decrease in perfusion and attempts to compensate for it. For a time the body's compensating mechanisms work and blood pressure is maintained. Some early signs of shock are actually caused by the body's compensating mechanisms at work. You will note an increased heart rate (to increase blood flow) and increased respirations (to increase oxygenation of the blood). Constriction of the peripheral circulation (to redirect blood to the vital core organs) results in pale, cool skin and in infants and children increased capillary refill time.

Decompensated shock: At the point when the body can no longer compensate for the low blood volume or lack or perfusion, decompensated shock begins. Late signs such as falling BP develop.

Irreversible shock: Irreversible shock exists when the body has lost the battle to maintain perfusion to the organ systems. Cell damage occurs, especially in the liver and kidneys. Even of adequate vital signs can be restored, the patient may die days later due to the failure of irreparably damaged organs."

The rest of what is written on shock isn't really consequential to this discussion.

So if this is what Basics are taught and assuming most aren't as dedicated, professional or interested in furthering their education as many of those who grace this board, then I can see that individual basics should easily recognize stages and types of shock. But that Basics as a group likely won't. Not if this is the extent of the theory training they get.

[Doczilla]

Something else to add here is to question the diagnosis of "GI bleed". There are plenty of care providers who would see a small amount of blood in vomit and label it a GI bleed, when that's really not the problem at all. "They vomited twice, then the third time there was blood in it. It's a GI bleed."

I agree with the other comments here about significant bleeding being a stress test. If there are ischemic changes on the EKG, this is cause for emergent transfusion of uncrossmatched blood. The EKG can tell you to some extent if the patient is tolerating the anemia or not. No, the 12 lead shouldn't take precedence over basic stabilization, but should be on the list.

Regarding EMS49393's post, perhaps it was NOT a gut feeling that prompted them to recommend transport, but appropriate assessment. The patient had patently abnormal vitals. Unless you're a screaming 4 month old, a pulse of 130 is abnormal. RR of 24 should raise red flags too. Unless I'm reading too far into this, it sounds like appropriate advice was given by the medic to accept transport and the patient refused (we can only go so far to encourage people not to make stupid decisions).

'zilla