What did EMS miss if anything

[RomeViking09]

I was on my Paramedic clinical rotation a week or two ago, we got dispatched to a call for a 2 car MVC, on scene one car had rear ended another at low speed, 2 persons in each car both with seat belts, minor damage to both cars no airbag deployment, no complaint of neck or back pain from any of the 4 patients on scene. Both of the front car passengers signed refusals, the rear car a 80ish year old lady was driving her 90 y/o husband to the ER for general weakness when she hit the other car at the red light. She signed a refusal with no medical complaint but requested we transport her husband to the ER. After assessment and history the patient was a 90 y/o Male with minor chest pain about 4 hours ago that went away with 1 NTG. 12-Lead showed NSR @68 no ST depression or elevation, no other findings, no CP at that time just felt weak. VS all within normal limits for age and history, INT established, placed on 3 L/min O2 by NC, and transported non-emergency to the ER. find out the next week that he died 2 days latter. What if anything could have been missed by EMS in this patient. (also checked BGL, and temp in addition to classic vitals, ECG & SpO2)

[Aussieaid]

I was on my Paramedic clinical rotation a week or two ago, we got dispatched to a call for a 2 car MVC, on scene one car had rear ended another at low speed, 2 persons in each car both with seat belts, minor damage to both cars no airbag deployment, no complaint of neck or back pain from any of the 4 patients on scene. Both of the front car passengers signed refusals, the rear car a 80ish year old lady was driving her 90 y/o husband to the ER for general weakness when she hit the other car at the red light. She signed a refusal with no medical complaint but requested we transport her husband to the ER. After assessment and history the patient was a 90 y/o Male with minor chest pain about 4 hours ago that went away with 1 NTG. 12-Lead showed NSR @68 no ST depression or elevation, no other findings, no CP at that time just felt weak. VS all within normal limits for age and history, INT established, placed on 3 L/min O2 by NC, and transported non-emergency to the ER. find out the next week that he died 2 days latter. What if anything could have been missed by EMS in this patient. (also checked BGL, and temp in addition to classic vitals, ECG & SpO2)

He most likely died from complications of old age versus anything from the accident although the stress of the accident may have compromised him further. He was 90 years old and she was transporting him for general weakness which could be from a myriad of causes at his age. Whatever the cause, it is more likely what he ultimately succumbed to rather than the accident.

I don't think EMS necessarily missed anything from what you tell us was done. If they had missed something vital he would probably have died before 2 days after the event.

Cheers!

(Edited for a "senior moment"!!)

Edited December 7, 2010 by Aussieaid

[RomeViking09]

Agreed, just subject to classmates saying I missed something in assessment or did not "treat" the patient as needed. My personal view is he was old and dying, now as far as 90 y/o patients go he was very healthy and I hope to be that healty at his age. But I want some input on what else if anything someone would do that I might have missed.

[mobey]

Tell them he died of a ruptured AAA.

Case closed.

If you missed something emergent that was going to cause death, the ER would have picked it up and treated it.

Armchair quarterbacking without all the facts including cause of death is so unprofessional. As students they need to learn that lesson.

[fiznat]

What was the cause of death?? How can we even guess about what you may have missed if we don't have that....

[Just Plain Ruff]

I was on my Paramedic clinical rotation a week or two ago, we got dispatched to a call for a 2 car MVC, on scene one car had rear ended another at low speed, 2 persons in each car both with seat belts, minor damage to both cars no airbag deployment, no complaint of neck or back pain from any of the 4 patients on scene. Both of the front car passengers signed refusals, the rear car a 80ish year old lady was driving her 90 y/o husband to the ER for general weakness when she hit the other car at the red light. She signed a refusal with no medical complaint but requested we transport her husband to the ER. After assessment and history the patient was a 90 y/o Male with minor chest pain about 4 hours ago that went away with 1 NTG. 12-Lead showed NSR @68 no ST depression or elevation, no other findings, no CP at that time just felt weak. VS all within normal limits for age and history, INT established, placed on 3 L/min O2 by NC, and transported non-emergency to the ER. find out the next week that he died 2 days latter. What if anything could have been missed by EMS in this patient. (also checked BGL, and temp in addition to classic vitals, ECG & SpO2)

I thnk you all missed the spectre of the Grim Reaper sitting next to the patient in your ambulance. Didn't you see Grim's Shadow? Surely those students who are saying you missed something would have seen that spectre right?

Tell your fellow students to STHU

[DwayneEMTP]

Good question I think, and interesting.

One issue that I have though, what are normal limits for vitals signs for a 90 year old male? Particularly one complaining of transient chest pain and generalized weakness?

What do you suppose the odds are of a 90 year old that TRULY has no previous history? I've had some, and was shocked to my core each time, but never accept that when told by this age group without extensive investigation.

Just curious.

You've already trumped your classmates by being brave enough to come here and hang your business out where strangers (Notice I didn't say perfect strangers) can judge you. So far they are still hiding in class talking out of their collective asses... don't go backwards now man..

Don't bail on this thread just because you caught a little criticism, get your ass back in here an participate! Trust me on this...

Agreed, just subject to classmates saying I missed something in assessment or did not "treat" the patient as needed. My personal view is he was old and dying, now as far as 90 y/o patients go he was very healthy and I hope to be that healty at his age. But I want some input on what else if anything someone would do that I might have missed.

I think that you did miss some things, and shame on your for "My personal view is he was old and dying..." , because if that was your mind set after developing your initial impression then that sets you up for doing really bad medicine. And have you ever seen an official diagnosis of 'old?' Old could mean long term coronary, pulmonary, vascular, neurological degradation or those things could simply be the herd of horses that you're supposed to pick the zebra out of, right?

I don't think that there were any skills that you didn't perform that you should have. But for your future medic career I think that there are perceptions that could be changed and degrees of suspicion that can and should be added for all of your 'obvious' patients.

Good question man...

Have a good day. Dwayne

Edited to ad everything after the quote. And again for a grammatical error.

Edited December 7, 2010 by DwayneEMTP

[HERBIE1]

Most likely the patient suffered from too many birthdays. I would say the MVC had nothing to do the eventual outcome- especially if he died 2 days later. I don't see anything EMS may have missed. The crash was minor, so I don't suspect a missed injury, but anything is possible, I guess.

Nothing wrong with exploring other possibilities so I'm not sure why the OP received grief for it. If something was missed, then it could be a teaching moment.

[ERDoc]

Without knowing the cause of death, there is no way to judge the OP right or wrong. For all we know, the guy was being discharged from the ER, slipped on a wet floor on the way out and ended up with a epidural. Let's say it was something cardiac. Is there anything else he could have done that would have made a difference? Nope, not likely. Was there a traumatic injury that killed him? If there was, what can EMS do about it? Bring the pt to the ER and that is what was done. I don't think anyone can say that something was missed or done wrong. That is the joy of medicine, even when you do everything right, people still die. It may have just been his time.

[Aussieaid]

90 y/o husband to the ER for general weakness when she hit the other car at the red light. She signed a refusal with no medical complaint but requested we transport her husband to the ER. After assessment and history the patient was a 90 y/o Male with minor chest pain about 4 hours ago that went away with 1 NTG. 12-Lead showed NSR @68 no ST depression or elevation, no other findings, no CP at that time just felt weak. VS all within normal limits for age and history, INT established, placed on 3 L/min O2 by NC, and transported non-emergency to the ER. find out the next week that he died 2 days latter. What if anything could have been missed by EMS in this patient. (also checked BGL, and temp in addition to classic vitals, ECG & SpO2)

I think that you did miss some things, and shame on your for "My personal view is he was old and dying..." , because if that was your mind set after developing your initial impression then that sets you up for doing really bad medicine. And have you ever seen an official diagnosis of 'old?' Old could mean long term coronary, pulmonary, vascular, neurological degradation or those things could simply be the herd of horses that you're supposed to pick the zebra out of, right?

I don't think that there were any skills that you didn't perform that you should have. But for your future medic career I think that there are perceptions that could be changed and degrees of suspicion that can and should be added for all of your 'obvious' patients.

I can't think of anything that should have been done that was not done according to the OP's report so not sure what you think he missed? You also have made an assumption that because he realized the pt was old and (probably) dying that he did not work them up adequately whereas it seems that the appropriate treatments and measures were taken. (i.e. 12 lead looking at the chest pain as well as treating as a trauma pt as far as I can tell). He may have been looking back in hindsight and understanding that the pt's co-morbidities were the cause of his death versus any lack of care on the medic's part. It is also an assumption that taking note of his age and condition caused them to decrease their level of suspicion for occult injuries and complicating factors whereas he did not say whether or not it may have instead raised their alertness to more potential complications. He was obviously taking into account the geriatric considerations or else he would not have been saying that "as far as 90 y/o patients go he was very healthy and I hope to be that healty [sic] at his age".

Without knowing the cause of death, there is no way to judge the OP right or wrong. For all we know, the guy was being discharged from the ER, slipped on a wet floor on the way out and ended up with a epidural. Let's say it was something cardiac. Is there anything else he could have done that would have made a difference? Nope, not likely. Was there a traumatic injury that killed him? If there was, what can EMS do about it? Bring the pt to the ER and that is what was done. I don't think anyone can say that something was missed or done wrong. That is the joy of medicine, even when you do everything right, people still die. It may have just been his time.

Exactly! The question the OP was asking was what else could they have done and was it possible they missed something that resulted in his death. I didn't see anything listed in their treatments that indicated they missed something that resulted in his death or else I believe in all likelihood he would not have lasted a couple more days. It seems they provided appropriate care for all his possible conditions/co-morbidities and I don't see anything else that should have been done prehospital that wasn't.

Cheers!