Pediatric respiratory care

[MariB]

Mari, that is because you haven't been with a volley on the east coast. At my VAC, if you didn't have a crew chief, the ambulance didn't move, even if you had 5 EMTs. Luckily we saw the problems with this and did away with it. It was actually pretty funny at times. We had this one 21 year old stereotypical blonde who they made a CC (I'm going to use the abbreviation since we've established what it means in this thread). No one had much respect for her (it was deserved). People who were much better EMTs than her would pretty much ignore her on calls and do what they needed to do. She would come back to HQ after the call with her face crunched up and stomp around saying, "I'm the crew chief. You are supposed to listen to me." I think she was one of the main reasons we got rid of CCs.

lol wow. On calls we have a driver, primary and sometimes a secondary. If the dispatch complaint is bad, a medic goes to scene.

Where I live I'm usually second to arrive and lately have been primary caregiver. Does that mean I make all the decisions? Well. No we will bounce ideas off each other , but in the end it is my signature on the pcr. So ultimately I have to make the final decision. If a medic comes I put in my paperwork " treatment such and such given by PS "

[ERDoc]

LOL, yeah, it's that bad. Like I said, the VAC I was with was pretty progressive and looked for ways to improve. We finally decided that the best policy was an EMT and anyone else. That way the other person could drive. You had to be "driver certified" to drive but that was waived in the event there was no one else to drive but they were not allowed to go L&S.

[island emt]

I'll wager a bet the CC is the one with all the whacker lights on his vehicle. It is NJ after all. :-}

[musicislife]

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I'll wager a bet the CC is the one with all the whacker lights on his vehicle. It is NJ after all. :-}

ill try to snap a pic. It's a Christmas tree on wheels

[MariB]

The kid might have looked at the paper cup and said " seriously?"

[MikeEMT]

While I agree with the other posts about the NRB I am going to play devils advocate here for the sake of discussion. I find it doubtful that the CC is incompetent and would do anything to harm the patient (maybe they are, I don't know). So this leads me to question your facts and whether you have the knowledge to treat the patient or if your using textbook medicine.

The patient was apparently having an Asthma attack and had an SpO2 of 89%. What were the kids vitals? Did you auscultate the lungs? Did the patient have a hx of asthma? Skin condition? Hot to touch? Audible sounds?

I could be wrong but it sounds to me like you focused strictly on the SpO2 reading and not the entire condition of the patient. In my system we don't use SpO2 for this reason, we give oxygen only when medically necessary and to be honest when I first started I hated not having Spo2 readings though I find we have better care and better outcome when not relying on SpO2 reading.

The other thing is maybe the CC was angry because he was testing you. Maybe he wanted to see if you could defend your actions. I have rolled into an ER numerous times only to be yelled at by doctors and nurses for either doing something or not doing something.

One of the lessons you will learn is regardless of what your protocol or book says, you need to be able to back up and defend your actions. Maybe, the attitude of the CC wasn't to come down on you but to see if you could defend yourself. I have not heard anything from you that supports your actions except for the SpO2 reading.

[MariB]

While I agree with the other posts about the NRB I am going to play devils advocate here for the sake of discussion. I find it doubtful that the CC is incompetent and would do anything to harm the patient (maybe they are, I don't know). So this leads me to question your facts and whether you have the knowledge to treat the patient or if your using textbook medicine.

The patient was apparently having an Asthma attack and had an SpO2 of 89%. What were the kids vitals? Did you auscultate the lungs? Did the patient have a hx of asthma? Skin condition? Hot to touch? Audible sounds?

I could be wrong but it sounds to me like you focused strictly on the SpO2 reading and not the entire condition of the patient. In my system we don't use SpO2 for this reason, we give oxygen only when medically necessary and to be honest when I first started I hated not having Spo2 readings though I find we have better care and better outcome when not relying on SpO2 reading.

The other thing is maybe the CC was angry because he was testing you. Maybe he wanted to see if you could defend your actions. I have rolled into an ER numerous times only to be yelled at by doctors and nurses for either doing something or not doing something.

One of the lessons you will learn is regardless of what your protocol or book says, you need to be able to back up and defend your actions. Maybe, the attitude of the CC wasn't to come down on you but to see if you could defend yourself. I have not heard anything from you that supports your actions except for the SpO2 reading.

OK, if you don't want to go by spo2, which we only use as a tool itself plus condition of patient, then the child was obviously in respiratory distress. If the child didn't have a history of asthma I think the op would have stated it was a call for trouble breathing. So. With asthma you will hear the tell tale wheezing, low spo2 levels from inability to exhale and the child will be in the tell tale positioning for trouble breathing.

So oxygen would be a correct drug of treatment

No days with what we all know about using too much O2, I think not having a pulse ox and using it as a tool is irresponsible for any local protocol. As I said, it is too be used as a tool only.

Let's not forget his cc never questioned his use of O2, just his choice of how he administered it.

[musicislife]

/>

The kid might have looked at the paper cup and said " seriously?"

yup, that and he might be creeped out by the blow by teddy bears we have on our rig, they're scary looking

[chbare]

While I agree with the other posts about the NRB I am going to play devils advocate here for the sake of discussion. I find it doubtful that the CC is incompetent and would do anything to harm the patient (maybe they are, I don't know). So this leads me to question your facts and whether you have the knowledge to treat the patient or if your using textbook medicine.

The patient was apparently having an Asthma attack and had an SpO2 of 89%. What were the kids vitals? Did you auscultate the lungs? Did the patient have a hx of asthma? Skin condition? Hot to touch? Audible sounds?

I could be wrong but it sounds to me like you focused strictly on the SpO2 reading and not the entire condition of the patient. In my system we don't use SpO2 for this reason, we give oxygen only when medically necessary and to be honest when I first started I hated not having Spo2 readings though I find we have better care and better outcome when not relying on SpO2 reading.

The other thing is maybe the CC was angry because he was testing you. Maybe he wanted to see if you could defend your actions. I have rolled into an ER numerous times only to be yelled at by doctors and nurses for either doing something or not doing something.

One of the lessons you will learn is regardless of what your protocol or book says, you need to be able to back up and defend your actions. Maybe, the attitude of the CC wasn't to come down on you but to see if you could defend yourself. I have not heard anything from you that supports your actions except for the SpO2 reading.

You do not monitor pulse oximetry at all? I can think of several situations where pulse oximetry is indicated and even what may be considered a standard of care such as during intubation or when attempting to decide if you want to intubate. For example, if you are not able to effectively bag the patient to saturations above 90%, you would have a difficult time justifying the intubation/RSI.

[MariB]

You do not monitor pulse oximetry at all? I can think of several situations where pulse oximetry is indicated and even what may be considered a standard of care such as during intubation or when attempting to decide if you want to intubate. For example, if you are not able to effectively bag the patient to saturations above 90%, you would have a difficult time justifying the intubation/RSI.

not to mention over oxygenation during codes, trauma or other heart issues

When on a code we do our best to keep o2 SATs about 92 to 95. Same with heart and traumas... pts seem to have a better out come if you aren't pumping them full of O2.

We use pulse ox on all calls, but yes, we do look at the whole picture.