miscusi Posted July 29, 2013 Posted July 29, 2013 I don't know why you are all so scared. I'm not scared. I am prepared to do my job... which is..... get him to the hospital so he can get the life saving treatment ? I have been to plenty of these calls just like this, (minus the metal part). its very standard. Air and chair, Air and chair... but as I said, ALS would do more.
MariB Posted July 29, 2013 Posted July 29, 2013 /> "57 yo, male, in sitting position c/o coughing and spitting up copious amounts of thick yellow secretions. Pt is looking gray. mother states he had surgery a month ago. coughed up blood and a piece of metal two days ago. Pt appears weak." well Im not saying he's healthy. but this isn't really so bad..... because.... He's sitting, that's good. he's coughing, that's good, looks grey, (but sitting) not so bad, the surgery was a month ago, not bad, the coughing up of a piece of metal was 2 days ago ( if it even really happened at all, senior citizen's story is not always reliable ), that's not bad... what the pt really needs is a doctor. so if he survived the last 48 hours after the metal cough, he can do 10 more minutes on the way to the hospital. The piece of metal coughed up was a stent.! The area is severely infected. He is in danger of losing his airway. He is septic, the infection is through out his body. Did you read what the vitals were? People die sitting up, doesn't mean squat. I would keep him sitting for breathing, but torn because I want to start treating him for shock! His airway comes first though. I would be preparing to assist ventilations and you are thinking you might call ahead. Eh. If it is his lucky day. I don't know why you are all so scared. I'm not scared. I am prepared to do my job... which is..... get him to the hospital so he can get the life saving treatment ?I have been to plenty of these calls just like this, (minus the metal part). its very standard. Air and chair, Air and chair... but as I said, ALS would do more. that is all EMTs in NY do? Wowsa why even test? You could save money having kindergartners do that.
miscusi Posted July 29, 2013 Posted July 29, 2013 (edited) The piece of metal coughed up was a stent.! even the more reason to realize there is nothing I can do for the pt but to get him to the hospital The area is severely infected. He is in danger of losing his airway. loses his airway? if you mean that it closes up, ALS can get a tube in. again, nothing I can do. He is septic, the infection is through out his body. again nothing I can do, gotta get him to the hospital where they have IV antibiotics and a doctor. Did you read what the vitals were? I didn't read... People die sitting up, doesn't mean squat. I would keep him sitting for breathing, but torn because I want to start treating him for shock! His airway comes first though. torn ? why torn? you know what you are supposed to do. I would be preparing to assist ventilations and you are thinking you might call ahead. Eh. If it is his lucky day. It is easy to bag him immediately, our BVMs are in the same bag the 02 tank is. Really, nothing to be scared about. Edited July 29, 2013 by miscusi
MariB Posted July 29, 2013 Posted July 29, 2013 I know what to do, but you don't seem to. That's what is scary
miscusi Posted July 29, 2013 Posted July 29, 2013 so please tell me, what special things you are going to do? I know what to do, and all of it is the same standard stuff I would do for anyone else. It's BLS, its not a lot there is to do.
ERDoc Posted July 29, 2013 Posted July 29, 2013 (edited) Mari, unfortunately in NYS, yes that is all EMTs can do. I guess we shouldn't be too hard on him since again, he really doesn't have the knowledge to appreciate how sick this person really is. In NYC with the closest hospital being a block away in most cases there isn't much need to learn to manage sick pts, just apply diesel. Please don't base your opinion of all FDNY EMTs and medics on this one newbie. Most are good people that don't want to see people die and do care about their pts and would know that this person is a disaster waiting to happen. With a whole year of experience under his belt he still has the cowboy mentality. Time and experience will hopefully change that or weed him out. EDIT: Miscusi, who exactly do you work for? In this thread you imply, though never state, that you are with FDNY but in the thread about transporting dead people. I would think if you were FDNY you would know the answer to the question of transporting dead people. Edited July 29, 2013 by ERDoc
miscusi Posted July 29, 2013 Posted July 29, 2013 (edited) correction: FDNY is only one of the many EMS agencies here in NYC. in NYC there are only two levels of prehospital care. the EMT-B and the PARAMEDIC. anything under paramedic is working at the basic level. ERDOC has his opinions on how a person should appreciate or feel or care etc etc.. that's fine, I don't mind the right to free speech. "not wanting to see people die" means you are emotional, not necessarily good, certainly do not mean you are competent. Competent is competent, Cowboy? there are no cowboys in NYC thus I don't understand what you mean. EMTs are not doctors, Paramedics are not doctors. Our goal here is to get the patient to the doctor in no worse condition than we found them. Please do tell me, what special things you are going to do for this patient that I was not going to do ? it is BLS, there isn't a lot to do ! we all have the same national standards, so please do tell me what it is that isn't already in the protocols that you want to see be done for this patient ? ( dont answer that, its for you to think about) This guy should scare the hell out of anyone that has a clue. He's septic with airway issues and has the potential to have a nightmare airway Not scared, because that's not my job, but the medic will come put in a tube. not scary, no nightmares. if the tube wont go in down the throat, then the medic can do the cricothyrotomy. I guess when you know what you are doing and trust your fellow EMS to do their jobs well, there is no place for scary panicky nightmares. Im done with this topic, be safe out there people ! Edited July 29, 2013 by miscusi
MariB Posted July 29, 2013 Posted July 29, 2013 (edited) My treatments within my scope of practice. Lets just say I have a 15 minute transport time to hospital Eyeing him from the door hearing his mothers story and seeing his head drop, learning his gcs is 14 I worry if he is losing responsiveness. I would alert my driver to call als to intercept. I will do respirations, pulse and spo2. He needs o2. He gets a nasal cannula at 6 since he is pretty low. If that brings it up over 96, I'll turn it down a bit to see how he tolerates it. If it doesn't bring it up to 93 to 94 I'll go with a non rebreather. I will listen to his lungs for bs. Since he may be altered "head dropped" I'm going to get a blood glucose. I realize it may be off a bit as infection can do that but if he has been sick, he may not have been eating or taking meds. Seeing he is coughing yellow secretions I will grab an emmisis bag and try to get him to cough up his sputum into that to show the doctor even though the Dr may or may not want it. I'm going to look him over, put the leads on him , grab a bp since there is a history of hypertension, his pulse is fast and our life pack is right there with us so its fast and quick. Grab his meds and go. Time to load. I will get the pupils medical assessment etc in ambulance enroute As I get the heart monitor print out. I'm going to spike a bag and get an iv ready for my medic. By now she should be meeting up with us. Time to reassess. While she is getting vials of blood and the iv going I'm going to do everything I just did minus the bgl. I'm going to ALERT the er we are enroute with a patient and give a radio report. At that time the medic would be busy doing her als part of the assessment. When we arrive I would take the sputum, blood vials and meds in with us and then wait around because he would be transferred to a bigger facility Eve though they just might fly him. Edited July 29, 2013 by MariB
ERDoc Posted July 29, 2013 Posted July 29, 2013 I'm well aware of the levels in NYC and have worked with many EMTs and Medics on LI who also worked in NYC. Again, you failed to answer the question. Do you work for FDNY, a hospital based service or one of the privates? You know exactly what I mean when I say cowboy. Should I use the term buff? I know you understand that. I also know full well that EMTs and medics are not doctors. I did EMS in NY, not NYC, for 10 years and know the systems from Staten Island to Montauk pretty well. When we say scared, you know we do not mean it literally. However, the fact that you cannot do anything more and cannot properly provide the care the pt needs because of the standards in NYS and the fact that you are an EMT should literally scare you. People are dying because of the dismal state of EMS in NY but that is for another thread. So what are you going to do when this guy goes unconscious because his SBP is 70 and you can't bag him and your ALS backup is tied up on another call and you have to take care of the pt. You are right, there is nothing you can do but watch him die. The fact that that doesn't bother you makes you a piss poor provider in any system. 4
MariB Posted July 29, 2013 Posted July 29, 2013 (edited) /> correction: FDNY is only one of the many EMS agencies here in NYC. in NYC there are only two levels of prehospital care. the EMT-B and the PARAMEDIC. anything under paramedic is working at the basic level. ERDOC has his opinions on how a person should appreciate or feel or care etc etc.. that's fine, I don't mind the right to free speech. "not wanting to see people die" means you are emotional, not necessarily good, certainly do not mean you are competent. Competent is competent, Cowboy? there are no cowboys in NYC thus I don't understand what you mean. EMTs are not doctors, Paramedics are not doctors. Our goal here is to get the patient to the doctor in no worse condition than we found them. Please do tell me, what special things you are going to do for this patient that I was not going to do ? it is BLS, there isn't a lot to do ! we all have the same national standards, so please do tell me what it is that isn't already in the protocols that you want to see be done for this patient ? ( dont answer that, its for you to think about) Not scared, because that's not my job, but the medic will come put in a tube. not scary, no nightmares. if the tube wont go in down the throat, then the medic can do the cricothyrotomy. I guess when you know what you are doing and trust your fellow EMS to do their jobs well, there is no place for scary panicky nightmares.Im done with this topic, be safe out there people ! We obviously don't have the name standards. I can do spo2 I can do a blind airway A bgl A 3 lead 12 lead these are for doctors and nurses benefit Cpap Bipap Epi pen Pt assisted nitro, inhalers Aspirin Activated charcoal Mast trousers (however our medical director has asked us not to use these so we removed them) Helmet removal Glucose.. Um hmmm what else. There isn't national standards. There is local protocols Dang it, didn't edit in time after seeing how poorly written that was so please tell me, what special things you are going to do? I know what to do, and all of it is the same standard stuff I would do for anyone else. It's BLS, its not a lot there is to do. I told you what I was going to do. But you got emotional. You got mad and "cried like a girl" and left the thread Edited July 29, 2013 by MariB 1
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