Redemption

[Doczilla]

Asys-

I think you did fine. You appropriately assessed the patient and need for interventions that don't fall under one single protocol. Demonstrating good decision-making, you even called for online medical control for further guidance before proceeding on. The system worked here, and, I suspect, to the patient's benefit. Add to that, the patient's condition changed in front of you, necessitating a re-evaluation of the course of treatment, which you did appropriately. Key here is that you didn't get stuck in one protocol and continue down that line after the condition changed.

I don't see any specific contraindication to any of the treatments rendered. In fact, it appears that they were all indicated. I don't know the significance of the 12-lead findings, not being able to see the strip myself. "Borderline" elevation doesn't count for much. Either the elevation is there or it's not, though that's not going to change your treatment prehospital. Some change may be expected based the elevated heart rate alone.

The protocols are guidelines based on typical presentations of common prehospital problems. This patient obviously didn't read the book (darn him). The protocols are designed to teach the paramedic the thought process that the physicians have in treating these problems and how far they expect you to go on your own. They are not intended to cover every single patient that you will encounter in the prehospital setting, hence the phrase, "treat the patient, not the protocol". (last cliche, I promise). If the telemetry doc is still giving you crap, bump it up the chain of command to the actual medical director. That what we're for: to keep you from unnecessarily getting sh#t from other docs who don't know what they're talking about. And the MD can tell the telemetry doc to consume fecal matter and expire prn.

'zilla

[Ace844]

"asys,"

Kudo's for being both an advocate for your pt., and using your squash. It has been my experience that when ever a progressive educated "EMS clinician" thinks "out side of the box", or goes out of their way to do the right thing then it raises "RED FLAGS". Why, because it is different from both the expected norm, and what most other practiotioners are used to dealing with. The sad part of this whole equation is that they actually expect the pt and or the EMS treatment to be FUBAR, when they get to the ER. :roll: :shock: :!: :!:

Interestingly enough I had a similar situation in my practice recently; and I ended up having a talk with my med director about it. At the end of the day he pretty much admitted the following; "When we have an EMT or Medic who is 'using his head' we get concerned that perhaps we as the med con, or receiving doc are missing something or not getting the whole story because we don't get alot of that. Thus we're abit hesitant, and our guard goes up.." Sad but true! :shock: :!: So congrats and Kudos for standing up for yourself and being a pt advocate as well as doing the right thing!! :!: :wink: 8) 8)

out here,

ACE844

[Beagle189]

The Doc was an ass. You did the correct things. Nothing wrong w/ your treatment and route you took w/ it.

[mediccjh]

Let me guess, it was Dr. Silverman????

[Asysin2leads]

Oh s--t, mediccjh, that's too funny. I refuse to answer on the grounds I may incriminate myself. Thanks for the feedback, all.

[mediccjh]

I'll take that as a yes.

I've actually hung up on him a few times, after I told him thanks for nothing and slammed the phone so he can hear it.

F--king docs in the boxes.

[streetsweeper]

Here is the problem.. There are good medics and bad medics. The protocols are designed to simplify the steps,, for the monkeys. I use them as a guideline. If you are comfortable adjusting your treatment and it works then great. BUT if you screw up then your Doc. will let you fry.

If you go outside the box and they live,,your a hero,,,, if they die,,, your unemployed.

Unless you are 100% sure of what you are faced with.. stay in the box THEY built for you. Get your paycheck buy a beer and blow it of. Keep eating bananas!!