Complex cardioversion?

[firefighter523]

Ruff, Are you even an ALS provider, I didn't see it in your title???

[ERDoc]

Ruff, wow, um was that a cyber-threat, with the whole fist thing!?? I'm over it..... Please refer to the BLS curriculum about implied concent!!! Let me help you understand this a little better. Watch this, we will do it in the 1-2-3 method just like in grade school. 1) If they are hemodynamically unstable, ie with or without pulmonary edema.

2) If they have a tachy arrythmia, wide or narrow.

3) If they don't have a DNR or living will present.

All of that equals, yes I know you hate to hear this.... Not telling them, and here is the worse part......CARDIOVERT!!!! PS, and possibly without sedation. This is the standard of care. OBVIOUSLY...........if someone is awake and ABLE to hear you, you would, like a good paramedic, tell them what you are doing, even down to "little stick" right before you jab them with your cath!!

This horse has been beat enough, keep your nose in the books!!!!

You need to put your nose back in a book. The way you treat your pts is criminal. Seriously, what you are proposing is against the law. This again is where we seperate the technicians from the professionals. Your hero wanna be attitude will get you in trouble someday. You need to recheck your BLS cirriculum on implied consent (or your BLS cirriculum is incorrect which is a distinct possibility). Not one of the three cirteria you listed makes you able to use implied consent. Just because a person has hemodynamic instability does not mean that they do not have the capacity to make their own decisions. Before you begin to insult someone you should make sure your arguement is valid, because in this case your facts are incorrect and your arguement is invalid. You might be able to get by on emergency consent, but it is thin ice and you have still gone against a pts wishes. Aren't we supposed to do care for our pts and not just their medical condition/monitor?

[Ridryder 911]

You should NOT let them decide, that is what you are there for. You are the professional, and are the one that is supposed to know what to do. Make a decision and go with it. Just hope it is the right one. This pt sounds like they are unstable. I would cardiovert, if vitals and and pt impression indicate. Blue lips, resp distress with rapid A fib would get electricity.

I suggest you read what is called " patient rights statement" as well take some cardiology courses. Patient rights describes that you are legally bound to offer the choice and option. Yes, emergency conditions may indicate to take action on the best behalf of the patient when the patient is unable to make such decisions. As ER doc described, there was no indication not to inform the patient. Actions like those help keep my second income as an expert witness profitable.

Second, I don't hope.. I much rather have educational knowledge of outcomes. A-fib with RVR is seldom needed for cardioversion.. Yes, I see and deal with it much more than those than usually in the field.. before you describe "stable environment" B.S., I work in the field full time as well for the past 30 years.

Look at the whole forest not the tree....

R/r 911

[scratrat]

1. You should NOT let them decide, that is what you are there for. You are the professional, and are the one that is supposed to know what to do. 2. Make a decision and go with it. Just hope it is the right one. 3. This pt sounds like they are unstable. I would cardiovert, if vitals and and pt impression indicate. Blue lips, resp distress with rapid A fib would get electricity.

Well, lets see here.

1./ So what you are saying is the pt cannot decide what treatments they want? You do know what assault and battery is right? I hope so, because if you ever touched my family member in the manner in which you speak, rest assured you'll be doing jail time. When my pt's tell me no to a procedure, I rationally EXPLAIN it to them, including pros and cons, if they still refuse, it is their RIGHT to do so.

2./ Make a decision and HOPE it's the right one?

Are you retarded? I hope you never say that in court.

3./ That may be unstable, but that still doesn't give you implied consent.

Finally, please tell me that, judging from your screen name, you are only a firefighter and not a paramedic? Please tell me you only play with hose and not with pt's lives????

[scratrat]

Guess what, If you see a supraventricular rhythm, and you cant tell if it is SVT or AFib, I don't think you would give a CCB before you would give adenosine!!! Adenosine is a natural occuring agent that will chemically convert PSVT to NSR. In the event that it doesn't, it will slow the Afib down so you can see it. Then you will treat accordingly!!!

How about a 12 lead ECG instead of blindly administering a medication and HOPING it works?

[scratrat]

I'm over it..... Please refer to the BLS curriculum about implied concent!!! Let me help you understand this a little better. Watch this, we will do it in the 1-2-3 method just like in grade school.

1) If they are hemodynamically unstable, ie with or without pulmonary edema.

2) If they have a tachy arrythmia, wide or narrow.

3) If they don't have a DNR or living will present.

All of that equals, yes I know you hate to hear this.... Not telling them, and here is the worse part......CARDIOVERT!!!! PS, and possibly without sedation. This is the standard of care. OBVIOUSLY...........if someone is awake and ABLE to hear you, you would, like a good paramedic, tell them what you are doing, even down to "little stick" right before you jab them with your cath.

First, the word is consent. And obviously YOU need to reread those definitions. None of the aforementioned text implies consent.

Second, if someone is "hemodynamically unstable" which, by definition, may or may not include altered mentation, has a "tachy arrythmia", and they do not have a DNR, you are just going to fire away without telling the patient?

wow....................... :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock: :shock:

[scratrat]

Sorry to everyone else....I just couldn't believe what I read. Sorry again.

[firefighter523]

Doc, with all due respect, I was talking about an EMERGENT situation. So you mean to tell me that is someone has an accucheck of 17 mg/dL, and is unconcious, you would be held liable if you didn't tell them that you are giving them an IV and sugar???? That is implied concent, and this is the same situation, it would be negligent if you waited for an answer from them. I want to reiterate, if the pat is aware of there surroundings and looking at you, of course I would let them know what is going to happen, I would do just that " Let them know" , not give them the choice, their life depends on the critical decisions we make. That is why we go to school, and put everything we have into education, to learn more and more everyday. Part of being a good provider is being decisive, it makes the pt more comfortable with you, and gives them the sense that they are in good hands.

I have dealt with a handful of critical pts that could NOT understand what I was saying to them, much less, they became flacid, and were on the brink of respiratory arrest, among other things. How the heck can anyone hold a provider liable for NOT telling them what you are going to do. YOU WILL BE HELD ACCOUNTABLE FOR YOUR ACTIONS IF YOU DON'T PROVIDE THE RIGHT THERAPY FOR THEM IN A TIMELY MANNER!! That is negligence and that is what you call CRIMINAL.

And Rid, If I have to see that you have done this for 30 years again in your text, I am going to puke!! Gloating is for CHUMPS!!

[Just Plain Ruff]

Ruff, wow, um was that a cyber-threat, with the whole fist thing!?? I'm over it..... Please refer to the BLS curriculum about implied concent!!! Let me help you understand this a little better. Watch this, we will do it in the 1-2-3 method just like in grade school. 1) If they are hemodynamically unstable, ie with or without pulmonary edema.

2) If they have a tachy arrythmia, wide or narrow.

3) If they don't have a DNR or living will present.

All of that equals, yes I know you hate to hear this.... Not telling them, and here is the worse part......CARDIOVERT!!!! PS, and possibly without sedation. This is the standard of care. OBVIOUSLY...........if someone is awake and ABLE to hear you, you would, like a good paramedic, tell them what you are doing, even down to "little stick" right before you jab them with your cath!!

Implied consent has nothing to do with this. The fact of the matter is that you sound like you are a renegade paramedic and that you would do something to someone without telling them what you are going to do.

OK here's the deal, I fear for your patients. You obviously didn't read my post about people being able to hear you when they are unconscious. You are dangerous.

As for the threat, there was no threat towards you and if I did threaten you I would come out and say it point blank and not do it in a veiled manner but again there was no threat to you. STEP AWAY FROM THE KOOL-AID and think before you accuse people of things.

All I was saying is that if you cardioverted me without telling me or not giving me sedation if my BP would allow it I would search you out or any other provider out and have words or yes, I'd clock you.

You seem to be in the mindset that you can do anything that you want to a patient and to hell with the patient.

You don't seem to understand the notion of my rights as a patient. Maybe you should talk to your legal department. If a patient tells you to not do something then you DON'T do it. Period. To do what the patient said not to do is assault and battery and much better medics than you have been tried and convicted on that charge.

I think you need to review your last post to me and re-evaluate things.

That's all I have to say about this.

[firefighter523]

Newsflash Ruff, people CANNOT hear you when they are unconscious!!! Answer my question, are you an als provider, or an ambulance chaser!??