Bells Palsy

[cosgrojo]

Long story short here... Went to take someone to the hospital from an assisted living home. Pt fell 2 days ago, went to hospital and was told he has fx ribs. Now, he is still having right sided rib/chest pain and is having a hard time moving around. Staff knows next to nothing about his baseline or his history. The only thing that they have listed is HTN. I'm on a basic truck, and rib pain=chest pain in my book, so I can't rule out cardiac. Also... why did he fall 2 days ago? Did ER work him up or simply take x-rays? Pt has substantial left sided facial droop that the staff has never noticed before. Equal strength x4 positive CSM's. Favoring left side... could be CVA, Cardiac, or his fx'ed ribs. Pt is sweaty, warm to touch, with a slurred speech pattern. A&Ox2. We are very close to hospital, so ALS was not going to do anything for us, and since they were just here doing another call, I knew they were tied up. We go blowing over to the hospital. We give report, tell them about all our findings and how seemingly contradictory they all were. He's been to this hospital before, nurse looks into her computer and says he has bells palsy. She was here the other day when he came in and remembers him, and knows he looks a bit different. 12 lead showed 2nd degree heart block. Very complicated patient that would have been very easy to overlook certain things, and based on his presentation and lack of information on history, would have been very easy to scream CVA from the hilltops.

I would love to sit here and rail against the Assisted living for not having a clue... but right now I feel more like making this a learning experience for EMT's. For all the brand new EMT's out there... and yes I remember when I was one as well... never stop asking questions. Find out everything you can about your patients and about the scene. Learn about other conditions that may mimic other one's. Stay away from getting tunnel vision on patients. It's too easy to be distracted by the 3 inch laceration on their scalp line that won't stop bleeding, and ignoring the fact that they had an MI causing the fall that made them whack their head on the table. You're never done learning. I learned things on this call. I've known what Bells Palsy is for a while, but I've never actually seen it in real life before. It can present itself VERY much like a CVA, but a lot of the times their are slight differences. I've read descriptions of the condition but never actually put that info into use yet. These patients can have MULTIPLE things that are threatening to kill them, not just one. Never take anything for granted, and stay diligent and work hard.

OK. I'm off my soap-box now.

[itku2er]

cosgrojo very well written post. That is some good advice for anyone in ems new old or inbetween. Its easy to get distracted by the small stuff and over look something major. Asking questions reading and studying is the one way to keep your skills sharp and your brain sharper.

Terr

[WendyT]

I have to vent and I mean no disrespect to people on here who work in this industry, but here's what happened.

You know the same bloody BS I get from the nursing home, they dont have a fcuken clue, my mother's lower denture went missing, nobody was planning on telling me and then they decide oh well she needs a new one. Yeah right you forget to call me when I told you ppl that no matter how small the problem maybe, you're to inform me and if you dont then you better pay for it because if you dont, do I have a right to sue?

Another incident, my mother gets aggressive, so she got mad at this other pt in the nursing home, along comes this woman whom I have never seen before and grabs my mothers hands tightly, I'm sitting on her bed and my mom cried out in pain you're hurting me. The woman said to my mother, oh just shut up, your disturbing the people and she went to leave and I got up and I confronted her and said if you ever man handle my mother like that ever again, I will slap you with a lawsuit so fast, you'll be in jail and you'll be out of a job.

She just looked at me in total shock, she doesnt work there anymore, after I brought complaints to the director, he told me there were other complaints besides mine, she was fired that day.

If the job is getting to you, time to move on and look elsewhere, perhaps not in the nursinghome industry.

I'm just bloody angry that there are blondes running the show there and the director is one of them.

I remember the Calgary medics showed up to take a 90 yr old pt to the hospital and NO ONE had a clue who it was they were coming for. They went through all the paperwork, I could see the medics getting impatient, so I stepped forward and said your supposed to take Lois landers, she's in the heritage section and she's ready to go, turned around and I said something to this one nurse who will remain unknown, just incase she comes on here. I said her information is in her room. The LPN turned to me and gave me the ugliest look. So I told her that I was glad I could be of help. lmao.

[katbemeEMT-B]

I think this is a problem all over. Whether it's a nursing home or assisted living facility, the care is below standard and down right dangerous. I'm not sure if some of these nurses (not all, some are great) were the bottom of the class or what but I wouldn't want them to care for me. Many of them just don't seem to care. They show up, put in their required hours, and leave. Worse yet, some of them become so frustrated with patients they become abusive and somehow they get away with it.

My grandmother almost died because somewhere between the hospital and nursing home they quit giving her her diuretic. She eventually went into congestive heart failure before they were able to figure out what the problem was. Luckily she was at one of the best hospitals in the Metro area. She has been moved to a much better assisted living facility and is doing great.

[JPINFV]

I'll stand up for assisted living places. The thing with assisted living is that, at most, the highest level of 'provider' (since they aren't medical providers) is a medication tech. They aren't RNs or LVNs at these places most of the time. It is strange, though, that I've gotten some of my best reports from staff members at assisted living facilities.

As far as nursing homes, have you been to every single nursing home in your area? Do you think that maybe one of the reasons that you only see bad care is because those are the facilities needing transport most of the time? I've got plenty of stories about nursing homes, but I'm not yet ready to trash all of them yet.

[WendyT]

This is the nursing home, my mother's father was in in the late 60's and her cousin was there in 1979 and now that she's in this dilemma that I should think about getting her into another care facility.

The problem with the city of Calgary, it's so darn crowded, the price of everything here is so darn expensive and it's called the waiting game, wait to see if anything becomes available.

I was advised to clean this house up and sell it, I could easily clear $475,900 for it.

Now all of them are not that bad of people, it's the true facts that you as a person couldnt do something about it.

It just simply says, what can you do as a fellow friend to help those people in said questions.

[Dustdevil]

[itku2er]

Well there are good and bad Nursing Homes and people that work in them just like there are good and bad people in EMS. Its like that you have paragods in ems and people that just dont give a **** anymore. Nursing homes have their problems just like anywhere else. SOME OF us DO care that work in them so dont say that all people in nursing homes are BAD. I wont say that ALL people in EMS are bad.

Terr

[katbemeEMT-B]

I did not say all nurses in nursing homes are bad. I think I actually stated "not all, some are great". But I can say that there are a great number of nursing assisstants, LPNs, RNs that just don't care. I am not making a generalization, just like I wouldn't make one about EMS. It does bother me that you put a loved in one of these facilities expecting they will be well cared for as they can no longer be cared for at home and then you find out that the care (or lack of) is killing them. It also bothers me that these caregivers feel they know more about what the patient needs then the doctor.

I will say this, and I have said it before; there are good and bad health caregivers everywhere. It just seems as though the bad ones migrate towards those that are the most vunerable. This is why I stated that it is of the utmost importance that family be completely involved. It is also important as family to recognize those caregivers that go above and beyond.

[cosgrojo]

Dust... You are either incredibly random and cracked in the head, or that was the most subtle, yet awe-inspiring, attempt at explaining that my thread has been hi-jacked.

Either way.. much respect.

+50 for sheer originality.