Case Study: Sepsis and Tachycardia (with EKGs)

[ExplorerShane]

I learned something new today! Thanks!

[brentoli]

No problem.

Just a suggestion, for simple terminology and basic procedures, google them first. Read up about it. Then if you have further questions, ask about it. Nothing wrong with asking questions at all. But reading up on something first, can help with the explanations further on, and also makes your questions seem more substantial.

[AnthonyM83]

Just curious. What prompted the priority transport? From what I can gather, the patient was on that fine line of stability? Not completely stable, but not exactly circling the drain?

If the patient is on the fine line of stability, wouldn't you want to get there faster? No one should be on the fine line of stability?

Note this is coming from someone who lives in a VERY traffic congested city. Going code 3 SIGNIFICANTLY reduces transport times, I'd say from 5AM to 10PM.

People were talking about blowing through intersections, but it shouldn't put you at that high of a risk, because your driver shouldn't be blowing through intersection in any circumstance. Code 3 driving, is like code 2 driving, just using your lights to circumvent waiting 2 - 3 cycles at each long stop light and requesting right of way. I turns a 40 minute drive into a 15 minute, sometimes, while going less than the speed limit.

[JPINFV]

People were talking about blowing through intersections, but it shouldn't put you at that high of a risk, because your driver shouldn't be blowing through intersection in any circumstance.

Oh, come on Anthony, being in So. Cal. you should know well enough that should/shouldn't and does/doesn't are two different questions. If everyone did what they should than there wouldn't be the term "California Stop" and the average freeway speed outside of rush hour would be 65, not 80.

[AnthonyM83]

True, true, but if you're the medic in the back, you can straighten out your EMT partner to drive appropriately...or choose or medic partner who drives appropriately. Or is that wishful thinking...

[brentoli]

I have a hard time justifying emergent transports.

What will the paitent recieve at the hospital, that you can not do?

How soon does this paitent need this intervention?

The only paitent I feel comfortable in transporting emergent, that I can justify readily, is a stroke paitent. Even then, at what point in the stroke window are we?

I apologize again for taking your thread in an unintended direction fiznat. If this discussion continues we can move to a new thread.

[AnthonyM83]

Well, if the patient is borderline unstable, one resource you have at the hospital is more personnel (provided they work as a team, can be useful if patient codes). More diagnostic equipment. But if it's going to save you only 5 minutes, no point really in going code. But if it's going to save you 20+ min and the problem is acute, maybe an "easy code 3" might potentially be beneficial to patient. (?)

[vs-eh?]

I have a hard time justifying emergent transports.

What will the paitent recieve at the hospital, that you can not do?

How soon does this paitent need this intervention?

The only paitent I feel comfortable in transporting emergent, that I can justify readily, is a stroke paitent. Even then, at what point in the stroke window are we?

What are they going to receive in hospital? At minimum they will receive the diagnosis/differentials from one or more physicians that you certainly cannot provide. They will receive pharmacological management that you cannot provide. Blood work acquisition and interpretation that you cannot provide to aid in a solid dx....Shall I go on?

Stroke patient only eh? Trauma, query MI, eminent pregnancy....

Listen, obviously you guys have issues with your "drivers" going L+S. That is more of a system problem. than a "benefit to the patient" problem. In certain cases (not all) and certainly more than query CVA patients, time to definitive care = survival sans deficits.

We don't have an issue with going L+S to the hospital here. Everyone here is a paramedic of varying level. They have driver education, specific specialized licenses, etc... They don't drive L+S like idiots, the generalization being that your's do.

[brentoli]

What are they going to receive in hospital? At minimum they will receive the diagnosis/differentials from one or more physicians that you certainly cannot provide. They will receive pharmacological management that you cannot provide. Blood work acquisition and interpretation that you cannot provide to aid in a solid dx....Shall I go on?

You missed the part where I said "Is this something where time will make a difference"

Stroke patient only eh? Trauma, query MI, eminent pregnancy....

What type of trauma? There are lots of trauma. I explained my ideas on an MI. Pregnancy, unless it presents complications, can be handled in an ambulance.

Listen, obviously you guys have issues with your "drivers" going L+S. That is more of a system problem. than a "benefit to the patient" problem. In certain cases (not all) and certainly more than query CVA patients, time to definitive care = survival sans deficits.

We don't have an issue with going L+S to the hospital here. Everyone here is a paramedic of varying level. They have driver education, specific specialized licenses, etc... They don't drive L+S like idiots, the generalization being that your's do.

Great, if your neck of the world is perfect, come teach us a few things. I am more then welcome to your ideas, but not your belittling.

[fiznat]

I'm really surprised to hear that a lot of you guys would take this patient priority 2 (no lights, no sirens). Here is what I was thinking:

As far as the width and breadth of my knowledge goes, the hospital essentially has limitless resources that I do not have within my truck. To mention a few are RSI procedures, CT scans, labs for blood works, extra hands, doctors, etc etc etc. I did not clearly know what was going on with this patient, and I am not so arrogant as to assume that the hospital did not have an answer, or a treatment, that I didn't think of or am incapable of providing.

Lights + sirens transport shaved maybe 8-10 minutes of travel time for us. I work in a city, and there is a lot of traffic, stop lights etc. I felt that this was a significant amount of a time for this patient.

I don't know. Perhaps it is in fact my "inexperience," but while I had some suspicions, I didn't really know exactly what was going on with this critically ill patient, and thought it was prudent to get the patient to the hospital as quickly as possible.