SterlingMaloryArcher

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Well, it's certainly not in our EMS protocols, but for something simple like my call tonight, here is my reasoning:

-Patient called for high home blood pressure reading ("190/110 and rising"), feels fine, no other complaints
-Patient is an old lady and it is flu season
-Patient is fluid overloaded (2+ pitting edema in legs bilaterally, murmur at Right Upper Sternal Border and she says she has never had a mumur)
-Patient takes HCTZ 12.5 and Lisinopril 30

My first blood pressure reading in the house was 210/120 and she says she usually runs in 130's systolic.

I told her there is not much we can do for her in the field and there are two options: Go to the hospital, or if you have (2 medical groups in my area with 24-hour on call service) then why can try calling the number and see if the doctor has anything for you to do that does not involve going to the hospital (knowing there is a good chance they will just say take another HCTZ)

She wanted to call and asked for me to talk to the doc and sure enough she told me to have her take one of each of her blood pressure medicines and if it doesnt go down in an hour then go to the hospital. I stayed with the patient in her living room for about 35 minutes while I wrote report and made conversation and then took her blood pressure again 150/90.

Do you guys think this is appropriate or innappropriate?
 

Apollyon

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Inappropriate. If I was your medical director, I would, at minimum, pull you offline, and, more likely, pull your card, pending revocation by the state.

If you are EMS, you have one job: stabilize the patient while you transport the patient to a receiving hospital. You do NOT "practice medicine"; right in the name, you are a technician. I tell you this as both a paramedic, and board certified MD.

What you described is practicing medicine.

However, having seen what you have posted elsewhere on this site, I have somewhat strong suspicion that your case stated here is not real. I don't know if you are even EMS. In any system with which I have been associated, were I on scene for 45 minutes (which I estimate, from when you encountered the pt, evaluated, spoke with their doc (who is NOT your medical director - first no-go), then waited on scene), I would have dispatch calling me first for status, then, wondering if I was in distress.

You do not say what level you are. If you were basic EMT, you were black letter wrong. If you are paramedic, you were wrong to say that there was little you could do in the field, which would indicate a competency problem. This doubles down on your recognition of a "new" murmur. Right there, you have your answer.

That's why I question the entire thing, kit and caboodle. You are nuanced enough to pick up a murmur, but not sharp enough to realize this alone indicates transport to the hospital?

So, again - inappropriate.
 

SterlingMaloryArcher

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Inappropriate. If I was your medical director, I would, at minimum, pull you offline, and, more likely, pull your card, pending revocation by the state.

If you are EMS, you have one job: stabilize the patient while you transport the patient to a receiving hospital. You do NOT "practice medicine"; right in the name, you are a technician. I tell you this as both a paramedic, and board certified MD.

What you described is practicing medicine.

However, having seen what you have posted elsewhere on this site, I have somewhat strong suspicion that your case stated here is not real. I don't know if you are even EMS. In any system with which I have been associated, were I on scene for 45 minutes (which I estimate, from when you encountered the pt, evaluated, spoke with their doc (who is NOT your medical director - first no-go), then waited on scene), I would have dispatch calling me first for status, then, wondering if I was in distress.

You do not say what level you are. If you were basic EMT, you were black letter wrong. If you are paramedic, you were wrong to say that there was little you could do in the field, which would indicate a competency problem. This doubles down on your recognition of a "new" murmur. Right there, you have your answer.

That's why I question the entire thing, kit and caboodle. You are nuanced enough to pick up a murmur, but not sharp enough to realize this alone indicates transport to the hospital?

So, again - inappropriate.
Wow seems harsh but okay thanks.
 
Last edited:

Apollyon

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Wow seems harsh but okay.
I am sorry that you feel it to be harsh, but that is the reality that I know. I don't want you to think that what I wrote was an appeal to authority; I just am well experienced with such things, and remember that good judgment comes from bad judgment, and bad judgment comes from experience.

And I am confident that you would rather have a detailed explanation, versus a pithy, singular "wrong" or "inappropriate".
 

frosted2

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I could think of a few things that I could have done en route to the ED...