Things I Learned on the Ambulance . . . .

[Tas]

This was asked before, I dug up an answer that 'seems' resonable:
http://forums.drslounge.com/showthread.php?t=109585&page=2&pp=25

I'm not an expert on airplanes or oxygen use by any means, but I ..*cough* borrowed *cough* this from an out of date pan american flight instructors guide for a DC-10...

....

l5. Q. What is the function and purpose of the rebreather bag?

A. The first part of the exhalation is rich in oxygen and

thus is suitable for rebreathing and it passes down

into the bag where it mixes with the incoming oxygen.

The bag then becomes extended and the slight pressure

thus formed causes the remaining portion of the

exhalation, which is high in carbon dioxide content,

to pass out through the sponge rubber discs. The

advantages of the rebreather bag are as follows:

(a) Rebreathing the oxygen rich portion of each

exhalation greatly increases the effective use

of the oxygen available.

(b) The carbon dioxide conserved by the bag

stimulates breathing.

(c) The humidity conserved by the bag prevents

dryness and soreness of the throat.

....

---

Members don't see this ad.

 

[Siggy]

EMT-Bs working interfacility transports have the inability to please anyone.

Dispatched for an ER call w/ a CC of "unstable chest pain" from a SNF. This place is litterally just down a side street from the nearest hospital. There isn't even a traffic light between us and the hospital. Pt. A/Ox1, unable to point or really communicate efficiently with us. Nurse reports left chest pain radiating to the arm w/ a BP of 180/something x 4 hours. We get about the same BP. (Please don't ask why the SNF didn't call 911). We load the Pt up (we being my partner, the trainee, and me) started on 15 LPM via NRB and transport down the street to the hospital. Travel time is less then 2 minutes.

The welcoming party:

1 extremely pissed off RN complaining that we should have called medics and giving us the tired old line, "What drugs would you have pushed if the Pt. had crashed in route"

Of course, if we called medics, the medics would have complained about how we should have transported.

 

[southerndoc]

Of course, if we called medics, the medics would have complained about how we should have transported.

It's a situation that all of us have been in. You would get criticism either way. It's so easy to criticize others when in fact you weren't in their shoes.

This is something I keep in mind everytime I receive a patient from an EMT, paramedic, or even receive a nurse report.

Yes, calling a medic would be ideal, but as you pointed out it probably would have delayed definitive care.

 

[Siggy]

Yes, calling a medic would be ideal, but as you pointed out it probably would have delayed definitive care.

Aye, we end up transporting quite a few really bad medical patients from [un]SNFs over time. My areas transport guidelines are "Any patient may be transported via BLS to the nearest PRC if the time to estimated paramedic arrival and evaluation exceeds transport time to the PRC." (http://www.ochealthinfo.com/docs/emstreatguide/i40.pdf).

Sometimes I actually get to feel more then a gurney van attendent.

 

[Flopotomist]

I think we have all been in this exact situation, and it is a judgement call. I personally always chose to call a 911 rig in, even though it would delay care (slightly) for medicolegal reasons. By doing this, I also helped "educate" the facility that dialing for a routine transfer rig was not going to let them sneak a patient out without the big fire truck being parked out front when the new customers were on tour.

 

[Jambi]

...not going to let them sneak a patient out without the big fire truck being parked out front when the new customers were on tour.

I actually got written up for doing this because there just happened to be new customers on tour. The Pt was really gorked too, no palpable B/P, cyanotic, altered (duh), I mean really bad. It was totally appropriate to call 911. Needles to say I left that company.

 

[Medic_9]

If the patient comes up to the drivers window of the ambulance and states they've just been stabbed. Believe them. (I live in a low major violence area).

Pulled into Tim Hortons parking lot so my partner could get a coffee, saw the huge line up inside (bars just let out) so decided not to get one. Was turning around in the parking lot, about to start backing up when a guy run up to the drivers side window. Rolled window down, conversation went like this.
Him: "I've been stabbed" (wide eyes, big pupils) as he lifts up his shirt.
Me: "Really?" as i'm looking at the laceration with abdominal contents evicerated (however you spell it) thinking...him that looks real.

---I thought it was a prank. We get people coming up to ask us for stupid things (bandaids, cold packs) or staying stupid things...I fell last week, should I go in..I was once in an ambulance...Can I go for a ride...Soooo thought this was along the same thing...nope.

Called dispatch asked for police, locked all the doors (assailant was no where to be seen) got into back with the patient. In the time span of 5-10 minutes (scene and transport) patient turned crappy, pale, diaphoretic, clammy, BP dropping...

Anyways. Moral is...Don't become so cynical that you don't believe what people tell you (Especially when the proof is right in front of you!)

 

[deleted6669]

in philadelphia folks used to wave us down all the time with stupid questions....my favorite:
"dude, how long for valium to not show up in my piss?"
my answer " 2 hrs"
bet he got a big surprise later that day......

 

[Jambi]

in philadelphia folks used to wave us down all the time with stupid questions....my favorite:
"dude, how long for valium to not show up in my piss?"
my answer " 2 hrs"
bet he got a big surprise later that day......

That is Hilarious

 

[LMalay]

I have learned to never ever ever pig out at Taco Bell on gorditas, tacos and nachos untill you are ready to burst and then to a Txp to a level 1 with an unstable Pt that requires you to stand and lean over alot while going down a very very bumpy and curvy road. Not to mention the Pt is puking his guts out all over the back of your tiny little van style rig... Took every thing inside of me not to yack all over the place myself.. From what my partner said I was as green as grass when he opened the back doors. I will never again be able to eat taco bell without remembering that night... hahahaha
Lisa

 

[deleted6669]

a former partner of mine used to sit on the jump seat and take a crap in a bed pan during long transports rather than pull over somewhere with pts who were completely out of it(intubated icu types, gomer runs, etc). this was all well and good until one of them woke up to look straight up his crack mid-bm....he didn't lose his job but only because he was in really tight with the management(one of the senior managers was his uncle)

 

[Siggy]

Shift change at nursing homes always occurs about 5 minutes before I arrive. As a result, none of the staff knows anything about the patient.

EXCEPTION:

Apparently sometime before 9pm, all of the nursing staff leaves except 1 nurse. Said nurse not only knows anything about the patient, but instead of admitting it, claims that it is all in the paperwork and doesn't have time to give the paramedics report because she "has to take care of the rest of the patients, and thus can not spend time helping out this one patient."

 

[LMalay]

OMG.... If my partner ever decided to take a BM in a bed pan while I was in the rig with him I would have so pulled over opened the back doors on him nice and wide while facing oncomming traffic...
Lisa

 

[a_ditchdoc]

We once had 911, people we are friends with, call our EMS headquarters to tell us that someone had been shot at our back door... "Hahaha...yeah right....click". They called back again, "Really, check your back door." Sure enough, there was a guy lying on the ground bleeding from a few gunshot wounds. Later we even found pock marks on the wall from the few that missed him. Luckily they built us a new station in a better neighborhood a few years later. But, not before people walked in with guns ("I just shot a guy..."), stole our cars, and smoked crack in our restroom...

 

[emsa5804]

My first intubation in the field was a drunk homeless guy in cardiac arrest. His last oral intake was Long John Silvers fish and Jim Bean Whiskey... Not a good combination

A paramedic with sleep apnea is not an indication to use the onboard CPAP... it tend to drain the main O2 rather quickly... Not that I would know...

 

[pm2do]

I am finishing up my first semester of med school and I am missing EMS but this is some of the things I learned in 12+ years of Fire/EMS (all different types of job environments, and I live w/ a FF so I can pick on them

1) There is such a thing called the lug nut theory: The vehicle with the most lug nuts wins.
2)Why paramedics don't drive engines. (not me) but someone in dept forgot to put parking brake on, truck rolled out bay, and down driveway, a car actually hit it (thats called job security for the person just couldnt understand why the truck was moving but she decided to still not stop and hit the truck)
3)DONT take off shoes of homeless person to do basic pedal pulse assessment, no amount of vicks or wrapping the foot in sheets will help
4) The more important your appointment ( or big physics final) after work, the later and more of an ALS critical patient you will have closer to your off time...
5) Going by ambulance DOES NOT guarentee you being seen faster in fact, more cars in driveway, the quicker you go to triage.
6) Remember if you can't stand the site of your own blood, then don't practice IV sticks on yourself and ask me to take it out quick (yup actually happened, my partner and I laughed while my supervisor turned very white)
7) Don't turn the patient towards the wall because they are projectile vomiting, although thought is nice, the splash effect is way worse ( also in ER dont give them the smallest kidney shaped container the splash effect in those are great too)
8)Remember to do your walk arounds on MVA in car vs pole, the bullet holes on the opposite side might explain all the blood coming out the back of head....
9) What the heck is a pre-code? The above pt was a trauma alert, but the FD LT called a pre-code instead ..
10) dont forget to call clear even when using LP 12, hands free, (yup know someone who didnt and shocked a FF needless to say she wasnt highly thought of by that crew for a while)
11) No matter how many times you tell the ER staff you were having the attack of niceness and decided to help bring the pt in from the car outside you are still suppose to have mental telapathy (sp?) and know automatically everything about the pt.
12) The "welcoming committee" (whether large complex, big church school etc) the more people waving to you and telling you where to go the more BLS the pt, the converse is true to the more critical you're lucky to find someone who knows whats going on
13) Yes you can give morphine to the 80+ y/o F w/ hip pain s/p surgery from while ago and not healed right even though they are allergic to sulfa....
14) do not ask in spanish: donde est delore (sp? or in my very white spanish where is the pain) they will start answering you very fast, instead ask pain here (in spanish) can get yes/no..
15) Remember no matter what and no matter who you are BLS before ALS...


I think this thread is great, laughed very hard reading earlier posts about Fire extinguisher and bleach....I am sure will think of more later..

 

[emsa5804]

Cocaine and bridges don't mix...

Last night we were dispatched to "Meet PD on a subject threatening to jump from a bridge." Upon arrival we were told the subject was being chased by the police and jumped from the bridge... getting to the pt added an additional 12 minutes to the scene time. Once at pt's side found that pt had jumped over a k-rail and fallen approx 150ft and landed feet first on gravel surface (railroad size gravel). Trauma alert given and emergent tx began. Pt delivered immobilized and IV etc... Unstable/Crepitus to pelvis, deformity/crepitus to right hip, 4 inch shortening and outward rotation to right leg, obvious fx to right wrist. ALOC (2nd to fall vs. cocaine, who knows... who cares... ALOC is the point) Total time with pt including scene and transport time 9 minutes 17 seconds. Upon arrival at "Trauma Center" find one nurse and empty house. RN sts this pt is level two and she told our dispatcher to send us to the level two hospital... Too bad... Pt is here and I gave trauma alert... Same ****, different shift from ED staff. Pt later codes and dies from massive internal bleeding...

Things we learned or are reminded of:

1.) Cocaine and Bridges don't mix.
2.) 150+ft fall is a level one trauma in OK, TN, CA, Europe... anywhere...
3.) RN's still cannot and should not triage EMS pt's over a phone... that is the job of the EMS personel onscene with the pt.
4.) Some "Trauma Centers" still don't want EMS to bring them trauma pt's.

Some call me bitter... don't know why... I love my job

On a lighter note... The pt was being chased by a police K-9. The pooch went over the wall and fell with the pt. K-9 dazed and ambulatory after fall collapsed in field next to roadway. PD helicopter lands next to K-9 and airlifts dog to Emergency Vet Clinic... K-9 is sore and bruised but will be just fine... I think Rin Tin Tin deserves a metal of valor...

 

[DropkickMurphy]

It wasn't the fall that killed him...it was the dog landing on him.

 

[Jambi]

I'm always amazed at how many people don't know how to use their inhaler, thank God for nebulizers.

 

[southerndoc]

I'm always amazed at how many people don't know how to use their inhaler, thank God for nebulizers.

That's the fault of physicians and nurses. It's our responsibility to teach them how to use the MDI's. When I write a script for an MDI, I always teach the patient myself. I make them demonstrate how to use it.

It annoys me how nurses do not obtain proper PEFR's using Wright flowmeters. This annoys me more than patients who do not know how to use their MDI's. I hate it when a nurse tells me that a patient's peak flow is 150. I walk into the patient's room, instruct them how to use the flowmeter correctly, and end up with 350-400. That's discharge material as opposed to an ICU admission!

 

[DropkickMurphy]

Actually be annoyed at respiratory therapists....that's their job

 

[southerndoc]

Actually be annoyed at respiratory therapists....that's their job

Peak flows are measured by the nurses. Respiratory therapy only comes to the ED for ventilatory management, continuous nebs, BiPAP/CPAP, and Heliox. RT's also do bedside PFT's (limited) for things such as Guillian-Barre Syndrome.

Routine nebulizers, peak flows, etc. are done by the nurses.

 

[Jambi]

You know what really grinds my gears?

People that don't know that their NTG is for.

The reasons I've heard, they usually start with, "my doctor told me to take this when"

My face gets flushed
I can't catch my breath
I get dizzy
when my belly hurts
I get dizzy and,
I feel anxiety
I get dizzy (did I repeat that one enough)
I feel numbness and tingling
I get a headache
when my back hurts...

It goes on and on..

And about not knowing how to use an MDI. I've used an MDI on and off since I was a kid. I never learned how to use is correctly until EMT class some odd years ago. Sometimes I am amazed at the ignorance of patients. I guess blame can be placed on providers for not educating Pt's but how much can you chock up to Pt's not caring or paying attention. I find it hard to believe that 70% of all the Pt's that I come across that take NTG were never educated on its uses and indications. Because of that I do lay some blame on Pt's.

 

[f_w]

Things I learned a long time ago working some EMS in a country far away from here:

#1 If you weigh 90lbs and your resting BP is 80 over nothing, you shouldn't take your friends NTG gel-cap just because she was told to take that if she doesn't feel right (LoL found pressureless and unconscious during sunday mass in a rural church at the far end of the county, 3-4 half-lives later she was back to her sweet self)

#2 Don't try to stop your 2ton truck by leaning with your back against the front bumper while your 4 year old inside is driving. Yes, he is only 4, but the truck is in 1st gear and a diesel (young guy with dung laced tire-treads on his chest and face on a sheep meadow at the very far end of the county).

as part of #2
#2a 110mph on a farm to market road might allow you to beat the chopper to the scene, but if you don't get to the scene you won't help the patient.

 

[fiznat]

haha I got a good one today:

If you are a hobo and you decide to try and hang yourself in public, please do remember the following:

-Your shoe laces will not work
-Tie yourself to a part of the tree that will hold your weight
-Do not fake a seizure when you land on the ground
-Remember to empty your pockets of or at least make use of any and all remaining crack rocks on your person
-When questioned by the police as to why you did this, do not under any circumstances cite the following reasons:
"Gas prices"
"I was entertaining the crowd"
"I mixed coffee and tea today"



The ED triage nurse couldnt help herself from laughing after hearing the story-- one of those laugh out loud, and then shake your head in disgust and (hopefully) a little empathy kinda situations. The guy was high as a kite, said he did "2 bags" of heroin x 2 hrs ago but he was talking a mile a minute with his eyes darting all over the place... "yeeeahh... so what ELSE did you have today, sir?"


EDIT: on a semi-related note, just out of curiosity does anyone know how much a "bag" of heroin actually is, and what the street value is for it? I always hear heroin amounts discussed in # of bags, are all bags in this case generally the same size or what?

 

[southerndoc]

EDIT: on a semi-related note, just out of curiosity does anyone know how much a "bag" of heroin actually is, and what the street value is for it? I always hear heroin amounts discussed in # of bags, are all bags in this case generally the same size or what?

I believe it's 15 g by weight, but only 25 mg of heroin. Some dealers put up to 100 mg of heroin in a bag, which is where you find your overdoses. Addicts usually don't overdose on purpose -- they generally only want to get high, not kill themselves. So usually they are unaware of a stronger than expected concentration when they overdose.

Street value is about $10-40, depending where you are, dealer, and concentration.

 

[Med-tallica]

I believe it's 15 g by weight, but only 25 mg of heroin. Some dealers put up to 100 mg of heroin in a bag, which is where you find your overdoses. Addicts usually don't overdose on purpose -- they generally only want to get high, not kill themselves. So usually they are unaware of a stronger than expected concentration when they overdose.

Street value is about $10-40, depending where you are, dealer, and concentration.

Did you by chance learn this on call?

 

[southerndoc]

Did you by chance learn this on call?

No, I'm a toxicology freak.

 

[Jambi]

Never eat a bowl of soup while driving, ever...

 

[DropkickMurphy]

No, I'm a toxicology freak.

Freak is right.... j/k

 

[freebyrdy]

I really do...makes some of the things I've seen look not quite so bad...

Some of the things I've learned....(actually....I knew...seems to be common sense isn't so common though....I've seen some incredible things)

When your pt codes...in a w/c....remove them from the chair before begining compressions....they seem to be more effective that way (I love SNFs)
When your pt yells "OUCH" with every compression it's ok to stop....(This one didn't want to even with medics telling her that they would take pt care....yes again @ a SNF)
On the scene of a MVA (w/multiple pts)...if your brand spanking new extremely green over ambitious adreniline pumped EMT hunts down the head and places it back on the victim who has been decapitated.....leave them be....Can they really hurt this pt by performing CPR?
Motorcycle Vs Overpass.....he ran into the pole- 100mph+.....There will be lots of his friends around...they *will* freak when you start cutting the leathers off...and if you can't open the face mask on the helmet....put him in a controlled area (ie..your rig w/doors shut and someone large at the doors) before attempting to figure out if it might be because the helmet is now backwards. (It was....only injury was that his head was now facing the wrong way.)
And one more CPR....Can anyone explain securing an airway and performing compressions when your pt is strapped to a backboard.....Facedown?
When you get a SOB pt who was breathing at 40+/min (per staff) but "She's much better now. Since we gave her some O2, her resp rate decreased dramatically"---First the O2 will be 2L (maybe even 4L) by NC (of course on the bridge of the nose/under the chin/laying next to the pt....) and the resp rate has slowed because it is now agonal.
When the ambulatory A&Ox4 pt refuses to go to the ER due to a uncontrollable nosebleed - (bp 102/58 - p 114) - because she insists that if the SNF staff will just give her her AM meds....esp the one for HIGH BP....the nosebleed will stop. Wait close by because as you leave the staff will give her the meds....and she won't be A&O when you come back. (You do get to transport with the pretty lights on though.........I think I spend too much time at SNFs)
When the full arrest was witnessed...they usually don't have rigor or lividity. I guess I could have asked *when* the person coded.
And sidenotes..............(AKA things I would love to say to LPNs.....)
If you (or your pt) missed your MD appt (f/u of course) do not call me to transport you to the ER so you can see your doc...chances are he won't come there. Esp btwn midnight and 6am
When you wake a person up 2 hrs after giving them a sleeping pill.....they are going to be a bit altered.....and maybe even almost impossible to wake.
Don't call me for a pt w/ AMS because the pt isn't responding to your questions when the real problem is you pissed off your pt and they have decided not to speak to you.
Before you call me for a pt w/ elevated temp & no response to APAP....take off the 8 (yes 8) blankets that are on her and see if that helps a bit. (Oh ya might turn the heat down some....it's only 85 out.)
If you call me at 3pm shift-change SAT because your pt fell MON and has a tib/fib confirmed by xray TUES (Obvious btw....) Don't call and complain because I upset your visitors by leaving *hot* to take this pt to the trauma center 20 miles away because there is no distal pulse now (no splinting and pt picks up her leg to show you how it dangles!!! Closest center as well)
And ...........No matter what color your pt is initially...........unless they are a Smurf........Blue is Bad - this is esp true when combined with RR <8 and no/barely palpable carotid pulse. Do not wait 20-30 min for private EMS...Call 911.
And last but not least......You called me...I came (this call had a 3 min response/on scene time)....pt is altered...My partner has made contact.....Do not expect me to be all smiles and nice when you tell me they are going to the hospital you just haven't decided how....as you "may need to call 911". Just because I currently work in private EMS does not negate my patch. I carry the same equip, the same drugs and have the same skills. You are now causing a delay in pt care. (And don't expect me to hang out and wait while you do the d-stick on your known diabetic to see if that is the cause of the AMS!)

Actually..........I know that seems like nursebashing.....I've run across some absolutely fab nurses...in all areas...who love what they do and it shows. I've also run across some who obviously don't give a rat's @$$ about anything but the paycheck.
And give me a good basic over a bad medic anyday...........90% of what we do is basic stuff anyways. The bad medics skip that and seem to forget how to do simple things.

Freebyrdy

 

[freebyrdy]

For those partners the drive like they are in a little sports car......
1000cc NS works well.....Make sure you are on a straight away before you smack them upside the head with it.
Towel rolls are good as well. (Same priciple as above)
You can also use pedi/infant BP cuffs (preferably in their cases), stuffed animals and other small objects - well aimed they get the point across.
Worse comes to worse.....Suggest they try to catch some zzzz's while you are out "posting". Then you get to drive around and see how many times you can make their head bounce off the window or if they lay in back....bounce off the bench/stretcher.
Freebyrdy

 

[IndyMedic5]

Also, would someone please alert the Nursing Staff at nursing homes that:


If your patient is Cold, CLammy, unresponsive, and has AGONAL breathing, IT IS NOT SUPPORTIVE OF LIFE...

and...

Proper treatment is **NOT** 2L O2 ON NASAL CANULA!!!

This is unfortunate but true... Nursing home nurses are not allowed to do any medical treatment other than standing orders, i.e.- place the pt on any form of O2, or give oral glucose, or glucagon for that matter without the Doctors permission. sad but true. unfortunately again this still gives no excuse for those nurses that do place a pt on 3lpm on a Non-Rebreather. Remember: these nurses are the ones that have been scraped off of the bottom of the nuses pool.

 

[Mayday]

I'm surprised this was never stickyed

 

[Karl_Hungus]

Another thing I learned early on as a medic is:
if you are thinking about intubating a patient you probably should be.

Doctor+pulse oximeter+nursing home friday afternoon shift= abuse of the 911 system.

Though it was posted over 2 years ago, it remains as true today as ever!

Whoever thought it would be a good idea to allow nursing home staff access to oximeters should be beaten with them.
Doctors who diagnose over the phone based on one piece of information (the SpO2) are next on the list.

 

[emtcsmith]

I know nurses aren't allowed to do alot, and thats a reason I don't want to be one, but the MD doesn't have to order common sense.

 

[leviathan]

I know nurses aren't allowed to do alot, and thats a reason I don't want to be one, but the MD doesn't have to order common sense.

Don't say that on your interview about nurses, man!

 

[Gatewayhoward]

Sounds heartless, but I keep joking to my fellow employees that we need to hand out pamphlets on how to correctly committ suicide. Like, don't OD on NSAIDS, you'll go into liver failure, seize and flop like a fish, and die of DIC.

 

[Aurora013]

Patients can in fact be allergic to benadryl.

If you are driving home from PT for your shoulder because you had surgery 6 weeks ago and you get into a low speed MVA (~15 mph), the pain you feel in your shoulder is most likely from the fact that you just went through PT, and not because of the accident.

If you call for a non-emergency patient and are told we can't get you an ambulance for another 1.5 hours (I work at a company that does both transports & EMS calls), don't be surprised that if you tell us your "not in distress chest pain patient" isn't an emergency, we still show up in 10 minutes anyways. And if you give a patient 3 nitro without a line, a) she's likely not going to be in any distress, b) will likely have a low BP, and c) will be complaining of a severe headache.

If your patient falls out of bed at 1 pm complaining of back and neck pain, when you call us at 6 pm to take the patient to the hospital, don't be surprised if they no longer have pain after you having given them tylenol 45 minutes ago.

If you are a 20 year old female EMT, chances are your male psych patients will not only find it attractive, but will decide to profess said love for you both on scene and again in the ambulance, complete with love songs.

Everybody complains about NRB on too low of a flow...but what about the concerned family members who up the nasal cannula flow to 10 LPM?

Confusion is normal for patients who have a history of Alzheimer's. Just because your grandmother has confused you with nearly every male member of her family thus far, don't be surprised when she starts referring to you as your brother, even if she's never done that before.

If you're planning on killing yourself, don't give a phone call to your best friend to tell them good-bye if you plan on OD-ing. Help will get there very quickly.

If you have a psych patient that walks past the nurses station and security desk, hitchhikes 15 miles into the next city and has been picked up by the cops and returned to your NH, don't call the ambulance for a "patient with psychiatric history to be transported to the nearest hospital" and conveniently forget to tell us of this escapade when we ask upon arrival. Because when we talk to the daughter who has no idea what's going on either, we will convince her its probably better to take him directly to the psych facility for evaluation, as opposed to being taken to the hospital, from where we assume he will be transferred to the psych facility eventually anyways (and being as we are the ones who will be doing the transferring, we'd like to save ourselves the extra trip). The psych facility won't be too happy about you bringing him in, and the NH staff gets annoyed that he never had a doctor check out his physical condition to make sure he didn't get hurt/sick while exploring the city.

 

[Siggy]

Everybody complains about NRB on too low of a flow...but what about the concerned family members who up the nasal cannula flow to 10 LPM?

What about the RNs who tries to titrate NC flow up to 15 LPM and then tells you to take this patient now because he is very sick (and turning blue).

If you have a psych patient that walks past the nurses station and security desk, hitchhikes 15 miles into the next city and has been picked up by the cops and returned to your NH, don't call the ambulance for a "patient with psychiatric history to be transported to the nearest hospital" and conveniently forget to tell us of this escapade when we ask upon arrival. Because when we talk to the daughter who has no idea what's going on either, we will convince her its probably better to take him directly to the psych facility for evaluation, as opposed to being taken to the hospital, from where we assume he will be transferred to the psych facility eventually anyways (and being as we are the ones who will be doing the transferring, we'd like to save ourselves the extra trip). The psych facility won't be too happy about you bringing him in, and the NH staff gets annoyed that he never had a doctor check out his physical condition to make sure he didn't get hurt/sick while exploring the city.

Your SNFs normally gives you report?

 

[DropkickMurphy]

What about the RNs who tries to titrate NC flow up to 15 LPM and then tells you to take this patient now because he is very sick (and turning blue).

Well....I saw a nurse who turned off the O2 to a patient who was basically agonal because she thought "O2 toxicity" was causing his problem. "He's a COPD'er after all!" *pulls hair*

 

[leviathan]

Well....I saw a nurse who turned off the O2 to a patient who was basically agonal because she thought "O2 toxicity" was causing his problem. "He's a COPD'er after all!" *pulls hair*

Hahahaha............why is it that nurses think they're more educated than us when they demonstrate such a lack of understanding of topics such as COPD? I mean, there is obviously a huge gap between the best and worst nurses, but even the worst nurses try to impose some sort of superiority over paramedics.

 

[Aurora013]

Hahahaha............why is it that nurses think they're more educated than us when they demonstrate such a lack of understanding of topics such as COPD? I mean, there is obviously a huge gap between the best and worst nurses, but even the worst nurses try to impose some sort of superiority over paramedics.

How about the CHFer with exacerbated CHF that you can hear breathing from down the hallway, and the nurse yells at you when you start bagging them, because you don't have standing orders from the doctor to give them oxygen?

 

[Aurora013]

Your SNFs normally gives you report?

Not if they can help it. But being as most of the patients we deal with are completely out of it, we make them give us one anyways. Or at least try to.

 

[Siggy]

I learnt today that Scabies generally starts between the fingers and work their way down.

(At SNF picking up patient with a CC of "fever"
Me: Anything else I need to know [before I see the patient]?
Nurse: Nope.
Partner: So there isn't anything you're not telling us about?
Nurse: No.
Partner: There isn't anything that the patient has that you wouldn't want to bring home to your kids?
Nurse: Nope

[uneventfull transport]
[at hospital ED]
RN: These bumps and sores on the legs looks like scabies

[partner, who is going on vacation on Wednesday, and I, who has finals on Wednesday, develops psychosomatic itching]

EMP while looking at the patient: There are too many bumps for there it to be scabies and there isn't anything between the fingers...

 

[Pemigewasset]

Bored police& pepper spray/mace taught me a valuble lesson- always carry Johnson's baby shampoo. A 10gtt set & a NC are required to neutralize the spray- whether you use it for perps is discretionary! I learned it 5 years ago when the local PD were visiting our station & one of them snuck his spray out & nailed his partner!

Where should I post some incredibly important info everybody needs to know about portable O2 cylinder gaskets?

 

[Aurora013]

People who try really hard to kill themselves and fail spectacularly become Born Again Christians.

We had a transport out of the local crisis facility to one of the hospitals that does inpatient admissions. The nurse's response to what was wrong with the patient was "Have you read the paper lately?" which was followed by her handing me a news paper clipping. Evidenly a guy put five propane tanks in the back seat of his car and turned them on with the windows shut, but since it wasn't killing him fast enough, decided to light a match. Said propane tanks shot ~100 feet in the air, his car turned into shrapnel, significant damage was done to the 5 cars near his, and pieces of metal/glass were found up to 1 mile away. The injuries to the patient? First degree burns to the back of the hands and his face, ONLY.

His current reaction? "I tried real hard to kill myself, but evidently somebody up there is on my side. There's a reason I'm still alive, and by-God I'm going to find it and make the best of it." And proceeded to regale me with stories of the goodness of the Lord for the remainder of the 30 minute transport.

 

[Pemigewasset]

"A&E staff dont take too kindly to me filling in a Patient report form for each personality of a schizophrenic!"


Since you've got all that extra energy, why dontcha come wash & decon my rig, eh? I can't write the one report without a hand cramp!

 

[DNP student]

A paramedic friend of mine learned that whenever you get a call for a cardiac arrest at an ice skating rink, get the pt off the ice BEFORE you defib; or be prepared for multiple pts (bystanders, partner, self, etc)

 

[Pemigewasset]

REMEMBER: everything you do must be in the patient's best interest & have a demonstrable benefit. eg: Splint & sling a humerus fx. Ergo, sternum rubs are out; no benefit to the pt. However, your average BS GOMER playing at being all gorked out can NOT sue you for 1)D stick 2) 16ga AC NS TKO & my fave 3)The NPA. I've yet to see someone remain "unconcious" when I thread that puppy! It's especially effective!