Reply
 
Thread Tools Display Modes
  #1  
Old 01-27-2014, 12:46 AM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
EMT's, Paramedics, MD's, Opinions on MedicAlert Jewelry

I had gallbladder removal surgery - first time I've ever been sedated - in December, which turned out to involve a bit of a complication. I have a small, ventral airway. It took 5 anesthesiologists two hours to get me intubated, and in the end the head of the department came in and figured out I had to be awake for the intubation, plus I needed a pediatric (size 6) ET tube. A big part of my recovery was due to mouth/throat/airway trauma and I was in the hospital an extra two nights because of the inflammation.

My surgeon (actually not just him, two others on the surgical team also said I will always need to be intubated awake or serious damage will be done) was very clear that I should get a medical alert bracelet or necklace that states "ventral airway" in case I'm ever found unconscious and need to be intubated. A tracheotomy would be the first choice, as I'm impossible to intubate if I can't help with it.

So, the question is, what's really the best thing to have engraved? I've mentioned this to a few medical people and they're not sure "ventral airway" would be obvious enough in an emergency to automatically mean "do a tracheotomy on this woman, don't even try normal intubation if she's unconscious."

And, as I've never known anyone who wears such jewelry, what's the best to wear, necklace or bracelet, and do you guys notice the ones that don't really look like the classic steel chain link bracelet? I've perused the MedicAlert website and there are a hundred options, many which don't look like what I would be looking for if I were an emergency responder.

It's scary to think how much damage could be done in the wrong situation, but I'm honestly considering a tattoo might me more useful!
  #2  
Old 01-27-2014, 09:43 AM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
One bump, since I posted this at a slow time. Hoping for some opinions.
  #3  
Old 01-27-2014, 11:21 AM
ThelmaLou ThelmaLou is online now
Member
 
Join Date: May 2010
Location: Neither here nor there
Posts: 13,319
Yikes. This is scary as hell. I don't actually have any ideas, but I'd like to hear some. Giving it another bump.

The following is no help to you but marginally interesting: I had a friend who had heart problems for which he went to the ER many times. When he got there, they would always start with some kind of standard Plan A, but my friend knew that would never work and they should right away go to Plan B. But of course, they didn't, and I guess couldn't, take his direction. When his cardiologist would show up, he would immediately put Plan B into effect and save the day. We used to joke that my friend should get the instructions for what to do tattooed on his chest and signed by his cardiologist.
  #4  
Old 01-27-2014, 12:02 PM
Time Like Tears Time Like Tears is offline
Guest
 
Join Date: Mar 2004
Location: Ray City, GA
Posts: 580
Luckily my main condition (Multiple Sclerosis) is not one that will every really be immediately life-threatening by itself. It can however cause some weird symptoms and actions that I may not be able to properly explain. Sometimes I lose the ability to speak clearly, and many of my worst exacerbation symptoms strongly resemble stroke.

My bracelet is a black leather band with an engraved plate that simply states my full name, my condition, and then 'ICE: SEE USB'. I have a bright red e-Med USB flash drive that contains all pertinent medical info, including emergency contacts, advance directive, etc. Most people I would be around know where to find it in my bag should something happen.
  #5  
Old 01-27-2014, 12:13 PM
cwthree cwthree is offline
Guest
 
Join Date: Feb 2004
Location: No, not there!
Posts: 2,318
Time Like Tears, where did you acquire these items? I'd be interested in purchasing something like this for my FIL.
  #6  
Old 01-27-2014, 12:14 PM
wevets wevets is offline
Guest
 
Join Date: Mar 2000
Location: hobgoblin of geographers
Posts: 4,246
Quote:
Originally Posted by SeaDragonTattoo View Post
So, the question is, what's really the best thing to have engraved? I've mentioned this to a few medical people and they're not sure "ventral airway" would be obvious enough in an emergency to automatically mean "do a tracheotomy on this woman, don't even try normal intubation if she's unconscious."

Hm. Not 100% sure - I've been out of cert (former EMT) for several years, so take what I'm about to say with a grain of salt. What's the length restriction on engraving? Would it be possible to engrave 'tracheotomy if unresponsive' and/or 'intubate w/ pediatric 6 ET tube' on the bracelet?

Perhaps our one of our better-informed posters (Cartooniverse, StUrho? I think we have a few other EMTs/Paramedics on the board - hopefully they will do a vanity search) will come along with more helpful advice.


Quote:
Originally Posted by SeaDragonTattoo View Post
And, as I've never known anyone who wears such jewelry, what's the best to wear, necklace or bracelet, and do you guys notice the ones that don't really look like the classic steel chain link bracelet? I've perused the MedicAlert website and there are a hundred options, many which don't look like what I would be looking for if I were an emergency responder.
Bracelet or necklace, either would work equally well when I was practicing and we would always check. It might be helpful to get one that looks like the other medic alert jewelry, who knows what the situation would be when you actually needed someone to find it.


Quote:
Originally Posted by SeaDragonTattoo View Post
It's scary to think how much damage could be done in the wrong situation, but I'm honestly considering a tattoo might me more useful!
IMHO, a tattoo may not be as useful, since it's not something I would look for on an unresponsive patient. Would you be thinking of getting the tattoo where the bracelet would normally be?
  #7  
Old 01-27-2014, 01:40 PM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
Quote:
Originally Posted by wevets View Post
IMHO, a tattoo may not be as useful, since it's not something I would look for on an unresponsive patient. Would you be thinking of getting the tattoo where the bracelet would normally be?
Yes, inside right wrist, with the red medic cross centered above the words.

Thanks for your answers, very helpful to know it's routine to check. It seems many people who should wear them, don't. (looking at you, diabetic friends)
  #8  
Old 01-27-2014, 02:46 PM
Spiderman Spiderman is offline
Guest
 
Join Date: Oct 2000
Location: somewhere East of there
Posts: 9,273
If you're unconscious but breathing, you probably don't need to be intubated. If your unconscious & not breathing, you may need to be intubated ASAP as this is a true life-threatening emergency. (Remember the A-B-C's stand for Airway, Breathing, & Circulation)
We're not going to take the time to do a full patient history or evaluation at this time; therefore, we're not taking the time to search for a bracelet that you may or may not be wearing under your long sleeve top that may or may not have anything to do with the emergency at hand.
So the question is would you like to be alive with a damaged esophagus? In the average person, intubation causes less damage than a trache that is the first option in the protocols. If repeated attempts at intubation fail, then a trache may or may not be attempted, depending upon local protocols.
I'm not saying their useless, just that our protocols don't have us searching for one as the first thing we do. If you're with a friend/family member who knows of your condition when we arrive, they could tell us not to intubate & to look at your bracelet & then after looking at it we could skip to step x in our protocols & give you a trache first thing. In this case, plain English is best because Murphy's Law says the medic doesn't know/forgets what "ventral airway" means.

To answer your other question, the purpose of them is to notify EMS of your condition in an emergency when you can't speak for yourself. Just remember,the more it looks like jewelry the less likely EMS is going to discover it. The original, clunky, ugly (?) one is your best bet. I'd also say a bracelet is better. We're likely to try to take a pulse at your wrist, or roll a sleeve up to start an IV meaning we're much more likely to see a bracelet than a necklace. While the underlying action may be appropriate, it sure looks inappropriate to the bystander if I'm going into your shirt to look at your necklace.
  #9  
Old 01-27-2014, 02:57 PM
Spiderman Spiderman is offline
Guest
 
Join Date: Oct 2000
Location: somewhere East of there
Posts: 9,273
Quote:
Originally Posted by SeaDragonTattoo View Post
Thanks for your answers, very helpful to know it's routine to check. It seems many people who should wear them, don't. (looking at you, diabetic friends)
If you're a diabetic & we find you unconscious, we'll go thru our protocols because your being unconscious is not necessarily related to your being a diabetic. It could be a low blood sugar, or it could be a stroke, or it could be an OD, or it could be etc, etc, etc. Checking of blood sugar is done fairly early in the process & if it's low, you'll be given appropriate treatment to bring it up & then further monitoring & treatment because you could be a diabetic with a low sugar who has also OD'd.
  #10  
Old 01-27-2014, 06:44 PM
St. Urho St. Urho is offline
Guest
 
Join Date: Nov 2001
Location: CO
Posts: 1,572
Quote:
Originally Posted by SeaDragonTattoo View Post
So, the question is, what's really the best thing to have engraved? I've mentioned this to a few medical people and they're not sure "ventral airway" would be obvious enough in an emergency to automatically mean "do a tracheotomy on this woman, don't even try normal intubation if she's unconscious."

And, as I've never known anyone who wears such jewelry, what's the best to wear, necklace or bracelet, and do you guys notice the ones that don't really look like the classic steel chain link bracelet? I've perused the MedicAlert website and there are a hundred options, many which don't look like what I would be looking for if I were an emergency responder.

It's scary to think how much damage could be done in the wrong situation, but I'm honestly considering a tattoo might me more useful!
I think the bracelet is definitely the way to go. We check a radial pulse on pretty much everybody, so it's the most likely to be found. I wouldn't go with the tattoo because even if it's in the same place I'm probably not going to read your tattoo if you're unresponsive.

As for what to put on it, that's a good question... Off the top of my head I'd say just keep it simple and go with Do Not Intubate.

St. Urho
Paramedic

Last edited by St. Urho; 01-27-2014 at 06:45 PM.
  #11  
Old 01-27-2014, 07:00 PM
jharvey963 jharvey963 is offline
Member
 
Join Date: Oct 2004
Posts: 1,672
I have a medical alert necklace that I wear. It has a 2 word name for my condition and the words "See Wallet Card". On the wallet card is a much better description and my current drugs are listed. Something like this might work for you.

J.
  #12  
Old 01-27-2014, 07:55 PM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
This is great information, thanks very much! From the bracelets I'm looking at, there seems to be plenty of space. I like "do not intubate" but don't want that to be confused for not resuscitating. I want an attempt at a patent airway, and for that to be a tracheotomy the first time. While I will be a DNR someday, if I'm not breathing due to an accident, or as yet unknown allergy or something, of course I want whatever's needed to be done if it's just injuries I can recover from. So, I'm thinking of this:

Do Not Intubate
Do Tracheotomy
Difficult Ventral Airway

My doctors made it very clear it I am impossible to intubate unless I'm awake. Going by the time it took with the resources of an entire hospital and 5 anesthesiologists (multiple scoping attempts, including fiber optic through my nose), and all that, I really don't want any first responders to even try and to just go for the tracheotmy immediately.

Any more feedback would be great!
  #13  
Old 01-27-2014, 08:48 PM
Robertfchew Robertfchew is offline
Guest
 
Join Date: Jan 2013
Posts: 29
Also they have a thing called vial of life. It contains all your medical info. Usually people will post something on the front door stating they have it and where it can be located.
  #14  
Old 01-27-2014, 09:21 PM
St. Urho St. Urho is offline
Guest
 
Join Date: Nov 2001
Location: CO
Posts: 1,572
Quote:
Originally Posted by SeaDragonTattoo View Post
Do Not Intubate
Do Tracheotomy
Difficult Ventral Airway
How about this:
Do Not Intubate
Alternate Airway OK


Alternate airway being something like a King Airway or LMA. Based on what you said, either of those would probably work fine- they don't go directly in the trachea and it's a blind insertion so there's no mucking around with a laryngoscope.

The ventral airway description is interesting, we usually talk about difficult airways being anterior. Maybe it's an anesthesia/emergency medicine thing.

Regardless of what you go with, I don't think it's something you need to lose sleep over. From what you've said, I think if you were found down without the medical alert it would go something like this-

Patient down, apneic
Try to intubate- wow, that's really anterior
Try back-up airway (King Airway for me)
If that doesn't work, either BVM ventilations and I'd only go to a trach if we couldn't ventilate effectively with the BVM.

St. Urho
Paramedic
  #15  
Old 01-27-2014, 10:03 PM
ThelmaLou ThelmaLou is online now
Member
 
Join Date: May 2010
Location: Neither here nor there
Posts: 13,319
Quote:
Originally Posted by St. Urho View Post
...snip

If that doesn't work, either BVM ventilations and I'd only go to a trach if we couldn't ventilate effectively with the BVM.

St. Urho
Paramedic
I guess that's the "Hail Mary" strategy, eh?

[To Catholics BVM = Blessed Virgin Mary]
  #16  
Old 01-27-2014, 10:36 PM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
OK, I like that, St. Urho. Based on the damage to my voice (lost it for a couple days), I think the doctors were concerned about future laryngeal and vocal cord damage along with whatever else could get torn up down there. I still get a hitch in my voice occasionally that makes me have to stop talking and cough. Mostly all better, though.

I also just double-checked with my mom what the surgeon told her over the phone while I was in post-op recovery. What she wrote does indeed say "anterior airway." I swear one of the residents called it ventral when we were talking a couple days later, or I translated it in my head to ventral (I'm a vet tech) and had it stuck that way since.

Anyway, thanks for pointing that out, and helping me compose an effective alert. There are more options for people of which I was unaware. Cats and dogs are much easier to intubate (straight shot).
  #17  
Old 01-28-2014, 05:07 AM
aruvqan aruvqan is offline
Charter Member
 
Join Date: Feb 2004
Location: Eastern Connecticut
Posts: 16,521
Quote:
Originally Posted by Time Like Tears View Post
Luckily my main condition (Multiple Sclerosis) is not one that will every really be immediately life-threatening by itself. It can however cause some weird symptoms and actions that I may not be able to properly explain. Sometimes I lose the ability to speak clearly, and many of my worst exacerbation symptoms strongly resemble stroke.

My bracelet is a black leather band with an engraved plate that simply states my full name, my condition, and then 'ICE: SEE USB'. I have a bright red e-Med USB flash drive that contains all pertinent medical info, including emergency contacts, advance directive, etc. Most people I would be around know where to find it in my bag should something happen.
Quote:
Originally Posted by jharvey963 View Post
I have a medical alert necklace that I wear. It has a 2 word name for my condition and the words "See Wallet Card". On the wallet card is a much better description and my current drugs are listed. Something like this might work for you.

J.
Hard to see your wallet card after you got whacked on the head and mugged. A cop buddy of mine when asked said that muggers tend to leave medicalert jewelry alone. Take that bit with a grain of salt, I can't see muggers behaving in a civilized manner any longer.

And I have a classic clunky medicalert type bracelet that is also a USB thingy that is loadable with all sorts of medical records and commentary. Mine is loaded with my meds history, my surgical history, assorted scans of imaging and so forth. That way I don't have to lug my records around with me when I travel. I got mine for $12 from Walter Drake online [I think, one of those cheap marketing to old fogey catalogs] but if you check google shopping there are a number of different options ranging from bracelets to necklaces to dongles.

[And I also have the classic meat tag tattoos, left ribcage and right ankle.] though I think a tattoo would also be good, in case the metal has gone away with a mugger or whatever, belt and suspenders.
  #18  
Old 01-28-2014, 05:40 AM
Rick Rick is offline
Charter Member
 
Join Date: Aug 1999
Posts: 16,451
I wear items from Road ID. I have both a bracelet and a dog tag.
Each has my name DOB, phone number, blood type and both a 800 number and a Web address where using the serial number and pin on the bracelet/tag my full and complete medical history is available.
The medical history has spaces where you can write out details of your medical history.
When I was in the ER with my gallbladder a doctor saw my bracelet and asked what it was. I told him, he was very impressed.
https://www.roadid.com/c/RoadID
__________________
Remember this motto to live by: Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather one should aim to skid in sideways, chocolate in one hand, glass of Scotch in the other, your body thoroughly used up, totally worn out and screaming "WOO HOO! Man, what a ride!"
  #19  
Old 01-28-2014, 12:56 PM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
I like these aru and Rick. I don't have a history that's relevant to any emergency other than what will fit on the bracelet, but my dad sure does. Now I'm going to look into these for him. Thanks!
  #20  
Old 01-28-2014, 02:42 PM
Rick Rick is offline
Charter Member
 
Join Date: Aug 1999
Posts: 16,451
Quote:
Originally Posted by SeaDragonTattoo View Post
I like these aru and Rick. I don't have a history that's relevant to any emergency other than what will fit on the bracelet, but my dad sure does. Now I'm going to look into these for him. Thanks!

I got mine not because of my medical history, but because I do long bike rides by myself and I could be in an accident.
__________________
Remember this motto to live by: Life should NOT be a journey to the grave with the intention of arriving safely in an attractive and well preserved body, but rather one should aim to skid in sideways, chocolate in one hand, glass of Scotch in the other, your body thoroughly used up, totally worn out and screaming "WOO HOO! Man, what a ride!"
  #21  
Old 01-28-2014, 03:37 PM
smaje1 smaje1 is offline
Guest
 
Join Date: Oct 2007
Posts: 579
I'm a Type 1 diabetic and I got a wicked cool tattoo on my right forearm, complete with a caduceus. If you have a hankering to get a tattoo anyway, it makes a nice conversation piece.

I was hit by a car while riding my bike once, and even though I was pretty much fine, an ambulance was called. I asked the EMT if he would have noticed my medic alert tattoo, and he said absolutely -- he checks people's arms for tattoos and bracelets.

Good luck with whatever you decide to do!
  #22  
Old 01-28-2014, 05:06 PM
gigi gigi is offline
Member
 
Join Date: Apr 2000
Location: Flatlander in NH
Posts: 25,528
Quote:
Originally Posted by St. Urho View Post
I think the bracelet is definitely the way to go. We check a radial pulse on pretty much everybody, so it's the most likely to be found. I wouldn't go with the tattoo because even if it's in the same place I'm probably not going to read your tattoo if you're unresponsive.
Is it still the case that you would ignore a DNR bracelet? I asked in a prior thread and was disappointed to learn that.
  #23  
Old 01-28-2014, 06:39 PM
St. Urho St. Urho is offline
Guest
 
Join Date: Nov 2001
Location: CO
Posts: 1,572
Quote:
Originally Posted by gigi View Post
Is it still the case that you would ignore a DNR bracelet? I asked in a prior thread and was disappointed to learn that.
That's going to vary widely depending on where you are. In Colorado a DNR bracelet (or necklace) is valid. I can't speak for other states.
  #24  
Old 01-28-2014, 06:40 PM
St. Urho St. Urho is offline
Guest
 
Join Date: Nov 2001
Location: CO
Posts: 1,572
Quote:
Originally Posted by Rick View Post
I got mine not because of my medical history, but because I do long bike rides by myself and I could be in an accident.
I have one of those too.
  #25  
Old 04-17-2014, 10:07 PM
SeaDragonTattoo SeaDragonTattoo is offline
Member
 
Join Date: Sep 2007
Location: Chicago, Far Northsider
Posts: 7,813
Update for anyone who's interested, I finally bought a bracelet and maybe put more info on it than necessary, but there was room so here it is. I sent the pic to my mom and she couldn't parse it, but I think anyone relevant will read it just fine.

I didn't take pics, but there was a discount for a second bracelet, so I bought another one with interchangeable silicone bands in 9 colors, great for work so it won't catch on anything like the steel links could.
  #26  
Old 04-18-2014, 01:11 AM
St. Urho St. Urho is offline
Guest
 
Join Date: Nov 2001
Location: CO
Posts: 1,572
Looks good! I hope you never need it, though.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 03:49 PM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2018, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@straightdope.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Copyright 2018 STM Reader, LLC.

 
Copyright © 2017