Well, let me rephrase to a simpler question - what’s the best way to get the ER docs to check with the regular docs before administering a medication, if we cannot rely on the patient to refuse it or realistically just keep her home in the first place? (If the assisted living place finds out that she’s fallen or not breathing well at night, they take her to the ER, regardless of any instructions that may have been left to the contrary, as far as I can tell.)
Unfortunately, there probably isn’t any good way to have that message reliably conveyed to the ER staff. I would guess the assisted living staff is contacting you or some other family member when she is being sent in for evaluation. It may behoove you to take that opportunity to call ahead to the ER if you won’t be able to get there personally.
Another option would be to list the antibiotics she has had a problem with as ‘allergies’. There are some antibiotics that are notorious for causing c. diff colitis.
What do the paramedics do that pisses you off?
St. Urho
Paramedic
Your insurance company hates you. It’s that simple.
Our ER co-pay is $500. So, our insurance company hates us more. Feel better, now?
Most of the time I really appreciate all the hard work that our EMTs do. There are a couple of things that get me riled up. The first is trying to do too much. Sometimes you can just load the patient and bring them on. I often see the EMTs trying to fit every patient’s presentation to the protocols. For instance a patient with bad chest pain who is short of breath with a wheeze probably doesn’t need a neb treatment which could exacerbate their problem if it’s cardiac in origin. But at least they’re thinking and using the tools they have. Worse are the guys who drop the patient off without doing anything who can’t tell you who they are, why they’re here, or anything else of importance. In my opinion, the paramedic’s primary job is to stabilize the patient. If they’re already stable, then 75% of your job is done!
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Is there truly a problem with hospital employees failing to wash their hands often enough?
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When someone arrives in your dept. with a severe head injury, concussion, etc., it is really necessary to keep them awake, the way they always seem to on TV?
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Yes. Particularly in the ER. I’m constantly running from room to room and don’t have time to stop and wash my hands every couple of minutes. Hand sanitizers are conveniently located and easy to use. I try to use the gel every time I enter or leave a room (which is sometimes the same time!)
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No. That’s television drama. Just like pulling out the bullet will save your life. The only reason to waken someone with a concussion is to check their mental status. I typically recommend waking them every 2-4 hours just long enough to make sure they’re able to wake up then let them go back to sleep.
This time last year I was working in a non-trauma Emergency department which sees over 3000 patients a year. Fun times.
I know that my stint in A&E made me much more cynical and jaded.
This was due to:
Drug seekers
People looking to make large insurance claims for very minor injuries
Saturday night bar-fight victims
The arrest-induced chest pain patient
The Self-harmers
The Friday 5pm nursing home dumps
The alcoholic frequent fliers
Having said that, I did actually love the work, just not the crazy hours (5pm-3am shift anyone?)…so I’m going into General practice.
Anyway, my question is:
Which phrase do you hate more?
“I thought I should get it checked out, just to be safe”
or
“The nursing home says she’s just not herself, but they can’t be more specific”
St Urho- without getting into specifics, if there is a major and potentially lethal contra-indication to giving a drug, no matter how commonly you give the drug and how rare that contra-indication is, checking for it before you give the drug is usually the safest plan.
The only problems I have ever had with paramedics involve variations on the theme of “applying the standard treatment protocol in situations where the protocol does not apply”.
ever read Fingers and Toes?
Thanks for starting this thread USC.
I recently heard a doctor giving a talk, and he said that if you went into an ER 30 years ago and were having a heart attack, you had a 40 percent chance of dying. If you go to an ER today and are having a heart attack, you only have a 4 percent chance of dying. Would you agree with this, and if so, what do you attribute this to?
Nope.
I wasn’t practicing 30 years ago, but it wouldn’t surprise me. Our ability to diagnose, stabilize and treat cardiac problems has vastly improved in the last several decades. In the past we did not have nearly the same ability to save heart muscle. Once you had a heart attack, if you didn’t die right away, you would likely suffer from years of continued problems such as congestive heart failure.
I’d just like to point out that I have the phrase incarceritic tachypnea copyrighted.
Oh sure, you couldn’t mention that before my shift! 
I was wondering, in this situation, if a medic-alert type of thing would be appropriate.
Which leads to my next question: how often are such things consulted? Do you specifically look for alert bracelets / pendants when you get a patient into the ER?
irishgirl - What’s an “arrest-induced chest pain patient”? I think I got all the others. Although, why dump nursing home patients late Friday? So the hospital has to house them over the weekend?
USCDiver - Did you do platform or springboard diving, and why don’t you do it anymore?
If you’re in the ER and the doctor says “we want to take your gallbladder out tonight”, is it a bad thing to schedule it for a couple weeks later?
StG
Not to intrude too much here, but a GB that is very inflamed and infected should probably not be left inside the patient. Chances are good that it would burst, sending forth bile everywhere and sending the pt. into the ICU.
(Going by a very close personal encounter in this instance. The rest of this is, of course, for USCDiver to cover.)
“You can’t take me to jail! I’ve got chest pain! Take me to the ER!”
Schedule what, the funeral?
If a qualified surgeon says that your gall bladder needs to come out right now, it’s usually best to listen to that advice.
[/stealing USCDiver’s thunder]
Qadgop - I was thinking arrest = cardiac arrest, not the legal kind.
I did schedule my choly for a couple weeks later, because I’d never had surgery before and the idea was scarier than the pain (this was after they gave me a few shots of Something Nice). I’m afraid of doctors and going to the ER was the hardest thing I’d had to do in a long time. It took me a while to work up my courage to have the surgery. In the end, the surgery was less painful than a gallbladder attack.
StG
I read them if I see them and take that information into context with the rest of the patient’s presentation. I don’t actively look for them because they’re pretty rare. I can think of one or two instances where seeing one changed some aspect of the patient’s treatment. In regards to ENugent’s particular case, I don’t give antibiotics unless I think they’re necessary to treat a bacterial infection. So if a patient has a bracelet that says “I had c. diff once after an antibiotic” it isn’t going to deter me from treating the more immediately life threatening infection on the off chance I’ll cause a secondary, but ultimately treatable and rarely life threatening complication.
Mostly springboard but some platform. Diving isn’t a sport that can be safely done every once in a while. It has to be everyday or not at all. Otherwise you can endanger yourself.
I think it’s important to make a distinction with regards to gall bladder problems. Having a ‘gall bladder attack’ or biliary colic is not necessarily an indication for emergent cholecystecomy, but if symptoms persist could lead to a surgeon recommending an elective and/or outpatient procedure. On the other hand, acute cholecystitis (infected gall bladder) is a surgical emergency and can lead to a gangrenous, ruptured gall bladder and eventual sepsis.
How do you feel about Nurse Practitioners (and those who work as Hospitalists)? Do you lean more toward “welcome relief” or “doing my job without med school”?
I know some doctors that love the NPs that work with them and cover their patients (especially so they can get some sleep!) and I know of a few that hate them on principle.
Also, I like what I am studying now but really, really prefer something more involved than the med/surg floor routine but people seem to think I’m crazy when I say I’m drawn to ED or possibly flight nursing. Am I crazy? I hate to say that I am excited that people are hurt, but I’d rather work on someone covered in blood and every second counts than make sure Room 184 completes her perineal care.
~ Shelli, nursing student