Question for all the EMT's and medics on here

[Light It Up]

BLS unit arrives on scene at a adult living center to find


A 57 yr male shaking severally normally does not shake (has shaken but not like this one other time in the past) bp 190/110 heart rate 130 (bp was very very difficult to obtain due to shaking) pt is normally alert orient x3 but is currently very out if it and loopy pt complains of being nauseous and dizzy and has stomach pain


As a EMT what would you do and as a medic what would you do


Thanks

 

[EMT-BLS]

BLS unit arrives on scene at a adult living center to find

A 57 yr male shaking severally normally does not shake (has shaken but not like this one other time in the past) bp 190/110 heart rate 130 (bp was very very difficult to obtain due to shaking) pt is normally alert orient x3 but is currently very out if it and loopy pt complains of being nauseous and dizzy and has stomach pain


As a EMT what would you do and as a medic what would you do


Thanks

As BLS? Simple. Pack up the patient, and go. We are not supposed to diagnose, we just need to get the patient to someone that can.

 

[JohnMarcson]

I am thinking this is going to end up being a backhanded way to question the actions of some crew. If this is simply a test question or you want to learn from a run you were on... post some more details. I feel like I'm walking into a "see I knew they messed up" post trap.


Without seeing, hearing, smelling and generally observing the actual scene it will be impossible for any of us to give a real answer. There is no good way to post the details of a run for critique here.


If you are just asking for general info, here is a general answer.


I run on a double medic 3rd service (not fire based) government 911 ambulance. We are responsible for the 911 calls for the country including the cities within which contain numerous nursing homes. I run ill people at extended care facilities very frequently. I also have worked for over 10 years in private EMS doing emergency, non-emergency and critical care transport. 90% of any level of EMS is basic assessment. The way I respond to what I find may differ slightly from a basic EMT, but we should be doing a very similar size up.


This is basic medical assessment..... I would run a LOC change call at an ECF as follows- In the room (under 5 min)- Size up, exam and history (if possible from pt, staff and paperwork). I'd investigate any red flags in the exam or history, mitigate life threats etc. Package, load. Reassess en-route; Vitals/exam, 12 lead, glucose check (if not done on scene), IV if time permits enroute. It's all going to depend on what we find. If I walk into the room and it smells GI bleedy, I'll do a full size up like always but ask about poop more than usual. If the glucose check is 12, I'll fix that. If he's been vomiting I'll check is mouth more carefully for dried blood etc. The list goes on.....


See where I'm going.....








tldr; You do a general medical assessment and note/gather more info on abnormal findings while treating life threats. Like you always do. You will never give us enough info to get a valid answer. Just tell us where you are going with this.... ie What other dept screwed up, who signed off your sick grandfather, how did the firsts dropped the ball.... etc...

 

[unlisted]

As BLS? Simple. Pack up the patient, and go. We are not supposed to diagnose, we just need to get the patient to someone that can.

Pretty much. Package PT for transport,do a full workup to your level of trg, (vitals, put on o2 if vital check calls for it, etc) document, monitor en-route, get to higher level of care.

 

[bwoodruff]

BLS unit arrives on scene at a adult living center to find

A 57 yr male shaking severally normally does not shake (has shaken but not like this one other time in the past) bp 190/110 heart rate 130 (bp was very very difficult to obtain due to shaking) pt is normally alert orient x3 but is currently very out if it and loopy pt complains of being nauseous and dizzy and has stomach pain


As a EMT what would you do and as a medic what would you do


Thanks

Without reading the other responses in this thread...


I'm an EMT-B so what I can do unless it is bleeding, fractured, giving birth, in need of comforting, in need of CPR, in need of oxygen, and a few other things there isn't a lot I can do besides call for a higher level of care and start towards the hospital.


In this case, I would try to obtain baseline vitals. Most adult living centers have these on record, or the staff nurses will have a general idea. It would be good to know if the tachycardia and hypertension are a little high or a lot high for this pt. In either case, I'm calling for ALS as soon as I arrive if they have not already been dispatched.


I would try to assess how bad the shaking is... is this pt. having a seizure? Are they cold/hot to the touch?


I'd have an emesis bag ready and apply oxygen (after consulting a pulse ox).


Other than that and my routine basic assessment there is very little I can do other than get this pt loaded quickly and transport ASAP, hopefully intercepting with ALS on the way.

 

[Bigassfireman]

Until we get a little more details, I'm gonna go ahead and say that I would go straight to defibrilation, set at the highest possible Joules that your equipment will provide. That should cure the shaking. :yes:


If this turns out to be a legit thread, I will offer a non smart ass answer for you.

 

[julietbravosierra]

Until we get a little more details, I'm gonna go ahead and say that I would go straight to defibrilation, set at the highest possible Joules that your equipment will provide. That should cure the shaking. :yes:

Your monitor allows you to adjust the joules?! lucky bastard!


As always, BLS before ALS. Perform your assessment, get your FULL SET of vitals, auscultate breath sounds, monitor pt, and act within your scope of knowledge as would you with any pt.. just wondering, why are you asking this here? Maybe ask your partner who was also there to shed some light on what he thought. It doesn't make too much sense in my mind to seek advice that may very well be inaccurate simply because of extenuating circumstances and variables that we do not know about. NOT trying to come across like a jerk in any way shape or form here btw.

 

[tnems7]

Let's remember that as a basic or advanced provider, you need to obtain a focused assessment and medical history on this patient. What medical conditions and medications are present. Too little or too much medication? Has the patient been able to keep usual dosing schedule? Or has that been upset by vomiting, nausea, etc.


Get as much information as possible, and transport the patient for more definitive care.

 

[Bonanno]

Im an EMT-B so here is what I'd do:


Rapid assessment, obtain full history/meds/allergies, get quick run down of when started/what did today, request MICU/ALS, vitals, O2, Package, transport to ER.

 

[patrol530]

I'm a cop, so I'd tell him it's a cramp & to walk it off. If that doesn't work, I'll recommend he knock off the BS, because we're not going to waste a transport to the ER so he can try and score some of the opiates he's jonesing for.

 

[Light It Up]

i will explain a bit further


i was dispatched to the call and when i arrived what i described was exactly what i saw i requested ALS/medics, when they arrived the berated me for 5 mins on how i am a moron for calling them and this is a bls call, when we got to the hospital he again cursed me out for calling for bull shite nothing i would say to him would make him listen i see the same crew a third time and he again rips in to me for calling for ALS


so i posted here to see what all of you would have done


when ALS got to us the medic says hi then turns to me and says he is stable you can go with out us so i informed him that he cant leave after making contact so he curses me out some more then hops on are bus the entire 6 min ride to the hospital he did not do a thing


at the hospital he says pt is stable with vitals of 198/122 heart rate of 148


i just want to see what you guys would do is all


thanks so much for those with serious legit answers

 

[Phoenix_Rising]

thanks so much for those with serious legit answers

We knew there was a backstory to such a post...next time give us the decency of telling the whole story prior to posing a question. Kinda like patient care,half a story doesnt go very far.


*edit for typo

 

[PursuitElectronics]

Was this an ALF for senior citizens or an ALF for dependancy? If the latter is the case, that should have triggered an automatic response to a possible drug reaction. Whether it be withdrawals or he just took a bad drug or reaction to a current med. Anyone of those could be the case. I have had people who are shaking violently because they are in the worst withdrawals of their life and wish they were dead. Heart rate up, blood pressure up is a common indicator..stomach pains and vomiting....if they are in withdrawals, they have been vomiting for days and diarrhea for days.....But I do not know medical hx to make a determination. Its all about assessment and patient medical hx.

 

[njtaz76]

As an EMT-B, basically, O2 and vitals, then transport, meet ALS enroute if PT appears unstable.


My concern with other answers on here are this: Where in the EMT-B (and new EMT) curriculum is a pulse ox taught, and interpreted? Yes, I use my own SpO2 monitor that I carry on calls, but I do NOT use that to determine if patient needs O2 therapy. And any EMT who does, is well... fill in the blank. It is an assessment tool, NOT a tool to determine if a patient requires O2. Its little stuff like this that really makes EMTs look bad. There are so many times an pulse ox is not accurate and should not determine if a patient needs o2 (as an earlier post stated --paraphrasing slightly-- "I'll give o2 after consulting a pulse ox").


Nice to have, good to use, but great way to loose one's job or patient's life.


Anyway, to continue further about being berated by a medic. In my 17+ years, I've had many medics try to berate me. When I was newer, I used to get upset over it. Now, I don't care. Why? Because I've been burned by the little old lady who was "weak" with stable vitals who was an actual MI patient. Or recently a "most likely flu" type patient who was vomiting and diarrhea (mild chest pain after all that started, so first thought? Muscle pain from vomiting a lot). Ended up, a STEMI. I beat the medics to the punch if its one that will try to make a snide comment by usually saying "guys, you know if I walked into the ER with this and this, I'm going to get my ass handed to me.. sorry but I have no choice". Of course, now a days, I've been around long enough that I only get an attitude from a new medic and usually that happens once... after that one time, they learn real quick I've been around too long to try mess around with lol.. I know too many of their people

 

[PursuitElectronics]

i will explain a bit further

i was dispatched to the call and when i arrived what i described was exactly what i saw i requested ALS/medics, when they arrived the berated me for 5 mins on how i am a moron for calling them and this is a bls call, when we got to the hospital he again cursed me out for calling for bull shite nothing i would say to him would make him listen i see the same crew a third time and he again rips in to me for calling for ALS


so i posted here to see what all of you would have done


when ALS got to us the medic says hi then turns to me and says he is stable you can go with out us so i informed him that he cant leave after making contact so he curses me out some more then hops on are bus the entire 6 min ride to the hospital he did not do a thing


at the hospital he says pt is stable with vitals of 198/122 heart rate of 148


i just want to see what you guys would do is all


thanks so much for those with serious legit answers

Unfortunately, there are alot of Paramedics who think they are ParaGods....Do not let a crew belittle you. They think their shit doesnt stink and if the patient isnt crashing in front of them or a serious trauma, they could care less. When the patient is A&Ox3 when they arrive and then crashes enroute to the hospital, then say I told you so! A GOOD Paramedic is one who has GOOD EMT skills. You need to be a GOOD EMT before you can be a GOOD Paramedic. Way to many forget that! Without basic EMT assessment skills and the basics, period, you might as well hand your license into the state, because your a liability waiting to happen!

 

[Bigassfireman]

BLS unit arrives on scene at a adult living center to find

A 57 yr male shaking severally normally does not shake (has shaken but not like this one other time in the past) bp 190/110 heart rate 130 (bp was very very difficult to obtain due to shaking) pt is normally alert orient x3 but is currently very out if it and loopy pt complains of being nauseous and dizzy and has stomach pain


As a EMT what would you do and as a medic what would you do


Thanks

Ok, now I'll offer a serious reply now that we have the rest of the story. As a medic: First,I would recheck vitals since they are elevated, just to make sure. Second, I would admin a few lpm O2 if not done already. I would then dig a little more for info about poss etoh or substance abuse. Get him in the truck and place a monitor on hime, the hr and bp warrant that. I would withhold any narcan due to him having a patent airway. Start an IV and maybe give Zofran. BS check just because he is disoriented to rule that out. Besides that, not much else to do. Nothing wrong with calling for a medic if you feel you need one, however, with a 6 minute transport, it may not warrant waiting for one if they are not able to arrive on scene withing a minute or two.

 

[Light It Up]

We knew there was a backstory to such a post...next time give us the decency of telling the whole story prior to posing a question. Kinda like patient care,half a story doesnt go very far.

*edit for typo

i intially wrote this post as a test question


like you would see in a EMT exam i wanted to hear what you all would say prior to me writing the back story

 

[Light It Up]

this is the type of place were drug OD is not likely

 

[EMT-BLS]

this is the type of place were drug OD is not likely

Making an assumption about something like that never a good idea. For all you know, the priest/rabbi you're treating just lost a loved one, and has been "self-medicating" to deal with the grief.

 

[Light It Up]

Making an assumption about something like that never a good idea. For all you know, the priest/rabbi you're treating just lost a loved one, and has been "self-medicating" to deal with the grief.

this place is a lock down type place we have gone there and taking ppl to the er at 2 am for not having gotten there meds since they ran out

 

[JohnMarcson]

It doesn't matter if you were right or wrong in calling them... it's never ok to act like that. If I think a run got under or over triaged by a basic crew I just discuss the run afterward with them. Usually they had a good reason, but sometimes one of us learns something or at least sees the reasoning. Whether it be an over triage, an unnecessary run, an unneeded assisted.. what ever... you don't treat another member of your team like that. If the basics saw something that made them call for a medic I transport with or for them... obviously they thought they saw something, if they are wrong we can discuss it like professionals after the run. I'd rather get called for something borderline than not called when I'm truly needed.


As far as the run, from the info we have I would consider it a "rule out" ALS run... meaning I'd do an EKG and start an IV if I had time after a full basic exam and history....but again that's not the real issue...