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29 December 2011

I did a lot of driving today.

And we attended a lot of cases.

62M - Pre booked transport for a medical appointment.
79M - Pre booked transport for a medical appointment.
75M - Was having a minor procedure needing sedation and had a slight regurgitation that was suctioned. The attending health professional refused to proceed until the pt's chest was x-rayed to clear from aspiration fearing pneumonia. The pt was completely asymptomatic, normally health, active, without any respiratory Hx and able to cough deeply if asked to. The look from the attending at hospital when I was asked for the five word triage was readable by even the pt when he demanded of us 'Well what am I doing here then?' and we simultaneously replied 'We don't know!'
75M - Emphysema and increasing heart failure leading to increasing SOB.
??M - Was assaulted in a Welfare Office but wanted nothing to do with us. SNR
53M - Very irregular AF hospital to hospital transfer.
64M - In a Dr's rooms presenting with chest pain, found with an O2 mask on and the residue of an aspirin on his lips. No notes, handover shouted from half way down the corridor by the Dr, finished with I'm to busy without my nurse can you handle him or something similar. Yes we can Doc and I left a copy of my 12 lead clearly showing the pt having a confirmed STEMI and he was in the Cath Lab about 20 minutes later.
42M - In custody of the constabulary claiming to have swallowed a plastic bag containing 20+ Oxycontin tablets (he was selling them). The qty had dropped by the time we arrived and he was asymptomatic advise to the Police check his Poo if you want because they should travel the length of his GI in the bag or call us back if he changes.
50F - Pseudo fitting.
67M - IP who was very nearly home so we helped him.
52M - Well known street IP removed from central city shopping mall to a suitable small hospital to sober a little.

Now a discussion, what would I have done on the third job.
Lets think of these few thing.
The patient had been nil by mouth apart from a mouthful of water for his BP meds this morning.
That was all that seemed to have come up. It was suctioned, he was sedated not unconscious so therefore had a gag reflex.
The procedure time of maybe an hour was now increased by the transport to a hospital.
Examination time because that's the hospital doing their job properly.
X-ray if they thought it necessary, they didn't (wiser heads and common sense).
Write a clearance letter and return of pt to original location.
Even then the hospital would advise the pt that if he felt any adverse effects from the regurgitation to call for an ambulance or attend his Dr or a hospital.

I believe that the procedure could have proceeded and this same advise be given to the pt and his carer after his recovery time and before discharge.

Is that unreasonable? 

See you at the big One.



ambsjuksköt said...
This comment has been removed by the author.
ambsjuksköt said...

64M with chest pain: It's really interesting that it looks the same over the world with these patients. No ECG, no IV, no medication...and allways a doctor who thinks he has something better to do!
//Ambsjuksköt - ambulance nurse in sweden