Damned if you do, damned if you don't. Sometimes you get patients who are waiting for you at the front door, keys in hand, suitcase packed with their favorite pillow, their face pressed against the screen for fear of missing you drive by. And before you've even put the truck in park and put your gloves on, they're bolting the front door and walking down the driveway. Whoa, whoa, wait a minute Ms. Sweet Elderly Lady... lets check you out first. This kind of presentation, if you will, by our patient usually leads me to believe that this is in fact NOT a life threatening call. And because we have the option to call for a basic rescue to come transport and/or refuse transport at all if deemed appropriate.... I'm usually headed down that path. I've run a plethora of these... usually constipation or trying to get to a surgery appointment on time. Frustrating to say the least, but I have an affinity for older folks and don't mind taking the time to check em out, give them the "next time..." speech and help them lock their house up.
Then you have the calls where either the patient or the family calls and while from initial presentation its not a load and go.... after you hook them to the monitor, a few flags raise.... then the 12-lead... more flags... and you're like, "OK, lets get going, we'll do everything else enroute." That's when your patient keeps finding just one more thing that they just HAVE to have. Be it insurance card, meds, ... their favorite pillow.... and you're approaching the line of either snapping that, "Look, we can't stay here any longer, we really need to get going, now." vs. getting that one more thing that will help relax them and not cause any undue distress. Its that affinity for older folks that keeps me tottering on that line. Sometimes I just have to be the bad guy. But its only for their health and well-being.
Then there was the call at 0800 this morning for a 20-yr male with a cramp in his foot. Really son,.... really? The cabulance is here...
Sunday, June 21, 2009
Thursday, June 04, 2009
Stereotyping
How many times are you getting dispatched and before the address is complete you already know the patient you're responding to. You can already picture their face, their living room (or street corner), their presentation and even their vitals. You get tunnel-vision.
Other times you get dispatched for the chest pain or difficulty breathing and on arrival you greeted with someone who appears to be having an emotional breakdown. A para-suicide-threatening moment. A psychosomatic anxiety attack. And again... you get tunnel vision.
A dangerous place to be indeed.
So we get called for a 40-yr old woman with chest pain. She's sitting in a chair at the county courthouse after standing in line to pay a ticket, hiding her face behind her large mane of hair. She looks like a model. Tall, thin, dressed to the nines with 3" stilettos. Not saying much of anything, rather letting the first responders answer after long pauses to our questions. I'm getting some tunnel vision. I ask about history. She is as vague as she can be. She thinks she had an MI in the past but doesn't remember. She can't remember anything else she might have. She says she takes meds but can't remember a one. My suspicion of anything serious is diminishing.
I put her on the monitor. Whoa!!!!! Quadrigeminal PVC’s on a NSR with runs of V-Tach. Well darlin, lets get going. We secured a line enroute and was on the apron in just a few minutes. All her other vitals were normal. Come to find another tidbit of information that, I at least, never learned in medic class. Hyperthyroidism causes tachycardia. I had known about hypothyroidism causing bradycardia.... why a=b therefore -a=(-b) didn't connect with me I don't know. I do know. Tunnel vision!!! She had hyperthyroidism and was not taking her meds!
So watch your tunnel vision. From those patients that we'd love to just buy a bus pass for to the atypical presentation. Full assessments folks. It's patient care. You just may be the only person on this world that gives a flying flip enough to respond to their need. Whether it be just some human interaction, a friendly face in their world of despair, or a true call during a life-threatening emergency. Trust me... I need to be reminded of my own advice everyday. Stay safe out there.
Other times you get dispatched for the chest pain or difficulty breathing and on arrival you greeted with someone who appears to be having an emotional breakdown. A para-suicide-threatening moment. A psychosomatic anxiety attack. And again... you get tunnel vision.
A dangerous place to be indeed.
So we get called for a 40-yr old woman with chest pain. She's sitting in a chair at the county courthouse after standing in line to pay a ticket, hiding her face behind her large mane of hair. She looks like a model. Tall, thin, dressed to the nines with 3" stilettos. Not saying much of anything, rather letting the first responders answer after long pauses to our questions. I'm getting some tunnel vision. I ask about history. She is as vague as she can be. She thinks she had an MI in the past but doesn't remember. She can't remember anything else she might have. She says she takes meds but can't remember a one. My suspicion of anything serious is diminishing.
I put her on the monitor. Whoa!!!!! Quadrigeminal PVC’s on a NSR with runs of V-Tach. Well darlin, lets get going. We secured a line enroute and was on the apron in just a few minutes. All her other vitals were normal. Come to find another tidbit of information that, I at least, never learned in medic class. Hyperthyroidism causes tachycardia. I had known about hypothyroidism causing bradycardia.... why a=b therefore -a=(-b) didn't connect with me I don't know. I do know. Tunnel vision!!! She had hyperthyroidism and was not taking her meds!
So watch your tunnel vision. From those patients that we'd love to just buy a bus pass for to the atypical presentation. Full assessments folks. It's patient care. You just may be the only person on this world that gives a flying flip enough to respond to their need. Whether it be just some human interaction, a friendly face in their world of despair, or a true call during a life-threatening emergency. Trust me... I need to be reminded of my own advice everyday. Stay safe out there.
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