June 25, 2010

Doing the minimum necessary

That phrase is ground in to our heads in school. Do just what needs to be done to your patient to get them to the hospital alive. If they don't need an IV, don't do an IV. If they can suffice off an OPA, don't use a King airway. If a King works, don't intubate. Etc etc. The problem is learning what the right amount is for us new Paramedics.

At this point in my career, I truly am uncomfortable making some of the decisions I make in terms of patient care, yet still make them because I know I have to.

Last week I had an OD at a rave who has a pulse rate well in excess of 160, and unconscious, BP 150/90 initially. We quickly got him to the ambulance and en route to the hospital, 5 minutes away. I did a quick assessment, did an EKG (SVT), made the (5th OD) call to the hospital, and tried fighting with the guys mouth to suction his gurgling respirations caused by him vomiting, to which he would clamp down on the catheter.

We got him to the hospital, they RSI'd him to get a tube, and he promptly went in to Vtach, which they shocked, and his BP went to 60/30, even with 5 liters of NS infused in two IVs. Body temp was 108.8* F... frying his brains right in front of us.

So that leads to my questioning of myself after this call. Did I do the minimum necessary? Did it suffice that I got him to the ER as quickly as possible, or should I have done more? Should I have attempted to cardiovert his SVT, with or without an IV, even though his BP was fine (elevated?) Should I have tried pushing Valium to ease his teeth so I could suction? Should I have put in an NPA? Should I have tossed on a few ice packs, seeing as he was warm, but I didn't have a thermometer?

Why do these thoughts only come to me AFTER a call, and not during?

This is why I want to do 911, and not IFT, so I'm in these situations more, and can get more comfortable with making the decisions necessary.

Stopped by the hospital a couple of days later, and one of the nurses said the guy survived the first little bit, and they had him up in the ICU, but the docs still don't have much hope for him. Even if he does live, his brains are fired.

And before anyone asks... it's not really eating me up. I'm not depressed, not sad, not mad. Just wondering if it could have gone better.

Until next time.

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