The reason I went into Emergency Medicine is to treat sick patients and hopefully make them better. I enjoy the surge of adrenaline and the feeling of deep satisfaction when I bring someone back from the brink of doom. It used to be that a bad attack of acute congestive heart failure afforded me just such an opportunity. Support the airway (intubate if necessary) and get ‘em on a nitro drip and blast them with Lasix. Very satisfying watching the patient start to breathe easier.
Anyway, no longer. Why? No, not because patients are taking better care of themselves and watching their salt intake. It’s because of our paramedics! They take away my chance to shine because they have gotten too good at managing it themselves in the field! Then can give endless sprays of sublingual nitro. The have 100 of Lasix. And most importantly they have BiPAP. It’s not uncommon for me to field a call from them where it sounds like the patient is going down the tubes and by the time they get to the ER, they are smiling from under their face mask asking for a urinal to diurese in! Sats that go from 78 to 98 by the time they are with me are not uncommon.
The only good thing about this is that I can fart around on the Internet for a few more minutes before I have to get off my ass and go see them….
Good job crew!
27
Jan
Become a paramedic ? ;-)
Pre-hospital management is getting better all the time.
Unfortunately my service has removed Lasix from our ambulances out of the fear that we’ll cause Hypokalemia, code a patient and get sued and that ‘research has shown that it increases stays in the ICU by two days at least when used in the pre-hospital setting.’
I won’t even go into my thoughts as to why this is a shame, but a useful tool is removed, nevertheless. :(
And to clarify before I get the pedantic response, I mean the ones who are obviously hypervolemic and are going down the tubes already. ‘Not’ every CHFer out there. We’re not all cookbook medics who don’t see the big picture outside our protocols.
I’m from Canada, the crews aren’t giving lasix (yet) but started some time ago with Adenosine for SVT. That makes me grumpy, because I like giving that for the rapid conversion. Very satisfying.
Several years ago our small town emergency department (20 bed hospital, 3 bed emergency department) was staffed by the Doctors from the local Family Medical Clinic. It was always understaffed and short handed.
It was not uncommon when someone coded for the hospital to call 911 to have the paramedics respond to the hospital. Their ambulance station was only 50 yards door to door from the hospital.
These days, the Emergency Department is staffed by Doctors from the Big City Trauma hospital about 80 miles away. It is better staffed and they don’t call the paramedics for help anymore.