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!

You say it’s your new policy to “not transport anyone with uncontrolled blood pressure”. Actually I would like to know what brainiac came up with that policy? If it was a doctor, I would imagine he or she is suffering from a massive stroke and has forgotten everything they learned in medical school. If it is not an MD, then I would postulate that they have demonstrated an absolute lack of understanding of basic human physiology and should look for a new job.

Now, take this damn patient back to the nursing home. He is always hypertensive.

I love the fact that many of you really are interested in the physiology of disease and that you are really trying to figure out what is the cause of a patient’s complaint when you pick them up. However PLEASE realize that your role in the field is primarily to stabilize and transport! Do not fart around trying to mentally masturbate about whether a patient has elevated pulmonary wedge pressures or what the patient’s total peripheral resistance is. INTUBATE the patient. You guys arguing over whether to give Nitro or to pour fluid in is immaterial when the patient is barely responsive, has agonal respirations, and is satting at 79%! Afterwards I will gladly be willing to discus this, but if you bring him in looking like garbage and with no respiratory effort, I am going to have withhold our debate about whether the patient is pre-renal or not till after I get that saturation up. Thank you.