Comments on: Want vs. Need

By: medic22

medic22 — Tue, 02 Feb 2010 13:33:14 +0000

Very true Texas, I also belong to the “smallest cath I can use” club, however, if I can, I like to push D50 through an 18. Just personal preference. Interesting how protocols differ from place to place. And yes, Glucagon would have been a great option if I didn’t get the line. But, I did. So, all’s well that ends well.

By: TexasMedic

TexasMedic — Tue, 02 Feb 2010 09:01:45 +0000

everything is all well and good except for 1 thing. You dont NEED an 18g IV to give a person D50. You can give a person D50 in a 20g just as easy as 18g. To be quite honost you can give a person D50 through a 22g if you really NEEDED to… I wouldnt recomend a 22g though just because that becomes time consuming and what not. But a 20g is perfectly fine. And if you really want to look at the glass halfway empty say you didnt get a line. 1mg glucagon is perfectly acceptable. Not preferred but accecptable. So what the guy NEEDED was to wake up with some form of glucose wether it be D50 or glucagon. Something our medical director preaches down here is you can do anything through a 20 or 22 that you can through an 18 it just may take an extra minute. Our protocols even state as long as it is appropriate it is preferred that in medical patients to place an 20g in medical patients and 18g in trauma. So next time you get that patient who is a diabetic and has crappy veins.. dont worry about freakin over trying to get an 18g in a small lady. Do something that will actually benefit the patient. Outweigh the benefit over risk.

By: Rob

Rob — Tue, 02 Feb 2010 04:20:08 +0000

I think you handled the call well… yea, he didn’t want to go, but you gained expressed consent after his daughter talked to him…he forgot to eat? maybe he has an underlying issue, such as alzheimers, where he is not able to care for himself on his own anymore, since he cannot remember to balance his medication and diet. Always err on the side of the patient….good job!

By: MysteryMedic

MysteryMedic — Mon, 01 Feb 2010 23:33:34 +0000

Thank you for the follow up with the additional details. I agree, there some diabetics that you just don’t feel right about and transport. The IV and gotta transport protocol is new to me though and sorta surprising because if a diabetic becomes orriented they can always refuse transport regardless of what was medically done prior to that condition. I would hope the average medic would allow the line to be pulled and have the patient refuse because to not allow the patient to refuse if they are AAO would be kidnapping no matter what the protocal says.

By: paramom 8

paramom 8 — Mon, 01 Feb 2010 23:04:46 +0000

Thank you for writing this. Enjoyed your clear description of all-too-familiar living conditions and the “gotta make this stick count” situation. And I thank you as well for being a patient advocate…I am often dissed for going beyond the “you don’t want to go to the hospital, do you?” mentality. It’s nice to know there are others out there that are not always just thinking about how fast they can get back to station…

God bless you!

By: EMSNeverLeavesTheSoul

EMSNeverLeavesTheSoul — Mon, 01 Feb 2010 22:22:08 +0000

Medic22,

You absolutely did the right thing. Protocols and EMS practices of course vary by region and company. IMHO, not all diabetics need to be transported to the ED after on scene treatment. BUT… it has been my experience that most of them do. Either way you look at it, we just don’t have the same tools that hospitals often take for granted. In the field, we must rely on our training, our experience, and our instinct. If there is any doubts whatsoever, we must do everything in our power to get the patient the care he deserves, even if it sometimes results in an “unnecessary” transport, so to speak. It is *much* better than the alternative.

All too many patients lack appropriate advocacy, and it is their health and quality of life that suffers in the end. Keep this attitude up, and you will be well worthy of that patch… and you’ll have the added bonus of knowing that you are making a difference. =)

By: Karl

Karl — Mon, 01 Feb 2010 22:13:30 +0000

Good Story but The patient should a stayed home with the daughter no need for transport to an overcrowded ed to recheck BS and give him a meal. Pt should of stayed home. I would of agreed to transport if this was a regular and multiple x’s of LBS. A call by his daughter to PMD would of sufficed. Along with her coming there and rechecking BS. Good dialog and use of expressionistic content.

By: Jim

Jim — Mon, 01 Feb 2010 21:36:31 +0000

Cool Story. I agree that this patient should have gone to the hospital. He may have been alert then, but if he was left home alone, things could have gone bad. Your preceptor is 100% correct. Our primary function should be patient advocate; sometimes that means pushing meds and sometimes not. Until we get out of the mindset of us being technicians we will continue to be treated like outsiders.

By: Ira

Ira — Mon, 01 Feb 2010 21:15:08 +0000

I always try to talk Patient’s into going. Even Diabetics that possibly don’t need to go. I’ve learned my lesson about refusals (death, repeat call for unresponsive Pt because they didn’t eat enough and the family member didn’t stay when they said they would, law suits, etc) and that lesson is that I HATE refusals. If I could I’d wait to start treatment until we got closer to the hospital but I don’t want to delay care. Too much stuff happens then. As my Medic Instructor pounded into our heads “If you have to err, err on the side of the Patient” and “Treat all the Patients (even the really annoying ones) like they are your closest family member.” You never know when the seemingly simplest diabetic call can turn into something really complex.

By: Carolinagrl

Carolinagrl — Mon, 01 Feb 2010 21:00:00 +0000

Yeah, I feel you. I’m new at IVs and it’s not even 50/50 yet. They want me to practice on anybody that gets in the truck. I’ve got issues with doing an invasive, painful (when I do it lol) procedure on people that don’t need it just for the practice. I’ve asked to go to the hospital for practice, nothing yet. I’m not inclined to try when it’s truly life or death yet. Hate to blow what turns out to be the only viable vien. Anyway I agree with your transport decision. I’ve been to herds of diabetics, don’t think I’ve come across one not breathing before.