Posted by: medicblog999 | July 5, 2009

Over to you – Post 3

partnersFollowing on from the recent posts from both myself and those included in edition 5 of ‘The Handover’, around communication issues, Mike from America has sent me in a post to share with you good people.

It needs very little introduction, other than to thank Mike for sending it in! Please feel free to leave any comments for Mike after reading the post.

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Communication…yeah I do that good!

You’re sitting on post in SouthernBigCity at 6:15 in the morning anxiously waiting for Dispatch to clear you for fuel.  Maybe, just maybe you’ll get off on time for once.  It’s been a busy shift; 7 hours at central posts with  two stabbings, a shooting, two asthmatics, and a nursing home cardiac arrest from hell (CPR anyone?…anyone?).  You’re finishing a 12 hour shift at a Post in the northwest suburbs – the “nice” part of town; all manicured lawns and upper middle class moneyed types. It’s your fourth night in a row and you really, really just want to go home. Fat chance.

The pager goes off at 6:30 for a “Respiratory” just ½ a mile from your location and your EMT  partner’s cursing enroute is louder than the siren. Arriving on scene you find a mid-40’s, chubby-ish male standing at his kitchen table tripoding and gasping for air with multiple inhalers strewn around the room.

Initial communication is brief and direct – he’s had progressively worsening dyspnea all night, refractory to multiple inhaler uses.

History: Asthma with multi-ED visits and two ICU (Ventilator) admissions in the last year

Exam:

Vitals (“Obs” for the Brits!) HR: 140 (EKG normal), RR: 40 – obviously labored with 1-2 word dyspnea, BP: 160/110, skin: cool, pale, moist, SpO2: 91% on HFO2.

Chest: Breaths sounds are equal bilaterally but with grossly diminished aeration and very tight inspiratory and expiratory wheezes bi-apically.  Every accessory muscle is in use attempting to maximize breathing mechanics and he’s getting tired.

You rapidly put an Albuterol updraft on as the fire department arrives (first responders but you usually beat them in the early hours) and you put them to work getting the stretcher in.  The patient is worsening and gasps out “epi”, “epi” – SQ epinephrine would be nice but, in your system, is contraindicated in patients over 35, especially if they are hypertensive,tachycardic and overweight.  Your Medical Director is paranoid about Epi-induced MI’s in older asthma patients.

As the stretcher is slid next to him he collapses onto it and has about 30 seconds worth of clonic activity with his jaw clenching and resps dropping to <10/min…yikes!  Your partner grabs the bag-mask while you lube up a 7.0 nasal tube – outwardly calm and focused while your insides try to tango, you get lucky… the tube goes in (no..you’re not that good…as I said; just lucky) so now you can bag and give more nebs in line.  He starts to get a little rambunctious but a little IV Valium takes care of that.

You have a reputation of being lousy with patient names and ages and no amount of effort seems to have helped with this, so you refer to everyone as “Sir” or “Ma’am” but this patient will probably start to come to a little on the way to the hospital so you really would like to know his name to help keep him calm. Luckily you notice a piece of mail on the table addressed to “Joe  Blank”  – problem solved.  Sure enough, on the way to the hospital he starts to wake up, staying calm as you explain what happened.  He even helps bag himself, nodding slightly as you ask if he’s ever done this before.

You arrive at St. Poshness  (I told you it was the upscale part of the city, why should the hospital be any different?) at the worst possible time.  It’s now after 7am and you’re going to have to deal with the day-shift nurses…you work strictly nights and they are not going to know you.

Sure enough, a chorus of;

“why is he intubated?”

“why did you bring him here?”

“are we the closest hospital?”

“why are you bothering us, we haven’t even had coffee yet?”

greets you as you come through the door with the patient.

Gritting your teeth you start to say;

“this is Joe and he is now awake AND CAN HEAR EVERYTHING YOU SAY”

You try several times to give report but still they are not getting it…frustration starts to set in as you quietly apologize to Joe for their rudeness.  Luckily the ED Doctor comes in and you’ve known him for years – one of the good ones, quick to assess Joe as he listens to your report.  This shuts the nurses chorus up and you’re finally able to transfer him to an ED bed.

As you get ready to leave you turn to Joe and wish him the best.  He has a strange look on his face and motions to you for a pen and paper.  This is what he wrote…verbatim…

“Joe? Joe?  My name is John… Joe’s my brother!

The moral?  None really, I’ve just called all my patients “Sir” or “Ma’am” since then.

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Thanks for sharing the story Mike. If you have a story you would to share (remember,you dont have to be a paramedic!!), a patients perspective would be good as well, please send it to my email : mglencorse@yahoo.co.uk.

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Responses

  1. I too am terrible with names, I called my next door neighbour Tony for many years before he told me he was called Alan.

    Nice post Dave ;-).


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