The beauty of the beast (sftblqt14) wrote in goodstories,
The beauty of the beast
sftblqt14
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what to do?

Not really sure what to do, if anything, I disagreed with my crew chief and so did the other EMT with me. I am new she has been there for 5 years and he has been there for 20+ and is an instructor to boot.

Arrive on scene to find an 86 years old man alert but not oriented sitting on the couch. Right away you could hear that he was having trouble breathing and you could see the liquid coming out of his mouth. He was incontinent, had a elevated bp and pulse and respitory rate. It sounded like he was gargling on his own spit, so my first thought is possibly suction and oxygen. He was a diabetic, so my crew chief right away says we need glucose in him, I said I don’t think he is alert enough to take glucose, he can’t even talk, I don’t think he can swallow. He says lay take his feet and lay him on the floor, I said to him he shouldn’t be laying on the floor, he is already having difficulty breathing, but he proceeds to take him off the couch and lay him on the floor, even more so now you could hear him, it sounded like he was choking on his own spit, So my crew chief says give him glucose I refused, he couldn’t’ swallow he need oxygen and he needed to get out of the house into the rig for the medics and he needed not to be laying supine. So I get oxygen ready and the women that was talking to the family , the other emt says to this man he can’t swallow why are you giving him glucose, he says look I know what I am doing he can swallow look he is swallowing now, this man was holding his head just pushing all the glucose in his mouth and the pt was just gargling and most of it was coming up out of his mouth, the cc just continued to give it and wipe his mouth, I said can you sit him up, he needs to sit up, after a while he finally says fine and sits him up, the other emt by now says the same thing. I leave, he asks for the stair chair, I said should we be using the stair chair he can’t stand or talk, or even keep his head up shouldn’t we use the reeves, he says get the stair chair he is fine. So I go out and this other emt is now helping with pt care, he asks her for yet another tube of glucose, she says he can’t swallow I am not giving it, if you want to give it to him you get it out of the bag yourself. He put 3 tubes of glucose in this mans mouth and all if it basically just came out of his mouth. The medics come b4 we get him out of the house, and as what’s going on, he says he is a diabetic and I gave 3 tubes of glucose.. they say well can he swallow he says yes and my other partner says No but he gave them to him anyway, they start assessing and say he needs to finish getting him out. They take his sugar it was around 33 or something in the low 30’s and immediately start an iv to give him glycogen s or whatever it is called, eventually the man starts to wake up. However, the call went horribly, after the call I went up to him and told him my thoughts on how the pt couldn’t’ swallow and should not have been supine while getting glucose, n should not receive glucose because of all the indications weren’t met. He say to me, he was fine, didn’t you see an improvement, I said no, I didn’t , not until the medics did what they had to. I spoke to the other emt that was with us she has the same thoughts, and hates riding with this one cc because he does things like this. I tried to do what I thought was right for the pt but I just got shot down and I am not a cc, he wouldn’t listen to either of us. I don’t know, but it just didn’t’ seem right. I hate being in that position, and I don’t know what to do about it, he is older, he has been there longer, he teaches it, but he wasn’t right on that call. How do you deal with situations like this?
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By going to the boss and filing a complaint....
I wasn't sure if i should do that right away, or if i should jut talk to my captain and see what he says. I dont know if people just do things differently than I do, but do u think writing a report right away would be irrational? but see its a volunteer squad, so i dont know if it would do much ya know, but still
The Captain would count as a boss to go to, especially if he has seniority over the crew chief. And I definitely thing filing a report would make sense, it seems this crew chief is showing negligence. Also, even if it is a volunteer squad, people can still be kicked out/reprimanded in other ways.
Well one thing I did notice: You complain about him laying down, and then you want him laying down in a Reeves to be txp'ed out of the house. :) Stairchair is fine with a patient who is semiconcious, especially if you want to keep upright, as you did here since the pt had diff breathing.

The WORST for a stairchair is actually a highly alert and combative patient, since they grab on to you/railings/anything and potentially knock themselves and you down the stairs.

Oral glucose the patient definitely has to be WILLING to swallow, ie, alert enough and coherent enough.

I had a 80-something year old male diabetic who was extremely hypolglycemic and he was 'alert', but was too combative/restive/confused to swallow the glucose.

I'd tell him to take it, he'd agree, I'd put it in his mouth and he'd spit it out all over me.
Incident report. Cover your own ass. Even if your captain won't accept it, write one anyway, seal it in a dated envelope, and put it with your personal records.
i ramble lol i dont know the medics said we should have used the revees, because he coudlnt even hold up his head, the diff breathing was becasue of all the saliva in his mouth, and the glucose he coudlnt swallow, it wasn't that he was spitting it out, it was more or less he couldnt' swallow and evyerhitn was setting so when he woudl breathe it would push everything out.. i am new though, my partner said we shoul dhave taken him out on the reeves and that is what i ment to say that she wanted him on the reeves not that, thats what i wanted... sometimes i get carried away, yeah i have used the stair chair for patients like him, the glucose, the man didn't agree, he didn't talk, he didn't move, he wasn't doing anything, except sounding like he was choking on his own spit, i guess that is what i ment by diff breathing because he had so much liquid in his mouth including the glucose this guy gave him, i asked the medic after the call since he was my emt instructor, he said the man wasn't alert enough for glucose, but i dont know
If you know you have ALS available to give him D50 or Glucagon, whats the point of trying to choke him with glucose?
That was my point, but the creiw chief decided otherwise.... The pt needed the iv of Glucagon, not tubes of glusose choking him, but my cc said he knew what he was doing....
Yup. I agree.

The Pt could have aspirated the damn glucose doing it the cc's way!
Wish I had something new to add, but the bottom line is that I agree with most if not all of what has been said. The glucose was bad, and the stairchair issue could be either way in my opinion. As my instructor says "If you are an advocate for the pt. then it's hard to go wrong."
just bite your tongue. i have found that older people on the force do stupid things because it's "textbook" for them. if the pt. declines after that, then you should take charge if you can. thats terrible that all of that happened
I totally agree about the glucose gel, a semi or unconscious pt can definately choke on it. However as a basic most people do ont realize if you are in a pinch, some glucose gel can be given even to an unconscious pt if done correctly. it isnt in protocols but if you put a VERY small ammount just inside the bottom lip it can be of some use as it will absorb through the mucous membrane without choking the pt. But 3 tubes is definately too much, maybe the cc was hoping for this reaction and went about it the wrong way but it is something to keep in mind if ALS is a ways out