Saturday, 7 February 2009

Is it Just me?

Is it just me or is this Paramedic over the top? Basically they are going to an elderly chap whose chief complaint is CHF/LVF. He is nasally intubated. What I was concerned about was the fact that the Paramedic said that there was no time for drug therapy so he just went straight to the top of the tree, INTUBATION! Now don't get me wrong if someone needs an airway I wont shy away from it but this guy is fully conscious! Sure, he's struggling for breath but surely trying nitrates, diuretics etc first should have been first line treatment. I've been to a lot worse than this patient and treated them with drugs and by the time they've arrived at hospital they are a completely different person, quite often with the A/E staff looking blankly at me asking why I rushed a relatively well looking patient in! What about assisting his breathing with a BVM, supplementing each breath increasing his SPo2 then trying drugs? I don't know perhaps I'm doing something wrong.

Having said all that the patient supposedly said thank you to the Paramedic for saving his life. All I'm saying is that I would of resorted to a more stepwise approach.


Anonymous said...

I agree, it seems a tad excessive, without treating the cause of the shortness of breath first.
However, as I have found out myself before, I wasn't there and didn't see the patient so it is hard to comment.
However, we all know some paramedics who will always go for the needle decompression, or the jugular vein, or the IO rather than trying other things first. Im not saying that was the case in this paramedic but it does seem a little odd!
I wonder what the A&E staff had to say?

Anonymous said...

Our first line drugas are nitro, morphine, lasix, CPAP if you have it. That looked like a big enough city to delay intubation until he got to the ER. It also doesnt seem like he premedicates him prior to intubation. And to top it off they hyperventilate him with the BVM.

mac said...

This program was from a while ago, back in the early nineties so cpap wasn't available prehospital (correct me if I'm wrong). We are still waiting cpap!

brendan said...

That wasn't medical care, that was torture.