Sunday, March 28, 2010

I think my IQ just dropped a few points...

Look, I am all for making mistakes. It's how we learn best. I am all for asking questions so you DON'T make mistakes. But seriously people...use your brain. It's that organ located in the lump 3 feet above your ass. If you occasionally engage that organ, you can save yourself from a lot of mistakes, and make yourself look less like a fool, and more like someone I'd want treating my family.

For my hospital time clinical, I go to a large, well-known university hospital. They also have a peds ER upstairs from the adult ER, but the critical care rooms (trauma rooms) are down in the adult ER. So whenever there is a consult for the peds ER, the adult ER listens in, just in case they end up coming to the adult ER.

As an aside, any paramedic student doing time in a hospital should listen in when a medic unit does a consult. Not only does it let you know if there are any traumas or serious medical cases coming in that you could look in on, but it also shows you the difference between a good consult and a bad one.

Any way, yesterday I heard the box go off, and listened in with the charge nurse. It was a consult for peds, but we listened in. The information was as follows:
12 year old male picked up from school with chest pains and trouble breathing. Unknown medical history per patient and school nurse. All vitals unremarkable (BP something like 120/80, P 80 something, R 18, O2 sat 100% ra). EKG shows NSR, IV with lock.

All sounds ok right? Then the medic consulting dropped the bomb. "Given that the patient is past the age of puberty, we would like to know if we should give NTG and ASA."

WTF?????? Are you serious? With vitals like that, and a kid who's 12, you want to give NTG and ASA? First of all, per MD protocols, a child is considered pediatric until age 15. Secondly, per MD protocols, NTG is no indicated in children. Thirdly, haven't you ever heard of Reye's Syndrome? You know, what possibly happens in children who are given aspirin? (Granted, I don't know the time frame and dosages required to give a child Reye's Syndrome, but still).

But the biggest problem here is this. Regardless of the age and so on, look at the vital signs. There is ZERO sign of any kind of heart problem, and, absent any concrete history, I'd be hesitant to give ANYTHING.

So yeah, I think my IQ dropped a few points listening to that consult.

At any rate, the rest of the clinical on Friday went well. The clinical Sunday went well too. Not as many skill check-offs as I would like, but several good medical patients that were serious head-scratchers and a good experience to sit in on.

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