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  • #16
    Quoth crazylegs View Post
    Ladies & gents - please tell us everything, we're trying not to do anything with drug interactions that'll end up causing you (in some cases) massive harm.
    Welcome to the wonderful world of EMS! Better get used to it; this will happen often.

    Often patients don't get the connection between symptoms. And heart patients classically deny they're having a heart attack.

    I would ask the guy, though: "Why didn't you tell us about your heart problems?" If he insisted he had none, I'd be concerned for an altered mental status along with the chest pain.

    Quoth Dytchdoctir View Post
    This is why you document - in detail and at length.

    On the other hand, many people engage in a paradoxical little behavior meme I call, "trying to suit the story to the perceived audience". We often joke that the paramedics get one story from the patient, the nursing staff get another, the attending physician gets yet another. The person who gets the story that is the closet to the actual truth, is the housekeeping worker who gossips with the patient while mopping the floor.
    I've been through this one so many times, I've got dain bramage from the . Very frustrating, and the patients don't always do it on purpose. The doc may just ask a question just differently enough that some long forgotten memory jogs, and out comes the real story.

    Quoth trailerparkmedic View Post
    My absolute favorite patients are the ones who bring their meds with them. I have no problem sorting through their giant ziplock bag if it means I get accurate medications doses. My least favorite ones are the ones who say "I take a white pill and a blue pill for my heart." What's wrong with your heart? "Oh, I don't know. I just take the pills."

    I'm going to have fun in the ER.
    Enjoy!

    Here's the one that used to drive me nuts: the big ziplock bag full of multiple bottles of the same pills, with different dates on them, and sometimes varying dosages that make it hard to know just what it is they're actually supposed to be taking . . . especially with all the different docs.

    Then there's the folks who put all their meds in one big bottle, so you have NO idea what's actually in there! Used to deal with that one all the time in corrections; inmates would get bloody pissed when I told them I couldn't give them any of their own medication until they saw the doc . . . because I couldn't figure out what they were actually supposed to be taking! (They didn't know either, other than "pain pill" or "anxiety pill").

    My dad did something like this years and years ago. I was home visiting, when Mom woke me at 2am because Dad couldn't breathe and was having chest pain. I wanted to call 911 but he refused. I had a stethoscope with me, and listened to his chest . . . knew it was a rip roaring case of pneumonia from the sound (plus the fever), so we did go to the ER at my insistence. Basically I told Dad, "you're going to the hospital now. You can either get in the car, or I call 911. Your choice." Grumbling, he agreed . . . then picked up his car keys. I took them from him and informed him I was driving (Mom doesn't drive). He tried to balk, but I pointed out . . . I had the keys. Should I also get the phone? He got in the car.

    So I grab up his meds to take with us since he didn't have a written list.

    Long story short, he was admitted and spent a week in the hospital. But then his diabetes got out of control . . . because he was getting half his usual dose of his anti-glycemics. Seems Dad had been dumping his new prescriptions in his old bottles . . . which had the wrong dose. Dad's regular doctor was out of town on vacation, and his partner was unwilling to change the dose without consulting with him (and couldn't seem to find anything in Dad's medical records at the office . . . I think he just kept forgetting to look it up). We were so relieved when the regular doc got back in town a couple of days later and fixed the orders.

    When Dad got home, I insisted he keep an up to date written copy of his medical history and his meds in his wallet at all times . . . which he did until the day he died.

    Quoth raudf View Post
    Don't attach it to the back of the door. Put it in a binder with your name on it and put all information inside the binder. I included insurance info, blood type, allergies, list of meds (types/doses/condition requiring them,) medical conditions past and present. We've affectionately nicknamed ours the Footballs, because in an emergency, you grab 'em and run. Just gotta remember where you put them... I've told my parents where mine are.
    That's a really good idea. I've had family members who do that when they care for a very sick relative . . . and it's wonderful.

    Quoth 24601 View Post
    Please, please, PLEASE have a certified copy of a DNR readily available if there is one. There is nothing worse than having to work a code when one is in place, but no one can produce it. One family member was taken away in cuffs for assault when we were just trying to do our job. No paperwork, we have to go all out.
    Quoted for TRUTH!!!!!

    Really, guys, if you take nothing else away from this, take this one thought: by law, the medics can't pronounce. They must use all available resources until told to stop by the ER physician, who doesn't know Aunt Sally from Adam.
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

    Comment


    • #17
      Who would we contact to get a medical POA and a DNR (or whatever medical treatment level we want) written up?

      Is the family doctor likely to have 'fill in the blanks' copies of such forms, and be capable of certifying them?
      Seshat's self-help guide:
      1. Would you rather be right, or get the result you want?
      2. If you're consistently getting results you don't want, change what you do.
      3. Deal with the situation you have now, however it occurred.
      4. Accept the consequences of your decisions.

      "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

      Comment


      • #18
        Don't count on your "living will" being respected either. If you sign papers saying "no feeding tube" etc., but your family says to put one in, the hospital will do what your family says.
        Women can do anything men can.
        But we don't because lots of it's disgusting.
        Maxine

        Comment


        • #19
          Seshat, I don't know how it works in Australia.

          In the US, you can download a medical power of attorney and living will form off the internet, find some witnesses, and be done in 10 minutes. It doesn't require a lawyer or a doctor or anything. I like the 5 Wishes living will because it allows you to be pretty detailed in what you want and it looks like it would make lay people think about things they wouldn't normally consider. It's accepted as a legal document in most states. It's not accepted as a legal document in my state, but I did complete it so my husband has it as a reference (he doesn't know what things like PEG tubes or pressers mean).

          My state has the medical power of attorney form available online for free, if you want an idea of what you're looking for.

          I have limited knowledge of Out of Hospital DNRs--this is what you need to keep EMS from trying to save you. This is something that is common in hospice and very uncommon otherwise. If you're worried about a situation where you're in the hospital and there's no hope for recovery, your power of attorney can do an in hospital DNR if the situation arises. That's usually just a signature. My state's form requires a doctor's signature here, but I don't know if that's my state being special or a routine thing.

          Like Sparky said, the most important thing is to make sure that your family is aware of your wishes. Don't pick someone who will ignore what you want. If necessary, explain why you want something. My husband and I had a long conversation about why I have a specific time limit on any extraordinary measures.

          Comment


          • #20
            Quoth Seshat View Post
            Who would we contact to get a medical POA and a DNR (or whatever medical treatment level we want) written up?

            Is the family doctor likely to have 'fill in the blanks' copies of such forms, and be capable of certifying them?
            I'd look online with your local government; they may have forms you can fill in available for down load. A legal site that specializes in Australian law may also be useful. Don't pay for a form; there should be plenty of templates available for free.

            I don't know about the POA laws in Australia, so take this with a grain of salt, but in the US you can get a POA template, fill it out, and you sign it with witnesses in front of a notary public. It then has a binding legal force of law. There is usually a revocation clause that allows the person to revoke the POA if they don't like how the person is handling it. You can get them done up with an estate attorney, which is not a bad idea if you can afford it so the lawyer can make sure it says what you want it to. But you don't need to.

            You can get a Durable POA which covers everything, a Limited POA which covers just the finances, or a Healthcare POA which covers medical decision making only.

            A Healthcare POA cannot be overridden by an angry family member who disagrees with the POA's decisions, whereas a Living Will can be. Providers are not going to risk a lawsuit over a Living Will, especially since the patient is unlikely to be able to file a complaint about treatment they don't want; they usually lack the mental capacity to protect their own rights.

            Everyone should sit down with the family and have a frank discussion on what their health care wishes are in case of a calamity. I did with my parents (or rather, they did with me) so I know exactly what they wanted. Unfortunately, they never got around to getting either a POA for their financial affairs or the healthcare POA written, so my brother and I have to go to court tomorrow to ask a judge to appoint us permanent guardians of our mother (who has Alzheimers) just so we can pay the bills, sell the house, and determine what end of life care will be. I wrote a very detailed Advanced Directive for Mom based on her conversations with me when she still had her faculties.

            Unfortunately, my brother opposes organ donation because she never became an organ donor on her state ID. She wanted to be an organ donor, but she discussed it with me not him and it makes him uncomfortable. I'm in a position of having to pick my battle: do I fight it out for her wishes, or do I choose to stay on good terms with my brother and have access to my nieces and nephews.

            Quoth Sparky View Post
            Don't count on your "living will" being respected either. If you sign papers saying "no feeding tube" etc., but your family says to put one in, the hospital will do what your family says.
            See my comments above. A Living Will has no force of law. A Health care POA does, and cannot be overridden unless the disgruntled family member is willing to go to court over it.

            So pick your healthcare POA very carefully. Choose someone who shares your values and that you trust to follow through on your wishes. If you don't want a feeding tube, and you pick a healthcare POA who is a hardliner on the "sanctity" of life, and who believes Terry Schaivo got a raw deal by having her feeding tube removed, then expect your wishes not to be followed.

            Your healthcare POA does NOT have to be a relative. My healthcare POA is my best friend, because he's 1) rational in stressful situations, 2) knows my values and feelings on end of life care very well, and 3) will not hesitate to execute my wishes as we've discussed because he is such a good friend and person. I love my brother deeply, but his views on end of life do not coincide with mine and I think it would be difficult if not impossible for him to carry out my wishes. So I chose not to put him in that position.
            They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

            Comment


            • #21
              Rugz and I are doing ours soon and printing one off for Nan, as the one for our state has the option of stating the person or people that you don't want notified about your health and stating that they have no say in your medical care. Since one of my worst fears is being stuck in a persistant vegetative state with my mother as my primary carer, I'm very grateful that I have the option to ban her. It also helps to make sure that Nan's daughter doesn't try to take advantage of her again. I'm also glad that it has an empty spot for extra care options, ie "If I'm in a coma, as well as the care options that I've already chosen, I would like the healthcare professionals to talk to me and tell me what they're doing, as well as have audiobooks/music/radio played for me via a device that my family will provide."
              Don't tempt pixies, it never ends well.

              Avatar created by the lovely Eisa.

              Comment


              • #22
                Quoth 24601 View Post
                Get used to it, people don't tell you jack most of the time.
                I've done 3 years of volunteer ambulance work - this was probably the best/worst example I've come across

                Quoth Dytchdoctir View Post
                This is why you document - in detail and at length.
                Absolutely - I always put 'none declared' if someone says they're not taking any meds, it shows I asked & they said no...

                Quoth Seshat View Post
                Note to self:

                Make up three pages of medical info, one for each of us. Keep up to date, attach to the back of the front door.
                Better would be an obvious sticker on the inside of the front door which shows the location of said info - there's a scheme here that puts med info in a film pot in the fridge & an easily recognisable sticker on the door telling you that. From what you've said a folder will probably be a better bet . Don't know if you mentioned it but having next of kin details (those who can in law make care decisions for you) as well as any other appropriate documents would be wonderful

                Quoth Panacea View Post
                I would ask the guy, though: "Why didn't you tell us about your heart problems?" If he insisted he had none, I'd be concerned for an altered mental status along with the chest pain.
                <SNIP>

                Really, guys, if you take nothing else away from this, take this one thought: by law, the medics can't pronounce. They must use all available resources until told to stop by the ER physician, who doesn't know Aunt Sally from Adam.
                Ah - when reminded he discussed it, he just couldn't initially remember, but when his memory was jogged he had full recall.

                In the UK paramedics can recognise life extinct & stop working on a patient - a lot more sensible in some circumstances.
                A PSA, if I may, as well as another.

                Comment


                • #23
                  Quoth crazylegs View Post
                  Absolutely - I always put 'none declared' if someone says they're not taking any meds, it shows I asked & they said no...

                  Better would be an obvious sticker on the inside of the front door which shows the location of said info -

                  In the UK paramedics can recognise life extinct & stop working on a patient - a lot more sensible in some circumstances.
                  Great idea with the sticker!

                  When I ask a question like what meds do you take, or do you have any medical history and the patient says none, I write, "Denies." None declared could indicate that the patient just didn't bring it up, not that you asked the question. Denies also protects me better if the patient later claims he DID tell us about something when he actually didn't.

                  Sad that we have to take those kinds of steps, really

                  In the US, paramedics and nurses aren't considered smart enough to know a dead body when they see one. In hospitals, with ready availability of physicians, that's OK. In the field, not so OK. We end up working a lot of people who should be let go.
                  They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                  Comment


                  • #24
                    I have a pac-safe bag that holds all my current meds except the spare lantus in the fridge [Navy sends me 3 months of meds at a crack, I put a weekly supply in a med dispenser] I keep a set of emergency duplicate [30 day supply] prescriptions in the inside pocket of the pac-safe, as well as the complete list including nonscrip meds [like biotin, calcium, omega 3 and such, even though those are also kept in the pac safe] and a complete listing of my conditions, and contact numbers for the various doctors I see and for what.

                    I once drove myself the 30 miles to the sub base in Groton back when it still had an ER, on s Sunday. Went in the long way past the file office to make sure I had my medical record because I had chest pains and was light headed. We didn't have the money for an ambulance co-pay, the roomie of the time didn't drive at all, and nobody around at 10 pm at night. Luckily it was only a case of post-pneumonia pleurisy. [Of course, the Dr Death that saw me prescribed penicillin, which I am allergic to but that is another issue.]
                    EVE Online: 99% of the time you sit around waiting for something to happen, but that 1% of action is what hooks people like crack, you don't get interviewed by the BBC for a WoW raid.

                    Comment


                    • #25
                      Quoth Panacea View Post
                      In the US, paramedics and nurses aren't considered smart enough to know a dead body when they see one. In hospitals, with ready availability of physicians, that's OK. In the field, not so OK. We end up working a lot of people who should be let go.
                      Does this restriction cover even the cases which would be obvious to someone with no medical training (e.g. patient has been decapitated)?
                      Any fool can piss on the floor. It takes a talented SC to shit on the ceiling.

                      Comment


                      • #26
                        You still have to call medcom/hosptial. Paramedic cannot pronounce TOD on their own, a doctor has to call it.

                        My first big car accident had a decap, I let my medic know (basic student at the time) and moved on. We delt with finding the head later, I think the police found it first.
                        Last edited by kpzra; 12-17-2011, 10:35 PM.

                        Comment


                        • #27
                          Quoth wolfie View Post
                          Does this restriction cover even the cases which would be obvious to someone with no medical training (e.g. patient has been decapitated)?
                          Essentially, yes, though no one would even try CPR in such a drastic case. Field Paramedics don't have to start CPR if the police gets to the scene first and declare the victim dead, which they do in such obvious cases. Depending on where they're located, they have some discretion of their own.

                          Other medical professionals are not required to start CPR, but once you start you can't stop.

                          I had to do CPR in the hospital on a woman who was very clearly dead, because we couldn't find her DNR order, and the doc hadn't arrived yet. I've several patients like that (include my first code, where the guy wasn't found until he was in full rigor mortis, but we had to do CPR anyway).
                          They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

                          Comment


                          • #28
                            Quoth Panacea View Post
                            (include my first code, where the guy wasn't found until he was in full rigor mortis, but we had to do CPR anyway).
                            I don't think I'd be capable of that! I think I'd throw up.

                            I do, however, have an extreme reaction to death/death symbology.
                            Seshat's self-help guide:
                            1. Would you rather be right, or get the result you want?
                            2. If you're consistently getting results you don't want, change what you do.
                            3. Deal with the situation you have now, however it occurred.
                            4. Accept the consequences of your decisions.

                            "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

                            Comment


                            • #29
                              One of the patient's husband the other day was really amazing. It wouldn't surprise me if he was a doctor, nurse, or a paramedic given how much he knew about her condition and medications. He also could just be that much into his wife since it was obvious he really, really loved her. However, he had all of her medications lined up on the coffee table and knew everything about her past.

                              Comment


                              • #30
                                Quoth emt_cookies View Post
                                One of the patient's husband the other day was really amazing. It wouldn't surprise me if he was a doctor, nurse, or a paramedic given how much he knew about her condition and medications. He also could just be that much into his wife since it was obvious he really, really loved her. However, he had all of her medications lined up on the coffee table and knew everything about her past.
                                I've met a lot of family members like they. They really get invested in care giving and become really knowledgeable. They're great resources for the nursing staff.
                                They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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