The Ball game

[crazylegs]

Finally, TNN says to the patient and family, "Look, I'm trying to take care of your heart problem here. When you decide you want to let me do that, you let me know." And she walks out.

I do not get people some times. You're in the fucking hospital. You know your heart is not right. Why the fuck wouldn't you let the health care people do their jobs?

This is why I like working on an ambulance. If you're a decent human being I'll move heaven and earth so you can ride in with your relative. If you're a d1ck then I'll cite weight issues, insurance issues and confidentiality issues and you are NOT coming aboard.

When that patient removed the cuff, I really would have been tempted to ask the her wnat she preferred: seeing the ball game, or living long enough to have someone tell her what the final score was...

Had that convo, told them in no uncertain terms they would likely die if they don't get treated. MCA allows me to be blunt at times

[EricKei]

MCA allows me to be blunt at times

The ClueBat 4000 DX. For those times when a good dose of reality needs to be administered via blunt force application.

[Shalom]

And when that doesn't work, the patient can sign out AMA and go off into the wild blue yonder.

That's assuming they LET him.

Two weeks ago, I tried that myself. Didn't work. Had to wave a lawyer at them before they'd let me out.

New thread forthcoming, don't want to thread jack. Probably Friday, I have to go to sleep now.

[Amina516]

That's assuming they LET him.

Two weeks ago, I tried that myself. Didn't work. Had to wave a lawyer at them before they'd let me out.

New thread forthcoming, don't want to thread jack. Probably Friday, I have to go to sleep now.

In my neck of of the woods we can only keep a patient if they're suicidal or homicidal. I'm interested in your tale. eyeballs peeled.

[Shalom]

In my neck of of the woods we can only keep a patient if they're suicidal or homicidal. I'm interested in your tale. eyeballs peeled.

They probably were assuming the former, given how much Valium I'd taken to prepare for the MRI+gad and blood draw. I know my limits, but they don't.

[Sapphire Silk]

That's assuming they LET him.

Two weeks ago, I tried that [signing out AMA] myself. Didn't work. Had to wave a lawyer at them before they'd let me out.

Just between you, me, and the fence post, AMA forms aren't worth the paper they're printed on. Most AMA forms would not stand up in court. If you sign the patient out AMA, you're acknowledging you knew the patient was in dire straights when they left.

You're better off letting the patient elope than admit that in writing.

[blas]

When my brother was in the hospital a couple of years ago with apendicitis (pardon my spelling), my mom got stopped by multiple nurses who told her that my brother was one of the easiest, nicest patients they'd had in a long, long time, let alone one of the only cooperative and polite ones in his age group that they've taken care of.
'
It's a long story, I'll spare ya'll, but he ended up having to be hospitalized for a ruptured appendix, and he needed a bag stuck in his side to drain the infection that had bubbled next to his ruptured organ....and while he did NOT want to be hospitalized or be treated like he was helpless or be restricted, he never once argued with the doc or nurses, never once didn't listen, always let them take his vitals or do what they needed to do and was always very nice or polite when asking for something.

I was really impressed with the nurses as well. After what I went through with people like my ex, I have nothing but respect for ER nurses and orderlies who have to make rounds taking care of people in hospitals (because people are effing JERKS even to people helping them!), but those ladies were just awesome all around.

[EvilEmpryss]

In my neck of of the woods we can only keep a patient if they're suicidal or homicidal.

One could then argue if someone knows they're likely to die if they check out AMA then they are, in fact, suicidal.

[Luna Baby]

I had to chuckle when reading the original post. My mom was about 5-6 weeks post surgery for a partial lung removal (ball games were relevant to that hospital stay, as well**). At that point, she should have been feeling somewhat better but was having a really bad day in that her heart rate had jumped up to 130-150 range and would not come down. She's had a tachy rhythm for years and takes a med for it but apparently, something wasn't quite right. She called me to let me know she'd driven herself in to the urgent care to see about it. I had just come in from my longest run ever (literally-20 miles) and had to high tail it across town. I get there and the staff is bringing out the crash cart and getting it all set up to transport her via ambulance to the ER so that the emergency staff could do something for her heart. I get in the car and follow the ambulance back across town and we see the ER doc. She decides to do some 'cardio-vert' procedure and low and behold it works! Yay! But she won't let Mom go home until all labs and x-rays are back. Mom is begging this doctor to please let her go--she HAS to watch the ballgame. Mom is one of the biggest Univ. of KY fans I've ever seen.

**Back at the time of her surgery to remove the lung, she came out of surgery fully awake and doing great. Even asked for coffee in recovery. Refused ANY pain meds until she was promised that they wouldn't knock her out, only make her more comfortable. She finally admitted to the doctor and nursing staff that Kentucky was playing that night and she would NOT miss that game. And she didn't.

[jedimaster91]

She decides to do some 'cardio-vert' procedure and low and behold it works!

Nerd moment here since I recently went to a class about EKG rhythm and monitoring. Synchronized Cardioversion is very similar to defibrilation. The idea is to use an electric current to shock the heart out of a bad rhythm. Although, with cardioversion, you want to be sure it's synched to the patient's heart beat, or else you might throw them into a worse rhythm. If I recall correctly, Torsade's is the main concern, which can happen if the heart tries to beat too soon after the last beat and doesn't give itself the chance to relax and refill. It often leads to V-fib if not corrected.

EKGs really are fascinating. If you know what you're looking for, you can tell quite a bit about someone's heart.

[Sapphire Silk]

Nerd moment here since I recently went to a class about EKG rhythm and monitoring. Synchronized Cardioversion is very similar to defibrilation. The idea is to use an electric current to shock the heart out of a bad rhythm. Although, with cardioversion, you want to be sure it's synched to the patient's heart beat, or else you might throw them into a worse rhythm. If I recall correctly, Torsade's is the main concern, which can happen if the heart tries to beat too soon after the last beat and doesn't give itself the chance to relax and refill. It often leads to V-fib if not corrected.

EKGs really are fascinating. If you know what you're looking for, you can tell quite a bit about someone's heart.

V fib is the concern; if the charge hits the T wave, when the ventricles are repolarizing, they can basically shake like jelly. Because there are no effective contractions, blood does not circulate and organs are not perfused.

It looks like this:

Torsade de pointes is a form of Ventricular Tachycardia where the axis of the VT changes from one pole to another. It is caused by a severe magnesium deficiency. It can also lead to cardiac arrest and turn into V fib.

It looks like this:

[Luna Baby]

Nerd moment here
SNIPPED
EKGs really are fascinating. If you know what you're looking for, you can tell quite a bit about someone's heart.

Geek speak to me. They didn't use any electric shock. It was an IV med pushed really quick. Doc and staff stood by for the 5-10 seconds it took to take effect. I basically 'over heard' what they were doing since the discussion was still directed at Mom since she was still coherent and able to communicate.

EKG readings still confuse me. Probably best I left nursing school early and went into accounting.....

[Sapphire Silk]

Geek speak to me. They didn't use any electric shock. It was an IV med pushed really quick. Doc and staff stood by for the 5-10 seconds it took to take effect. I basically 'over heard' what they were doing since the discussion was still directed at Mom since she was still coherent and able to communicate.

EKG readings still confuse me. Probably best I left nursing school early and went into accounting.....

They gave you adenosine. It's a version of chemical cardioversion.

It's a neat drug: it literally stops the heart. The idea is the heart will restart itself.

The drug has a half life of 6 seconds. When you push it, you need another nurse pushing 10-20 ml of saline into the line at a higher point at the same time. Otherwise the drug metabolizes before it does any good.

The patient is literally awake when they flat line. Good times, good times.

[Luna Baby]

They gave you adenosine. It's a version of chemical cardioversion.

It's a neat drug: it literally stops the heart. The idea is the heart will restart itself.

The drug has a half life of 6 seconds. When you push it, you need another nurse pushing 10-20 ml of saline into the line at a higher point at the same time. Otherwise the drug metabolizes before it does any good.

The patient is literally awake when they flat line. Good times, good times.

I don't remember a 2nd nurse pushing anything but then again, when the doctor explained what would happen, I think we were all holding our breath. She told Mom that it would feel like she had just been punched in the chest and then it would be over within seconds. Mom said she felt it (she gasped, actually) and then it was over. Said it didn't hurt, but that she knew she'd been "jump started". All is good now.

Thanks for the explanation. You always put it into terms easy to understand.

[Sapphire Silk]

I don't remember a 2nd nurse pushing anything but then again, when the doctor explained what would happen, I think we were all holding our breath. She told Mom that it would feel like she had just been punched in the chest and then it would be over within seconds. Mom said she felt it (she gasped, actually) and then it was over. Said it didn't hurt, but that she knew she'd been "jump started". All is good now.

Thanks for the explanation. You always put it into terms easy to understand.

Thanks!