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  #11  
Old 12-14-2011, 04:05 AM
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Use a larger gauge needle
If it was sized proportionately some patients could walk down the bore...
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  #12  
Old 12-14-2011, 10:48 AM
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I need to sit down with Nan and make up a medical folder with her, including a certified copy of the enduring power of attorney and a witnessed/certified list of her preferred medical treatment. Its hard to explain to her that it's one thing for her to tell us what she wants, and quite another to explain why Rugz asked for no heroic measures and DNR when he's the main beneficiary listed in her will (Her kids will contest it so Rugz is covering his ass). The other thing that's hard to get through to her is that she MUST tell the doctor everything! Telling them about an allergy to iodine isn't being annoying, neither is telling them that the morphine is making you feel fuzzy, sleepy and breathless but not doing anything for the pain. I love her dearly, but they can't help her if she's too shy and I can't speak for her as I'm only her granddaughter-in-law and do not hold power of attorney. Thankfully she has a current list of medications and the matching conditions stored with her current meds.
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  #13  
Old 12-14-2011, 01:57 PM
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I want to make a 'grab and go' kit that includes not just the medical info, but stuff like mortgage paperwork and certified copies of ID documents.

I guess a 'grab and go' kit like that with the medical folder brilliantly and clearly marked would do the job.

(Perhaps red, with white crosses blazoned on it, and the relevant names prominently marked.)
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  #14  
Old 12-14-2011, 06:49 PM
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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.

  #15  
Old 12-14-2011, 09:44 PM
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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.
In My MIL's we had the POA and the DNR copies in it. Plus all contact information for relatives and friends. Saved us hours the one time we had to take her in for altered mental status. She was horribly mean the entire time, refusing to tell anyone anything, threatening suicide, murder and bodily harm on all and sundry. I just quietly handed the folder over to the admissions person. And the nurse. The looks on their faces.. My hubby apologized to everyone who came into contact with the old cuss. Needless to say, she was admitted and spent a week in the dementia ward.

*sigh* The nurses in the ER and then the ward said it was the Alzheimer's, but my hubby's aunt (MIL's sister) says that the illness was only an excuse to be a horrible EW, because she was that way her entire life.

And I lost an aunt on my mom's side because her husband refused to tell the ER crew the entire truth about what was going on. They were both drug addicts. She died from a rupture in the intestine went incredibly septic and.. well, drug complications didn't help. So... yeah.

  #16  
Old 12-15-2011, 01:12 AM
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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.

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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.

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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.

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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.

Quote:
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.
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  #17  
Old 12-15-2011, 05:05 AM
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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.

Disclaimer:
My professional areas of expertise are computing and writing: I am not a doctor or a lawyer.
When your health, freedom, etc are at risk, always see a professional.

  #18  
Old 12-15-2011, 01:33 PM
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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.
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  #19  
Old 12-15-2011, 01:52 PM
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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.

  #20  
Old 12-15-2011, 05:51 PM
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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.

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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.
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