Treating the Monitor

I seem to be talking to myself a lot so I'm finding it really hard to find the will to blog. Been that way for about a year or so. But then I didn't start this for anyone but myself so who cares? I started losing the will to write when I started getting a bunch of nasty comments because I dared comment about the quality of our volunteer system. Let's be clear. I was once proud to be one of them. It's changed here. I don't know YOU or YOUR system so I'm obviously not talking about you. So if you're not spending your time lying on the couch lifting your feet so I can vacuum under them, trashing the kitchen and then calling me your "paid maid", only showing up for the "good calls" or picking and choosing which calls you want to go on, and bitching because the equipment is dirty/broken/missing something but you've never lifted a finger - then you don't volunteer here. I'm really sorry these people are making you look bad. YOU I treat like gold. I love my good volunteers and take the time to give them the help they ask for because one day they'll be working along side of me. The rest can go screw themselves. I don't need their "help". *END OF TODAY'S RANT*

Lately I've noticed a trend that's kind of disturbing. As a credit to the people who trained me, I was always told to NEVER treat the monitor. You treat the signs and sumptoms of the person sitting in front of you. So here are two patients I was presented with in the same night:

Patient 1: 87 years old, long time smoker. She's been sick for about a week and has seen her doctor TWICE this week. It's 23:30 and she's chipper as all get-out but decides it might be nice to go to the hospital to be seen because she thinks she has the flu. Her doctor gave her antibiotics the day before (she's had one dose) but she doesn't really seem too keen on taking the rest. She's one of those people that calls all of her relatives right before she calls the ambulance so that everone arrives about the same time. She walked out to the ambulance and we gave her a ride. Her oxygen sats were 87% RA. Weird. She was in no distress whatsover. The charge nurse freaked out. I was pretty much thinking it could have been her 1. arthritic hands, 2. poor circulation 3. the fact that it was 23 degrees outside and she did not have gloves on.

Patient 2: 70 y/o female, triple bypass four weeks ago, long time smoker, COPD and asthma. You could tell she had been fighting the COPD for a long time because she had clubbed fingernails. She presented with SEVERE respiratory distress but a sat RA of 92%. 100% on 15L by NRB but still in severe distress. After a combivent she improved a great deal but she was still pretty junky in the lungs. At a four minute transport time I only had time for so much. It's strange not having that 30 minutes in the back of the medic anymore!

I heard a nurse tell a patient that she was "not breathing right". It wasn't that her sats were low. The nurse wasn't even in the room. Apparently the patient had set off an alarm because she was breathing shallowly. It's the way she breathes. In the EMS room at the hospital a medic was talking about how he had a patient that "went to crap" in his ambulance. Then he described how the patient's pacemaker wasn't working and pacemaker was misfiring. Turns out the patient was asymptomatic but was throwing all sorts of different rythyms on the monitor. So, OK. You can deactivate the device, right? But if the patient is asymptomatic why do you say they're going to crap? Sounds like you're the one freaking out son.

OK, so if I'm not talking to myself here... Am I being silly? Am I missing something? I haven't been a medic for more than a few years, but I've been a provider since 1992. I pretty much make a decision without really consciously doing so. Lately I've started second-guessing my descisions. It's always been my opinion that we rely too heavily on machines to make a diagnosis and seem to be relying on one piece of information rather than a host of them. Am I wrong? Should I reconsider?