Case Study: Paramedic Hartman
This document is in response to your verbal request via phone call on Thursday May 31, 2018. Since you stated you were unable to put this request in writing, I hope that I address all of the concerns yourself, Dennis Lunde, and Dr. Shaun Patterson requested.
PRID #50771811
Scene description: Found patient supine in bed with head elevated in care of Tri-Boro Ambulance. Patient in obvious respiratory distress with copious amounts of thick milky white substance coming from both mouth and nose. BLS attempting to suction the mouth with hard tip suction catheter.
Clinical process: Paramedic Hartman properly sized and inserted a nasal airway to obtain a patent airway since there was so much fluid in the airway. Both paramedics noticed that …show more content…
Due to the uncooperative patient, Paramedic Hartmann had difficulty getting the patient to comply with opening her mouth to receive the medication. Due to the dispatch information, I enter the home with the O2 bag which contained the CPAP setup. Applied the CPAP to patient with a PEEP of 10, because that was the only setting. Upon BLS arrival, the patient was taken to the ambulance. Once in the ambulance we noticed that the patients respiratory effort was becoming increasingly fatigued and she was less tolerant of the CPAP. Attempts to administer further Nitro sprays were unsuccessful, again due to the patient being uncooperative. Due to the deterioration of the patient’s respiratory effort, and the belief that the patient would be intubated upon arrival at the emergency department, the decision was made by myself and Paramedic Hartman to contact medical control and request order to RSI.
Concerns:
Dr. Patterson asked if we considered requesting orders for push dose nitro, and a nitro drip. The answer is No, because on that given night we did not have the capabilities to mix the nitro drip required. Due to an IV solution shortage, we no longer have 250CC bags of normal saline. And on that night, 100cc bags were not available in the vehicle or in the re-stock supplies. As per inquiries to multiple tour chiefs, Mr. Lunde is supposed to distribute the procedure to mix the nitro in the 100CC supplied CC
PRID #50771811
Scene description: Found patient supine in bed with head elevated in care of Tri-Boro Ambulance. Patient in obvious respiratory distress with copious amounts of thick milky white substance coming from both mouth and nose. BLS attempting to suction the mouth with hard tip suction catheter.
Clinical process: Paramedic Hartman properly sized and inserted a nasal airway to obtain a patent airway since there was so much fluid in the airway. Both paramedics noticed that …show more content…
Due to the uncooperative patient, Paramedic Hartmann had difficulty getting the patient to comply with opening her mouth to receive the medication. Due to the dispatch information, I enter the home with the O2 bag which contained the CPAP setup. Applied the CPAP to patient with a PEEP of 10, because that was the only setting. Upon BLS arrival, the patient was taken to the ambulance. Once in the ambulance we noticed that the patients respiratory effort was becoming increasingly fatigued and she was less tolerant of the CPAP. Attempts to administer further Nitro sprays were unsuccessful, again due to the patient being uncooperative. Due to the deterioration of the patient’s respiratory effort, and the belief that the patient would be intubated upon arrival at the emergency department, the decision was made by myself and Paramedic Hartman to contact medical control and request order to RSI.
Concerns:
Dr. Patterson asked if we considered requesting orders for push dose nitro, and a nitro drip. The answer is No, because on that given night we did not have the capabilities to mix the nitro drip required. Due to an IV solution shortage, we no longer have 250CC bags of normal saline. And on that night, 100cc bags were not available in the vehicle or in the re-stock supplies. As per inquiries to multiple tour chiefs, Mr. Lunde is supposed to distribute the procedure to mix the nitro in the 100CC supplied CC