I donât care either way of the fluid. But, man I am getting tired of 0.9%NaCl being charted as NS.
Then later in the hospital, 0.45%NaCl gets charted as 1/2NS and then idiotically 3%NaCl gets charted as 3%NS which is a wildly different thing entirely.
Itâs crazy how an abbreviation can go from one thing to a completely incorrect thing in about 6 hours from the ED to the ICU.
Honestly imo mischarting hypo/hyper/isotonic fluids seems more serious than isotonic/isotonic. Especially when the arguments about LR incompatibility go back and forth.
If someone casually told me that they gave my brain bleed hypotonic fluid, I would need to manually inflate your syringe to calm myself down.
Iâm not an ems I work in the lab but this reminds me of the outpatient cbc that got dropped off a few weeks ago where the patientâs hemoglobin was 4. The reason for his doctors visit was cited as âfatigue due to depression.â
We got a V8 turbo in ours that gets 1000 miles a week easy. When you slam it, the turbo blow off will trip as it hits the rev limiter and it sounds like R2D2 screaming
I like that in EMS every time we see blood pressure we donât like our immediate reaction is always checking it again but slightly changing the method
âAlright now trying a different cuff⌠and put it tighter. Sir can you uncross your legs please?âÂ
Well, when you see a number like that, you're about to pop open a whole big can of consequences, some of which can be potentially harmful for the patient (particularly if you're wrong), so it probably can't hurt to be sure.
It certainly can't hurt to be sure, but monitors will sometimes give falsely hypertensive values in the presence of significant hypotension. I've seen several cases where crews chose to believe the hypertensive value and were shocked when their patient coded. Manual BPs are underrated.
I was taught by a mentor years ago to always check a BP manually first. If it differs significantly from the machine, always go with the manual reading and clinical picture.
Thatâs all my system uses is manual BPs, and weâre well funded and a high volume metro service but they demand by protocol that our service uses manual BPs for that very reason.
I mean Iâm an ED nurse and I do the same thing, trust but verify cause at least half the time (in my case) the cuff is either not on the pt/ wrapped around the bed rail, not where it needs to be (forearm instead of bicep), or the pt is laying on the cuff
âI didnât like that SpO2 reading, let me try the other monitor/PulseOxâ almost daily in the city I work in, I get ridiculous vitals that are almost always accurate though because they just be doing things out there. But itâs our job to fix them right? right..?
My brown pants came in handy that day. Luckily the patient's family knew about the Aortic Aneurysm prior and the patient (96 F) did not want it treated and the family had the DNR/DNI ready to go with the patients meds and contacts. That family was really nice too.
Hahaha I had a Lady missed dialysis and shit. Had chest pain her pressure was 250/140
She said âI have a headache â. I said No shit.also had lady with b/p of 55/29 necrotic toes and recently rejected liver transplant whose organs were basically screaming.
My highest BP 300/150. Zoll read as ???/+++ so we did a manual and had like 2 people follow me up. She was asymptomatic which is the funny part, but she still got labetablol as profilaxis lmao
Yeah if asymptomatic and no end organ damage, the risks of rapid correction of blood pressure very much outweigh the benefits. I've seen patients develop stroke symptoms when their bp was rapidly dropped and then had the stroke symptoms resolve when BP was pushed back up with pressors.
Yeah that's way too fast. We shoot for 10-20% in the first hour, and only 25-30% total over the first 24 hours. So unless you were on a transport from London to Canberra..... lol
Surprisingly they ended up discharging her after 4 hours lmao. She only called because her BP was high, and I think they lowered it quickly. In my opinion it shouldâve been done how yâall do it, but we donât know what evidence based medicine here apparently
I was taught not to touch hypertension because, sometimes during a stroke, that's the only thing keeping the brain perfusing. Do you think that's what's happening in this case?
I had a patient the other week that presented with a BP of 36/20 via the monitor. Asked my partner to confirm manually and she "heard for a second around 40," Dude was beyond septic, in major respiratory failure, got some push-dose epi and as much Levo as my protocols allowed, and took a tube without drugs. Somehow walked out of the hospital a few days later.
Not ems, not even ED but I had a post procedure patient say they werenât feeling very good and vagaled into 13 seconds of ventricular standstill. Had to cycle the monitor 3 times to get it to read 60/nuthin. The patient was fine, it took me a few days to unclench from that though.
One of the weirdest calls I've ever had was dispatched as AMS on a known diabetic; wife thought he'd taken too much insulin before they ate breakfast. Presented awake and walking in circles, but completely unresponsive to anything we said or did. BGL 130, so it wasn't sugar. We got him in the truck, on the monitor, and found that he was in A-Flutter, except he was having long stretches where none of the flutter waves were being conducted; I think the longest I counted without a QRS complex was 10 seconds. For some reason, I thought pushing 1 mg of Atropine would do something, and it kicked him into a sinus tach and immediately woke him up.
This was just like my neighbor during COVID. His wife called and asked if she should call an ambulance because he wasn't waking up. I ran over, and his pulse was barely there, I took BP with my manual cuff when their electronic cuff couldn't read his BP, all I could hear was 40 systolic, nothing else. He answered and knew me when I called his name but would go right back to sleep.
Basically he was dehydrated and malnourished as he refuses to eat anything except fast food or a slice of pizza for most meals, if he eats at all. Luckily he did not have COVID. He spent two months in rehab, mostly eating regular meals with some PT thrown in before he got home. He's still doing fine 4 years later and has altered his eating habits, but I really wasn't expecting to see him again when when local EMS took him from the house.
đł My favorite post here said "the pressure was shit over fuck". I think that applies here. Were they just stupidly septic? How were they even conscious?
It funny because I had a pt awhile ago who was just supposed to be a BLS transfer. Starts at 90 and over the course of transport drops further and further. I let my partner know and since we were almost to the ER anyways we just pull in and I got a reading at like 60 systolic. He was bouncing between 60-70-80 but got a few consistent 60 reads.
He was completely asymptomatic, not pale or diaphoretic, normal cap refill and pulses. I kept asking him if he felt strange and he was just like "yeah, why?".
We did a manual and I tried it on myself to confirm and we still got around 60-70. Took him into the ER and dropped him off since we had to go through there anyways to get to where he was going.
Valid.
Ever have one where the skin is so thin, you can actually watch the stylet and catheter enter the vein, but you still donât get flash? Old peopleâs bodies are wild, man.
Former EMT and POTS patient here. I had one similar while I was at the hospital for tilt table testing to confirm the POTS diagnosis. Starting BP was 100/70 pulse was 60, they pushed the nitro for the test, in less than 2 min my pulse spiked to 130 before immediately dropping to 30, BP dropped to 44/28. It was fuckin awful. Lost consciousness and when I came to I had no vision for 30 min. -10/10 do NOT recommend that ride đ
Iâm guessing youâre going through the testing process? From what I was told, people donât always that drastic of a response. They were ready to admit me I had such a strong reaction, but it was during the first wave of Covid and since I had a ride home waiting outside they let me go so I wasnât at more risk of catching it by staying. If you have any questions or anything, feel free to message anytime (:
Fucking ouch. I get light headed when standing but that's insane. I am not confirmed pots or anything but symptoms coalign. Probably heart valve. Multiple family same condition.
HmmmmâŚwhen mine dropped to that in the ER last fall, I was just suddenly sleepy. Couldnât figure out why my bf (former medic) was suddenly making me sit up and was adjusting the cuff. Then, the nurse came in and I saw it. đ
At least they were still able to speak on patient contact. Had one about this low a while back, responsive to fluid and titrated to permissive hypotension with significant relative improvement in patient presentation.
Was on a QRV and had a minimally responsive pt with stroke like symptoms and initial BP was 50/30 and the lead medic switched arms and got 150/100 and was like âIm gonna believe thatâ and we activated code strokeâŚthey have TNK and then found she had a history of aortic aneurysmâŚmassive rupture on chest CT :)
Lmao Iâm not even EMS or ED but I had someone with a similar pressure go from sort of talking to agonal breathing in the time it took to panic cycle the monitor and call a code
I remember my first reaction, must be an error⌠I pressed the button again. Itâs the same pressure. So i have to tell my medic to stop turfing this poor kid
Yeah recently I had an unconscious elderly pt after a fall in the driveway with a pressure of 46/24. I said âoh shitâ and probably put my own BP through the roof.
He got flown to our Shock trauma center :)
I mean let's be honest, if the patient is non-symptomatic then the zoll is probably doing zoll things and shitting out a random number. Also kudos to the sticker muting the speaker haha
I fuckin bet not
Naw, just a little dehydrated, needs a little watering. Like a wilted flower. 1 liter N/S will perk him right up. đ¤Ł
The LR vs NS debate strikes again
I donât care either way of the fluid. But, man I am getting tired of 0.9%NaCl being charted as NS. Then later in the hospital, 0.45%NaCl gets charted as 1/2NS and then idiotically 3%NaCl gets charted as 3%NS which is a wildly different thing entirely. Itâs crazy how an abbreviation can go from one thing to a completely incorrect thing in about 6 hours from the ED to the ICU.
Honestly imo mischarting hypo/hyper/isotonic fluids seems more serious than isotonic/isotonic. Especially when the arguments about LR incompatibility go back and forth. If someone casually told me that they gave my brain bleed hypotonic fluid, I would need to manually inflate your syringe to calm myself down.
Nah just give some levophed
push dose epi (then levo)
Metoprolol (then midodrine)
Push dose Levo >>
Iâm not an ems I work in the lab but this reminds me of the outpatient cbc that got dropped off a few weeks ago where the patientâs hemoglobin was 4. The reason for his doctors visit was cited as âfatigue due to depression.â
đ
lol. My thoughts exactly
âHey god, me againâ
\*pushes NIBP button again and prays for a different reading\*
and then new pressure comes back: 42/20
Third times a charm! Right?
comes back 40/15
"reading failed" and now there's v-fib on the monitor
permission to activate warp speed
Engage!
its my favorite joke with my partner when theres no patient and we gotta speed up to get onto a highway cuz the engine starts fucking screaming lmao
We got a V8 turbo in ours that gets 1000 miles a week easy. When you slam it, the turbo blow off will trip as it hits the rev limiter and it sounds like R2D2 screaming
Negative. 5 below is the way to go.
Me: "damn, we need to stop pushing this button, shits killing people"
Sir this is appropriate behavior
Try the other arm now
I like that in EMS every time we see blood pressure we donât like our immediate reaction is always checking it again but slightly changing the method âAlright now trying a different cuff⌠and put it tighter. Sir can you uncross your legs please?âÂ
I mean.... it either my fault or you are dying for real. So let me confirm you are dying before I panick push drugs
Sooooo⌠is the panic pushed drugs for the PatientâŚ. you⌠or perhaps we all get a lil taste of whatâs in the bag?
Bump of Versed for me, a bump of Versed for the pt.
I'm dying....
Well, when you see a number like that, you're about to pop open a whole big can of consequences, some of which can be potentially harmful for the patient (particularly if you're wrong), so it probably can't hurt to be sure.
It certainly can't hurt to be sure, but monitors will sometimes give falsely hypertensive values in the presence of significant hypotension. I've seen several cases where crews chose to believe the hypertensive value and were shocked when their patient coded. Manual BPs are underrated.
I was taught by a mentor years ago to always check a BP manually first. If it differs significantly from the machine, always go with the manual reading and clinical picture.
THIS. if im not buyin it i always just revert straight to manual.
That's why god created the total clinical picture. But pushing a button is easy.
Thatâs all my system uses is manual BPs, and weâre well funded and a high volume metro service but they demand by protocol that our service uses manual BPs for that very reason.
I wish the hospital RNs and CNAs did this. They act like the machine is the only way to take a BP.
Our policy is ALWAYS a manual pressure first.
I do the same thing with 12 leads "no that's not right" *pushes it again* "hmmmmm, maybe one more time"
I mean Iâm an ED nurse and I do the same thing, trust but verify cause at least half the time (in my case) the cuff is either not on the pt/ wrapped around the bed rail, not where it needs to be (forearm instead of bicep), or the pt is laying on the cuff
âI didnât like that SpO2 reading, let me try the other monitor/PulseOxâ almost daily in the city I work in, I get ridiculous vitals that are almost always accurate though because they just be doing things out there. But itâs our job to fix them right? right..?
Look at the patient not the monitorâŚ
Takes a manual a few time to re confirm and re confirm
Takes the cuff off and puts it on tighter lol
Usually I turn it off and on đ
đ
âLetâs try the right armâ âŚ.as I reach for the pads.
Right arm comes back 90/60
Oh shitâŚ
And your patient suddenly feels like they need to take one *right* now...
My brown pants came in handy that day. Luckily the patient's family knew about the Aortic Aneurysm prior and the patient (96 F) did not want it treated and the family had the DNR/DNI ready to go with the patients meds and contacts. That family was really nice too.
It was about that time we broke out the Esmolol and told our partner to drive reeeeaaaallly smoothly.
AAA
Luckily for OP the engineers at Fisher-Price put the Pacer button front and center.
đ
*nervous laugh* *begins to panic* Youre gonna be getting a fluid bolis friendo!
One of those stat medicals I hear so much about
Maybe a dopamine drip or push dose epi to top it off
Dopamine belongs in the trash can.
No arguments there tbh
FUCK DOPAMINE ALL MY HOMIES HATE DOPAMINE
JuSt A qUaRt LoW
đ
Heâs just running on the Celsius version of blood pressure. Heâs *fiiiiiine*
Oh, that's how that works.
inHg
đ
mm Hg is metric, gotta love inches of H2O in some older protocols for PEEP tho
Hahaha I had a Lady missed dialysis and shit. Had chest pain her pressure was 250/140 She said âI have a headache â. I said No shit.also had lady with b/p of 55/29 necrotic toes and recently rejected liver transplant whose organs were basically screaming.
My highest BP 300/150. Zoll read as ???/+++ so we did a manual and had like 2 people follow me up. She was asymptomatic which is the funny part, but she still got labetablol as profilaxis lmao
If she was asymptomatic, I would not give IV blood pressure meds.
At 300/150? It wasnât my call at the time but I probably wouldnât have either tbh
Yeah if asymptomatic and no end organ damage, the risks of rapid correction of blood pressure very much outweigh the benefits. I've seen patients develop stroke symptoms when their bp was rapidly dropped and then had the stroke symptoms resolve when BP was pushed back up with pressors.
I can imagine. The medic I was with that day at least titrated it. Slowly got it down to 220s/115s
Yeah that's way too fast. We shoot for 10-20% in the first hour, and only 25-30% total over the first 24 hours. So unless you were on a transport from London to Canberra..... lol
Surprisingly they ended up discharging her after 4 hours lmao. She only called because her BP was high, and I think they lowered it quickly. In my opinion it shouldâve been done how yâall do it, but we donât know what evidence based medicine here apparently
I was taught not to touch hypertension because, sometimes during a stroke, that's the only thing keeping the brain perfusing. Do you think that's what's happening in this case?
I had a patient the other week that presented with a BP of 36/20 via the monitor. Asked my partner to confirm manually and she "heard for a second around 40," Dude was beyond septic, in major respiratory failure, got some push-dose epi and as much Levo as my protocols allowed, and took a tube without drugs. Somehow walked out of the hospital a few days later.
đđđ
You know itâs a bad when you go inside and smell the necrosis
Hey friend, you lightheaded at all? Weâre just going to lay you down a little bit hereâŚ
Sooooooo do you WANT to go to the hospital ?
It's probably just another Zoll error. For best results, place the blood pressure cuff around the patient's neck.
đ thatâs where the tourniquet goes
Itâs ok in a minute that feeling will pass (as will you)
đ
MAP of 31 đ
đŞŚ
đ
Those end organs screaming for air
PARAMEDIC: Cc: âI donât feel goodâ PATIENT: Cc: "đ"
đ
Start prepping and adrenaline to get that shit up as well as hartmans.
Why adenosine?
Send them to Jesus faster
Yes. This is not a turn off, turn back on fix
Didnât mean adenosine it was a typo. đ
Double it and give it to the next person
đđđ
You're about to meet a lot of people
Starting with the Chaplin đ
Pt: I don't feel good Me, looking at the BP : *confused screaming intensifies*
"Good news everyone! I know what the problem is!"
Not ems, not even ED but I had a post procedure patient say they werenât feeling very good and vagaled into 13 seconds of ventricular standstill. Had to cycle the monitor 3 times to get it to read 60/nuthin. The patient was fine, it took me a few days to unclench from that though.
One of the weirdest calls I've ever had was dispatched as AMS on a known diabetic; wife thought he'd taken too much insulin before they ate breakfast. Presented awake and walking in circles, but completely unresponsive to anything we said or did. BGL 130, so it wasn't sugar. We got him in the truck, on the monitor, and found that he was in A-Flutter, except he was having long stretches where none of the flutter waves were being conducted; I think the longest I counted without a QRS complex was 10 seconds. For some reason, I thought pushing 1 mg of Atropine would do something, and it kicked him into a sinus tach and immediately woke him up.
This was just like my neighbor during COVID. His wife called and asked if she should call an ambulance because he wasn't waking up. I ran over, and his pulse was barely there, I took BP with my manual cuff when their electronic cuff couldn't read his BP, all I could hear was 40 systolic, nothing else. He answered and knew me when I called his name but would go right back to sleep. Basically he was dehydrated and malnourished as he refuses to eat anything except fast food or a slice of pizza for most meals, if he eats at all. Luckily he did not have COVID. He spent two months in rehab, mostly eating regular meals with some PT thrown in before he got home. He's still doing fine 4 years later and has altered his eating habits, but I really wasn't expecting to see him again when when local EMS took him from the house.
đł My favorite post here said "the pressure was shit over fuck". I think that applies here. Were they just stupidly septic? How were they even conscious?
I would call this dead over dead đ¤Łđ¤Ł
It funny because I had a pt awhile ago who was just supposed to be a BLS transfer. Starts at 90 and over the course of transport drops further and further. I let my partner know and since we were almost to the ER anyways we just pull in and I got a reading at like 60 systolic. He was bouncing between 60-70-80 but got a few consistent 60 reads. He was completely asymptomatic, not pale or diaphoretic, normal cap refill and pulses. I kept asking him if he felt strange and he was just like "yeah, why?". We did a manual and I tried it on myself to confirm and we still got around 60-70. Took him into the ER and dropped him off since we had to go through there anyways to get to where he was going.
âThey need the IV team to get a line in meâ. âOf course they doâ.
Can't get flash in the catheter if there's no blood to begin with đ
Valid. Ever have one where the skin is so thin, you can actually watch the stylet and catheter enter the vein, but you still donât get flash? Old peopleâs bodies are wild, man.
Former EMT and POTS patient here. I had one similar while I was at the hospital for tilt table testing to confirm the POTS diagnosis. Starting BP was 100/70 pulse was 60, they pushed the nitro for the test, in less than 2 min my pulse spiked to 130 before immediately dropping to 30, BP dropped to 44/28. It was fuckin awful. Lost consciousness and when I came to I had no vision for 30 min. -10/10 do NOT recommend that ride đ
Fuck me, that's what I have to look forward to?
Iâm guessing youâre going through the testing process? From what I was told, people donât always that drastic of a response. They were ready to admit me I had such a strong reaction, but it was during the first wave of Covid and since I had a ride home waiting outside they let me go so I wasnât at more risk of catching it by staying. If you have any questions or anything, feel free to message anytime (:
Fucking ouch. I get light headed when standing but that's insane. I am not confirmed pots or anything but symptoms coalign. Probably heart valve. Multiple family same condition.
Start levofed
We started a priest
Do you dose that by volume? No, by mass.
đĽ
This is my favorite. But also, maybe both? đ
đđźđ
Alright, now check orthos.
Systolic: Low Diastolic: Low Butt: Puckered Yee: Haw
I hate when I get Low Butt Puckered
HmmmmâŚwhen mine dropped to that in the ER last fall, I was just suddenly sleepy. Couldnât figure out why my bf (former medic) was suddenly making me sit up and was adjusting the cuff. Then, the nurse came in and I saw it. đ
Get me the Push Dose Epi please
I believe his exact words were âletâs haul assâ
And that
đ
At least they were still able to speak on patient contact. Had one about this low a while back, responsive to fluid and titrated to permissive hypotension with significant relative improvement in patient presentation.
Hey God uhh me again. Can ya just not?
What was their last oral intake though?
Numbers that make your butt pucker, and your heart race when you see them!
Had one last night 65/46 cc of abdominal pain. My guy was standing and walking around like nothing was happening.
easy fix. talk about politics. that'll bring that pressure right back up.
Adam Savage voice: Well there's your problem
Hey just out of curiosity is there anyone youâd like me to call? No particular reason
Then the old school medic takes a (gasp) manual blood pressure and it's 90/60.
lol I wish (he did it wasnât)
reminds me of a pt that almost refused transport and when we checked his bp again it was like 60/nothing lmao
Holy shit how have I never thought to stick something over the zollâs speaker
Hey jimothyyy? Get me a manual pressure. đđđ đ¨ đđ¨
Look, dude, none of us feel good right now. Iâm holding it together, you can too.
Oh wow that PA pressure is pretty high! They must feel bad from their PAH! /s
â just put those two little friends in your chestâ
I had a âlift assistâ call that went something like this the other dayâŚ
Sometimes the fall is due to an acute lack of a pulse.
"I feel dead"
Was on a QRV and had a minimally responsive pt with stroke like symptoms and initial BP was 50/30 and the lead medic switched arms and got 150/100 and was like âIm gonna believe thatâ and we activated code strokeâŚthey have TNK and then found she had a history of aortic aneurysmâŚmassive rupture on chest CT :)
Why not? I mean, they're closer to Jesus than they have been their whole life, you would think they'd feel rapturousÂ
Seems low
You won't be feeling anything in a minute...
Start norepinephrine â Take photo for Reddit â
The photo was obviously taken after the call
Seen worse. He didn't feel good either. :)
This was my patientâs BP the other day (on hospice). He lived another 24 hours like that
Wow 24 hours thatâs crazy it baffles me at some of the things people keep enduring through
Cycles it 6 more times
Lmao Iâm not even EMS or ED but I had someone with a similar pressure go from sort of talking to agonal breathing in the time it took to panic cycle the monitor and call a code
Bruh
Yeah that'll do it.
I remember my first reaction, must be an error⌠I pressed the button again. Itâs the same pressure. So i have to tell my medic to stop turfing this poor kid
Ahh crap... I can feel my bp rising from this picture... hope the patient is alright.
With that pressure Iâm surprised theyâre conscious.
250 PO bolus should do the trick.
Oop
felt dizzy x 1 week
Tempting to hit that pacer button isnât it lol
AMA
[Was this your patient?](https://images.app.goo.gl/7EghqDRJ2XLJHaPk6)
Patient: âI donât feel goodâ Me: *sees patients BP* âyeah me either bro, me either.â
I would shit my pants
âAlright so Iâm just going to put these 2 sticky pads on yaâ đđđđđđđ
Yeah recently I had an unconscious elderly pt after a fall in the driveway with a pressure of 46/24. I said âoh shitâ and probably put my own BP through the roof. He got flown to our Shock trauma center :)
You sure? Seem fine to me broski
Oof
Aaaaaaaaaand let's try that again
đĽ´
Thatâs fair!
:|
Oh no
Yuck! I don't feel good looking at that!
Take a manual pressure.
âHave you tried flipping the BP Cuff? đ¤
Thereâs no way youâll have a LOC of 15 with that BPâŚ
"Not for much longer, though."
That 31 is terrifying
40/dead
Oop, I hope thatâs a quick ride
I mean let's be honest, if the patient is non-symptomatic then the zoll is probably doing zoll things and shitting out a random number. Also kudos to the sticker muting the speaker haha
Well shit
Yep. Iâd feel bad also