Flightmed archive for July-2003
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Flightmed archive for July-2003



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Seriously now, revisited



Hi Gary...
 
I'm staying out of the fracas... let me know when it's time to duck the slung mud!  (Or is it truly over?)  Meanwhile, you asked for input about a patient scenario, and I have 2 cents I'm not using right now, so here goes.
 
In response to your Haiti patient... yikes, what a mess he was!  Regarding the MD in charge of the flight, perhaps he didn't understand your terminology when you reported the "PIPs".  You were referring to peak inspiratory pressures, right?  Or I might just be revealing my ignorance about abbreviations commonly used in a field other than my own.
 
Anyway, perhaps you may have gotten further with the doc if you'd pointed out the patient's symptoms, like the shifted trachea, and tactfully suggested a careful reassessment of the patient's airway/breathing.  I'm no doc, but I've known a lot of edgy and threatened ones in my career.  Sometimes we need to carefully lead them where they need to go.  (Just as my partners have carefully led me many times, I'm sure!)  Unfortunately, your patient had to wait till the thoracic surgeon got there to have the situation remedied.  And meanwhile, your doc may have felt a bit foolish for missing this critical problem.  (Which leads to you getting reprimanded just because he thought he looked bad in front of another doc.)
 
It's hard to be tactful when your patient's crumping, but as they say, you catch more flies with honey than with vinegar.   Especially in our field.
 
On our flight team, we have no RT, just two RNs.  If this had been our patient and he'd crashed, we'd ALL be on the chopping block.  It's a team effort.  And just as my partner is not "the team," likewise no RN or EMT (with or without P) or RT or MD is "the team."  When the patient crumps, it is THE PATIENT who is on the chopping block, and we need to remember that, and function together for the patient's best welfare.
 
I guess maybe that was 3 cents' worth.  I owe ya.
 
Best regards and fly safely,
 
Cece Peterson, RN, BSN, yada yada
LifeFlight, Pittsburgh, PA
 
----- Original Message -----
Sent: Saturday, July 12, 2003 1:50 PM
Subject: Re: Seriously now

I am not sure what you mean by not signing my post? I thought that I did, anyway, I have a request that will be phrased as a comment. I would like to know why most of the responses were fired back hasty with little thought of the content of my line of questioning, yet, they were answered by 'IM as qualified to do this therapy as you are.'

Here is my request. I am just an RT/EMT. I am not a doctor nor a Ph.D. Day after day I read the postings and I think to myself, here are all these flight professionals with a million years of combined experience, what a great resource for someone like me to have.  Granted, we may have gotten of to a rocky and turbulent start. But I think this is a great way for all of us to compare notes and use this list as it was intended.  I would like nothing more then to have a sounding board for complicated flights and a peer review of actions. I was in Haiti last night getting a patient with bilateral chest tube post GSW. Five rib fractures on the penetrating side and two Fx's on the opposite. There were many changes in condition which required many vent changes and such, I reported the PIP's to the MD in charge of our flight he asked what was a PIP? I could see the direction the patient was headed in, nothing was done. Finally I got to the Thoracic surgeon that placed the chest tubes, showed her the shifted trachea, and requested a change in tube placement or needle decompression. I was reprimanded my the MD for over stepping my bounds, when no one else would react. When the patient crashed the RT running the vent would be on the chopping block.

Please, I would like some constructive feedback, lets hear it...

Finest Regards,

Gary RT/EMT


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