I Look At The Clock

“Code Blue, ER. Code Blue, ER”. I can still hear that calm, unalarmed voice over the intercom. Seconds later, John Doe, a 50-year-old male, is rushed in through the double doors of the Emergency Room with an EMT pounding on his lifeless chest. Although the medical staff had been preparing for some time, it still appeared like a scramble to resuscitate this man’s life. It was my first shift as a medical scribe; I had no idea what to expect. While paramedics shouted the jargon-filled report, the surrounding chaos was quieted by the physician who maintained the room's composure. The instant the pulse was obtained, I was overcome with a foreign feeling that can only be described as pure exhilaration as if the epinephrine injected into the patient manifested its effects on me.

The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His

The 911 operator, Christi, handled the emergency in a professional manner and, she remained focus on getting information out of Jeffery to see if his father Johnny was breathing. I know for sure Christi’s heart consumed with emotions because her co-workers husband was at deaths door. Furthermore, when a family member and close friend calls for assistance during an emergency, as an EMD professional you must remain focus on the safety and health of the caller. Sheila’s life is now comes to a halt and her profession as a 911 operator will never prepare her for the loss of the love of her life. Life and death is difficult to fathom, therefore, we must put into perspective that as an EMD professional you are not immune to tragedy at

I am a registered nurse that traditionally works night shifts in the emergency room (ER). During the majority of my night shifts, I encounter the same frequent combination of unhealthy frail patients that are in need of immediate relief or assistance. The most common cases I see throughout a great deal of my shifts contain patients that are experiencing heart attack symptoms or extreme abdominal pain. They also include those who are under the influence of drugs or alcohol, were involved in a car accident or have fractured bones. I even see the occasional gun shot wounds.

Pulling off the ramp, we turned onto Church Hill Road responding on a priority one for the cardiac arrest. I tried to review my field guide en-route to the call, but all I could see were flashing lights reflecting off the guide’s pages and crowds of cars moving over for our wailing sirens. Within three minutes we had arrived on-scene and it was clear that our patient was not in cardiac arrest; however, his 12-Lead EKG and oxygen saturation were marginally reassuring and pointed to an active heart attack. At this point in my EMS training I was a BLS provider, but had adequate knowledge to assist Kathy. Instinctively, I went right to work and loved every second of it. The concept of formulating a differential diagnosis in the field and testing that theory is one of the principle factors that kept drawing my back to EMS. In addition, I developed an unparalleled appetite for knowledge, stemming from my desire to get every differential diagnoses right. Coming to this realization early in my EMS career, we [healthcare providers] frequently forget that patients often lack the medical knowledge provided to us through years of training. Behind CT Scans and MRIs are patients with questions. Having the ability to provide compassion, sympathy and reassurance to a patient is a central part to their recovery and survival; therefore, we [healthcare providers] need to be able to care for our patients on a holistic level, focusing less on the disease and more on the

The patient is a 72-year-old female who arrived to the emergency department in cardiac arrest. Emergency medical services reports the patient was last seen eating breakfast at her nursing home and was found an hour later face down and unresponsive. After it was determined the patient was in asystole, an intravenous catheter was started and two rounds of Epinephrine was administered. Upon arrival to the emergency department the patient had pulseless electrical activity with sinus tachycardia on the monitor. Airway management was in process with a bag valve mask on 100% oxygen and chest compressions in progress. After intubation and stabilization the

Clipboard and stethoscope in hand, I walked toward the double doors that flashed emergency in bright red letters above. It was my first clinical shift as an EMT student, and first day jitters flittered around in my stomach, I had no idea what to expect. However, I was not expecting to witness the fragility of life. About a half an hour into my shift the rapid response alarm blared through the emergency room. I turned to my preceptor and quizzically asked what this meant. “A rapid response is a patient who is in need of immediate medical care and intervention. As an EMT who is part of the rapid response team you will be expected to assist with vitals and chest compressions. Let’s head toward the recess room, and I’ll explain more there.” Eventually, we reached the recess room, and the rapid response team was already there preparing for the arrival of the patient. A nurse was on the phone with the firefighters that were bringing the patient in. Seconds later she announced “It’s a STEMI”. Then fright ran through my veins. A STEMI is medical jargon for a segment elevation on an EKG. In other words the patient’s coronary artery is completely occluded. The patient is suffering from a heart attack. Prior to this, I had never seen someone who was having a heart attack. However, the thing that terrified me the most was that I knew I would be expected to perform chest compressions. I had only ever performed chest compressions on a dummy.

After his lunch break, Tom didn’t have long to wait before the paramedics burst in through the swinging double-doors of the ambulance bay wheeling in a young man on a gurney. Edward, a veteran EMT, recited the vital signs to Tom and Dr. Greene as they helped push the gurney into the trauma room,

As a result of the failure to adhere to the safety precautions before utilizing the automated external defibrillator the patient was severely burned on his neck and shoulders. “The patient can show a legally sufficient relationship between the breach of duty and the injury; this concept is referred to as proximate causation” (). If standards of care had been meet the injury that the patient now suffers could have been prevented.

In April 2012, Mr. Hammett’s death was ruled to be human errors that individually would have been unlikely to harm him but proved collectively to be fatal. Mr. Hammett surgery was at at private hospital that did not have any after hours medical cover. During the procedure his oxygen saturation levels were almost perfect, maintaining it at 99%. Somehow during or after being transferred to Post Anaesthetic Care Unit (PACU) his oxygen saturation levels fell to 64%. The anaesthetist assumed that it was caused by an obstructed airway and discharged the patient to the ward; he did not look for anything further to be wrong with the patient. Mr. Hammett complained continously to the RN of high levels of pain; the RN ignored him and referred to him as a “wimp” when switching shifts. Although Mr. Hammett was on a Gemstar pump, which recorded him pressing

Employee John Lee (Regular FS employee-Forester-PRRD) was taking his work capacity test at the Chadron High school track when at approximately 10:00am started to experience fatigue and then collapsing on his last lap. Cyd Jenssen (Public Affairs Officer-S.O.) an RN nurse, Mike MattMiller (Job Corps Fire CRWB-S.O) and Ben Jech (Engine Crew Lead Member-PRRD) both former EMT’s assisted John at the scene. Ice packs were placed under arm pits and oxygen was administered until the arrival of the ambulance. John was conscience during the entirety of the incident. John was transported by ambulance arriving at the Chadron Community Hospital at 10:20am. Fluids were administered by IV. Was noted from the MD doctor that John had a significant case

There are errors and hazards in care that occurred in the Mr. B scenario. One error was the emergency room physician’s failure to recognize the signs and symptoms of deep vein thrombosis (DVT) that Mr. B was presenting. If not treated early, a DVT can become a pulmonary embolism, a fatal condition that Mr. B unfortunately developed. Another error in care that happened in the Mr. B scenario is the nurses’ failure to monitor Mr. B’s ECG and respirations. Early detection of critical ECG and respiratory changes could have initiated medical interventions that would have saved Mr. B’s life. One hazard is the emergency room nurses’ heavy patient load at the time of Mr. B’s sentinel event. Another hazard is having a licensed

On 8/1/2015 S/O EMT Perez was dispatched MS-508 regarding general weakness. S/O EMT Perez announced his presence and knocked at the door. When there was no answer at the door S/O EMT Perez enetered announced his presnece and proceeded to search the apartment. S/O EMT Perez found the resident in the bedroom. The resident, a Mrs. Mrs. Marianne Klatt invited S/O EMT Perez in and stated that she had general weakness and wanted her vitals to be checked. S/O EMT Perez performed an assesment which revealed the following; Blood Pressure 140/20, Pulse 68 and Sp02 96%. S/O EMT Perez discussed the results of the assesment with the resident and stated that her vitals appeared to be within normal levels but she could be tranported to the hospital if she

| Lesson Outline: Allocated teacher-NExplaining legal requirements : Duty of care: A duty of care is implied when the person who is requiring your assistance is in your workplace. E.g. patient, co-worker or visitor. Consent of an unresponsive patient is assumed in an emergency situation. (Crouchman, 2009; Milne & Mellman-Jones, 2010).Cultural awareness/sensitivity: We need to mindful of varying cultures when assisting patients, as different cultures prefer to be unexposed which is necessary when defibrillation is required. Eg, Muslims (Hattersley & Keogh, 2009). Confidentiality: Following an emergency situation it is vital to refrain from speaking to others outside the workplace about the patient to ensure the patient’s privacy and dignity. Think about how you would feel if you where in the patient’s situation. (Maeder, Martin-Sanchez, Croll, & Ambrosoli, 2012)?Limitations: Remember that once you start you can’t stop until you’re physically unable to or help arrivesDebriefing: Participating in the debriefing process is vital due to the enormity of the situation, enabling the nurse to express

The book states “notice the incident, interpret the event as an emergency and assume responsibility for helping” (Myers 340). Meaning that first thing Mr. Cruz need to or rather should do in a case like above described, is to increase no matter how, to receive help from other people surrounded by him. Because of his extreme pain, he needs to draw fast as much of the attention he can get to himself and make the people around him, aware of his heart attack. For example by waving other individuals or to one particular one. If waving people to him isn’t working out, he needs to additionally be vocal and yell or even scream for help several times. Another thing that might work that someone might come to help Mr. Cruz besides waving or yelling for