Good Communication Is Essential!

Huh? Wuzzat? You say something?

One thing I was always taught was to listen to what was told and confirm what you thought you heard. Yeah, I've had those moments where I "thought" I heard something and my brain played tricks on me. I'll take it as part of growing old (er).

Maybe it's part of selective hearing. Maybe it's selective listening. Maybe (God forbid) it's a combination of both. Again, I'll always use the standby of just getting old. I know my hearing isn't what it used to be and I'll blame that on my partial hearing loss. I can see myself in 10 or 15 years wearing a hearing aid if things don't get better. I'll be using a doppler in the back of the bus just to hear a patient cough.

Precepted a new Paramedic student the other day and had to laugh when we were done with our run. Older lady who wasn't feeling too hot and wanted to go to the ER. She'd just gotten home after a hx of seizures and had been home less than 1 hr prior to our arrival. We got her all loaded up and put in the bus, O2 and monitor done, lock placed and secured, cbg done, and then all was fine with the world.

Then, out of nowhere, <<bllllleeeeeeccchhhhhh>> here came the pukes. Just one easy round of it with a couple dry heaves. No projectile messes but enough to cause a little cleanup to happen. Looked over at the monitor and see her rate drop to the mid to high 50s. Her initial BP was 100 / 60. She had vagaled out on the toilet which was the reason for the call (unresponsive but breathing). She now was talking and alert but all this happened at once. I asked for another BP. It was still a little low, lower than before but not under the magic threshold of 90. Still bradycardic and I noticed some couplets beginning. She said she felt all right but still was sick at her stomach.

I'm sitting at the patient's head in the single seat while the student's on the bench seat on the patient's left side. I hear him say something about giving her some drugs. I hear "dopamine" and his question of if we should give her some or not. "Dopamine? I haven't given that in over 10 years and only used it twice in 20 years!" Huh? He wanted to give her that? For having a sick stomach, a little pukey, a little bradycardic with some couplets and a slightly low BP? Really???

So I begin quizzing him on the drug; it's uses, contraindications, side effects, dosages. All of these things he's not too sure of since they're just beginning pharm in his class. After a couple minutes I ask him why he's wanting to give such a powerful drug for these reasons and him not know everything about it's actions and reactions. It just didn't make sense to me.

His response was, "Dopamine? Huh? I was talking about Zofran." Oh dear God,... He was confused as to why I was battering him on the why fors and why nots of giving dopamine and here he was asking about something else. I was giving all the reasons why not, what sort of reactions we could look for IF it was given to any patient. I had been thinking to myself and wondering why in the hell he wanted to give dopamine, yet I didn't bother to confirm with him exactly what it was he was wanting.

Ever called in a report and a doc says one thing and you hear another? Ever asked for an order, you get one response and hear another? Ever played the telephone game as a kid to see how one sentence starts and then ends totally different?

Kind of one of those "look at the drug three times before giving it" to make sure the right one is in your hand. I know that in my 23 years of EMS I've never been in the back of ANY bus that's quiet. I've taken patients in cars, trucks, buses, ambulances, boats, and helicopters and there is no such thing as a quiet ride to the hospital anywhere in the world. If there is, I haven't found it yet. If nothing else, this one reminded me (and us) to always confirm orders or requests before doing anything. Ask for confirmation and repeat things. Document if necessary and question if something's just not sitting right.

We didn't give her zofran. She puked once and that was it. Saved another!