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Unlucky

We responded to a call for respiratory distress at a nursing home. We arrive to find a 91-year-old unconcious with labored breathing at 30 breaths per minute. His blood pressure is low at 90/44, and his pulse is a little quick at 90. He is attached to a nasal cannula at 4 lpm, with his mouth gaping open, so the cannula basically does nothing. Okay, I’m annoyed. I tossed him on a non-rebreather mask while I further assessed him.

I soon learn that he has been this way for nearly two hours. The nurse says they called now because he wasn’t getting better. Now, I’m pretty frustrated, but not exactly surprised. This is pretty typical handling of patients in distress by this nursing home’s staff. Oh, and I had to walk outside to get the nurse to even come in the room to give the story.

He was also still attached to his feeding tube, more annoyance. Okay, go out and ask them to remove it. The nurses reply, “you’re taking him to the hospital?” … you must be joking.

My partner and I prepared to the stretcher and I called dispatch to give the receiving hospital a courtesy call that we would be arriving with a patient in severe respiratory distress and are bagging him (using a “ambu bag” connected to 100% oxygen to pump air into his lungs).

I don’t like te hospital we are heading to, but it’s the closest so there’s nothing we can do. I make sure my partner is ready to go as he is bagging our patient in the back and I drive lights/sirens to the hospital.

As we roll in, me pushing the stretcher, partner bagging as we move, the nurse asks us if this is their “notification” after I announce “this is your notification”. Wow. Get our patient on their bed and give the disposition to the doctor. I say “he has a DNR, but no DNI”. Immediately, she looks to the nurse and says “don’t bag him, put him on a mask, he is DNR.” I remind her that he is not DNI and that he is not yet in respiratory arrest and therefore he may be artificially ventilated. She gives me a dirty look and says “in the hospital, DNR means no bagging no intubation”. I have never heard this before and am pretty confident that I have brought respiratory distress DNR patients to other hospitals that were promptly intubated. However, care was transferred and we have no say in their treatment. Attached to the monitor the patients O2 sat was 76% on a mask and he was looking tired.

Want to know who the doctor was tonight? The same one that I wrote about in my post “102”, where a medic and I brought in a DNR respiratory distress patient that died about 5 minutes after the doctor ordered her put on a mask instead of bagging. I feel this woman is playing god and deciding for their patients and the patient’s families that because they are old and have a DNR (no DNI mind you) that they should have little to know treatment. 25 minutes after being brought in, there was still no IV access established, despite his pressure of 90/50 on their monitor. I guarantee there is nothing in his DNR about no fluids. Pathetic, and I loathe the next time I have to take a patient in distress to that hospital and especially to that doctor.

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Categories: EMT
  1. WKC
    January 27, 2010 at 3:40 pm

    Another case of a “jaded” doctor, who forgets that her patients are human, and should always be treated with the best care possible. Would she want her father treated in this matter? She needs a major “wake up” call, and her supervisor should be notified as to her M.O.

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