MG>GS>Mike, this is the 1990's successor to the ever popular "room air
MG>GS>blood gas" that ERs used to insist were absolutely vital for
MG>GS>patient care. Never mind that the patient is gasping for air even
MG>GS>with an O2 mask on!
MG>It sure is!  And it drives me nuts.  Fortunately there are only a few
MG>ER's in our area that actually pull stunts like this, our main ER is
MG>not one of them.
Some of the hospitals in my area still insist on doing this, but I must 
say that most don't. Of course, I work in an urban setting, so the 
hospitals are bigger. It seems that the urban hospitals are more, shall 
we say, progressive, than the smaller, rural hospitals. Although there 
are some that would disagree with me, I am sure. 
MG>Y'know that I actually had a RN hollar and complain at me because I
MG>didn't take the extra few minute to take the pt's clothing off before
MG>starting my IV.  She was complaining that I made her job harder
MG>because now she had to getthe clothes off with an IV attached.
I've never had that, although I had one nurse complain that the IV I 
stared was "too big" and in the patient's ACF, not in the hand as they 
did in the hospital. How big was "too big", 18ga! 
MG>     ...did I miss something in medic school?
Probably, but this wasn't it.  Sometimes people, even professionals, 
can't see beyond their own little bit of the universe. Happens to 
doctors too. Here's an example. Last winter we had a woman who fell, or 
maybe jumped off of the roof of a five story townhouse apartment. Landed 
in the middle of the street and was probably DRT. The call came in as a 
pedestrian struck, which considering that Boston has a very high rate of 
pedestrian fatalities didn't wasn't unusual. When we got there, we 
figure out the real story. Even though she was in arrest and was going 
to stay that way, we decided to work her and transport her to the 
nearest hospital, about a block away. This hospital is major teaching 
hospital, and is world famous, but I won't say the name. Suffice it to 
say that it is one of our preferred institutions. We scooped the 
patient, taped her head in place, without foam blocks, started 
transport, tubed and lined her. Got to the hospital and they gave it the 
old teaching hospital try. About 3/4 of the way through their efforts 
the Attending Physician came over to my partner and I and told us that 
we really should have fully C-spined the patient as she was now 
paralyzed. My partner and I were very curious as to how he new this, 
considering that the patient was still in arrest. He replied that she 
had no rectal tone when they did the exam, and that meant that she had a 
high level cervical fracture. Not being able to help myself, I asked if 
the fact that she was in arrest could account for that. He must have 
realized what he had said because he looked at me for about 5 seconds 
before walking off and mumbling over his shoulder that we still should 
have immobilized her. 
G>Don't even consider that this pt was a dyspnea/CP case and that it
MG>was about 22 degrees outside.  Sure, next time I'll strip him down to
MG>the buff before I start my line, then I'll get around to the Nitro.
Hey, sometimes cold fresh air can be very bracing! You should have asked 
her to take off her clothes and step outside to see if she liked it. 
When treating this type of patient, or any sick person for that matter, 
we try to bundle them up as much as is possible, not the opposite. Let 
the hospital staff worry about taking off their clothes in the nice warm 
hospital.
MG>God, what are some of these yo-yo's thinking?!?!?
Sometimes Mike, they just aren't. 
Gary
þ CMPQwk 1.42 129 þThe scenery only changes for the lead dog.
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