Thursday, April 2, 2009

Ahhhhh Moments

A paramedic student works on his intubation technique.

I'm in the middle of what I term as "clinical sprints"; every day I work on a different 911 ambulance as the lead paramedic often for 14-24 hours per shift. This grueling schedule will go on for the next week or so until I graduate the course.

During these clinicals I feel myself learning and maturing as a new street medic. Today we responded to a 96-year old woman who had fallen outside on her deck and fractured her hip. When we arrived I found her sitting up against a hot-tub with her left leg rotated inward and shortened in length, a tell tale sign of a fracture. Normally these injuries are excruciatingly painful and have catastrophic results for the elderly. A week ago I would have splinted the leg, started and IV, and began pushing narcotics for pain management. Today I stepped back and realized that the woman was not, for some reason, in a great deal of pain. This is often the case with elderly women; maybe they've seen so much in their lives that pain is often relative.

I withheld the IV and the narcotics, realizing that I don't need to do some procedures just because I am able to, but rather its better to use my clinical judgment and make the best choice for my patient. There was no need to start what could have been a painful IV in the arm of my patient while bouncing down the road in the back of an ambulance for nothing more than to push a pain medication that this lady really didn't need in the first place. If the ER wants an IV they can start one themselves in a more clean and stable environment.

I was happy with my decision, and believe that it was a step forward for me; sort of an "ahhhh moment" Realization comes in small steps.

1 comment:

Gertrude said...

Congrats on your growth! It is a good thing to feel yourself mature as a provider and to learn to trust the new instincts you are buidling.
I do have a thought on pain management that I always try to remember especially with my elderly patients. Elderly patients do have a great ability to manange their pain and they can appear as if they are in no pain at all. They do not like to complain or feel as if they are a burden to anyone. Because they don't appear to be in pain it does not mean they have no pain. Pre hospital pain management is a hotly contested issue. There are studies that say patients have better outcomes when their pain is managed early. Just food for thought really.