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Discussion

Calling EMS

Ok, we have been here 4 weeks and the ambulance has been here 4X!!!

Holy Moley!

1 for seizure (unknown hx at the time of the call) with head injury - No brainer

1 for Epi admin- no brainer that is our protocol

Two incident of escalating chest pain,

1 has some chronic health issues, multiple meds, not great color to start with

I was concerned about an PE given the intensity of the pain, parents were at least an hour away

1 an athlete came out of a game complaining of sharp chest pain, not relieved with rest (30 min), use of his inhaler (expired) but at least he had his spacer!

In my heart of hearts, I was scared for the first one, not a wimp, not a complainer, in spite of being in a lot of chronic pain. Turns out to be a part of her chronic health condition. Whew! Parents were all good with it.

The 2nd one, I was sure it was a panic attack, but his form only said hx asthma and seasonal allergies, kid from visiting team, parents again more than an hour away. Vitals were good but I think he blew off every bit of CO2 in his body leading to contracture and spasm of his extremities, unable to speak, no wheeze, satting in the hi 90's...but...

So I called and he was transported and yea it was a panic attack.

I stand by the call, (so does my AD and principal) and no one is questioning it, but it feels like I knew it was a panic attack, yet....

I don't have the ability (or desire) to diagnose a panic attack. I feel bad EMS came 2x for what ended up being not a true emergency.

Oh well, it's a crap shoot I guess!

Good thing my fire guys like me and respect my decision making. They were completely fine and supported my decision on both questionable calls.

Thoughts?

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    I would rather call 911 for a panic attack than not call for something that ends up being life threatening. Diagnosing is beyond our scope of practice anyway. We need to stop beating ourselves up ( I have done it myself) for not 100% knowing something. At the end of the day, you advocated for the safety of the students in your care and that is a job well done.

    I have a 12-lead in the drawer of my desk that nearly cost me my medic patch because I thought it was a panic attack. It wasn't until we put him on the EKG that things changed and I saw his HUGE MI (14mm of elevation, 1° heart block and bigeminal PVCs). He went into VT en route and had to be cardioverted, went straight to cath lab and coded on the table but survived. Always go with your gut!!!

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    Remember as nurses it's not our job to diagnose even though we feel like we should be able to but yet even doctors don't diagnose until after they run some tests! You definitely made the right call because you just didn't know for sure and how could you? You erred on the side of caution and that's not something you should ever regret! Heaven knows all the backlash you'd have gotten for not calling and something bad happening so never feel bad for making sure a child is ok and for protecting yourself!

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    When it comes to ABCs, always err on the side of caution. No one is going to get their license revoked by acting in good faith for the patient. But they will yank it if you start practicing medicine and dismiss it as a panic attack :)

    I remember during my EMS years, I had a nurse ask us why we had the pt. on a NRB when he was sating @ 98% on RA. Because he was breathing 38 times a minute? I'd be a fool not to!

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    First EMS call of the year for me today! Student with nut allergy ate cookies another student brought in; turned out they that had nuts in them! Itchy throat, wheezing, epi, ambulance ride; positive outcome. And some more continuing education about not eating things without checking/knowing ingredients.

    I am very happy to have a three day weekend!

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    First EMS call of the year for me today! Student with nut allergy ate cookies another student brought in; turned out they that had nuts in them! Itchy throat, wheezing, epi, ambulance ride; positive outcome. And some more continuing education about not eating things without checking/knowing ingredients.

    I am very happy to have a three day weekend!

    Gah!! How old is the student?? So happy you were there for that kiddo! He/she must've been frightened!!

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    Gah!! How old is the student?? So happy you were there for that kiddo! He/she must've been frightened!!

    Sophomore - not the first reaction the student had, however (the first one was very scary for the student and happened at school with me using Epi). Old enough to really push the importance of not eating items without knowing all the ingredients in them.

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    Unless you have a 12 lead, IV's and a lab, how can you be 100% sure of what you have? EMS has some of those tools, but even we err the side of caution and transport the patient. Yes, we might roll our eyes (I'm guilty), but these are kids whose bodies can compensate for a lot of things. It's always better to be safe than sorry.

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