Okay, a little background. We have a very nice little RV park in town that is popular. At 0930 I got a pt by ambulance, an older man who was down for at least 3 hours......fell in his RV while on his way to the BR. Why his wife didn't wake up, I dunno. Why he didn't call out for her, I dunno. He lay there stark nekked for at least 3 hours before she woke up and found him. The doc and I questioned him, he was very with it and said there was no fall, no dizziness, no chest pain, nothing. He had a recent hx of GI bleed but his labs with us were fine. He had severe pain because he couldn't get to his routine pain meds this morning, so I gave him 2.5 of morphine IV. That literally snowed him for 3 hours but he finally woke up enough to talk to us, but he had mentation changes: if left alone he seemed almost obtunded. Somewhere in there I put in a foley and got crud out; he was uroseptic. Called the on call doc to admit him and she said "Just because of his age, let's get a troponin." We were not expecting an abnormal result so we were all shocked when it came back at 29!! Scratch the admit, start working on transferring him. I got the runaround from the hospital near where the pt lives; to save time I called the ambulance company to get a critical care transport started. The crew arrived an hour later, and right after that the pt started crumping on me.
Oh yeah......we are a rural facility, no specialists. Our ICU is like a larger hospital's tele unit.
The transport nurse actually told me, "I can't transport him, he's too unstable for transport."
Eh?????
If he's too unstable for transport, he's sure as (^%# too unstable to stay here!!!!!!!
His trop was elevated because he laid on the floor for 3 hours. He is probably in rhabdo and does need to be transported for workup. I work at a large university cardiac intensive care unit and its lifeflights call whether they can fly or truck them. If our peeps are obtunded or whatever they will want them intubated before transport. Its almost impossible to inubate in a chopper. Its hard to alot of things in a chopper for unstable peeps. We leave it up to them to make the call.
I've never had that problem, and I've sent out some pretty unstable patients. Just last week, I sent a lady out who came in V-tach, had been shocked like 12 or 13 times, had a lidocaine drip, amiodarone drip, dopamine, and heparin drips and kept going into v-tach. I shocked her 4 times while the medics were loading her on the stretcher for transport, but they would have NEVER refused to transport her because she was too unstable......that's their job, they are trained for such.
His trop was elevated because he laid on the floor for 3 hours. He is probably in rhabdo and does need to be transported for workup. I work at a large university cardiac intensive care unit and its lifeflights call whether they can fly or truck them. If our peeps are obtunded or whatever they will want them intubated before transport. Its almost impossible to inubate in a chopper. Its hard to alot of things in a chopper for unstable peeps. We leave it up to them to make the call.
When I worked in CCU (years ago) I was always under the impression that troponin was pretty much cardiac specific unlike ck, myoglobin or even MB. I had read some cases where troponin was slightly elevated with renal failure but wow a troponin of 32! I didnt know this could happen from trauma or general muscle injury. But that is why I still read this board even though I am not in nursing anymore.
I once refused to transport a post-cardiac arrest patient without a physician on board. He was in and out of cardiac arrrest and throwing every rhythm you'd ever want to see, one right after the other. It was like one of the old ACLS rhythm tests gone insane. I figured by the time I called in and got orders for one rhythm it would have changed. Since we don't have telemetry to the hospital, I wanted somebody who could look at the pt and monitor and give me orders. Our protocols are good, but not real good for rapidly changing situations.
They weren't real happy about it, but they did get me a physician from somewhere.
wouldnt you want the crap to hit the fan in a stable environment, like your er? Yes, you know he needs a higher level of care, but I actually do understand this.
What can you do when a patient needs to be transported and the ambulance service refuses the patient? Can a nurse travel with the patient to the next hospital to assist?
Hopeful, the ambulance company will not allow our nurses to travel because we don't work for them....liability.
RNOT, you're right to a point.......this pt was not going to stabilize without the higher level of care, which we could not provide. The pt needed to get there asap. If he had stayed with us we would have lost him. I called the air ambulance service and they were perfectly willing to take him for me but were grounded because of weather, and the flight crew could not believe what the transport nurse had said. This nurse has a history of not wanting to take anything but the most stable pts out and has been written up several times by both sending facilities and her own coworkers, but she has a personal relationship with a company higher-up.
The comapny's policy is to get the transport team dispatched as soon as possible because of distance and they even will help us arrange for a receiving facility. This nurse, however, will not assist in any way; last night she literally threw up her hands and walked out of the cubicle, saying, "I'm not getting involved in this, I'm not taking him until he's stabilized."
Specializes in ER, ICU, Infusion, peds, informatics.
hopeful, the ambulance company will not allow our nurses to travel because we don't work for them....liability.
wow, we are required to go with certain patients, much to my motion-sick prone self's dismay.
if the patient is on a drip that the paramedic isn't authorized to monitor, we have to go. if the patient is going to an icu, we have to go (unless we are able to turn over care to an rn, such as when we send them via helicopter). if the patient is on a drip that requires an iv pump, we have to go (to make sure we get the pump back :) ).
always intersting how things are different in other parts of the country.
Critter, our ambulance company has a critical care transport service.....an ICU nurse, a medic, and an EMT. Before the company hired RNs for transport we used to go. I've made several trips yelling when we hit a bump hard enough to bop my head on the ceiling.
Specializes in ER, ICU, Infusion, peds, informatics.
critter, our ambulance company has a critical care transport service.....an icu nurse, a medic, and an emt. before the company hired rns for transport we used to go. i've made several trips yelling when we hit a bump hard enough to bop my head on the ceiling.
wish we had that, and not just for my nausea and has, :)
we sent a trauma pt from our er to a higher level of care a while back that was reportedly doa.
i wasn't working that night, so i'm not privy to the details, and i have not idea why an rn didn't go along.
our fire medics are very, very, good; but they don't transport hospital to hospital. the medics for the transport companies vary as far as skills go.
i'm not saying that the patient would have lived if an rn had gone along, but i'm a bit worried for my coworker that sent the patient and didn't go, liability wise.
i'm told that the requirement for an rn to go varies from state to state, and i know the transport medics usually seem to be offended when we have to go along. sometimes their attitude makes nurses want to "forget" that they are supposed to go along.
heartrn4duke
16 Posts
His trop was elevated because he laid on the floor for 3 hours. He is probably in rhabdo and does need to be transported for workup. I work at a large university cardiac intensive care unit and its lifeflights call whether they can fly or truck them. If our peeps are obtunded or whatever they will want them intubated before transport. Its almost impossible to inubate in a chopper. Its hard to alot of things in a chopper for unstable peeps. We leave it up to them to make the call.