To Give or Not to Give

Ambulance Outside Hospital Bay
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**Before I start this post, I would like to thank all the support from my readers.  I have stopped posting for a while due to personal issues that I had to deal with.  I have to say that your support has been very encouraging.  Thank you.

I got jolted out of my sleep as my pager buzzed its static complaint, urging me to get up.

Dispatch:  “99 Zulu, 99 Zulu.  Code 3 call.”

What time was it?

I tossed my blanket off, pulled my boots on, grabbed my knapsack stashed with a paramedic’s well-needed emergency supply of food, and entered the ambulance bay.  My partner was not yet there, I looked at the CAD (Computer Assisted Dispatch) system and it didn’t appear to be working.  The call did not show up on the screen.

Ring!!  Ring!!

The telephone goes off angrily.  I quickly walk from my vehicle as my partner enters the driver’s seat and grab the phone off the station wall.

Me:  99 Ambulance Station

Dispatch:  “Hey, did you guys get my call?”

Me:  “Yeah, we were just about to leave, the call isn’t showing on the CAD.”

Dispatch:  “I can give it to you now, do you have a pen ready?  Or do you want to take it on the air?”

Me:  “I’ll take it on the air, we’re just about to pull out.”

I hop back into the ambulance.

Partner:  “What was that about?”

Me:  “Dispatch wondering if we got the page.  She seemed to be in a rush.”

Partner:  “99 Zulu.”

Dispatch:  “99 Zulu, Code 3 for a 90y/o female complaining of SOB (shortness of breath), recent insertion of pacemaker. “

Partner:  “10-4.”

Off we go lights and sirens down the early morning street.  There was not a single car in sight, as we noisily woke up the whole town.  As we flew down the street, I started my patient care report and wondered how bad this shortness of breath is and if it’s related to her pacemaker.

We had a bit of trouble distinguishing which house was the one we were called to, the houses didn’t have the house number on it.  As I jumped out of the vehicle towards the house with the lights on to double check, a lady comes out, she didn’t seem too distressed.

Me:  “Hi, did you call us?”

Lady:  “Yes.”

Partner:  “I’m just going to back up into the driveway.”

Me:  “Ok.  Before you do that, can you give me your gum?  I’ve still got my early morning breath.  Also I’m going to grab the jump kit and head inside before you back in.”

Partner:  Tosses me her gum.  “Sure thing.”

I lugged the large pelican jump kit towards the house. 

Me:  “Good morning.”  Err…wait…maybe I shouldn’t have said that, maybe it’s not such a good morning for her.

I quickly change the subject.

Me:  “So what’s going on today?”

Lady:  “It’s my mother, she’s not feeling well.”

Me:  “Where is she?”

Lady:  “Oh she’s right there on the couch.”

I look to where she points and find an elderly lady lying flat on her back on a couch.

Me:  “Hi there.”

I smile.

Me:  “What’s your name?”

Patient:  “Jane.”

Me:  “Hi Jane, what’s going on today?”

As Jane proceeds to tell me her story, I get her to sit up on the couch.  Her pulse is strong, irregular and she’s talking in full sentences.  Her breathing doesn’t look bad at all.  I find out she started having a strange feeling this morning as she went to the washroom and hasn’t been feeling good yesterday either.  I place a pulse ox on her finger as my partner walks in with the oxygen tank.

My patient’s oxygen saturation is at 98% on room air, and her breathing effort was easy.  I find out she had the pacemaker inserted a few weeks ago and since then she’s had a dry cough that won’t go away.  She’s mostly complaining of feeling tired.  I auscultate her lungs and it’s clear throughout.  Technically I don’t need to give her any oxygen because she’s breathing fine.  However, when I ask, she says she finds it difficult to breath.

Partner:  “Want some oxygen?”

Me:  “Sure, lets do a nasal.”

And so we run the call, get our patient packaged and en route to the hospital.

Me:  “How are you feeling now?”

Patient:  “Good, I feel better after having some of this oxygen.”

Me:  “Great to hear!”

My patient’s breathing quality, effort and saturation hasn’t changed from my first assessments.  What must be taking place is the placebo effect.

In this scenario I chose to give oxygen even though it’s not necessarily required.  I wanted the placebo effect.  In the mind of my patient, she was having trouble breathing.  She called us because she was worried and wants help.  I believe as a paramedic we need to take care of our patient’s emotional state (the mind) as much as we are trained in taking care of their physical well-being.  A little bit of oxygen isn’t going to hurt this elderly lady, yet it helped ease her mind and allowed her to feel that help was given.   Some may be against using the placebo effect, but I ask this:  What is our ultimate goal for each patient? Isn’t our ultimate goal as a paramedic to help ease the pain of the patient, whether it is physically or mentally?  If so, why not utilize all the equipment and tools we have?  Including our knowledge of the placebo effect?

 

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Comments
7 Responses to “To Give or Not to Give”
  1. Chris Reimer says:

    Agreed. A little O2 would not have any negative effect on this woman medically, but it’s emotional value is immense.

  2. Alex says:

    Hey M,

    It seems that SOB is a common problem with pacemakers that are not correctly tuned. http://abcnews.go.com/Health/HeartRhythmTreatment/story?id=5215602

  3. Silvia says:

    So did the hospital find anything wrong with her?

    • B says:

      I love reading your blog and I respect your decision-making process. I am going to play devil’s advocate though.

      To me the giving of O2 helps the patient in the moment but its not sustainable. The next time that she feels shortness of breath, mentally or otherwise, she and her supports would need to rely on another ambulance call to fix the situation. To me, the role of caring for her mental insecurity doesn’t lie with paramedics but with her family, friends, or other involved professionals.

      Coming back to your side, I think you did a very caring thing that was within your resources. In reality, there probably aren’t many or enough services to help a woman who mentally feels like she’s short of breath. So you made up for that through your own role. Thank you for your blog!

      • PocketMedic says:

        Hi B,

        I love playing devil’s advocate. And just for discussions sake: I agree with you that it is not the be-all-end-all result and obviously she needs a more secure form of care. That being said I much rather have her call us again for shortness of breath in the future than not call per say, in case she was really having SOB the next time. Also regardless of whether I give her oxygen or not, she had already called us, and whether I made her feel better or not en route, in her mind she wanted to go to the ER which was the definitive care she’s seeking. I have a feeling that there was something else going on with her, although I can’t say. Perhaps she’s having an asymptomatic heart attack, as she said she felt it after a long walk, and often it’s hard to tell with elderly females.

  4. EMcGee says:

    I agree its are job to respond to the calls regardless of how many times we have to go or if they have something wrong with them or not, and the boy who cried wolf dose not apply in are field cause we would be the ones in trouble for not helping these pt’s even tho they can be the reason we are sleep deprived. love the blogs

  5. Horace says:

    Great post! I will totally save this for future research.
    Cheers!

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  • Courage is the discovery that you may not win, and trying when you know you can lose. -Tom Krause
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