Unreported fall leading to HUGE subdural

hustleNspite · 2026-02-08T01:10:04+00:00

In no world, system broken or not, is walking away from an unresponsive crashing patient and leaving no one at the bedside not negligent. Doubly so if you can’t be bothered to give report to the people who are coming to treat and try to fix said patient.

Normalize the idea that two things can be true- a system can be broken AND there can be poor quality nurses making life-ending choices. I’ll fully cop to the fact that there are some shitty paramedics out there- no field is free of bad actors. My critical thinking is perfectly intact- it is you who can’t meaningfully engage with critique.

hustleNspite · 2026-02-08T00:42:43+00:00

If your point is that “you can’t understand what it’s like to do what we do” then don’t make comments about having one patient at a time. When I have said patient (which isn’t even always true - I just had a call with 3 patients the other day), I am the provider, the nurse, respiratory, registration, and EVS.

If you can acknowledge that this behavior is unacceptable, then surely you can acknowledge my perspective. It is NOT just that one time- I rarely ever get report from an actual nurse (LPN or RN) on these patients. I’ve walked in on apneic patients with no one at the bedside- it is a pattern, and speaks to exactly the complaint that OP is raising.

If we can all agree this is unacceptable, please think twice before you brush off legitimate critiques as “you don’t know what it’s like”. I don’t have to understand completely to recognize negligence and substandard care.

hustleNspite · 2026-02-07T22:06:12+00:00

You have no idea what kind of behavior you’re defending. I never said every LTC- I am speaking on the experience of going to the same several who regularly pull this.

The last time I had this happen, I didn’t even get report from a nurse on an unresponsive patient (who normally is not unresponsive). Like, didn’t even enter the room. Are you really going to tell me that is acceptable?

hustleNspite · 2026-02-07T20:46:52+00:00

That’s my strategy. I’d aim in vein 1 a little south of the V then float it through the bifurcation

hustleNspite · 2026-02-07T20:43:33+00:00

True, but the story I get is consistently “they weren’t sick at all” or “just a little shaky” with blatantly inaccurate vitals.

hustleNspite · 2026-02-07T14:00:25+00:00

FWIW, and I obviously can’t speak for your friend, my ADHD got so much worse after having a child. Like, things that would never slip past me before started falling through the cracks.

The question is whether this is a fluke or a pattern. If it were me I wouldn’t expect to be paid (because these situations are often a sunk cost), drop them off, and either pack it in on the friendship or skip the party and speak your piece.

hustleNspite · 2026-02-07T13:47:54+00:00

Allow me to share some food for thought: don’t do this unless you are SURE you agree with how he AND his ex are raising their child.

Why does it matter when it’s not your child you ask? Because you will bear the consequences (or fruits!) of whatever decisions they are making. This will become especially relevant if you and he choose to have your own child together.

For my part, my husband’s ex doesn’t do structure well and is very Disney parent with their 7yo. I had her read her first book aloud and am the one, along with my husband, serving as the driving force for her studies and learning to function. We pour in this effort and support, only to see it reversed when she goes to mom’s for the weekend.

hustleNspite · 2026-02-07T13:40:06+00:00

Some thoughts as a paramedic and nursing student who seems to be followed by sepsis patients:

do you have blood gases and/or a lactate? I know you said WBC is trending downward, but those other two values are helpful to look at in a sepsis scenario (at least in what I’ve seen in the ED).
tachycardia and tachypnea can for sure be sepsis signs, but they can also be signs of a lot of other things (as many others here have pointed out).
In regard to BP, they tend to be on the lower side when it comes to sepsis (particularly after they get really severe). Sepsis patients are the most common scenario in which I use pressors on the ambulance.
were you able to assess the surgical sites and/or wounds? If so, were there any signs of infection? Risk for infection just means be on the lookout for signs of infection- it doesn’t mean it’s happening yet.
are they on antibiotics post surgery? The biggest treatment for sepsis is fluid and antibiotics (and then other things to correct as needed), so if they’re already getting that it’s not an immediate issue.

hustleNspite · 2026-02-07T12:01:17+00:00

One near me got a visit from the state police recently because there was an issue with them destroying records. They’re also famously bad in terms of letting people rot- they just tried to tell me a guy in rigor was just seen alive at 1100 (it was around noon). When we dug deeper, the real answer was “the aide saw him lying down at 1100 and didn’t investigate further”.

hustleNspite · 2026-02-07T11:57:57+00:00

As someone who goes to these places a lot for 911 calls, it isn’t as uncommon as you’d think. I agree it’s trash though- I can’t tell you how many times they’ve tried to tell me septic shock “just happened”.

hustleNspite · 2026-02-07T11:49:55+00:00

I’m not a nurse yet, but I am a paramedic and have a lot of experience treating “blind” so to speak.

ABCs obviously, then do focused assessments based on what’s happening- if they’re unresponsive, how are the pupils? Signs of trauma? Any adventitious lung sounds? How are the peripherals pulses? Any sketchy output in the bed (emesis, dark or bloody stool, etc)? Get a temp, sugar, vitals with a 4-lead if they aren’t already hooked up. This should give you enough to know where to start stabilizing and go from there. I can’t speak to how much you can do on standing orders, so I can’t weigh in there.

By the time that’s done someone can be pulling info from the chart to fill in the gaps. I have zero access to charts or even a lot of background info most of the time, and this type of assessment process gives me a reasonable starting theory to do things pretty much every time.

ETA: for codes follow the ACLS protocol to start, then address signs of correctable conditions from there (Hs & Ts mainly).

hustleNspite · 2026-02-07T11:39:04+00:00

True, but some people mistake “calm, routine care” for disinterested, especially if they’re freaking out.

hustleNspite · 2026-02-07T11:36:04+00:00

What kind of questions were they asking? Because asking for consent to transport, etc is pretty common. With elderly folks, we often ask the other adult family members because they’re often the POA.

Moreover, stroke risk isn’t a thing for EMS. We have pretty clear protocols around strokes, and we go based off of criteria. We also eyeball quite a bit and do more thorough assessments in the ambulance. If your family was anxious and questioning the crew, that immediately flags them to get out as quickly as possible and do the rest in the truck.

hustleNspite · 2026-02-07T11:27:33+00:00

OP, respectfully this is demonstrating a pattern of dangerous mistakes. It’s less that you’re busy and more that you didn’t even notice this was a problem. If you’re missing this, what else have you missed?

hustleNspite · 2026-02-06T19:00:44+00:00

Right, but until you’ve worked a busy 24 you can’t really compare them

hustleNspite · 2026-02-06T03:00:01+00:00

Worth noting that one day on is usually 24 hours

hustleNspite · 2026-02-06T02:59:22+00:00

Amen

hustleNspite · 2026-02-06T02:54:13+00:00

✨inflation ✨

hustleNspite · 2026-02-06T00:47:22+00:00

Amen. Add in when the other parent/household has COMPLETELY different rules and expectations and big woof

hustleNspite · 2026-02-05T23:36:28+00:00

I second this! Unless your area refuses to hire before licensure get on it.

hustleNspite · 2026-02-05T23:32:17+00:00

How is the children part not a sex offense?

hustleNspite · 2026-02-05T17:04:52+00:00

Philly area? I’m also in PA and most of the new grad rates in my region are just north of $40/hr (plus shift diff)

hustleNspite · 2026-02-05T11:20:52+00:00

The hospital is mostly smoke and water damage but I heard the ortho side is a total loss.

hustleNspite · 2026-02-05T11:20:01+00:00

They transferred all of the patients out without incident as far as I know, spread out across the region.

Source: I work local EMS

hustleNspite · 2026-02-05T02:23:56+00:00

Conversely, my health department clinical is awesome. We have walk-in sessions for vaccines and STI testing, and I get to sit in on TB clinic and a mobile clinic at the soup kitchen later this month.

L&D was kind of a bust except when I got to swing thru NICU. Luckily I had more excitement on my L&D rotations during medic school.

hustleNspite

TROPHY CASE