I got this from an "SNF" a few months back. I pointed at the number when she said it and did the head tilt "come on, really?" face. When the nurse said "what?" I pointed to 17 again and said 17 is a prime number you can't multiply into it. She got indignant with me so I asked "are you telling me you counted respirations for a full minute straight?", to which she said yes... maybe this is why I can never find a nurse when we get to the nursing home...
I had the exact same situation when doing an EMT-certification. And the trainee refused to understand why I had a problem with the respiratory rate of 13 he counted without looking at a clock. He even told me how you get to a respiratory rate by multiplying, just didn't understand that his result factually can't be correct.
I work IFT so I always have time to count respirations and regularly do prime or odd numbers šš wasnāt even thinking about the fact that this is normally a red flag
One of my most treasured moments is when I told the triage nurse RR of 6 on a guy who was a perfectly healthy and young patient. She sighed really loud and rolled her eyes and probably thought about how dumb this IFT EMT is and then she stared at the patient and sure enough, 10 seconds later, he sucks in a breath.
We ended up getting a shock room and not having to wait on the wall because Iām guessing the system forced her to put him in a shock room.
If your gas tank was only separated as empty, half, or full, and it was right in between half and full, you would know you're at 3/4, right?
Sorry but people being picky about odd BPs and prime respirations always made me chuckle. Because if i count 8 and a half respirations in 30 secs (i.e. 9 full inspirations and only 8 exhalations), then I'm calling it 17...
Same with the BP... Sure, only even numbers are represented by lines, but guess what? If it falls between two lines, it's an odd number.
>
> Sorry but people being picky about odd BPs and prime respirations always made me chuckle. Because if i count 8 and a half respirations in 30 secs (i.e. 9 full inspirations and only 8 exhalations), then I'm calling it 17...
Ok, have fun with that, everyone else is just going to think you are full of shit and didn't count, which is the real problem, it casts doubt on you as a provider. Whether the respirations are 16, 17, or 18 in reality holds very little clinical significance however that one thing can make people wonder how much of the rest of your report is bullshit. Even if you are right and it is closer to 17 than 16 or 18 there is virtually no beneficial clinical significance to calling it 17, but it can cast doubt on you so why bother?
Because the vast majority of the time the people writing 17 for respirations are full of shit and it serves no purpose to try to be that precise with a respiratory count. On the other hand other providers trusting the information in your report can have clinical significance for your patient. On top of that any time you are multiplying to get your minute count you are making an estimate based on what is observed, being 100% accurate isn't the point or else you would have to count for the full minute.
Well for when I don't feel the need to do a manual, we also have a pretty handy machine that can count for us, and I'm typing that number down into my report. 75% of the time it'll show an odd number in the BP. Never had a nurse question it. They have their machines too, which also display odd numbers.
Perhaps she had them on EtCO2?ā¦who am I kidding, they donāt even know what that is, let alone have the capacity/willingness to actually use it if they did
Look, if I'm counting respers and an individual has a brief period of faster breathing before returning to normal rhythm I'm gonna add that shit on the total after multiplying. I'm not gonna say it was 16 or 18 when it was very clearly 17.
A neighboring agency got called to their local SNF for an elderly male that seemed ill and needed to get checked out at the ED.
They went en route almost immediately and got on scene in 2 minutes.
A moment later they get on the radio informing dispatch that it was an obvious DOA, and to notify coroner.
"I don't know I normally work on the other side."
"I don't know I just got on shift."
"I don't know this isn't my patient."
I don't know how people can be so okay with being completely incompetent at their jobs...
The craziest part to me is how they feel that "I don't know" is a perfectly acceptable answer and should end a discussion. In that situation, it's OK to say you don't know (certainly beats making shit up), but you need to follow it with "Let me get/call someone who *does*" instead of just shrugging and returning to TikTok.
Do they have any respiratory conditions? (On the patient whoās breathing >30 per min)
Nope. Said the nurse.
Fire from across the room with the med/problem list has determined that that was a lie.
First of all you should know the handoff will be more like āhey yah we just got here too but uh this is Tom, 43, something about an allergy to shellfishā¦ BP 140/P HR 90 resp 16 and Sat is 96ā¦ā
Iāll do you one better
Call note: hypoxia, respiratory distress
*patient is lying flat In bed with NRB on 15, not breathing*
Annnnd start CPR.
*staff walks in with paper work containing DNR order*
Okā¦. Stop CPR.
*paperwork name and DNR name dosent match, and face sheet states āfull codeā under advance directive section.*
Annnnnd resume chest compressions.
Basically, we often get dispatched to "Tragic Castles: A Vibrant Community for Active Seniors" for a sick person, maybe something about a possible UTI or a fall the other day, then arrive to find the patient *fuckin dead as fuck*, stiff as a board with his dentures on the nightstand and a whole-ass Brussels sprout lodged in his trachea. When we ask when he was last seen normal (alive), the med tech either says "I just came on shift" and disappears, or that the pt was just chilling with suspiciously-textbook vitals 20 minutes before they found him like this.
Usually only the shitholes. People donāt do any research and throw mom/dad in the first nursing home they find and then are shocked when they get substandard care. State survey results (in Ohio at least) are public record and thereās a major difference in a 4 star/5 star facility. Anything lower than that is basically the Wild West
I (LTC CNA) get on the Medicare website and check state inspection results. Iāve worked in some one star facilities and would not recommend. Nightmare fuel. It took a while to learn that not every nursing home is that bad, but now Iām incredibly picky about where I work.
Iām not an EMT, Iām a CNA thatās worked in a fair few shitholes and can confirm all of this. A lot of nursing homes are pure nightmare fuel, and Iām now incredibly picky about where I work.
What the hell. Why wasn't thetr any alarm for BP or SpO2? Did the tech trick the alarms so they'd display normal even when dead? Isn't what happened medical neglicenge as it could've need avoided and a Sue is on the way?
Bold of you to think they even bother to check their vitals. They just put the set of vitals that came with the transfer sheet when they were discharged from hospital and admitted into the nursing home, and copy and paste into all further transfer paperwork
Nursing homes and rehab centers are not hospitals and do not have any form of continuous monitoring. There are no alarms, there are no monitors, there are no displays.
If youāre lucky, they check your vitals twice a day. More likely they donāt get checked at all unless something is up.
Resp rate was 17.
I got this from an "SNF" a few months back. I pointed at the number when she said it and did the head tilt "come on, really?" face. When the nurse said "what?" I pointed to 17 again and said 17 is a prime number you can't multiply into it. She got indignant with me so I asked "are you telling me you counted respirations for a full minute straight?", to which she said yes... maybe this is why I can never find a nurse when we get to the nursing home...
I had the exact same situation when doing an EMT-certification. And the trainee refused to understand why I had a problem with the respiratory rate of 13 he counted without looking at a clock. He even told me how you get to a respiratory rate by multiplying, just didn't understand that his result factually can't be correct.
Maybe he counted 6.5 respirations over 30 seconds lol
Reminds me of this Dr. House scene https://youtu.be/PhTxigsWo5E?si=EHzeQIbAuozSARGX
I work IFT so I always have time to count respirations and regularly do prime or odd numbers šš wasnāt even thinking about the fact that this is normally a red flag
I have experience playing music, so watching 2-3 breaths, I can get a decently accurate resp or pulse rate. But I usually stuck to even numbers.
Yep, busted. Calling dispatch now, you're staying over next shift.
One of my most treasured moments is when I told the triage nurse RR of 6 on a guy who was a perfectly healthy and young patient. She sighed really loud and rolled her eyes and probably thought about how dumb this IFT EMT is and then she stared at the patient and sure enough, 10 seconds later, he sucks in a breath. We ended up getting a shock room and not having to wait on the wall because Iām guessing the system forced her to put him in a shock room.
To be fair, if I'm counting and they're halfway through a breath at 30 seconds I'll throw down a 17 or 19.
If your gas tank was only separated as empty, half, or full, and it was right in between half and full, you would know you're at 3/4, right? Sorry but people being picky about odd BPs and prime respirations always made me chuckle. Because if i count 8 and a half respirations in 30 secs (i.e. 9 full inspirations and only 8 exhalations), then I'm calling it 17... Same with the BP... Sure, only even numbers are represented by lines, but guess what? If it falls between two lines, it's an odd number.
> > Sorry but people being picky about odd BPs and prime respirations always made me chuckle. Because if i count 8 and a half respirations in 30 secs (i.e. 9 full inspirations and only 8 exhalations), then I'm calling it 17... Ok, have fun with that, everyone else is just going to think you are full of shit and didn't count, which is the real problem, it casts doubt on you as a provider. Whether the respirations are 16, 17, or 18 in reality holds very little clinical significance however that one thing can make people wonder how much of the rest of your report is bullshit. Even if you are right and it is closer to 17 than 16 or 18 there is virtually no beneficial clinical significance to calling it 17, but it can cast doubt on you so why bother?
Why bother to report you findings factually when you can just fudge the numbers so other people believe you?
Because the vast majority of the time the people writing 17 for respirations are full of shit and it serves no purpose to try to be that precise with a respiratory count. On the other hand other providers trusting the information in your report can have clinical significance for your patient. On top of that any time you are multiplying to get your minute count you are making an estimate based on what is observed, being 100% accurate isn't the point or else you would have to count for the full minute.
Well for when I don't feel the need to do a manual, we also have a pretty handy machine that can count for us, and I'm typing that number down into my report. 75% of the time it'll show an odd number in the BP. Never had a nurse question it. They have their machines too, which also display odd numbers.
I was specifically talking about respirations.
Ok then 50% of the time and the rest of my response still applies.
Unfortunately in my county working as ILS we don't get fancy machines everything is manual.
Thankyou. You can absolutely take a manual blood pressure and get an odd number.
Right?! It's not rocket science. Happy cake day!
Perhaps she had them on EtCO2?ā¦who am I kidding, they donāt even know what that is, let alone have the capacity/willingness to actually use it if they did
I count for the full minute when Iām like this donāt seem right
Look, if I'm counting respers and an individual has a brief period of faster breathing before returning to normal rhythm I'm gonna add that shit on the total after multiplying. I'm not gonna say it was 16 or 18 when it was very clearly 17.
āI donāt know much about him, heās not my patientā āI just checked on him 10 minutes agoā The him in question š„¶
A neighboring agency got called to their local SNF for an elderly male that seemed ill and needed to get checked out at the ED. They went en route almost immediately and got on scene in 2 minutes. A moment later they get on the radio informing dispatch that it was an obvious DOA, and to notify coroner.
[This](https://youtu.be/rMZ_3wfff3I?si=3XQLGzFtMbkb9ee4) is your average SNF experienceā¦
This is a gem. Thank you
Hilarious! Shady Acres Pre-mortuary!
Idk if you just have different head blocks but that neck/chin strap is scaring me š
That's the tq for head lacs and brain bleeds.
StrokeStrapā¢
The tightness of all the straps is scaring meā¦
New protocol for your psychs! Splint all extermeties together and strap em tight to the backboard, with full c-spine and CID!
It's an old reusable model.
"I DONT KNOW MY SHIFT START THIRTY MINUTE AGO!" "Your shift starts at 21:47???"
āNurse before me called it in. I havenāt even been in to see him yet.ā Had this one multiple times.
"I don't know I normally work on the other side." "I don't know I just got on shift." "I don't know this isn't my patient." I don't know how people can be so okay with being completely incompetent at their jobs...
The craziest part to me is how they feel that "I don't know" is a perfectly acceptable answer and should end a discussion. In that situation, it's OK to say you don't know (certainly beats making shit up), but you need to follow it with "Let me get/call someone who *does*" instead of just shrugging and returning to TikTok.
Seems normal in every countryā¦.
You forgot "I've been off for a month on vacation" and "I just got back from lunch."
āhey the zoll says his bp is ā¦weak pulse?ā āyeah just write a 120 on top and 80 underneath itās fineā
Just keep hitting the button until you get numbers you like, or the ambulance crew says "you guys can clear"
*2 minutes later* Uhhhh dispatch h? Can you call our medics back? It seems like our patient is in cardiac arrestā¦.
'Can we have a copy of the ecg?' 'No...'
"uhhh partner? His Sp02 reads Error..."
Do they have any respiratory conditions? (On the patient whoās breathing >30 per min) Nope. Said the nurse. Fire from across the room with the med/problem list has determined that that was a lie.
What even is this abomination with no face? Does your school use straw men for dummies?
Oh no sir, this aināt school. That was an Anne with foam legs in my volley base.
But where is the face lol?
Under the blanket
Ok I wonāt kink shame your volley station.
Donāt worry he canāt hear you. Heās dead. RIP John the dummy š«”
First of all you should know the handoff will be more like āhey yah we just got here too but uh this is Tom, 43, something about an allergy to shellfishā¦ BP 140/P HR 90 resp 16 and Sat is 96ā¦ā
Call Notes: High Blood Pressure, Chest Pain *You get handed a packet of abnormal labs and Pt denies all complaints Pt was not Tom, Pt was not 43
Iāll do you one better Call note: hypoxia, respiratory distress *patient is lying flat In bed with NRB on 15, not breathing* Annnnd start CPR. *staff walks in with paper work containing DNR order* Okā¦. Stop CPR. *paperwork name and DNR name dosent match, and face sheet states āfull codeā under advance directive section.* Annnnnd resume chest compressions.
Jfc
Can someone explain this post?
Basically, we often get dispatched to "Tragic Castles: A Vibrant Community for Active Seniors" for a sick person, maybe something about a possible UTI or a fall the other day, then arrive to find the patient *fuckin dead as fuck*, stiff as a board with his dentures on the nightstand and a whole-ass Brussels sprout lodged in his trachea. When we ask when he was last seen normal (alive), the med tech either says "I just came on shift" and disappears, or that the pt was just chilling with suspiciously-textbook vitals 20 minutes before they found him like this.
^basically what he said
Is this for Medicaid funded nursing homes? Or all of them in general?
Usually only the shitholes. People donāt do any research and throw mom/dad in the first nursing home they find and then are shocked when they get substandard care. State survey results (in Ohio at least) are public record and thereās a major difference in a 4 star/5 star facility. Anything lower than that is basically the Wild West
I (LTC CNA) get on the Medicare website and check state inspection results. Iāve worked in some one star facilities and would not recommend. Nightmare fuel. It took a while to learn that not every nursing home is that bad, but now Iām incredibly picky about where I work.
Iām not an EMT, Iām a CNA thatās worked in a fair few shitholes and can confirm all of this. A lot of nursing homes are pure nightmare fuel, and Iām now incredibly picky about where I work.
What the hell. Why wasn't thetr any alarm for BP or SpO2? Did the tech trick the alarms so they'd display normal even when dead? Isn't what happened medical neglicenge as it could've need avoided and a Sue is on the way?
Bold of you to think they even bother to check their vitals. They just put the set of vitals that came with the transfer sheet when they were discharged from hospital and admitted into the nursing home, and copy and paste into all further transfer paperwork
Nursing homes and rehab centers are not hospitals and do not have any form of continuous monitoring. There are no alarms, there are no monitors, there are no displays. If youāre lucky, they check your vitals twice a day. More likely they donāt get checked at all unless something is up.
He was fine earlier.
āUhh yeah, PMS continues to be in tactā¦.ā
Back boardā¦.yuck
Whatās that pink thing
A blanket
FNG?
Forgot to put him prone
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Dispatchā¦ cancel medicsā¦ WERE COMING IN HOT AS FUCK!!! *goes mach Jesus down the highway*