When you have a patient who has been vomiting blood all day and he has a blood pressure of 90/60 lying down, you don’t “check posturals” and you certainly don’t sit him up. Nor do you look questioningly at your training officer when both medics say in chorus, “Get him back on the floor and take that non rebreather off him.”
What you do is lay him back on the floor and get the non rebreather off of him. Oh, and you might want to roll him over onto his side so he doesn’t aspirate his vomit.
And get some sheets and blankets to wrap him in because you might have missed the fact that he’s 4+ diaphoretic, cold as ice, and white as a ghost, but the medics didn’t.
Really. It’s not rocket surgery.
I’ll deal with your training officer later on.
Oh my goodnes!! Yikes! What part of vomiting blood all day, didn’t they get? Posturals? Are you serious?!? I hope they get re-schooled (or preschooled) big time. That is simply not acceptable and scary as all get out.
Wow. I’m gobsmacked. I’m glad for the patient’s sake, that you were there to correct things. Thank you! Geez, I got faint from just reading your post.
I thought you said you worked in the northeast? Sounds like around here to me.
i really hate it when people do orthos on less-than-normotensive people. thank you for this post.
I added my thoughts in TOTWTYTR’s EMS Tip Of The Day.
I usually cover this as, “if the patient tells you they feel dizzy when sitting/standing or feel like they are going to pass out, just assume they are orthostatically incompetent.”
[cue war story]
I had a call a few years back, old guy was on his hands & knees puking in the toilet, GI bleed coming violently from both ends. Conveniently he was naked and splattering the wall behind him (you can thank me later for that visual). My new-ish EMT partner wanted vitals before we took him down stairs. I decided to defer said vitals and just get in the truck and go. Aforementioned new-ish EMT partner decided to climb up into the patient compartment with me and get a set of vitals whilst I was securing venous access. He looks up at me and said “Matt, his BP is like 74/32, is that bad?”
*facepalm*
“Drive, kid, just fucking drive”