Nurse Ratchet.

Ok I run a basic truck which means i get hammered on my shift.....I get all the transfers and the bs {bull shit} emergencies........which makes it hard to get a good partner because they all want on a medic truck and i can understand this I miss being on a medic truck but i do get my share of emergencies I have only had to turn a pt over once to a higher level of care. because of the fact of the location of the hospital is 25 min away and the pt was circling the drain and needed things done that was out of my scope of practice. but I get called to a fall in a nursing home not uncommon in a nursing home. I get on scene to see granny foo foo laying on her back with a pillow under her head they had moved her from her original position...
80+ yr old female laying supine in floor {supine = on her back} she is alert and orientated with a huge hemotoma on her forehead above her left brow at one time before i got there it was bleeding but now dried blood so i am not concerned no bleeding it stopped its controlled... she fell trying to get out of bed so she fell a short distance did hit her head on floor but not pain in neck back extremities pelvis none no where else on her body but her forehead where the bump is... so i choose not to spine board it was considered but based on the pt choose not to because of pt's age and curve of her spine would cause more harm than good and was not necesary not to mention fiesty lil old lady that let me know real fast she was an rn and she new if she was hurting else where or not but she thanked me for my concern and understood why i was asking her..ok we got that out of the way ok i help her sit up she is not dizzy no nausea. the nurse at the nursing home said her bp was 72/45 hmmm ok i look at my partner which is not the brightest bulb in the pack but still i am stuck with him....load the pt in the back of the truck i notice her skin color is pale take her pulse its irregular and 150 hmm....no complaint of chest pain i notice her breathing becoming labored....shallow at 26 i ask my partner please get a bp while i get dispatch to put me through to the closest er .... he tells me his pb is 94/65??? ok i don't believe him i can't get an uneven number no matter how hard i try lol so i take the bp myself and i get 112/76....pulse still 150 irregular first time i have felt a pulse this strong and it actually be irreguar so that was neat for me... not for her but for me to experience feeling that was cool as hell... she is cold so i am not sure if my pulse ox is reading acurately at 87 but none the less I place her on 2 liters of oxygen via nasul canula her respirations are still 26 shallow and labored.....her skin color is pale......shock? maybe from the fall possible elevate feet........history of anxiety yes among other things....is she having an anxiety attack possibly.......is something else going on.....maybe? can i hook her up to a monitor and start and i.v or intibate her if she goes into respritory or cardiac arrest on me ..hell no... can i combitube......hell no..am i frustrated i can't do more for her should something happen hell yes.....but for the most part her vitals are maintaining this is good......but.....the closest facility which is only like 6 min from me does not have catscan so they told the nursing home to send her to the next town that does have a catscan........am i comfortable with this noooo i am not.....do i bother a paramedic to come and bail me out of a long transport with a possible pt that could possibly go south.......no......I give report of my findings to the closest facility to see if they will stablise before transfering out.....I tell my partner take me in the directions of mgh......but drive slow it won't take us long to get there they might divert us anyway to monroe....
I get nurse ratchet holy hell this woman un-nerves me to no end.....
"this is T with....____ ambulance I need to give you a pt report....."
she cuts me off...." go to north"
"but i need to give you a pt report before you divert me..."
"doesn't matter your coming in from the nursing home with the fall and i told them to go to north."
"you need to hear my pt report before you choose to divert me...."
she cuts me off again......
oh bitch is gonna hear my report then decide so I talk over her and tell her anyway and tell her now you can try to divert me if you choose to. while she is still talking over me or trying to...
" ok np i'll call north now that i have given you my report and you have refused this pt."
I call north granted we are right at mgh.......
" hello this is T with ____ amublance i need to give a pt report i have been diverted to you and refused by mgh this is what i have... 80+ f a/o x 4 chief complaint hemotoma over lt eyebrow no bleeding blvs are bp 112/76 p 150 irregular r 26 shallow and labored pulse ox showing 88 now pt's skin is pale and cold cap greater than 2 gave pt's past medical history. I have been refused by mgh and diverted to you because they do not have catscan....I am going to tell you up front i am a basic truck not a medic truck..I will not be having an i.v or anything else other than oxygen on this pt when i come in."
"mgh refused this pt only because they don't have a catscan machine they can stablise this pt then send them out if it is needed. my suggestion to you is go to your closest approriate facility and that is mgh do not by pass them follow your acls guidelines and cover your ass T don't bring them this way we are to far out and your pt needs to be stabilised before coming here."
"Thank you ma'am will do"......yeah ok so i didn't have to tell them I was a basic truck but it is something that they needed to know before they gave me orders to do things that are out of my scope of practice or my pt ends up crashing on me en-route....
call dispatch again......put me through to mgh....
"mgh nurse ratchet....."
oh shit again this is gonna get ugly.......
hello bitch is what i really want to say but refrain we are on a recorded line....
"hello again north refuse said you need to stablise this pt before sending them the pt and to follow my acls guidelines after i gave them my report on this pt....so we are coming there oh and i am rolling in now......."
"well your vitals better match what i get your the basic truck aren't you....they better match mine.....your the basic truck ..your the basic truck aren't you."
" I sure am i'll be right in there to see ya."
I hang up take a deep breath am i rattled by nurse ratchet yes always she always has a way of belittleing people.......and looking down on lower levels of care than her....damn i am rattled i am even studdering which is something i do not do on a daily basis crap i feel like an idiot.....i go inside......with my pt.....to bad my partner just can't go in by himself lol .....i know i know i shouldn't let her do that to me but i do and she does.........do i try to hide it yes.....is it working i have no clue......
"oh "she says to the pt...."you have a boo boo someone could of put a 4/4 over it and cleaned it up."
hmmm i am thinking to myself least of my worries its a bump wasn't bleeding i was more worried with her respritory at the time and arguing with your stupid ass on the phone but i say nothing my hands are shaking i am tryin to write my report..........then it hits me what i forgot to do but meant to do .......listen to her lung sounds shit i forgot .......damn i am kicking myself hard for this.........in the middle of getting mgh my partner getting bp which i thought was wrong trying to talk to mrs. bitch on the phone while trying to get a better set of vitals because i knew they were going to take her and i would have to play a game of lets try to find an accepting er..short transport time........I meant to listen to them when i hung up with the bitch the first time not expecting to have to waste time calling around.....damn it how can i forget to listen........thank god they were clear.......when the dr. listened to them or else me and nurse ratchet would of had a round again........which her bp was higher than mine i am sorry if a machine can pick up a bp better than my ears but it wasn't her bp i was concerned about it was her breathing her skin color and temp and me feeling like a dumbass because i forgot to listen to her lung sounds....but the only thing nurse ratchet seem to focus on was the fact i didn't put a 4/4 over her bump and wipe the dried spot of blood off of her forehead................I ignored her went outside called C and told her everything C by the way was an old paramedic partner of mine and very good at report writing and walked me throught it because i felt nurse ratchet was going to write me up but so far so good on that but yes we make mistakes sometimes would it of made a difference in my report with her had i listened to her lungs sounds at that point no not to nurse ratchet but still i felt terrible i forgot to do .....i never forget but obviously i did that time.......next time i work over on the other shift and nurse ratchet tries to divert me i think i'll piss her off real good and tell her oh your just a nurse you can't divert me i have to hear a dr. and if she tells me he is right there standing i'll just have to tell her again your just a nurse your words have no meaning to me since after all i am just a basic truck which she dispises...........God i don't know how much more of her i can take something has to give here.