Subaqua Sternal Rubs

So last night I finished my 12 hours on, 12 hours off times 96 hours marathon ambulance shift. Unusually, we only had one call in the last 12 hours… a 34 year old male with abdominal pain. I was first on scene and I basically had completed my assessment and a set of vital signs prior to the arrival of the ambulance. (It was dispatched as a 2-Alpha - no red lights/sirens.) Now I was technically the highest certified provider there as a NYS-certified EMT - Intermediate. However, I am not currently on-line (able to legally do any of the skills I have been trained to do) since the Regional Emergency Medical Organization, (who is in charge of allowing advanced providers to practice) said that I would have to redo my internship every time I came back from school for breaks of a month or two. They wouldn't count medical school as Continuing Medical Education for an EMT. Insert expletives here. Anyways, as the advanced provider, it fell on my shoulders to determine if this patient required ALS. The patient had sharp right lower quadrant abdominal pain for approximately 4 hours and he wanted to make sure it wasn't appendicitis, since his brother had had it. I decided to take the patient in BLS, since even if it was appendicitis, the most the medic would have done would have been start an IV line of normal saline (salt water). This intervention would have made absolutely no difference in the 15 minute transport to the hospital.

Some other considerations:

1. The patient was able to eat a pizza with ham and pineapple from probably the greasiest pizza place in town after the pain started. He did not complain of nauseousness, vomiting or loss of appetite, all classic hallmarks of appendicitis.
2. The pain was not centered at McBurney's Point (1/2 way between the anterior superior iliac spine and the inguinal ligament) and it did not originate around the umbilicus (belly button - T10 dermatome - Wow I did learn something in anatomy.)
3. The patient said it hurt, but when I pressed on it, I barely got a reaction. No rebound tenderness, no palpable (or pulsatile) masses, no guarding, no rigidity.
4. Vital signs were completely normal. Blood pressure 118/68 and pulse in the 60's. Response to acute pain usually cause an increase in the blood pressure and pulse.
5. The charge nurse at the Emergency Department we brought him to was so impressed, that he sent the patient out to the waiting room to be triaged… (Granted the halls were lined with stretchers occupied by patients, so they were kind of busy)

So I guess he didn't really need ALS… You pre-hospital providers agree? Still wondering his eventual outcome and diagnosis. Hoping he didn't rupture in the waiting room. :-/

Email to Friend Print