Hi,
Can you have a listen to this call?
My initial thoughts were the patient was urinating blood, had burst blood vessels, and unable to determine if having blood in stools we should have erred on the side of caution and not proceeded with aspirin. GI bleed is a disqualifier for aspirin administration, and we didn’t have an answer to the question. The patient had some form of internal bleeding.
However, in the Bible [Principles of EMD]:
Topic: Caller doesn’t know the answers
Question: What do you do if you cannot get a straight yes or no answer to the questions? What is considered the best course? Proceed or stop? There is no guidance for “I don’t know.” We get that answer all the time with grown children calling for elderly parents who can’t tell us if Mom or Dad has a heart condition or not. Which side do we risk erring on?
Academy Answer: An unknown answer is to be considered okay to proceed. Since the only time ASA could be administered is if the caller and the patient are in the same vicinity, they most always know or can ask the patient. We at the Academy have not heard that this is actually a problem so far. Statistically, an unknown answer would be highly likely a “good to proceed” situation.
Thoughts??
Thank you!!
Donna Barton
Manager | Medical Dispatch Standards | Clinical Systems
NSW Ambulance
Rozelle, New South Wales, Australia
Hi,
I have a small advantage in knowing that the physicians on our standards council purposefully did not include bloody or blood tinted urine as a contraindication and were more concerned about active GI bleeding. And whilst they did ultimately make GI bleeding a contraindication, they did so rather reluctantly knowing that the risk of a single dose of aspirin exacerbating a GI bleed is low compared to the potentially life-saving benefits of ASA administration in the potential MI setting. And this really sounds like a kidney stone, doesn’t it?
With all of that aside, as EMDs are not privy to this information, nor are they clinically qualified to make such a decision without Protocol, there was no evidence or mention of bloody or tar-like stools, and blood in the urine is not a contraindication. My impression was blood in stool was not known. Therefore, I would have given the ASA.
But given the fact that we are even discussing this, I wouldn’t fault an EMD either way.
Interesting call.
Brett A. Patterson
Chair, Medical Council of Standards
International Academies of Emergency Dispatch®
Hi Brett,
Just had an interesting discussion during an ACE calibration call.
The patient’s complaint was blood in urine with a recent history of UTI [urinary tract infection]. Given CC of UTI w/associated bleeding and not primary issue of bleeding it seems that P26 is correct, but P21 is also correct and preferred as we will get shunted to P21. Do you agree?
Calltaker selected P26. Then we had a discussion about the correct answer choices to KQ3.
The correct answer is “yes” to bleeding because answer choice “MINOR hemorrhage (external and unrelated)” is not correct because it is internal and related to the UTI.
We would love your thoughts on this one.
Thank you,
Kim Rigden
IAED Associate Director of Accreditation
Hi Kim,
This was an unexpected and unintended consequence associated with the new P26 Rule that was designed to exclude unrelated external bleeding from a wound. It’s not that the Rule doesn’t address the hematuria issue (it was not meant to), but it does raise the issue no one really noticed before as they would simply shunt, and that’s still the right thing to do. While the hematuria is not serious, it is likely related to the MEDICAL CC of UTI. This is technically MEDICAL bleeding of the NOT DANGEROUS type—21-A-1-M.
Does that help?
Brett
Thank you, Brett,
So P21 IS the most appropriate CC for hematuria associated with UTI.
Thank you very much.
Kim
