Called out for decreased level of consciousness. Arrived to find an elderly lady sitting in a chair and you could hear the snoring from the hall. History from those on scene was non-existent, something like GERD and insomnia. We get her loaded up and start doing our thing. In the midst we find that her blood sugar is 48. OK, we can fix this, started a line and gave her some D-50 and she perked right up. Vitals were otherwise OK. She is slightly cool and very diaphoretic, both could be explained by the hypoglycemia. Her only complaint is slight, diffuse abdominal pain. I put her on the monitor and saw some depression, so I decided to do a 12-lead.
You tell me what you see, (I know that the clarity isn't that great, but it's the best I could do). Maybe I need to go back to 12-lead class, but I see depression in leads II, III, AVF, 5 and 6; elevation in V1, V2 and V3; with a left bundle branch block. She is completely alert now so I ask about her history. She has no cardiac history what-so-ever, only other things were diabetes and hypertension.
This is where me and the Medic I was working with differed in opinion. I saw an elderly lady with atypical pain and 12-lead changes who also happened to be hypoglycemic. We fixed one, and now we need to work on the other. I was proposing 325mg of aspirin and a spray of nitro, (she was already on O2), and a no-delay transport. In my mind she was a poster child for atypical presentation for MI. But, alas I was overruled. My partner saw an elderly diabetic that we fixed. He was not concerned with her 12-lead or her presentation. So we did nothing, just ran her in routine traffic and that was that. I didn't even ask him why afterwords.
So, am I right or wrong? Am I thinking correctly? Or am I the over-eager, sparky new kid? I think I am right, I think that the other medics that I have worked with are either burnt out, lazy, incompetent or scared. I don't know which, possibly a combination of all 4. Then again, sometimes I'm not so sure. This is just one call out of several here lately that me and the Medic have disagreed on the level of care that was needed. And I am usually wanting to treat the patient. Either because I think that something needs to be fixed right now, or for preventative reasons to try to head off something before it gets worse. The other thing is that I have been working with someone different just about every shift for the past month or so. So it's not just one person that this has happened with.
On the other hand, I have ran a few calls with 2 different medics that pretty much let me run the show and agreed with my decision making. One call was a trauma from a MVA that ended up coding on us. The other ended up being a head-bleed that had been down for almost 12 hours. That lady was in bad shape, she had fallen and puked. She was all bruised up and it looked like point lividity, except she had a pulse. She had also been laying in her own vomit for those 12 hours and had aspirated. I wanted to tube her but she was clenched and I couldn't get a nasal tube to pass. So I gave her a couple doses of Versed and then tubed her. The only thing either Medic did was bag the patient and hand me stuff when I asked for it.
So, do you see my delima? On one hand I am being told that I shouldn't do anything and the other we went all the way. I'd appreciate any and all comments on this matter.