Doctor's on ship

[nrdsb4]

Regardless if we are hearing their "version" of the story, if a cruise line wants to advertise that they have ships doctors available for emergencies then they should be providing that service from the second you step on that ship until the second you get off. What if this had been a cardiac arrest, would this person have suffered a worse fate. Any properly trained RN should know that a seizure can be a life altering event and needs to be cared for quickly and efficently.

 

According to post #12, Carnival advertises that they will have a doctor onboard during certain hours, but not necessarily while at port. Sounds like they have themselves covered.

 

If the person had a heart attack while the ship is at port, the proper course of action is the same as if you were at a grocery store or at the mall, or any number of other places: you call 911.

 

People seem to forget that when you go on vacation, you will not necessarily have access to the same quality of medical care as you might normally. They are not going to put state of the art, level 1 trauma and emergency centers on every cruise ship that sails the sea, nor are we "entitled" to that. They are offering an infirmary as a courtesy, but these infirmaries have limitations with regard to staff and technology.

[dealia]

I know it sucks, but most of the time, the seizure finishes on its own without help from medical personel. Very rarely does the seizure itself cause harm.

 

OP-hope all is well, seizures are awfully frightening to watch.

 

All is well now thanks. Doctors say he may never have another one again.

 

I know that usually a seizure will finish without help from medical personnel, but in my husbands case for some reason his blood pressure plummeted so low that they could not get a reading.

It was very scary while the seizure was happening because he had his face buried into a pillow and was having problems breathing. The breathing is labored in someone who has a seizure , but he was being suffocated by the pillow and I couldn't turn his head .I don't know if the lack of oxygen is what made the pressure drop or not ,but it was the most scariest time in my life. Being miles from home and in a crisis situation.

[ezjack1825]

a properly trained RN knows that have to respect what the state will and will not let them do.

 

what that means is that they can monitor the seizure, ensure the person will not harm themselves during the seizure, not stick anything in their mouth, and not hold them down.

 

that is not a lot that they CAN do. (snipped the remainder for bevity)

 

It also depends on where the port was as to the laws and jurisdictions in place. In Florida, there is a good samaritan act and a cardiac resussitation act as a sub of the good samaritan act.

 

When I was in training as an EMT, we were also advised of the "equal man test". If ever questioned about your actions in a case, would an equal man (or woman) in a like circumstance with the same training have acted in a similar fashion. What that breaks down to in plain English is if you were trained to treat a condition and failed to do so or did so in a severely negligent manner, you are then liable. Likewise if you try something you are not trained in, you're liable. There are a LOT of things that people are officially or unofficially trained to do in the medical profession that is not recognized by the law for that licensure. When I went through training, I learned to use a defibrulator as part of the official coourse even though Florida did not license EMT's with defib, only paramedics. Does that mean if I'm at a scene with a defib unit there and it is needed that I should stop and not use it? You'd have to be kidding me if you think I should stop and let the patient die. Sure, I've done a lot of things volunteering that should of been done by a paramedic or nurse. If an accident scene is that bad, they're busy with more critical patients or more critical aspects of a certain patient, then you fill in where you know how. If you think I'm kidding, you better hope not - it saves lives. Proper or improper, it works when needed.

 

If the case is true that the nurse was away from the patient while he was in crisis as the paramedics arrived, their license should at least hold a warning if not suspended.

[luckycruzer]

Just to correct something Z-Pac is an antibiotic that is widely used for respiratory infections, sore throats etc. I my 32 years we have never used a Z-pak for STD's.

 

I get it everytime I have this ailment..but clearly on the label....No SEX..I even saved it...for what ever reason...to show DH, then pitched it..he got a laff..actually I did get better tho by the onset of the 2nd 1/2 of my b2b..thanks for you input, I'm sure u got a laff also

[luckycruzer]

Carnival advertises that they will have a doctor on board when the ship is at sail. Not necessarily while in port. They say they will have one doctor on most ships but 2 on a couple of the ships.

 

A seizure is scary for people to watch but truly, there is almost nothing you can do if you do have the authority to inject meds. I would not want a nurse deciding what to inject a new pt with no known history without having the supervision of a doc. I know it sucks, but most of the time, the seizure finishes on its own without help from medical personel. Very rarely does the seizure itself cause harm.

 

Zithromax is also used for STD's by the way--it's great for chlamydia and usually for gonorrhea too. (That's why teens will tell me they have pneumonia and want me to just call something in, ie Zmax :D )

 

OP-hope all is well, seizures are awfully frightening to watch.

 

for clarifying Zpak..I lived in Edmond for 6 yrs..lots of pals still there

[nrdsb4]

I get it everytime I have this ailment..but clearly on the label....No SEX..I even saved it...for what ever reason...to show DH, then pitched it..he got a laff..actually I did get better tho by the onset of the 2nd 1/2 of my b2b..thanks for you input, I'm sure u got a laff also

 

 

Well, it can be prescribed for sexually transmitted diseases. The package probably states "no sex" because the patient being treated for the STD could still pass on the STD during treatment and should abstain until the infection is completely gone. It does not mean a patient being treated for a sinus infection needs to abstain from sex during treatment.

 

But, big note, some antibiotics can interefere with the efficacy of birth control pills. That information wasn't passed on to me once and I have the child to prove it! She's a gem, though, I'm so glad I was ignorant.:)

[cookc61462]

Just to correct something Z-Pac is an antibiotic that is widely used for respiratory infections, sore throats etc. I my 32 years we have never used a Z-pak for STD's.

 

WHile a Z-pak is indeed used for respiratory and other infections, zithromax (the antibiotic IN a Z-pak) IS used to treat Chlamydia.... (a STD)

 

Just saying ;)

[luckycruzer]

and am waaaay passed the speed limit..but tx for the extra info. I'm sure there is need for that med is such close qtrs

[sassy0930]

everyone who is trying to defend this nurse really needs to put themselves in the OP's shoes. Even if you have experience in the field you wouldn't accept what that person did. The rude behavior and comments. The LACK of care. the fact that he was not monitoring the patient AT ALL when the paramedics came in. He was being spiteful that the boy had called 911 and when they showed up he wasn't paying any attention. No person in or out of the medical community would accept that if it was THERE loved one being mistreated.

 

as for future cruises, no the ship's doctor isn't there all the time. and he's there in limited capacity because the facilities are limited. Even if he could save your life in a land based ER doesn't mean he can do it at sea with the equipment he has. Just is the way it is. but it's worth knowing.

[themarm]

It also depends on where the port was as to the laws and jurisdictions in place. In Florida, there is a good samaritan act and a cardiac resussitation act as a sub of the good samaritan act.

 

When I was in training as an EMT, we were also advised of the "equal man test". If ever questioned about your actions in a case, would an equal man (or woman) in a like circumstance with the same training have acted in a similar fashion. What that breaks down to in plain English is if you were trained to treat a condition and failed to do so or did so in a severely negligent manner, you are then liable. Likewise if you try something you are not trained in, you're liable. There are a LOT of things that people are officially or unofficially trained to do in the medical profession that is not recognized by the law for that licensure. When I went through training, I learned to use a defibrulator as part of the official coourse even though Florida did not license EMT's with defib, only paramedics. Does that mean if I'm at a scene with a defib unit there and it is needed that I should stop and not use it? You'd have to be kidding me if you think I should stop and let the patient die. Sure, I've done a lot of things volunteering that should of been done by a paramedic or nurse. If an accident scene is that bad, they're busy with more critical patients or more critical aspects of a certain patient, then you fill in where you know how. If you think I'm kidding, you better hope not - it saves lives. Proper or improper, it works when needed.

 

If the case is true that the nurse was away from the patient while he was in crisis as the paramedics arrived, their license should at least hold a warning if not suspended.

 

i can see where you are coming from.

 

now riddle me this: how many RNs do you surmise have had extensive training in the area of seizure control? how many LPN's? how many CNA's? that is what is at the heart of this particular situation. without that training, one is neglecting to give treatment. they are simply not improvising based on something they may have heard about. i am going to guess that NOT a lot of RN programs provide extensive and speciallized training in seizure control - it is something that someone would become skilled at if they sought out masters level specialization courses following a BSN, or if they gravitated towards one of a small handfuls of niches in the medical community.

 

this is NOT a defense of that particular nurse. it is a commentary based upon the poor woman's belief in her first post that the nurse "should" have done more medically for her husband.

 

bottom line, without that speciallized training, that nurse SHOULD NOT have started ANY treatment without the direct supervision of a physician, and even that holds limitations.

 

as an EMT, would YOU consider administering a muscle relaxant anally because you read about it in an article during your training, and some happened to be "lying around"? do you think that would pass the "equal man test"?

 

heck NO you wouldn't! because as an emt you know that you can monitor seizures only. you can make sure the patient does not cause more harm to themselves (no risk of fractures from falling off stuff, hitting stuff, cracking their head on the ground). you WAIT. because time is USUALLY all it takes.

 

is it frightening? YES! is it easy to watch? only if you are a sadist. is it easy to feel for our board member? heck yeah! her shoes were not easy ones to fill that day.

 

but that does not mean we get to start creating alternate realities out of the scope of practice as outlined by the state medical board.

[bluefintuna]

I've often wondered where the cruise lines draw from a pool big enough to staff all the ships with doctors.....amazing.

[PINEVIEW01]

All is well now thanks. Doctors say he may never have another one again.

 

Glad to here your DH is doing ok now:)

[nrdsb4]

i can see where you are coming from.

 

now riddle me this: how many RNs do you surmise have had extensive training in the area of seizure control? how many LPN's? how many CNA's? that is what is at the heart of this particular situation. without that training, one is neglecting to give treatment. they are simply not improvising based on something they may have heard about. i am going to guess that NOT a lot of RN programs provide extensive and speciallized training in seizure control - it is something that someone would become skilled at if they sought out masters level specialization courses following a BSN, or if they gravitated towards one of a small handfuls of niches in the medical community.

 

this is NOT a defense of that particular nurse. it is a commentary based upon the poor woman's belief in her first post that the nurse "should" have done more medically for her husband.

bottom line, without that speciallized training, that nurse SHOULD NOT have started ANY treatment without the direct supervision of a physician, and even that holds limitations.

 

as an EMT, would YOU consider administering a muscle relaxant anally because you read about it in an article during your training, and some happened to be "lying around"? do you think that would pass the "equal man test"?

 

heck NO you wouldn't! because as an emt you know that you can monitor seizures only. you can make sure the patient does not cause more harm to themselves (no risk of fractures from falling off stuff, hitting stuff, cracking their head on the ground). you WAIT. because time is USUALLY all it takes.

 

is it frightening? YES! is it easy to watch? only if you are a sadist. is it easy to feel for our board member? heck yeah! her shoes were not easy ones to fill that day.

 

but that does not mean we get to start creating alternate realities out of the scope of practice as outlined by the state medical board.

 

I have to agree with you. I am an experienced cardiology nurse. I can be quite helpful in a cardiac event, but I can't say that I would really know what to do during a seizure other than the typical stabilize the patient and keep him from harming himself-type stuff. I would not be attempting heroic state of the art anti-seizure interventions. I would do what I could to protect the airway, make sure the patient is breathing, has a pulse, etc. Your basic life support measures. I'm not exactly sure what the patient's wife expected beyond that. It's a ship for goodness sake, not a major metropolitan medical center. I think maybe the general public's understanding of a ship infirmary and staff might not line up with reality. Nurses are not doctors, though they do provide invaluable services.

[luckycruzer]

I've often wondered where the cruise lines draw from a pool big enough to staff all the ships with doctors.....amazing.

 

possibly a medical one, as it is a contract position.just like CD, waiter, housekeeper. In my orig cruzing days, a Doctor would be on a a non-paying guest to "man" the Dr's office, as was the dance instructors. And Dr was on call, more than 4 hrs a day.. I had to wait til 4pm, on port day, and I was in the mid of my b2b, and I had taken sick the eve b4. The bill was quicker reaching me, than the service!

[zirka]

My mom and I both needed to use the infirmary on our August trip on the Liberty. We both had different dr's. We also were told that the ship cannot sail without the doctor. So as far as being in port, I don't know if they would need to be on the ship. I am sure they would have one on board at all times. I can't say for sure though.

[ezjack1825]

how many RNs do you surmise have had extensive training in the area of seizure control? how many LPN's? how many CNA's?

 

as an EMT, would YOU consider administering a muscle relaxant anally because you read about it in an article during your training, and some happened to be "lying around"? do you think that would pass the "equal man test"?

 

On both, no, I do not have statistics nor would I attempt administering a med not knowing the person's medical history but I sure as H**L wouldn't leave a patient even for a moment. Even in critical cases if you need supplies, a layperson can do that under your direction. You do not leave a patient.

 

If the OP's comments were accurate that her DH's BP was indistinguishable at one point, how would the nurse know that on the other side of the room or be able to give accurate information to the medics on scene when they got there? He/she wouldn't - that is NEGLECT!

[themarm]

On both, no, I do not have statistics nor would I attempt administering a med not knowing the person's medical history but I sure as H**L wouldn't leave a patient even for a moment. Even in critical cases if you need supplies, a layperson can do that under your direction. You do not leave a patient.

 

If the OP's comments were accurate that her DH's BP was indistinguishable at one point, how would the nurse know that on the other side of the room or be able to give accurate information to the medics on scene when they got there? He/she wouldn't - that is NEGLECT!

 

perhaps you have read more into the situation than what was presented.

 

from what i read, the nurse was on the other side of the room writing on the chalkboard AFTER the paramedics intervened and were working on the husband. wouldn't you agree that at that time, it was the paramedics running the show? or do paramedics look to a LPN or RN for a treatment plan when it is clear that the situation calls for a physician?

 

while the paramedic that taunted the nurse at the chalkboard clearly was of a similar mind-vibe as the op, i would not call wasting time during an emergency to play power games 100% professional. personally, that would irk me as much as the cold bedside manner of the nurse.

[ezjack1825]

From the OP:

 

"By the time the paramedics came on board my husband was down in the infirmary. One of the paramedics actually yelled at the nurse " Hey your patient is over here buddy" because he was writing something on a chalk board on the wall rather than paying any attention to my husband."

 

 

Looks to me like the nurse had abandoned the patient to update notes. I don't know about all medical practitioners, but that's why I always have a pen and pad in my jump bag. If it's a crisis situation, I don't even bother with the pad. I have on several occasions just written vital signs on my left arm so I could hold it out for the medics to read off the stats and notate them while I/we continued to treat the patient. And yes, several times it has been with a fine tip sharpie as it was the first thing I could grab. It might take a while to wash off, but oh well. I'd rather give better patient care.

[themarm]

From the OP:

 

"By the time the paramedics came on board my husband was down in the infirmary. One of the paramedics actually yelled at the nurse " Hey your patient is over here buddy" because he was writing something on a chalk board on the wall rather than paying any attention to my husband."

 

 

Looks to me like the nurse had abandoned the patient to update notes. I don't know about all medical practitioners, but that's why I always have a pen and pad in my jump bag. If it's a crisis situation, I don't even bother with the pad. I have on several occasions just written vital signs on my left arm so I could hold it out for the medics to read off the stats and notate them while I/we continued to treat the patient. And yes, several times it has been with a fine tip sharpie as it was the first thing I could grab. It might take a while to wash off, but oh well. I'd rather give better patient care.

 

 

to me, that account does not specify that the nurse at no point tended to the patient. it signifies that at the moment the paramedic said that, the nurse was writing on the board.

 

i see no problem with that, so long as the paramedics have taken over. the man needs a doctor. the doctor is off the ship, so priority number one is getting him there.

 

the problem here is that neither of us were in the room, so neither of us know for sure. the op's post is rather vague and is not terribly detailed with respect to what happened first, second, third, etc. nor does it give any indication of time elapse. NOR SHOULD IT HAVE TO.

 

bottom line, no matter how much it ticks you off -- that nurse CANNOT initiate any new-fangled treatment interventions.

 

also end of story - it is a good thing that the husband has come through.

[dealia]

 

from what i read, the nurse was on the other side of the room writing on the chalkboard AFTER the paramedics intervened and were working on the husband.

 

The paramedics did not intervene they arrived after the nurse began writing on the board.When they arrived the nurse had his back to my husband ,that's why I think the paramedic said something to him.

[themarm]

The paramedics did not intervene they arrived after the nurse began writing on the board.When they arrived the nurse had his back to my husband ,that's why I think the paramedic said something to him.

 

in that case, wow :eek: (assuming your husband was in an active seizure still).

 

i would not expect a nurse to go beyond basic precautions. but if he was across the room while seizure activity was happening, then he is not going to like it when the karma bunny bites him on the buttocks.

 

you are cruising out of ny, right? where do you get to go?

[Chief93]

Being a paramedic myself

 

Hey, so am I, just wanted to say hi.

 

 

FYI, a paramedic is never outside their level of licensure. I've often wondered why cruise ships don't have them as well as nurses. If you're in the ER (or infiramry) you really need a nurse, if your outside you really need a paramedic. It's two different worlds.

[dealia]

 

 

you are cruising out of ny, right? where do you get to go?

 

Yes we are cruising out of NY . We are going to San Juan ,St Thomas and Tortola.