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Well done! Keep up the good work. Don't be surprised though when you do well on a test. If you know the material, you should expect to do well!

Hello All! I am currently enrolled in an EMT-B course in New York. Very excited to learn everything I can about becoming an EMT and possibly on to becoming a Paramedic. I'd love to hear from anyone about their experiences and level of education. Any advice would be greatly appreciated. Looking forward to chatting with you all!

I just want to emphasize a point Vent made earlier. Not all dyspnea patients need or will be helped by a bronchodilator. Specifically, not all pneumonia patients with dyspnea need bronchodilators. Pneumonia is fairly specific to the alveoli, if your patient has an alveoli problem without bronchospasm, dilators are not all that helpful. Remember, we do not have beta adrenergic receptors in our alveoli, contrary to what many people believe. Rather, the decision to use a dilator should be based on good evidence pointing to bronchospasm. Unfortunately, albuterol is not the scrubbing bubbles all purpose lung cleaner and general purpose respiratory cure all that people often make it out to be. Take care, chbare. Vent was stating Duoneb is a brand name for a medication produced by a specific company, Dey Laboratories. In fact, Duoneb does come in a single dose container. Therefore mixing your equivalent of a Duoneb is not technically Duoneb as this is in fact a brand name. Take care, chbare.

Now to get a little more specific. Albuterol is the cure all for everything or so it would seem. If you don't know what is going on in the chest, they get an Albuterol neb in hopes of sorting out the sounds left or that appear after the treatment. Atrovent (Ipatropium Bromide) is generally more effective in COPD patients. However, since asthma can also fall into the broad category of COPD and the lung remodeling that occurs, Atrovent may also be a good med to use with the Albuterol. For PNA, it depends on the history, type and site of the PNA as to whether Albuterol can be effective. Sometimes patients may have a bronchospasm present with the PNA and sometimes not. However, if a neb is given that is powered by O2 from a tank, the patient will probably rave about how good they feel just because of the extra O2. The extra flow may also enhance the intrinsic PEEP effect that may splint some of the airways. This is one of several reasons why I prefer a mouthpiece neb over the mask. CHF is also controversial. If the patient has an underlying PNA or pre-existing lung disease which could also have been an initiating factor for the CHF, Albuterol or Albuturol/Atrovent may help but I would not delay initiating other therapy such as CPAP. For pulmonary edema post operatively following lung surgery and early stages of ARDS, we have been conducting studies for Albuterol (Salbutamol studies in Canada). We have noticed some improvement with the Albuterol and not as much with the Atrovent (Ipatropium Bromide). But, there are many factors to consider with each patient.

Thank you for that introduction Jake. It is important to find out when the patient started using nebs/MDIs and what type. Some people are given MDIs at their GPs office but are not given any clear instruction about why or when. Thus, we now have very good medications that are under scrutiny due to fatal incidents when the problem is actually a lack of communication. The LABAs fall into this category unfortunately. It would be important to note if the patient is mistakenly using an LABAa as a SABA or rescue inhaler. I personally have seen at least 5 emergencies involving LABAs recently. One was from EMS who had the patient on a "Duoneb" while the patient was holding an empty Symbicort canister which their had just gotten a script for on previous day. The HR was 250+ but that was not known since the patient was not hooked up to a cardiac monitor until they reached the ED. Palp HR by radial was 80. The patient was also told by the Paramedics to take "another hit" off the LABA while they sat up a nebulizer. So the Paramedics has assumed the patient was holding a rescue inhaler (SABA) and did not check what med they had just told the patient to take. Rookie mistake or one of extreme carelessness that can be potentially fatal. Here are some links for all the new meds out there. Note that Albuterol is not yet available by the generic name of "Albuterol" with the HFA formulation. If you see a generic canister of Albuterol (CFC propellant), check the expiration date. However, there are brand name "Albuterol" MDIs on the market. SABAs http://www.aaaai.org/patients/resources/medicationguide/saba.stm LABAs http://www.aaaai.org/patients/resources/medicationguide/bronchodilators.stm Cromolyn and theophylline http://www.aaaai.org/patients/resources/medicationguide/cromolin_theophylline.stm Inhaled Corticosteroids (not Advair and Symbicort which contain a LABA) http://www.aaaai.org/patients/resources/medicationguide/inhaled_corticosteroids.stm Leukotriene Modifiers http://www.aaaai.org/patients/resources/medicationguide/leukotriene_modifiers.stm Immunomodulator http://www.aaaai.org/patients/resources/medicationguide/immunomodulator_medications.stm Also, many of the nasal sprays will have similar names as the MDIs including the corticosteriods and Atrovent (Ipratropium bromide) and can easily be confused at first glance. http://www.aaaai.org/patients/resources/medicationguide/nasalmedication.stm Sidenote: Duoneb may not be the name seen as often since the generic Albuterol/Ipatropium bromide is readily available now and a little cheaper.

Welcome to the City! Congratulations on your choice in becoming and EMT and a career in EMS. It's very exciting! My advice is learn as much as you can! Follow the people around everyone talks about on how great they are. Ask questions, lots of them. Get your hands dirty and get into things. Read lots, study lots.

Welcome to the boards. Not much experience to help you here. Only about 3 weeks in the streets. Loving it so far. Learning tons everyday. It is always a leaning experience on a call.

I passed the Cardiology Module Exam today. I was pleasantly surprised, made an 80 on it. Thanks for the websites and tips. Now onto the 2nd Medical module. My brain is fried

How many of you carry printed Vial of Life papers to pass out to anyone who comes to your station, or stops your ambulance if you stage in different places. Theres so many people that dont know about these sheets that not only make our jobs easier but they can prevent possible mistakes from being made due to the pt being unable to speak for whatever reason, or a mother who is losing it and cant tell you what is wrong with her child. Something to think about. Get them printed and get them out there, its a free 1 page print of the vial of life website.

Welcome to the Madhouse! (from an EMT-B of 37 years experience) Where are you taking the classes, and at what agency are you going to use the skills? For reference, I am in the FDNY EMS Command, having started in a community based Volunteer Ambulance Corps, and volunteered there concurrently with 5 private ambulance service providers (Inter-Facility Transfer, usually referred to here as ITF), then the NYC Health and Hospitals Corporation EMS, prior to the merger into the FDNY. The VAC went under in 1996.

One of our local hospitals supply cards that neatly fold up and fit in a wallet. They give us a stash when we need them so we can hand them out to our patients. If I have a patient with multiple issues, medications, and allergies, and they do not have a card, I will give them (or a family member) a card and explain it's importance. In addition, I offer to assist them in filling them out once they are discharged. I give them the number to the station and tell them to call and leave a message for me. I will go and visit them, take my PCR with me, and conduct a nice, thorough interview. I'll ask to see any discharge paperwork as well, to make sure their form is as complete as possible. Many are grateful for the help, and I think many are grateful for the company. I'm lucky that I work in a pretty small area now with a call volume around 4000 a year. I've gotten to know my regulars, and I've had a lot of patients that I've grown fond of. We have several multi-residential buildings for elderly and disabled people and I try to make rounds to them every so often to check on my most frequent fliers. Our community knows us, and they support us very well with donations. I really believe it's these small acts that help the community understand who we are, what we do, and that we want to be there to take care of them when they need us.

As stated at 1:28...

http://sprojects.mmi.mcgill.ca/heart/puz990914r1.html

Another good place to go is HERE. Bob Page, the "12 Lead Medic", has some interesting stuff on his site as well. Just my 2 cents worth.

I have this book also, it is wonderful. The best thing you can do is find people you know who have books, pick through them and find the best fit for you. Then get your hands on an ECG packet, we have one at work for new hires to do their ECG interpretation test with. I have a few from school and work, they have many different rhythms in them, and just practice. But understanding the way heart works is key, if that doesn't make sense nothing else will.

"Rapid Interpretation of EKG's" ( "The Orange Book") is a really good text for understanding the heart.

skillstat.com

We do several of these a year. We set up camp at various locations. Such as supermarkets, walmart, and other places likely to see many people. We offer a vital sign check and include that in their vial. We hand out pamphlets on medical conditions as well. We also have quite a few on hand to give out to people coming into the station and on the ambulance. (fyi, this is all at a Volly station. At work, we do similar things too) edit: seriously? A negative for that??

negatives is the new black