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So have we developed a new obesity scale here? Obesity=lose a twinkie, moderately obese=lose the remote, morbidly obese=lose the chiuhuaua.

Come back Biebs!!!

I use a Litmann Select stethoscope and while I am pretty good at obtaining BP's I can always improve. Someone told me that the Diaphram on the Select picks up both High frequency and Low frequency sounds depending on how much pressure you apply. That got me to thinking, are Korotkoff sounds considered high frequency or low frequency? I normally get BP's without too much thought in what I am doing. Finding out about the Select Stethoscope though was eye opening because there were a couple of difficult ones that I couldn't obtain a BP on and had to use a dual head. I now think this was more to user error and how I was holding the diaphram on the patient rather than just not being able to hear.

I will answer your questions based on when I became an EMT (circa 1993). 14. What are opportunities for advancement? To what position? Is an advanced degree needed? (If so, in what discipline?) Paramedic or management 15. Is there a typical chain of command in the field? Yes and it depends on where you are 16. What are the different salary ranges? I can't answer this. 17. What other kinds of workers frequently interact with this position? Firefighters, police, doctors, nurses 18. What are the main or most important personal characteristics for success in the field? You have to want to do it. It is not something you can do half-assed. 19. What are the satisfying aspects of your work? Helping people and an occasional adrenaline rush 20. What are the dissatisfying aspects of the work? Is this typical of the field? Unhappy, unrealistic pts. Getting called out of bed at 0300 for BS 21. How would you describe the atmosphere/culture of the work place? Depends on where you work 22. Is there evidence of differential treatment between men and women EMTs with respect to job duties, pay, and opportunities for advancement? It can still be a boys club but is not even close to the FD 23. What do you feel are the toughest types of problems and decisions that you must make? Where to get lunch. Otherwise you make some decisions that may affect someone's life or ability to function, however at the EMT level this is very limited. 24. What are the demands and frustrations that typically accompany this type of work? What are the greatest pressures, strains or anxieties in the work? 25. What do you know now which would have been helpful to know when you were a student? 26. Any other important questions that I have not asked that would be helpful in learning about the job or occupation? Thank you for your time.

From the looks of it, at least 7 days so far. I agree, we seem to have a very unstable pt and I would say that electrical cardioversion may be in order. I would still like to get some more info from the staff/chart while we are setting up.

I'll play, hope it helps.

Is that a record? I think we should shoot for 1,000,000

Yeah, sorry, I worked a long shift, maybe someone else will have the brain power tonight

Just my personal observations over the decades Doc. we had a pt that could store a two pack of twinkies in each side of her belly rolls, just in case she got stranded away from her supply system. We're on the way to the hospital one night , I'm on the phone to the ER at the front of the box & look up::: she's opening a slightly squashed package of twinkies. Now all she had on was a mumu [translates into many yards of flowery cloth shaped into a tent] and when asked where she got them , she lifted up a roll and showed me. The smell was enough to make me hurl.

Dwayne: I don't consider a person OBESE until their fat rolls have Fat rolls. Not talking the rolls you can hide a twinkie in :: the kind of fat rolls where they lose their Chihuahua in. Someone who can lose 150 0r 200 pounds and still be obese. When a Pt's calfs are bigger than my waist, they are obese.

I have had plenty (10+) patients die in my ambulance. If a patient codes during transport we pull over & work it. The ER is not going to do anything I can't out here hours away from a major trauma centre, The science just does not support a rolling code. I personally take no pride in abusing a corpse so I can chant these rediculous chest pounding mantras with the rest of the monkeys.

Some of my nastier bagpiper friends say "Yer sister's lipstick!" Traditionally, they wear nothing under the kilt, but I understand for the more squemish, there are underwear sets that are matching to the kilts.

I can hear just as well in the back of the truck wit a $30 sprague as with my wife's master cardio II Littman. It's an acquired skill thats takes time to learn. When you start releasing the air from the cuff, palpate at the wrist and listen at the same time. It may be a right brain skill that only lefties can do though:::

I am well aware of the anatomy and I too palpate the Brachial. However the patients that I had difficulty with were Bariatric patients and I wrongly assumed that pressing harder to get through the fat would make it easier to hear the BP. I was discussing this with a doctor because I was concerned about the difficulty I was having and he told me that my stethoscope had a tunable diaphram to pick up high and low frequencies. He had to take off before he could explain further. If Korotkoff sounds are low frequency that would explain why pressing harder actually made it more difficult to hear. On one of the patients I was able to use a different stethoscope to hear - a dual head. I don't know what I did differently but I did something that made it so I could hear. The other patient I had to palpate the BP because I couldn't hear at all, I couldn't even palpate the Brachial. It concerns me when I can't hear a BP which is why I asked this, because for those of us with tunable diaphrams knowing the frequency of the sounds were listening to effects how we hold the diaphram on the patient.

How you perform on CBT has no bearing on your potential as a provider. That goes for any level, from EMT to Paramedic to RN to PA... CBT is a tricky bastard, and you really have to learn to play the game by the rules they set for you. You have to learn what the best answer FOR THE TEST is, and answer accordingly. I'll give you an example from the NCLEX: You're a school nurse out with the kiddos on field day. Kiddo falls out of the tree, and is complaining of leg pain. What do you do? A: Send someone for help; B: Give the kiddo a Tylenol; C: Instruct the kiddo not to move and stay with them until help arrives; D: Tie the kid's legs together. C seems like a no brainer, right? Well, with the info given in the question, there's no indication of any trauma other than to the leg, so you do D to provide splinting and protect CMS. (I know. I was SO PISSED...) The answer is not always airway... the test is adaptive, so you have to pass a certain number of a certain level of difficulty questions in each category to pass... if you're answering right but you're at or below the pass threshold, you still fail. Prep courses are good; I used the Kaplan book to prep for NREMT and I used the Kaplan computer based prep for the NCLEX. If you know the material, and you brush up on the critical topics, and you can pick out the "correct" "critical thinking" answer instead of the quick, obvious common sense answer, you'll do better on CBT. Do you have any test anxiety? Dyslexia? Dyscalculia (dyslexia with numbers)? Need extra time? Do you take the entire time to take the test? Do you get bored/lose focus? How'd you feel after taking your previous exams? Good? Failed? Knew you failed? There's more to it than just sitting for it again. The game doesn't change, your approach to the game has to change... Wendy RN-ADN CO EMT-B

I find it difficult to explain that intuitive synthesis of information that one begins to acquire as a healthcare provider. That a patient's condition is more than the sum of the pieces (BP, respiratory effort, labs, psychosocial situation, etc). Some folks understand that concept, but others look at you like you have three heads or imply that your "spidey sense" or "intuition" is useless in practicing medicine... I beg very strongly to differ... I usually have to draw lots of parallels to non-healthcare related things to get someone to understand it that's having a hard time with it. That's the hardest thing I find to explain... Wendy RN-ADN CO EMT-B