jwraider

Sorry guys was going off what I could remember in my head the call was about 4 weeks ago and I was an observer/doing emt skills as part of medic school (pre-internship to get 911 experience). He was average weight to skinny not fat for sure. (or portly!) So if you are differentiating between emphysema and chronic bronchitis he appeared emphysema like. I can't remember his color or moisture level or temp sorry! The audible "vocal sound" was a grunt I guess ... I don't know if thats the right adjective but it points to the right line of thinking. I agree, get a better assessment done before treating , there were 6 people on scene so enough to have everything done fast. Again sorry I don't remember his meds or exact Hx at this point other than the medic asking if he had "COPD"... The PT was asked about CP multiple times and admitted to having some on the way out to the ambulance which made things more complicated. In my county nitro is often administered before IV access. For example on a CP call you'll see 02,a quick 12 lead/BP,then Nitro/aspirin and then transport where an IV is done and possibly morphine. I've only seen one IV on scene for routine ALS medical calls and that was the FD who had arrived 5 mins before us. Anyone else have an idea of how long albuterol should take to have an effect or is it just too variable?? If thats the case what is the best onset time you've scene ?

I recently participated in a call and the medic used albuterol while trying to decide if the PT was experiencing CHF or exacerbation of COPD. I was left wondering if using albuterol (which could have side effects of increased HR or HTN) before ruling out CHF is bad? Would those sidefx just be a minor relative contraindication because of severe respitory distress?? He also said that he decided to move to CPAP because the breathing treatment was not working after about... 1 minute into the treatment... In your experience how long does albuterol really take to take effect (my drug sheet says 5 minutes) Thanks! The call if you're interested: 65 y/o male pt difficulty breathing found in tripod position making vocal sounds on expiration. (HX of COPD) Initial lung sounds are absent or diminished (medic basically couldn't hear anything) SP02 on RA 74% Medic places PT on NRB... and requests a breathing treatment be started. PT placed on monitor and BP taken (treatment started 30 seconds prior).... 165/108. Medic says "hmmmm.. might be CHF" PT taken to rig and we get CPAP ready. Medic goes to admin Nitro but PT states he took Viagra about 8 hours ago (Nitro spray was at the mouth not sure how the medic kept from pulling the trigger!) Code3 transport and about 5 mins into it above treatment is having a positive effect. PT had poor IV access so morphine never got onboard. MD diagnosis was exacerbation of COPD.

I second the idea that people want to help but we should be careful not to force anyone to help unless say we are in a situation like the original poster described (great job by the way). I recently saw someone struck by a car outside school and went over to help while waiting for the ambulance. It was a very busy street with a few hundred people running around the scene. I'm kneeling there trying to assess the PT and every 2 seconds I was being handed napkins, water bottles, "I took CPR once you need help?"... (I'm assuming he meant a course not having it done to him!). So I guess it can be too much at some point.

Thanks guys just getting a sense of how you have been approaching it makes me feel better and like it is manageable!

Hey guys... little frustrated here. Currently attending a paramedic academy and the instructors from time to time like to say "you guys really should be learning your home meds..." (we are about 5 months from the internship phase) Right . Great. Thanks. I would really like to go into my internship with home meds being a strength (fairly important factor and all in the assessment!) but it seems like the way to learn them is though experience. There are just so many in my book without rhyme or reason to match them to their action. I have been trying to use scenarios which include home meds to practice and everytime I see a med I look up what it does but it just doesn't seem like enough (memorizing the book seems impossible). I know lot's of excuses ! Anyone have advice or a method I could use to start building my knowdlege and retain it for actual use? My next course of action is to try and find a resource that narrows it down to commonly seen meds (and work from there). Thanks so much!!

I'm in school now (cardiology division even) and these are the absolutes we were taught to differentiate a wide complex tach from VT or a SVT. See VT in II Look @ V1 If mostly positive: -- monophasic,biphasic QRS = VT -- Triphasic = SVT ( confirm by looking in V6, QS complex or deep wide S = VT) If mostly negative -- Wide R wave, delayed nadir, slurred downward slope = VT -- Ski slope (very steep straight downward slope)= SVT (confirm in V6 any Q wave = VT) Some of those terms ae probably specific to my teacher. She stated these rules are 99% accurate. Looking at this 12 lead I'm going VTACH due to the mostly positive complex in V1 being biphasic and a deep wide QS complex in V6. Would be interested to hear back since I'm just learning!

whoops I forgot something.. One other thing I didn't hear from FF personal in So-cal was the opportunity to volunteer. Here in Sonoma county there are many volunteer departments. If you have that opportunity it's a great way to gain experience and actually serve a community now as a FF. Some VFD will require you to do a community college fire academy first and some provide their own training. It gives you the option of approaching the fire side first as well and then going onto medic school. The north county san diego fire academy is really an academy for medics to do and enter a hiring pool for the area FDs (if I recall correctly).

Mike best of luck to you thought you might be interested in what I'm doing as I was in your exact spot this time last year in San Diego. I want to be a FF because of what they stand for for me (integrity,courage,compassion and more) and after learning that many FFs in CA need to be medics now I've decided to do both. My background is in computers and I've really enjoyed the medical field / education so far. I don't see these as 2 seperate careers or jobs but that's a whole other argument =) Anyway 1 year ago I was living in San Diego and was looking at all the same options you are and this is what I did: 1) Attended an accelerated EMT-B course in December in San Jose. Prior to the course I had met with several fire personal and ems personel to prepare myself for the commitmant I was undertaking. One of them gave me an EMT-b textbook which I studied for several mnths on my own before entering the accelerated course. I gained confidence before entering school that I could understand the information and could get alot out of an accelerated or "immersion" style program. 2) Looking at the states many paramedic programs I settled on Santa Rosa Junior college (I have family in the area). The course requires pre-reqs of Anatomy and ECG classes which I took in the spring semester. When you look into different programs remember that not all of them offer the same things. My course has great relationships with local agencies for clinical time and internships while other schools don't. My school requires us to wear a uniform and participate with integrity and a high degree of professionalism which I think is great. 3) I worked (still do casually while attending medic school) on a BLS interfacility ambulance during the spring and summer (about 700 hours). I feel that you do need SOME experience whether it's 911 or interfacility for you to fall back on. There are a 1000 things about an ambualance that you will pick up easily just by working on one that you won't have to worry about as a new medic. Someone posted that EMTs should have X amount of years of 911 experience before becoming a medic. Well I'm not sure how easy that is to do considering FDs handle so much of the 911 call volume (so RM / AMR might be the only option). But I'm VERY thankful for the time I spent doing interfacility. I'm not saying it's "better" but there are several EMTs in my program who went directly to 911 EMT work who do not have the 100s of hours I do in the back of an ambulance with a patient 1 on 1. At the same time I'm not very experienced in watching how a medic runs a call and actual BLS treatments (inserting airway adjuncts, CPR) but my point is having one or the other gives you something to build on. Good luck to you feel free to PM me if you need any help I have a step by step plan for achieving my goal here in the state of CA. Personally I will jump at any opportunity to serve as a FF/medic where I am now or back in SoCal. I'm not worried about the $$ per say (I do want to support a family someday) but for example the starting pay for a FF/medic up here is in the 70-85k range while I believe SD is closer to 45-50k. There are some great opportunities outside of So Cal so keep your options open !

why use lights and sirens when you have a front mounted gun??

I did ER time with my medical director which I'm sure was an opportunity for him to evaluate me and others but it was nothing like an oral board.

What dust said complete the vitals... SP02 maybe temperature and a detailed assesment.. DCAP_BTLS.. Looking for things we couldn't see while she was in bed under the blankets. FOr example how does this person go to the bathroom? Foley? Diaper? Any info on urine output or bowel movements? How do her legs look? Also maybe a better Hx although sometimes a SNF doesn't have a nurse who speaks english can we pretend this one does? =) What was she doing earlier in the day? Activity? oral intake? Are any of these symptons new or are they chronic? (Lung sounds). I'm assuming the care at the facility is minimal if their only complaint was she was unresponsive and didn't report on the rest of her condition.

$25k a year in sonoma county full time. I think most companies have a set yearly earnings in mind for full time employees then adjust the hourly rate depending on what type of shift you work. Which is why 24 hour shifts pay less per hour than say an 8 hour.

The EMT mentioned in the article is not a "lowly" FF or a FF at all I bet. SFFD has a division for EMS only with a position for a straight up EMT @ close to $40k a year I believe (very busy EMS city). Several cities in CA have transporting EMS divisions and provide excellent service so you probably can't lump all FFs into the "poor EMS provider" category. Interesting that SFFD will hire people who do not have certs issued by a local EMS agency (that was req for my job just a few miles north). I agree with some of the above posts... 1) the Prehospital environment could become more professional and 2) Be recognized better for what is done. Imagine what might happen if our next president gets universal healthcare and people stop worrying about ambulance trip costs.

I have a format I follow for interfacility transfers: 1) State where we arrived and who we found: "XYZ unit AOS @ sending facility to find X y/o male/female pt supine in bed" 2) State how pt presents: "Pt presented AOx4, C/O L hip pain, 6/10. Pt obese (130kg) , agitated, diaphoretic" 3) State why the pt was admitted + what important drugs they are on: "Pt admitted D/T L hip pain / secondary to hip FX from mechanical fall. Pt given 5mg Morphine by sending facility." 4) State how we moved the pt including info showing why an ambulance is req for transfer: "Multiple attendants req to carefully slide pt to/from gurney" 5) State what we provided pt and what happened during transfer with more reason for transfer: "En route monitored vitals (166/90, 86 , 16) provided orthopedic wedge between legs.Pt is HTN C/O of L hip pain 8/10 with Hx of CHF." 6) State where we took them and why: "Transferred to recieving facility for XRAY of L hip/leg, service not provided at sending facility." End Result: XYZ unit AOS @ sending facility to find 75 y/o male pt supine in bed. Pt presented AOx4, C/O L hip pain, 6/10. Pt obese (130kg) , agitated, diaphoretic. Pt admitted D/T L hip pain / secondary to hip FX from mechanical fall. PT given 5mg Morphine by sending facility. Multiple attendants req to carefully slide pt to/from gurney. En route monitored vitals (166/90, 86 , 16) provided orthopedic wedge between legs. Pt is HTN C/O of L hip pain 8/10. Hx of CHF,ETOH,Arthritus. Transferred to recieving facility for XRAY of L hip/leg, service not provided at sending facility.

The program I just applied for requires anatomy and a basic ECG course I couldn't imagine trying to learn both while learning medic skills due to the amount of time I've spent on these pre-reqs by themselves.

BSI precautions and scene safety = not part of the news world apparently.

"Medications: Albuterol MDI, ASA 81mg, Ativan 4mg, Lasix 40mg, Lexapro 20mg, Lopressor 100mg, Protonix 40mg, Wellbutrin 300mg, Co Q10 120mg & Vitamin E 400IU. PMHX: Allergies, Anxiety, Asthma, Brady-Tachy Syndrome ( Dual Chamber Demand Pacer), Chest Discomfort/Tightness, Depression, HTN & SAH. " Why is she taking protonix? I thought it was for acid reflux which I don't see that in the history. I'd ask her if she has GERD and what she does for the symptons and possibly suggest drinking a glass of milk if she didn't have any ideas. Total newb here interested to know if that helps or I just killed the patient with my milk idea =)

"It does seem that schools tend to scare the hell out of people about tourniquets these days though." I'm trying to remember what the lesson was exactly but we either aren't allowed to use them now or aren't trained to use them on purpose. I let it go so I can't recall but I'm sure that's why you're experiencing this with EMTs. For an extremity bleed we are taught to pile on the bandages (never removing them) raising the arm then applying pressure to the brachial. THis is where the skill stops.

Thanks guys I swear I even saw it (SICK) on a test question (may have been my class final or NREMT). I figured it was that simple. 1 Reason why a BLS provider may be more apt to go along with the physician is they know less and look to the doctors and medics for guidance more often and are used to listening to them? Did that make any sense? heh For example a Basic gets that order and thinks to themselves "Well this doctor must know what he is doing (in regards to protocols on top of the procedure) while a Medic who has been through more schooling and been around longer may not go along with it.

Sorry derailing newb question.... "1 to SICK"... Can someone explain what that phrase means exactly and why it is used? I can't find it in my text book and I've been seeing it in practice questions. Thanks for the cool scenario very educational.