fireflymedic

There's another great resource called drug calculations for the busy paramedic. Look it up on google and you should be able to find it. Good luck.

The formula for drip rates varies depending on what you are solving for, but that is a basic formula. Sometimes conversions need to be made first. As far as being covered in the LVN program, I would definitely think so. I would be quite suprised if it weren't. Good luck !

wow, can we say overkill?

Ah in my adventures in teaching here's what I hear the most basic class - I am just doing this to get on with a fire department (basic is required of FF here, and if they don't have to put 'em through puts them higher in the app process) paramedic class - I just wanna fly (whatever happened to being a great ground provider?) Nothing wrong with either goal - that's fine if that's what you want to do. Goals are a good thing, but it seems that is the ONLY thing I hear anymore. Is this just me or anybody else experience this? What has this profession come to?

I'm gonna head to this I do believe. Been once before and it was a good time. Anyhow, ERIC - you know who the cheapest to fly out of louisville is? Let me know if you find a cheap flight 'cause I am NOT doing that drive again ! Did it when I went to pick up that filly and refuse to do it again. If I go to baltimore again, I'm flying. I'm looking around, so if anybody's got suggestions, let me know ! Thankee !

While some standards need revamping, as the article stated, the needs of a fire based system and a private system are entirely different. This is just another way for the fire service to weasel its way into the EMS industry to where there is no alternative but to do fire or get out from what I'm seeing. Having started in a fire based service, and staying there for several years before switching to the private EMS sector or county based (which is primarily what is in my area), I would never return. I was disgusted with how things were ran - granted that is my opinion, but fire and ems are two separate entities and the utilization of "paramedic engines" really is a diversion from putting an appropriate amount of ambulances on the road. The EMS crews were over worked and often exhausted while the fire crews sat back doing nothing. Granted there is a place for each in emergency services, but I'm all for the recent divorces that have been happening like crazy around here for fire and ems combined services. Also, how long until they start setting the standards for personnel? You know it's bound to happen. While EMS falling under the fire commission here has brought good changes overall, each know their place and function as a separate entity. Fire doesn't try to tell EMS how to run things, just like EMS doesn't try to tell fire how to do it's job. How many times has an ambulance showed up on a fire scene and told them how to do their job? Not many that I know of and if they told they were immediately told F off. However fire showing up telling us how to do our job is a frequent occurrance and we permit it. Not trying to rehash the old fire vs ems debate but is something to seriously consider here. EMS needs to declare itself as a separate entity now, or we'll see bad things happening. Fire has no place trying to design my CCT truck as they don't know what my needs are as that is not their specialty. Certain types of trucks won't fit into certain areas we serve and require a unique response - will NFPA alot for that? Probably not as their focus is large urban areas, not the middle of nowhere where you may have to cross a creek to get to someone's house or go up the side of a mountain ! Just things to think about before we jump on this bandwagon.

Okay kids, this patient was actually my mother. Had DVT in saphenous vein. Calf was swollen, slightly red and tender (but I didn't give all that didn't want to give it away). In actuality, she didn't tell the medics or doc that she had a history of PE despite having them twice. Doc got hooked into thinking it was just sciatica (uh yeah - thanks idiot community) and medics dismissed her giving her just O2 on the way up, no 12 lead done until ER. Pt was placed on long term coumadin therapy with maintenance INR of 2 and recovered without further complication. Good job ! Like your aggressive thought process and treatment.

thanks for all the responses - much appreciated

As far as illegal drugs go - in my dept we're tested frequently and if one should pop positive for anything, they better have a darn good explanation because you're not allowed to work even on pain killers without reporting it and having a doctor's sign off (most of the time you get pulled from the truck and definitely not allowed to drive). As far as partner reaking of alcohol and no one talking? Two years ago a fellow was arrested driving an ambulance under the influence. His partner chose not to report him despite him stating there was obvious alcohol smell. I was a former supervisor at this department (thank god left 2 months prior) and had written him up twice for alcohol within 8 hours of shift (which is our call out time) when he appeared wobbly and sent him home. The incident made national news, he was arrested straight out of the ambulance and put in handcuffs, immediately relieved of his job and his license that day by the state board, and is currently serving the last of a 5 year sentence in the corrections facility. So people, yes it does sadly happen. This is not the only report of this either.

haven't experienced that problem yet JW - not to say that it might not, just that I haven't had it yet

You all, don't judge until you've walked in another's shoes. You don't know what the situation was so I would say it's really not your place to comment. Just because a mistake is made once doesn't mean it should last a lifetime, particularly if that mistake is corrected. I know medics that have attempted suicide, had significant depression, drug and/or alcohol problems, and physical illness. They all were given time off of dismissed quietly and allowed to regroup before returning to the profession. Most that came back are okay now - the few that aren't have walked away from EMS entirely. Show some courtesy, this is why people in our profession don't speak is because of condemnation like this when they do. This person was brave for her response. Give her the respect to state what she did and leave it at that.

Okay kids, I like your thinking so far. Class is now in session. This little lady is not a nursing home patient - she lives at home with her daughter who has noticed a progressive shortness of breath the last two days and tried to get her mother to go to the hospital, but being a stubborn old country woman would not. Prior tumor was non cancerous, treated with surgical removal and 6 weeks radiation. Right leg is slightly swollen and she said pain is primarily behind the knee. She's been in the chair last two days due to leg pain but in general due to arthritis daughter says she doesn't move around much. Currently neurologically intact and within normal limits of someone her age. Well alert and oriented. 12 lead is normal in all leads. Speech is normal and fluid and yes she can speak in full sentences. But yes, she does look sick. Slightly diaphoretic and a little grayish looking claiming she's feeling a little nauseated now with being moved around. This lady is quite heavy (about 300 lbs). Pt's meds are synthroid, lipitor, potassium supplement, fish oil, vitamin D, vitamin E, calcium, clonodine. Also has history of acute kidney failure from 1 year ago. Meds are to take over anterior pituitary function as was damaged by radiation and tumor. So you put her on O2, give some nitro, some asprin, and a little morphine. She states relief of chest pain has resolved to a 2 out of 10, but still states severe leg pain and currently no further headache with those interventions. You're 30 min transport out from a hospital even remotely competent of taking care of this patient - anything else you'd like to do for her? Any thing else you think going on? More to come.

I'll give the meds first, then drop the NPA for a few reasons - get better absorbtion than if NPA is placed first, you may actually supress the respiratory system more as is a risk with any benzo given (but I have found to be more prominent with versed), and they are going to be post ictal for a while anyway and giving the benzos actually prolongs post ictal time so those are all factors in my decisions. As I mentioned though, if the need arises (such as I totally knock out someone's respiratory or the situation warrants it I will tube). Someone else may have different thoughts, but that's what horse I'm riding.

You respond to the home of a 67 year old female who is complaining of severe chest pain and headache who has called EMS herself. Upon arrival, you find the home to be in quite a disarray and the lady says she has difficulty getting around due to arthritis which has been worse the last week particularly in her right leg. She is speaking to you in full sentences, but frequently moaning and complaining about her chest and her head which she states is a crushing quality 8 out of 10 intensity. You do your assessment and find vitals to be as follows : BP 140/94, Pulse 110, Resp 24 even unlabored, SpO2 98% room air. You try to get her up out of her recliner which she states she has been in almost all the time with legs elevated for last two days and she nearly collapses on you due to weakness in her legs. She states reason she called tonight rather than going to the doctor was the chest pain which she thought heart burn and has been treating with tums the last three days increased dramatically and her intense headache. She tells you her medical hx was a brain tumor removed 10 years ago, diabetes, and pulmonary embolisms x 2 about 8 years ago. She hands you a walmart bag full of meds, some of which she is actively on, others she is not. What would you like to do for this lady and what's goin on with grandma?

An aura is actually part of the seizure itself. It proves that it is partial onset and depending upon where it is originating depends on what type of aura they get or if they get one at all. Some people's seizures generalize so fast they don't realize or recognize the aura. From sounds of it, this was most definitely a seizure and post ictal time varies depending on individual. Some people bounce back in a few minutes from a partial seizure and others may feel out of it for up to 2 days with uncoordination and disorientation (resemble someone slightly buzzed) for generalized. In my book, she definitely wins a trip to the ER.

Recently while teaching a class and covering OB using the brady book during discussion for a prolapsed uterus following childbirth they instructed and I'm not kidding advocating the basic "push it back in place using the fist" and to leave it there until arriving at the hospital. Now I don't know about you guys, but one I have NEVER heard of this practice and it was concerning to me as we teach students, especially basics to never place anything in the vagina (with the exception of a V to help create an airway if needed for the baby). I've previously taught with other books and in my experience not had this issue, but if so, treat as an exposed organ. Don't push it back in due to risk of increasing infection, cover with moist sterile dressing, and leave it alone ! Anybody else have some input on this?

From what I'm reading into this, and perchance I'm wrong, but it seems their request is simply to be treated with respect and dignity something every patient regardless of the validity of their complaint should receive without question. As far as the psychiatric evaluation though, I beg to differ. One day the cutter may cut too deep or produce a significant burn, whatever. In that instance is the question of suicidal intent brought up or is it just dismissed as an accident? These people IMHO need intensive monitoring to ensure their behavior doesn't progress to this point of concern. If it means a bit of discomfort and addressing things they don't like then tough. Do we not start a line on a cardiac patient because it might hurt? No, we do it to administer meds which will save their life. The same applies with psychiatric interventions and these self injury patients. I'm not seeing the difference with which to treat - they claim that psychological is same as physical and treat with same respect and care but avoid the appropriate care? You can't have your cake and eat it too.

I have done with the MAD device which I definitely think is the optimum way to go. However, if your company didn't have those then you can do a 14 gauge cath minus the needle on a regular syringe - works just as well almost. Have used both methods with good success.

We have a mixed bag for options to go with seizure patients. We have IN and IM versed, IM ativan, or we can go IV if we get one with any of the above or valium. It's pretty much medic's choice. It's a really good set up we have and from the few times I've used IN versed, I've been happy with it. The only issue I have with any med going IN is it typically goes down the back of the throat and next thing you know, you've got 'em pukin. However if patient warrants that route, I'll go it. I admit I'm pretty aggressive when it comes to treating seizure patients. I drop NPA's on almost all of them because you know they are able to really protect their own airway and getting alert when they pull it out. That's a personal thing, but if they're cyanosed pretty good, I'll opt for the tube. It's not to be mean (I am truly a kind person) but I'll be first to admit I have no problem being aggressive if I need to.

Hey, if anybody's gonna hijack this thing and abduct AK it's gonna be ME ! As for the lack of sarcasm and humor - I have plenty thank you very much - in fact I bet a 50 I work circles around your dinasour tail AK ! For the rest of ya - bring it on old timers - let's have it out old un's vs young uns !

I fully intend to stay in this profession past 45 if I am physically capable and mentally stable enough to do so even though I will be eligible to retire at 38. I know several medics that are around 50 that I respect and would run with anyday over a younger medic because they are more mature and knowledgeable. Also, some can outlift our younger medics and generally have a better work ethic than the current younger medics in general. Perhaps this is just my general area and not the case in other areas, but I think forced retirement is a bad idea and rather retirement requirements should be based on the individual, not the age.

first off, just a thought here people, nasal intubation is only useful if they ARE breathing - if they aren't breathing, it's not an option, so give it up ! If they are breathing at a reasonable rate, then bag with them, if not bag with them and supplement along ! Do your job people, don't expect someone else to do it for you !

For us here's our choices FOR PAIN toradol dilaudid morphine fentanyl FOR ANXIETY/SEDATION fentanyl ativan versed valium use diprivan on transports frequently etomidate here it's take your pic and choice the drug box - it's more medic's choice and liking and the situation so there's a variety of flavors

Okay, I know this post is old, and the paper has probably long since been done, however I'll weigh in. First of all, you want to talk about discrimination in EMS - try the horse industry. It's 10 times worse. I was in it and still am to some degree and people constantly make the comment to me "you're responsible for breeding stallions?" It gets really old and the sexism is all because women menstrate and they think the horses will go after them - something I've proven wrong over and over again. Slowly very slowly the mindset is changing. After working and being in that industry for several years prior to EMS it was actually a relief to move into the EMS sector, I found it more welcoming. I was the only girl out of all 3 classes offered (which ended up equaling about 75 people), and currently work in an all male dominated service which is about 150 guys. Doesnt bother me in the least. I can lift with the guys and can definitely hold my own. I would expect that if I couldn't to be discharged just like anyone else. I had to pass the same physical test as the guys and I've worked fire as well which forced me to pass the same tests. No special treatment here, nor do I expect any different from anyone. My theory is, if you can't do the job get out which applies across the board to girls or guys. I've had some male partners I could out lift, and yes being short has had it's disadvantages, but its not the weight difference that's an issue, it's the height and would be the same problem with girl or guy my height. As far as partners, I've been in stations with male, male female, and female compositions for partners and the majority of places I've worked will not ride two females together because it's just not a good mix. As others have said, never have I felt looked down on because I was a female. There have been instances where being a female has been beneficial such as with rape or OB patients. Also, sometimes a patient who is wanting to fight with the guys will back down and I'm able to resolve a situation much easier than they might have simply because of the don't hit a female mentality (on the same token, when it comes down to it, if I need to kick butt I can with the best of 'em). I work in a rural area that definitely has the barefoot and pregnant mentality among it's citizens and frequently I get interesting looks or questioning from my patients. I let my skills speak for me, not my mouth. I think that does more than anything as it does for any medic. Does sexism exist? Sure it does - the last female that worked here was fired and they weren't keen on hiring another because the last one was "too prissy". I changed their mentality a bit, but their not ready to go out and fill the place with them, though I definitely don't think it has held me back. I have progressed through the ranks same as anyone else, feeling no benefit or condemnation because I was female. However, I think too many people get caught up in the mentality of "I'm a women I won't get a job". Though one valid comment to this effect - employers are hesistant to hire a young female for one reason and this has been stated to me several times. They are afraid of them getting married, having kids, resulting in maternity leave and possibly leaving afterwards. Though I have yet to have this be an issue with getting a job and I've worked all variations of EMS, the majority male dominated. Maybe others have not had this luck, but I've been okay.

Depending on the topic, especially with the scenarios and things they may be specific to ALS or BLS - sometimes I like to sit back and give others a chance to voice their thoughts as opposed to me jumping in and sending things over their head possibly (in a BLS thread) or taking away from the scenarios they get that are directed towards them. Now as far as other topics, I'll post my say here or there sometimes I just take a look to see what the question was or what the information is. Somethings do not warrant a response in my opinion (that alone is giving my opinion), other times I am busy and don't have the time to write out a respectable answer, therefore I choose not to speak as opposed to writing something which may be misunderstood. Also, I choose to avoid posts which are out there solely to inflame or piss people off or enter the age old AlS vs BLS comments. I no longer care to just rehash what has been said over and over. If it is pertinent or I feel I have something of value to add to the conversation I will, otherwise, I choose to remain quiet and let others voice their say. Also, if it is specific to another country, then I feel I would be ignorant to speak about what I do not know as with anything else unless I have a question regarding that country or anything else regarding their system or protocols. Hope that gives you a better insight into my mind Crotchity.