Kaisu

Was it your intention to convert - or to control the rate? What was the onset of aflutter?

City, meet cynical_as_hell. 8) Although we don't have partners in the sense that we are assigned to one person every time we run, for all practical purposes, supervisors can make an effort to put people together more often than not. I want to introduce my partner the last couple of runs. You all know that I had a very rough go of things in the early days at this service. This gal made my life infinitely better, actually standing up for me when it was not a popular thing to do. She is a smart cookie and a good human being. Say hi if you get the chance.

By all means respond with your interesting case. The transfer was ED to ED but I believe the eventual floor was ICU. The facility is not a burn center.

EXCELLENT article. Thank you for providing that. Once again, another area of ignorance exposed and rectified. This is an amazing job.

And did you know Richard that "tribe" in Canada is a pejorative? In Canada, the politically correct term is "band".

I have one.. it's not real impressive, but I love to get messages from friends... http://www.myspace.com/neversaydiekai I also have one on facebook... but its about the same so.... http://www.facebook.com/people/Kaisu_Fisken/833864898

I will say a prayer for you. Stay strong - whatever happens you will be OK. It's hard to accept when things are so painful, but we both know that you are in good hands. God bless.

I was on the last day of a 72 hour shift and had finally gotten to bed. It was around 10:30 PM. I get wakened by my partner less than an hour later telling me I have been assigned to an emergent transport into Vegas. It's a big city hospital with burned out cynical staff, tough as nails triage nurses and some of the best and most economical patient care in the Cal-Nev-Ari region. I had just finished a day where, among other things, I had fought it out with our medical director over Dr. 911 refusal to grant use of morphine in NTG refractory cardiac pain and wiped blood and tears out of the eyes of an alcoholic combat vet with serious facial trauma and head injuries. I was looking at a minimum of 4 1/2 hours on this transport. The transfer documents said 29 year old male - chief complaint skin rash. WTF? Skin rash ? - this is emergent at almost midnight?. Pick up our patient. He is calm, alert and orientated and very pleasant. He has a swollen appearance, a yellowish cast to his sclera and a red skin rash over most of his body. He has received morphine for pain ( rated 7/10 prior to treatment) with a good response to the pain medication. Other meds/Tx include a 1000ml NS bolus and 40 mEq potassium infusing via pump. The patient's skin is sloughing off his face and ears and he apologizes for his appearance. He is ashamed that his skin is coming off and shows up on his black t-shirt. The patient's 2 year old daughter is asleep on the floor in the corner of Dad's ED room, his spouse and 4 year old son are anxiously waiting in visitor chairs at bedside. I get a hinky feeling about this man. Although hemodynamically stable, and in no apparent distress, he presents to me as the sickest patient I have seen this shift. We get a boatload of paperwork sorted out and load the patient. I set him up on the monitor, verify the patency of the IV, make sure the infusion is infusing, make sure the patient is comfortable. He says his pain is only a 3/10 or so and tells me that this is the first time all day he is warm. ( OK -no air conditioning for me I will sweat it out with him here in the back). I dim the lights and off we go. He falls asleep and I read the transfer documents in the light of the alaris pump. Patient was being treated for a sinus infection. He had been on bactrim for about 14 days and had come into the ED with personal vehicle complaining of the painful rash. Liver enzymes off the chart. Diagnosis - Stephen Johnson Syndrome and hepatitis. Now, I blew the EMTs away yesterday because I knew what Guillam Barre was, but Stephen Johnson Syndrome? This had not been covered at medic school. I went to a pretty good school, and that was a clue that it had to be a relatively rare condition. The patient wakes up and is talkative. I start eliciting details. His only medical history was asthma that had begun in his early teens and "gone away" by his late teens. Hmm.. clue 1 - reactive airway disease. Clue 2 - allergies to penicillin and codeine - hmm.. auto immune system issues.... Hx of current illness - The patient has a history of sinus infections. He tells me that he has had one a year. In the past, they had been treated by common antibiotics with no problems. This year, the patient had moved and had a new doctor that prescribed bactrim. Shortly after beginning the course of treatment, the patient began experiencing fever, chills and increasingly severe headaches. He had complained of these symptoms to his doctor. His complaints had been dismissed as part of the course of the sinus infection. Finally, about 3 days prior to his entry to the ED, the patient had stopped the antibiotic. He had done this unilaterally, intuitively understanding that bactrim was part of the problem, not the solution. The patient tells me that not only is the skin sloughing off his face and head, it is coming off his genitals. He has blisters in his mouth that make it impossible to eat and painful blisters on his feet that make it difficult to walk. He tells me he can't figure out which he wants first when he recovers - a big plate of macaroni and cheese or a huge steak. We discuss the merits of each, finally concluding that he wants a huge rare sirloin with a side of macaroni and cheese. I have this horrible intuition that the man may never get to this meal. We spend the rest of the transport enjoying my partner's frustration with the idiots that drive slow over Hoover Dam. Nice man - dreadful condition. Thanks for letting me share.

oops... thought you meant NPA and voted mask ok - (gives head shake - I am within an hour of the last 12 of a 72 hour shift...) makes no sense to intubate and not bag...

We average 30 calls a 24 hour shift with 3 teams - that's average. Its pretty important to be able to get sleep when you can...

Oh Wendy girl I feel your pain. Being the newbie just sucks. You are doing the right thing coming here and asking for input. The experienced people on this forum have helped (and I am sure will continue to help) me so much. I credit them for saving my job. I can't help you because I am struggling to find my place here too. It can be overwhelming. It helps that I really don't give a rat's behind what people here think of me personally. I am doing everything I can to be the best paramedic I can. Now that I am on my own without instructors/preceptors, overseers - whatever you wanna call em looking over my shoulder I am finding my own rhythm. When I was being introduced to the field, I was blindsided every day by crap that made no sense. I worked very hard at staying non-defensive, being open to input and thanking people for taking the time to try and teach me - even if in my heart I thought they were full of s***. It's amazing with the big egos in EMS how quickly the person's mind turns to themselves. They go on and on with their half baked self justifications while I nod my head and look suitably impressed. About half the time, people tell you stuff that is valuable and really constructive. I made sure not to take stuff personally, even if it was personal because they really didnt know me just like they really don't know you. Listen, evaluate, learn and grow. It hurts - but it is worth it. Good luck gal.

Modified Kelly - 24 on, 24 off, 24 on, 24 off, 24 on, 96 off. Beginning Jan 1, we go to 48 on, 96 off. Tough gig for those that can't sleep whenever they get a chance to. I'm good with an hour here, 30 minutes there as long as I get 3 or 4 at some point uninterrupted. Sorry about using an obscure term.

I have a daughter who works as a corrections officer in Ontario. She makes 72K per year but does not live better than me. The cost of living for her is so high I actually do better in terms of the stuff I own, the stuff I buy, the dinners I eat out, etc. etc. etc. Whenever she visits me she is amazed at how cheap things are. When I visit her, I am blown away by how expensive everything is. I know this is anecdotal and not stats but its what I got. 8)

Brand new baby paramedic - 0 years of experience - 10.51/hour - with modified Kelly shifts (10 shifts per month) I make 250$ per shift or 35K. There is a ton of overtime available - by taking a couple of extra shifts a month (now 24 hours at 16$/hour, I make 400$ per shift. Big private service so I got really good benefits that cost me peanuts. After 6 years of service, all the benefits are paid for. The rate goes up every year of service too. It's not gonna make me wealthy, but its plenty enough money for me.

I've seen them convert with diltiazem... kinda a bummer if you were only trying to control the rate.... PS - I've seen an ER doc convert afib with metoprolol and mag... not calcium channel blocker but the mag sorta does that....

50 bucks - no thanks.. way too expensive for me....

Thanks - it means a lot to me.

Dehydration, vagaled down on the toilet. Give him IV fluid - our protocols say 250ml and reassess.. a young healthy kid can take a liter.. fix the BGL - D50 making DAMN sure you have a patent IV - stick him on a heart monitor - take him to the hospital.

My large private will begin running 48 hour shifts in January. While currently we are doing 24 on - 24 off for 3 and then 3 off, manpower shortages often have us picking lots of extra shifts. Full timers (like me) are supposed to be taking 10 shifts a month but we are now mandated to take a minimum of 13. Many times we do a 72. The shift runs 0800 to 0800. The rules say morning duties MUST be done and NO sleeping until after 1200. My supervisor waved the no sleeping before 1200 rule for me on my last 72 provided my am duties were complete. It works out.

You are a very perceptive man Dust... this is a very insular almost redneck crowd that doesn't take kindly to outsiders - especially one from out of state, female and not doing it the way they did. These folks are mostly holdovers from before the big private took over. The corporate oversight and discipline is a good thing... This EMT called the GM and said " If I have to work with her I am going home". They said " Walk then pal - cause that is the drill." He is one of the most senior EMTs here and one of the most influential. I like to think that the co. backed me because I am an amazing medic but the fact is that they need me - any warm body with a medic cert - more than they need the EMT. The harassment from the ole boys has started. Fortunately, I've forgotten more about that simple minded crap than they know. My goal is to put my head down and become the best paramedic I can be. I also know lots of Wisconsin trained medics that now have a connection to a spot where they can get all the hours and OT they want - if they are tough enough to hack it. Maybe we can drag this place kicking and screaming into the 21st century for para medicine... PS.. I will be back crying in my beer here more than this once before all this settles.... stay tuned 8)

I just want to thank you guys. I implemented most of the suggestions made to me. As Dust suggested, I figured out the root cause for my mistakes. Most of my clinical experience was in the ER setting. We never got a BGL off of an IV stick. (blood draws from time to time sure, but no BGLs). Both of the problems I had were directly related to errors when getting that blood for the BGL. I don't get a BGL off an IV. If I need it, I will do the lancet thing. Secondly, I got religion. My instructor had treated retractable sharps as SAFE sharps when really, they are SAFER sharps. I had to think of a sharp as a loaded pistol. I know how I feel about those. Thirdly, I verbalize my process. When I take out a sharp, I say "Sharp" and when I dispose of it, I say "sharp contained". My EMT partner hears this and is a secondary check feature for me. Fourth, I limit the IV sticks in the field. Just because my company wants one doesn't mean the patient needs one. It is risk benefit thing and why expose a patient to a stick in the back of an ambulance if its not necessary. I just got off a 72 hour shift. The EMT that threatened to walk off the job if paired with me worked with me during the last 12 of this marathon. It was all good. I am feeling much better about this job. It is a tough gig but I am making it work. You were all here for me and I can't tell you how much I appreciate all your help. This place is terrific. Thank you again.

Don't get me wrong CBEMT - It was a very good point. My confidence is so shaken by the stuff that has been happening here that I am trying to keep my head down and avoid any and all flack until I have my sea legs. To me, that means doing things THEIR way until I get out from under a microscope. The point you make is valid and demonstrates paramedicine at the highest level. What I really need is a service that will let me run with preceptors (good ones) until I gain the confidence to say "F--- you - this is best for my patient not for the recovery of costs". That puts things on a whole other level.

OK - the lady was in a lot of pain. She had been sent to a facility for treatment of the abscess but nothing had been done. I figured at the very least we could get some pain relief into her.

Oh yeah... if you don't get the IV in, you are reprimanded for poor time management to the extent that I have been told that if the transport time is short I need to get the IV BEFORE we leave the scene. :shock: ( IV automatically ups the transfer from BLS to ALS.)

So.. with a 1/4 lb. burger coming in at about 400 calories (150 of that fat), the 15 pounder is good for 24,000 calories or about 8 days worth for that 180 lb man. WOW! Add about 3 lbs of straight fat and there is some major processing that has to be done by that guys body. Does anyone know if it is possible to OD on fat - what is the lethal dose? Is there one?