ccmedoc

Very true. Even if you get an interview..IF..You will most likely have to prove your skills in a competency lab..Very few of which can be attained in EMS. This, I have not seen. I have seen the accelerated 12 and 24 month generic Bachelors to BSN programs, but never a generic bachelors to MSN. The MSN, and NP, is to be phased out shortly in favor of DNP..A lot of people think this won't happen, but I believe it will. In short, save your money and time. Get the pre-requisites you need and attend an accredited ADN or BSN program. Most BSN programs are only slightly longer than ADN programs, but the course work and expected quality of this work is greatly increased. Most of these require more advanced sciences than associates. It mostly depends on what you want to do as a nurse. If you are doing it for the money, find life elsewhere. You have to want to do it to have any longevity.. In my opinion.

Hey Dwayne, try this

Other than the previous two, we (generally) initiate Epinepherine with cardiogenic shock and a blood pressure of 70 systolic or less. between 70 and 100 systolic we use Dopamine, and above or around 110, use Dobutamine..less work on the heart. You can get as in depth with this as you want, and each doc likes different numbers, but this is a good starting point. A lot of these meds are titrated with each other or a few others for the desired effect..depending on the patients condition of course.

Yep..works quite well, with the right probes..

As AZCEP said, the term is largely subjective. I think that it is more appropriate for the patient to describe the feeling of a tight chest, as opposed to describe a sound on auscultation. Tight, as in the feeling that the patient gets..that they cannot expand their chest to accommodate enough air.. Wheezes are wheezes, rhonchi is rhonchi, rales are rales..'tight' is not an airway sound, nor should it be used to describe one..In my opinion that is.. :? I do understand that intense wheezing or lack of sounds all together is commonly called tight chest referring to the bronchoconstriction..Similar to using the term 'junky' to describe a wet, rhoncus chest..common, but incorrect.. I think a physician would appreciate a more descriptive term..as would I if I were trying to treat or prepare for a patient.. my $.02...give or take

HMMMMM :-k :scratch: ..I've been called worse... Got to go with Vent on this one....take your lumps and move on, I don't know who looked worse on this day of which you speak.. :wink: But it could have gone better..

Try this simulator/game...We give to nursing students.... http://www.skillstat.com/Flash/ECG_Sim_2004.html Needs to be played in internet explorer..Shows up really small in firefox and the like..go figure..

Man, he makes himself sound sooooo simple while his musings show him as one of the more intelligent, grounded kooks on this board...jeesh! He is right though..a good A&P background, and showing up to class most of the time and........The test really is silly.. :wink: Good luck and concentrate on the practical...

Let me start off by saying that this is only my opinion on this topic..there are, as has been posted, different theories of how to deal with people..I do not see where any are inherently wrong, they just don’t all work for me. I know that some individuals need absolute control of a situation, while other like a more dynamic flow..If it works for you then awesome..but keep looking at other alternatives. I hate to see people stagnate in archaic business and professional beliefs and practices simply ‘because’… This “idea” or ideas I am talking about are the variable..By ideas, I am referring to treatment options, transport options, communication options, anything that applies to the job at hand, etc...kind of an abstract notion..nothing concrete..whatever it takes to get the job done. Since they are just other means to the same end..the context they are taken in is situation dependent and up to you, as the senior provider. I don't mean to have a democratic debate over every decision, I am saying that if someone on your team or crew has another way of doing something, or a "better" way to treat a patient, let them present it to you as appropriate...what you do with it from there is your business, depending on you comfort zone and ability within your protocols to make adjustments.. I would agree that most students see obscure ailments in the most mundane of presentations. I don’t think the opinion of a student is going to change the treatment of many patients. What I am saying is to allow them to have these opinions, and use them for what they are. In this scenario, the student thought they were seeing a CVA..maybe, while you were allowing them to obtain a blood glucose level, explain that you would take that under advisement…I would venture a guess that after the reading came back, no further explanation would be necessary.. I’m not saying to have a discussion at the patients side, what I’m saying is that if one of your partners hints that there is a different, better way to do something..and it is appropriate for the situation, then maybe everyone concerned may benefit from entertaining this thinking… instead of having a hard, fast, "I’ve done it this way for years so f%$k off and do it my way" attitude.. Agreed..but in my opinion, to take in other viewpoints may add further insight..to automatically disregard the information due to lack of licensure could lead to failure..You don’t have to do what they say but maybe they have seen it done some other way that will save you time and possibly improve patient outcome.. I guess I don’t see my job as just a job of doing what I am told and simply following orders..I work in a dynamic field, and because of this I am allowed some latitude..Part of being able to make decisions based on changing conditions, whether it be a patients condition or the field in general, is continued education for me and my subordinates. Part of this, to me, is also learning from my coworkers..whether they have more experience or higher licensure than me or not. I am a get the job done in the most efficient, safe, and appropriate manner guy..If that includes doing something different than my usual, or taking good advice from a new guy, then so be it..I had the chip removed from my shoulder long ago.. It just seems very limiting to me to simply say that "this is your little insignificant job description so don’t think past that" and because of the fact that you job description is inferior to mine, you cannot offer anything of consequence to me" simply because you are the boss.. None..while the assessment and initial treatment plan is being formulated, you probably had a plan in a few minutes, your partners opinions could be noted..tell them you don’t agree, show them the reason (BGL), and proceed. I would venture if it was done in a calm, professional manner..you have gained their respect for not only listening, but handling the patient appropriately. No further discussion is necessary. I never advocate discussions between differing care views in front of patients. After the call is fine..unless it is a blatant dangerous course..then actions need to be taken immediately, albeit in a professional and patient friendly manner. A note on the respect thing..It is said repeatedly in this and other posts that “I don’t need their respect, I need them to do what I say”..My argument against this is that outsiders can sense mistrust..especially when it is a loved one’s or their own well being at stake. Since prompt, efficient, safe, and appropriate patient assessment, treatment, and transport is a priority for us, I think mutual respect is a must. Bickering, off handed comments, or a simple gesture can make patient/caregiver rapport very difficult. This affects their outcome potential more than most people realize. Patients that don’t trust you can’t relax, will withhold information, will refuse treatment, and may not fair as well as someone that does trust you. The respect and trust of your crew that you will make the best possible care decisions, and be willing to change you plan of care in the best interest of the patient, goes a long way towards this end..in my opinion, from what I have seen.. Sorry about the length, I have a hard time getting my points across on this subject in less than 30 pages..if I get them across at all.....Take it for what it is worth.. :?

The statement was not meant to be a personal attack on you, only a personal observation by me. It appeared a bit arrogant to me that you would put yourself in the place of being the only one to gather information, any meaningful information anyway, and be the only one to see the big picture. It also appeared to me that you were saying if the other people did not do exactly as you say, they will surely miss something (of importance)..As if you would be the only professional on scene to see the entire operation in its entirety..: I was taking this as seeing the medic as the all knowing one and discounting all other input..that the medic speaks and all others do...without question. If I was wrong..sorry 'bout that... Although I do insist that the paramedic, or lead paramedic, be the ultimate medical leader on scene...I think it a failing to believe that this one person is the only professional with the vision to see all important facts and presentations.. and that any input should be stifled in the understanding that if 'it isn't my idea, it's wrong'. I have seen, numerous time this week as a matter of fact, nurse input change the plan of care for a patient..to have treatments initiated by a physician that he thought was previously unwarranted....This is not a sign of weakness on the docs part..the patient is far better off with these changes, as the dialog between the nurse and the doc changed the care plan..strength in diversity and everything.. The dialog is not always productive, and presentation is key..mutual respect..Simply because the physician is higher license, doesn't mandate the nurse, or anyone else for that matter, to do something they believe to be not in the best interest of the patient. If care was not initiated that some individuals, that were not physicians, thought was necessary...I have seen cases taken to attending docs if the problem was a resident.. I have seen the chief of staff contacted in the case of a questionable attending.. So anyway...personal attack, absolutely not. I am sorry you took it that way. By having some growing to do, I was insinuating that in time, you may see the Paramedic (you) as the leader of a group of professionals (hopefully), and take advantage of the strength of others by allowing input, altering care plans accordingly, and ultimately improving patient care by being receptive to input from 'subordinate' members of the group or team..although team seems to be a bit of a buzz word here... I, this is only my opinion, think that you could change your point of view a bit...maybe with less emphasis on you as the gangleader with unconditional power and more emphasis on learning from others and using their strengths to your, and more importantly your patients, advantage and ultimate success.. I guess maybe, in my mind, it could be taken as a compliment more than an attack. The fact that you are young, intelligent, and ambitious....learn from others and take what they give you...use some and throw the rest away... Learn to be an efficient leader and adjust your styles accordingly, I hope that criticism does not put you off, but strengthens your resolve....If nothing else it makes you think, and to me that makes it worth the effort.. ....carry on... :wink:

Just some backgrouond... This is a ludicrous statement. In hospital is far from a authoritarian atmosphere..These are bygone days of "nurse do this or else..". There is a legal and ethical duty to evaluate every situation and treat the patient accordingly, in their best interest..not yours. You, or a nurse, is not compelled to perform any procedure on a patient simply because you were told to..this is negligence to some..malpractice to others.. This is an arrogant and self important statement. By discounting the rest of the players on a scene, YOU will be the one who ultimately misses something..Only my opinion, but I believe you have some growing to do..I have yet to see a paramedic that was a one-man-show..at least a good one :shock:

Sounds like they did..it is hard to tell if bilateral weakness in an 80 year old is preexisting or not. With careful transport, which I'm also sure they did with an 80 year old..I seriously doubt that packaging this patient with more than a c-coller would have provided any benefit..only potentially made things worse.. Kinda depends on the type of fracture also..doesn't sound super bad..Unless you c-collar everyone with a fall history, it will probably happen again. Just be very vigilant with the elders, give them every benefit and educate yourself on the differences due to age related changes in their body.. Keep your head up..they were going to send her home anyway.. :oops:

I still disagree..this is old school thinking, and I have seen otherwise. If, when you come on scene, the people there know and respect you..you will most likely have an easy go of it. I have seen the opposite happen to colleagues that were difficult to deal with and simply demanded compliance with no respect from their subordinates. I don't think the school should focus on teamwork either..I think they should educate paramedics that are practical, critical thinking, individuals able to take control and command respect..the teamwork and leadership is separate and should be accomplished in the work environment. Again, I believe this is old school thinking. Husbands, wives, and other family in these positions is definitely asking for trouble. As for the friends, I think it depends on the quality of the individuals...You can never be friends with all of your subordinates..the people you lead..but I believe that forthright honesty, conviction, an obvious commitment to excellence, and straight honesty can level the playing field and garner respect in this arena. The ability to separate business and everything else is not a quality everyone enjoys.. As for the boss/leader thing, this is kinda how I see it..every leader is a boss. But every boss is not the leader. What defines the difference between a boss and a leader? The biggest difference between a boss and a leader is this; the boss is respected and obeyed because of their seniority. A leader is respected and looked up to as an example not only because of seniority but mainly because of the qualities of character and ability. Those who aspire to become leaders must lead by example and the team must always have a firm belief that the leader will be there during every crisis. Not to fix the blame, but fix the problem. If the team members find that the leader does not follow what they preach, they will have no respect for him. They may obey them, but the respect will be missing. Leaders gain this respect by their actions. They look and act sincerely. There is no mismatch between their words and actions. They look integral in approach and character. To be a leader, every boss must display characteristics such as knowledge, planning, anticipation, foresight, action, result oriented approach, perspective, respect every team member, earn their respect, act as a friend and act as a mentor. To be a good leader, in my opinion, need these qualities. Once a person earns the respect of their team members they ceases to be only a boss and transforms into a leader. Accountability is huge...I can't stress this enough. This goes with rapport, if your people know they can work without fear of unjust penalty or prejudice..they are more willing to work freely and confidently with and around you. This happens, without a doubt, and it seems you have been on the short end a few times (what I get from your writing)..hopefully the exception and not the rule. I have been in very bad situations with some of my people. Jobs and, potentially, licenses on the line. I have not had anyone roll on me or vice versa. Maybe I'm just lucky, but I prefer to think it is a respect thing. Management and leadership are multifaceted, and many different approaches exist..these are just my opinions from my experience..

You know, I have read this post, and I have found no valid evidence that points to the canoe trip as anything other than a vacation. It appears to be a "break the ice" modality, and allows for the students to get to know each other. This is not the same as what you have been alluding to in your behavioral science references.. A group, even a group that gets along and plays well together, does not equal a team. Three days on the river, bon fires, and a workout with a hockey player sounds like a lot of foo foo, feel good stuff. For the behavioral science portion you are looking for to be effective, the team building getaways that corporate America is so fond of, incorporate a lot of trust building exercises, leadership seminar, exercises to bring out qualities of leadership in individuals (if there are any), promote self efficacy, and offer education about what a team is and how to function as such. The canoe trip, hiking, biking, extracurricular stuff is for diversion. to lighten the load, so to speak. Without the information on teamwork, you simply have a group playing together. This is where, in my experience, just throwing students into group work or teamwork exercises undoubtedly ends with one primary worker, and a couple of tag alongs. This is where this comes in..... ......my experience as well, as both a student and an educator. I would expect to get better results from paramedics educated on how to be an effective leader as well as how to function in a team. An effective leader leads by example as opposed to simply telling people what to do (read..BOSS). A paramedic needs to be this effective leader since most onscene personel look to them for reassurance and guidance. Teamwork follows with the leadership...simply being a boss breeds discontent, and even the strongest "team" will fall apart. EMS is a team sport, but the paramedics need to be the leader of the team in the field, and an effective communicator to the in hospital team... To voice the opinion in a professional manner to the other medic is the epitome of teamwork. It is not only encouraged to speak up, it is your responsibility. A good leader, notice leader not boss, would take the criticism in stride and use it or put it aside. You need to know your place. Two effective leaders can work together, in my opinion...two bosses usually clash from the power trip. I couldn't disagree more....(sound familiar?)Health Care Team A true leader has the rapport with his team to make these comments or decisions in the best interest of his team. This is, in my opinion, the difference between a team and a group, a leader and a boss.. Paramedics are inherently the medical person the group looks to for guidance in the field, whether they want to be or not. I believe that effective leadership training is what would allow the paramedic to turn this group into a team..NOT a canoe trip with hockey players.. As for the program..may be a good educational experience. As for the canoe trip building teamwork and leadership qualities...I don't like it either... (edits...I kept finding stuff) :shock:

Most protocols would undoubtedly leave it up to the medic. Assessment and presentation (not necessarily in that order) is key. If the patient presented extremely unstable, then pacing sooner than later would be recommended. I am not against the trial of the 3mg of Atropine before pacing, given that the patient was, in my mind, able to withstand the time allowance. Pacing pads should definitely be applied as ASAP. The ACLS2000 protocols recommended the 0.5-1.0 q 3-5 min then proceed to TCP. There too, if ASSESSMENT showed the patient very unstable, or the paramedic felt that the Atropine was not going to be effective, pace. Symptomatic is a bit of a relative term. To say that anyones protocols would be rigid in this sense is a bit presumptuous. Someone that presents with postural hypotension is most definitely symptomatic, but do they need to be paced?...Kinda depends, huh? IMHO, 15-30min is acceptable in most instances of bradycardia, presuming no deterioration in status...

http://www.emtcity.com/phpBB2/viewtopic.ph...ghlight=#163509

Yeah, according to the FDA, "three milligrams (0.04 mg/kg) given I.V. is a fully vagolytic dose in most patients." I don't know about you, but most people that I give it to weigh more than 165 lbs. The best I can figure is that the .04 mg/kg is for the smaller individuals, just stop at 3mg for the big ones or patients that are simply bradycardic. We have been giving it in arrests as a single bolus of 3mg at times, depending on the doc.

:shock:

I find it laughable that you believe that the staff in an ED do not understand the monitoring equipment on an ambulance, especially capnography. I would venture that any airway equipment would be tended to by a respiratory therapist or physician anyhow. If the approach in the ED is in any way as arrogant or conceded as your tone here, I wonder why they don't respect your equipment. It has been stated here, ad nauseam, that capnography is a very valuable tool in the prehospital, as long as the equipment and education is there. This is not the case in the majority of areas in the U.S. I believe that physical examination and assessment is by far the most reliable and "technical" tools we have. To correlate this with an adjunct such as capnography is only a bonus. If you have them, absolutely use them..When RSI is in the picture, they are standard. Most people don't RSI, however. Bottom line, if you can't get the tube, what good is capnography. Even if the tube is verified, there is more than one lung pathology that would indicate possible placement error. At that point...who or what do you trust?? I agree with Vent on this one..seems a bit one sided.

I have to agree with chbare on this and his other comments..If you have it then you should use it. Especially with intubated patients..long or short transport. Absolutely!! :thumbleft:

If you are serious about immobilizing the infant, they have specialty devices out there called papoose boards. I think a company by the name of Jerome markets them. I can't see keeping many of these around, although they are nice for immobilization. An alternative is to pad the shoulders, use a KED device to immobilize the infant. The disadvantage is that it limits the access to the infant for assessment, and IV access is also limited as the arms are bound in the KED. I have used swaddling with blankets, padding the shoulders, and using towel rolls around the head and body...with good results. Most infants will relax and quiet down with the swaddling. spend some time in L&D if they will allow to get a technique down, can be tricky at first...especially with squirming babys. The Broslow/Jerome papoose is nice, but cost money. The KED is in your truck already, most likely. I prefer the papoose, but I have been relegated to using the swaddle method quite often. It is cost effective and does the job quite well if you carry small blankets, or large towels on your truck. It is going to depend on your comfort level with pediatric patients, and what you are allowed to do by your supervision. Papoose board Just in case: The padding under the shoulders is to maintain optimum airway angle...BIG occiput and all...FYI

probably the best way to avoid this oh-so offensive criticism, that is most often meant to be constructive, would be to attempt some research into the question or statement being presented. It would seem that individuals are offended at the tone of the response, not the content. It is a bit aggravating to be asked a question, with obvious avenues of research available, knowing none has been attempted. I think this is a huge contributer to the animosity. Another is blindly expecting your (generic 'your') point of view to be widely accepted as correct, and being put off when much evidence to the contrary is presented. Maybe better debate skills are in order. Dwayne has a good suggestion: IMHO, if you disagree with the way someone is doing something, professionally or personally, and you bring it to discussion..you had better have a logical argument to support this feeling. If not, be prepared for the consequences. I have seen some extremely gifted communicators on this site, but you get what you give.. nothing less. Bottom line, if you want a well informed, learning experience, present yourself as well prepared and receptive..this means accepting the occasional barb from one of these highly qualified individuals, repeating themselves for the umteenth time, as well.. For the namecalling (hosemonkey, hose dragger,etc), I think if a person is comfortable in their profession, and their competence therein, this becomes academic and means nothing. I am amused and somewhat concerned when an individual takes such offense at these teasers. Most often they are dealt in jest, sometimes not :twisted: This has proven to be a good educational forum and, as such, one should come prepared. Especially if that is your purpose for being here. I would seriously doubt that a professor at the university would put up with a student repeatedly showing up unprepared for discussion or learning..and you PAY them..This is free, be prepared and use it to its full potential.. Just an opinion..

:bs: =P~ :evil4: [stream:28c9994dbd]http://ccmedic.fileave.com/brutal.mp3 [/stream:28c9994dbd]

Congratulations..setting a good example for all the others with the AAS and all. Although it took a while to get to this point, the real learning starts now, enjoy it..it can be an amazing journey with the right attitude.. Take some time and enjoy this..you earned it!!!

Agreed..If you have dreams about it, or feel anxious or unnerved when thinking about the situation, maybe see a professional counselor or other psychiatric professional. CISD is NOT the answer. Although I disagree with the mandatory CISD, I am very supportive of individuals getting professional counseling when needed. It is not a sign of weakness, quite the contrary.. The hospital that your Medical Control bases out of must have a social worker or similar you can talk to, confidentially, in regards to getting a session with a professional. Certainly, this should be considered if you, or others close to you, see a change in your temperament.... Casual discussions with peers may not be harmful, as long as they stay in the positive. But then again, like Dustdevil said..if it doesn't bother you now, don't dwell on it and make a problem where none exists at this time..You can't argue with that logic