paramatt_

I'll try this again, as I don't think I made the concept of the thread clear. I'd like to hear some way y'all communicate with patients and/or their families who are sick, and who are already anxious, panicked, or stressed (feel free to add another a synonym of your choice). I used this case as an example (albeit poor) but just looking for different approaches to communication strategies in situations like this. I'm not going to sugar coat anything, but I also want to keep hysterics at a minimum and looking for any insight on how to walk the fine line on how to be direct, clear, and empathetic without completely devastating someone (or their family) with such shitty news Also, just to clarify, my concern with the student's statement wasn't what he said, but rather the way he articulated it to the patient.

Denny, that's basically what I'm getting at....what works well from personal experience to relay this info to a patient without making the situation more stressful for everyone involved. The patient is going to get an aspirin, 02, a cannula, nitrates, a quick transport etc, but you still have to explain why all this is happening in a way the patient understands. And Kiwi, i'm all about being open and explaining to patient's what is happening, but being completely blunt with little empathy or thought behind it might not go down well, especially with the acopic or anxious types.

I was recently mentoring/precepting a paramedic student, called to a 57 year-old with chest pain. Patient normally well and healthy, on beta-blockers and a PPI. Anyways, presented with the following (of what I can remember): Central chest tightness, onset at rest, 8/10 at worse, clammy, nauseous, sinus rhythm, BP 165/90, anterior ST-elevation. Both the family and patient are quite anxious. The student, who was treating and doing the questioning/communicating with the patient, looks at me after the ECG is done to confirm what he's seeing. After a quick discussion of what the findings are and what our plan is, he says to the patient "It appears you're having a heart attack" +1 for being truthful, -100 for not thinking about another way delivering this to an already anxious patient and family. We had a good chat about the whole thing after the call, but wondering how everyone out there goes about this in an acute setting. Obviously there is no 100% correct answer as all situations are going to be different, but just curious of what sorts of methods work well from your own personal experiences.

Quoted from the article: "Over the intercom, a flight attendant asked if there was a doctor on board. "They were all standing over her, and at that time I identified myself as a Memphis firefighter." I'm having a real problem unstanding how this guy could rationlize being firefighter is synonymous with being a doctor. A very scary mind-set in my opinion.

Happens all the time. The call takers/dispatches can have it pretty tough to try and figure out what is actually happening/and what resources may be actually needed. Sometimes those who put in the calls have no clue or can't describe the problem. Other times people will play things down as they "don't want to be a bother". Try to get in the habit of keeping an open mind when going out to a job. Some people (myself included) will consider what the worst possible thing may be on the way to a job and work backwards down a list in a means to prepare Anyways, to answer your question, a couple recent ones that come to mind include "breathing problems" which turned out to be a DOA (dead for 30mins+) and a motorbike vs car ?DOA...turned out to be no car involved and only some very minor superficial injures.

Some really good advice in the previous posts. Just one thing to add regarding the clinical questions/scenarios: don't forget to verbalize that you're doing a primary survey (scene safety, response, most importantly ABCs). No matter what questions you get asked, if you can show that you have a solid & consistent approach you shouldn't have anything to worry about. If you can answer and explain how and why you'd put a traction splint on a patient, great. If you do that without checking if the patient is breathing first, you probably missed something pretty important. Good luck!

I would argue no, atleast not anaphylaxis I would agree that IM adrenaline would be an overkill as the patient has no systemic effects, but would definitely agree with the others that a neb of adrenaline would be a good idea. The edema is being cause by leaking capillaries, and even if it's not an IgE mediated type reaction like in anaphylaxis, there's no reason why it wouldn't work. Dex would be a good call as pointed out, however, the onest will be awhile and I'd be a bit more concerned about the amount of acute swelling/airway compromise Good topic

Just curious what your rationale is for not giving adrenaline. You said she has poor sats, any other ss/sx worth mentioning? pulse and BP? resp. rate? chest sounds? work of breathing? general appearance? rash? nausea/vomiting? altered conscious state? etc etc I guess what I'm getting at is what else are you waiting for? and what are your indications for giving adrenaline?

I would definitely be wary about going for the dextrose, atleast straight away and that's just the start....I'm sure we could spend all day thinking of other things that can cause somebody to be unconscious. Now in regards to treating the patient and not equipment, I have had false readings with glucometers in the past and if there's no calibration stick with the device I'm tossing the strips and getting a new box. So back to what would I do? Make sure I've done a thorough assessment before going for the dextrose as long as I'm able to discount anything else. I'd also be documenting all the negative findings my report to justify my rational for the treatment.

Hello all I'm one of the few (or maybe many?) out there who visits lots but isn't much of a poster. From some friendly encouragement I thought I'd say hello and hope to post a bit more in the future. I've picked up a good amount of useful info from just reading, so might as well contribute when appropriate. Just for a bit of background / context, I initially got my EMT about 10years ago, did a bit of study at the local community college level before moving from the US and completed a higher degree in paramedics....still living and working overseas. Though i'm happily working at the moment, I wouldn't mind getting into research or planning/management in the future. Anyways, lots of props to those, unlike myself, who do take the time to post and share what they know/share their experiences and of course to those who get out there and ask the questions in the first place Hope y'all have a good weekend

Just did a bit more reading today, as far as the evidence based stuff is concerned, treating with insulin isn't yet a standard practice, but may have its benefits. I think some of the intensivists/ED physicians down my way treat stress hyperglycemia, but definitely isn't a norm as far as I know. Also, I think there are still some issues regarding whether or not the sugar actually causes harm or if it's just an indicator. From personal experience I can recall one recent cardiogenic shock patient, initially with a BSL of 9mmol or so, on arrival to emerg about 30mins later who had a BSL of 20+...needless to say he followed the trend

Aside from what has already been stated, you might want to do some reading on “stress hyperglycemia”. This is relatively common with cardiac failure/AIM, or any other acute injury/stress state for that matter…need not have a history of diabetes Wiki has a brief article about it http://en.wikipedia.org/wiki/Stress_hyperglycemia Without going through the exact mechanisms (mainly to do with increased immflamatory response), the sugar levels can actually be an indication of patient mortality, that is, the higher the sugar the worse patient outcome. Check out the article below…very interesting results relating to the BSL and patient mortality. http://www.jstage.jst.go.jp/article/circj/70/8/1064/_pdf

Interesting topic Doc....I'm looking forward to hearing what you're getting at. Like the others I would say that a pulse rate increasing above 20bpm and a BP change greater than 20mmHg systolic or 10dia would constitute positive. I also remember reading something about changes can may not be acute (i.e. right when someone stands) so to repeat the check between 3-5minutes of standing. I suppose there would also be inconsistencies depending if the person is laying flat or sitting before standing....with the supine to standing patient having the biggest potential for orthostaitc change.

A very experienced (and now retired) colleague was telling me how he loathed the recent higher education & degrees in the field. As a relative newbie I respectively disagreed. Anyways, here's what I'd do. Full time semester based classes over 3 years for a bachelor degree. Basic level of math, English, sciences, etc is implied. 1 A&P I (including a bit of bio refresher) and lab Communications (combo of interpersonal, conflict resolution, and public speaking) Basic Life Support I (i.e. first 1/2 of EMT course) and lab Elective of psych or sociology 2 A&P II and lab Basic Life Support II and lab (w/ short ambulance rotation) Intro to research & evidenced based practice Medical/legal & Ethics 3 Pathophysiology I Intro to Pharmacology (including chemistry) Case studies (including intermediate skills and scenario lab) Mental Health Clinical Internship (Emergency & Psych) 4 Pathophys II Pharmacology I/Cardiology - double subject (including ECG interpretation) Advanced skills & lab (ACLS based) Clinical Internships (ambulance, ICU) 5 Pharmacology II Pediatrics, Obstetrics & Gynie Evidence Based Research Project Clinical Scenarios & Skill Lab Clinical Internships (Peds, NICU, birth unit) 6 Kinematics & Trauma and Lab Major Incident Command & HAZMAT Awareness Public Health/Epidemiology Clinical Internship III (ambulance) As for time, the ambulance blocks (other than the first one) would cover the length of breaks between semesters, or just about. The clinical rotations would be for 120hrs for emergency and 40 or so per each sup-specialty.

Just curious what counties recognize EMT-2s and who employs them? Also, I know Santa Barbara County has adopted an EMT-1 expanded or "optional skills" accreditation. EMT + 84 additional hours which allows administration of a couple meds, IM & SC injections, and a few other skills.

Just to add on to what Timmy has stated, if you want to be a paramedic in Australia, you really have to work for it. Even graduating from a 3 year degree program you'll end up commencing work at lower level (something like an EMT-I) with anywhere from an additional 9-12 month probation training. Rational? I figure a lot has to do with the lack of medical control - just about all standing orders, thus a heck of a lot responsibility. So what dose this have to do with volunteers? I think this sums it up quite well... As stated, yeah, you'll find some excellent and devoted volunteers in organization xyz, as well as some under trained paid EMSers...as previously posted quite the slippery slope to discuss really. Not to further debate the paid v. volly issue, but I find this to be quite interesting.. http://www.readersdigest.com.au/content/40144 http://www.gallup.com/poll/25888/Nurses-To...rofessions.aspx

G'day everyone, here's my knowledge on things down under... I'm from the US and currently working on my second year of a pre-hospital (paramedic) degree in Australia. If you're looking to head down here to work you will definitely to have to jump through some hoops, but that's not saying it can't be done. As far as I know (someone correct me if I'm wrong) you have to hold Australian permanent residential status to work for ambulances services in Queensland, Victoria, and South Australia. New South Wales does offer visa sponsorship, though as previously stated you have to go through the full application process and be accepted like everyone else. I am not sure about the other states. Another option is that of private ambulance services. It is possible, and not too difficult, to get a work visa which will allow you to come down and pick up a job. Quite honestly, I don't know that much about the private services other than they work events (car races, social/club activities, etc) and for private businesses. Also, they are not regulated - that is, the standard of training & scope of practice is set by each individual company. A third option that may make things easier is completing an online pre-hospital degree course through an Australian university. Good luck with everything, hopefully you'll make it down here sometime. Feel free to message me with any questions.