brock8024

Would having colleges with vol EMS service help with education??? I have seen some people that have their college posted and their program has ambulances that let the students work on them. I think this could help out with some education and clinical problems, if it is regulated the right way. Have each truck have 3 EMT's on it. One a hired NR EMT P and the other two from the program. One being a upper class man and the other a lower class man. Like at my school it would be a PC3 or PC4 student with a Basic student or a PC1 or PC2 student. That way the NR EMT P is there to help but the students get to teach what they have learned at the same time get to learn too. The clinical times can be increased because it is the school that is running it. I do not know if it would work or not but i have seen where some schools do this. Does this help out students for the ones that have been to a program like this?? Do you think it is a bad thing or a good thing? My school does not do this but from what I have seen on here it would help out I think because we have to fight hard just to get clinical sites and we get summers off and breaks and this would let students cont their education while on break. Maybe make it be required for them to do some many hours on it while on breaks or something. like I said I have seen some places that do it and was wondering if it works and if so why more do not do it. Thanks Brock

I had to write a paper for my second semester and it had to have a thesis. My paper was 10 pages double spaced. At first we all thought it was 10 pages single spaced but it was a type-o. we had to turn ours in 2 weeks ago. I done my over fluid resuscitation. it was ok, alot in my class done it over new CPR stuff and a few on incubation's and RSI. I think it is good for students to have to write a paper, I think it helps them learn about something that time may be short on lecture time for that subject. As a matter of fact we have had to do alot of papers. some one page or something but we are always having to write on a subject my instructor think is important.

with the trachea rutpure would you have that good of pulse ox and breath sounds? I would think that there would not be good chest rise or breath sounds and had a good pulse ox?

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The first thing that comes to my mind is diaphragmatic rupture, esp where he hit. It is more common on the left side of the abd. You can hear bowel sounds in the lung fields. That would account for the good raise in o2 sats, but getting the bowel sounds and the possible distention. brock

I read a article in JEMS that covered this topic. I will try to get a link to the web page. It was about how some services where making the nurse or doctor make sure tube placement was good before moving the patient. If the hospital staff refused and the doctor then said the tube was bad the medic had to call and 3 people came out. I think it was a supervisor and two other people. They looked at the whole picture, from CO2 monitoring to everything. Alot of tubes where good it was the ER staff that was in a frenzy to get the patient moved that dislodged the tube. I am not for sure if this is a issue or not. I know for my program I have to have I think 12 this semister but 20 or so over the rest of the program. I have done three 8 hour shifts so far. I am planing on asking if I can do more this semister. My instuctor makes us check eachother off every week on the dummy heads. We have to do 2 adult 2 peds and 2 ivs every week. If not we get in trouble. He says it is good pratice which I like. I mean airway is the most important thing there is. We all should be cont. our intubation skills no matter what. If that means we go to a OR after we are out of school once a month or whatever or find a ER. My 2 cents brock

I know what u mean that would be hard to do. I guess it was just peoples judgment with out knowing who was at fault and just assuming. but i fully understand. I think it would be very hard esp when a kid in involved.

i guess my point as that not always are they going to be at fault and it does not matter. we are there to treat patients not found out who is at fault or to judge them.

Ok I was not going to post on this but after reading what others have wrote I figured why not. 1st everyone is assuming that the people with the smell of ETOH is at fault. I do not believe it was ever said who was at fault, but I do not think it really matters. We are not judges we are professionals who chose a awesome line of work. We are there to help people no matter what. Let me give everyone a possibility and see if that changes things. Lets say that the drive that smelled of ETOH was not drinking but had been at a party and was the designated driver. Someone spills beer or what ever on him. He can smell of ETOH but does that mean he had been drinking. NOPE. 2ND I do not have kids but have seen some parents turn around to the back seat and give their baby something or try to calm them down while driving. So lets say this is what the mother was doing and went into the other lane and hit the other people. Is this possible YES. If this is how it happened would that change how you treated the Pt's. I would hope not. Like I said we are there to treat people not to let our emotions take over and things. This is how I would send the Pt's to the hospital. Pt #1 blk tag. Like others have said she needs a lot of treatments and resources are limited. so if she is still breathing when others are taken then treat her then. Pt #2 Blk tag. Think about it, this kid is bout to code which is going to take at least two members to work her to the hospital. And if I am coding a kid I personally would not want any other Pt's in the truck. Plus she has trunk, neck and facial trauma, she is going to be hard to get a airway on and are her injuries compatible with life? Pt #3 she has a broke arm so she can go with Pt #5 with the broken ankles. both need to go code 3 L&S. Pt #4 he had a lot of road rash which I have been taught to treat like a burn. He now has a very increased risk of infections, Fluid loss. Pt #6 he is another that I would worry transporting with another pt in the back. It sounds like he has either a tension pneumo or cardiac tamp. If there was a chopper then i would send Pt #6 and Pt #4 due to the road rash. Patients # 3 and 5 are going to go by ground code 3 Patients 1 & 2 are going to go either to the morgue or code 3 depending on how they are after the others are off the scene or are leaving the scene. Now please do not get mad at me for any of this but by reading what others have wrote it seemed that a lot was assuming what had happened and who was at fault. It really does not matter or should not matter to us who is. We are there to help people not judge them. I would hate to ever have to make the choice to blk tag a child. but I guess we have to trust in God or what ever you believe in to guide you to do the right thing. I read our code of ethics and no where does it say that we are to judge before we treat but to do no harm.

I currently work in wound care and hyperbarics and we have seen bout 5 or 6 cases this past year. Normally the treatment is OR then HBO tx's. and keep doing it til the NF is gone. It can be fatal. I would not want it in my chest area. All of ours where in the abd and thighs. We even had one pt die from it. I think it started as a soider bite and went to NF and about a week later she had died. that was bout the worse case i had seen.

I am going to put on my flame suit for this, but how did the child end up in the bath tub. I do not have kids, but I would think that it would be hard for a 2 year old to turn on the water in a bath tub and then climb in without someone knowing it. I am not blaming the parents but I would if some of this is not a guilt thing about wanting to keep him alive because on of them left him alone and that is how he drowned. brock

I started my medic school last Aug. My first semester was OK. All we done was pt assessments. We had to learn how to do a full history and physical on a pt. In that semester we only had 48 hours that we done in Er's to get our assessments good. We also had to give a 15 min presentation over either professionalism or injury prevention. In this semester we are going over the intermediate stuff and also trauma and shock. This semester we are doing 120 hours or so. 32 in OR, 36 in a ER, 48 at a EMS and 12 in ICU. I also have to write a 10 page paper this semester. Next semester it gets a little harder. We are going to be doing medical emergency and cardiac stuff. I think that semester is bout 140 - 160 hours of clinical time. Our last semester is Ped's,OB and stuff like that. I think that semester is all of 200 hours plus of clinical time. We also have to help teach a hour of basic school. The way I understand that is they pic a day for you to be there and you have to teach what ever they are going over. No prep just here is your subject and teach. We also have to do a community service project in our last semester. Before we graduate we have to spend 48 hours with our medical director of the program and pass that and pass a gate keeper time with a paramedic. We had to take a separate pharmacology class and everything. Brock

I do not know how others feel, but if I was dying and DNR or not does not mean I do not want to be treated. I also do not agree with the dying in a unfamiliar place. I somewhat do I guess. I mean the ER staff is jsut as caring as the NH staff. And how would you explain to a jury that you with held treatment from a patient while waiting for a nurse to find a DNR. A DNR to me is good for when the pt dies not to see if you need to treat them. That is just my 2 cents.

I worked in a hospital one time that on the DNR it had areas you could check what you wanted done. Like we had codes we would not intubate others where meds only. Meaning you puish the drugs but do not do anythign else. I think either you are a DNR or Not a DNR. But on the other hand I guess it is what the family and pt want with in reason. brock

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A couple of points. 1) with or with out L&S the ride in the back should not be hard for the medics back there. I think this was talked about a few times. 2) How would you explain in court that the patient was dead. Yes you gave the drugs and stuff but if a patient family member is crying saying you said stuff or was rude or acted like you did not know what you was doing I would think that would open a big can of worms. I mean we all should be professional but we all know those few people that act out of line or get to hyper during certain things that I think could ite you in the butt. 3) How are you going to explain in court that you transported granny 2 that is CTD and is going to code on you in the back of the truck but not the granny 1 that was already in arrest? I mean I know the reasons but will family members??? I think if you are going to call the code at the house alot should be done to prepare the family. I had to give a speech bout this last semister. What I have read is that we should let the family watch the code so that they know everything is being done. Act very very professional. Explain everythign that is going to be done and has been done. Then make sure you give the family member care after you have called the code. I would think that as long as everything went really really perfect then you should be ok. But that one time that it goes to hell in a handbasket then there might be a big lawsuit. brock

U said she has had some N/V. What Color is it, and how often. She could have a mass in her esophagus or stomach. I would almost bet a Esophagus veracious about to rupture. I would keep her pressure around 80 systolic if she is perfusion is good. TX- iv fluids 12 lead CT of ABD and chest keep NPO CBC,CMP,PT/INR, PTT, T&C a couple, Call her oncologist talk to family bout a DNR

This is what is sad. This patient from what you said had went into irreversible shock. I mean if you was to ask most nurses or any medical person the definition of shock and I would hope that at least 90% could tell you. It is sad that most do not know how to catch shock before it goes to far. And I love how the pt is always OK a hour before you find them. this just makes me mad because this guy did not have to die because of this.

hey thanks Rid. I will have to come up with a new thesis. what is a APA form. I have never heard of it. Yes I know he loves shock which is cool. I will try to come up with a new thesis today. Ten pages I think will be easy on this subject. It is just narrowing it down. thanks brock

thanks guys for the info. I was trying to think of a good thesis. It is H.Conner who is teaching this semister. I have asked if I could do some clinicals there with u but he said he was not for sure. I am sure I could if I asked enough. LOL So I need to think more of a statement than a question. I think I can handle that. thanks brock

hey thanks for that info. I am trying to narrow it down to what is important to paramedics. I am going to go into alot of trauma pt's and the amount they get. I figured pediatric stuff and elderly things would be good stuff to get into. thanks brock

I am having to write a 10 page paper single spaced for my paramedic class. The topic I have picked is fluid resuscitation. I am thinking about using this as my thesis There are many different fluids and quantities to chose from, however, are the right ones being picked for fluid resuscitation. Does this seem OK or do I need to change it up a little. My paper is going to go over the different types of fluids to be used and the doses. I am also going to hit on areas like different types of shock, burns, pediatric and elderly patients. I think I will also hit on different electrolyte imbalances that might be occurring in a pt and what fluids might be best to use. how does this sound. Please do not think I am asking for someone to do this I just want to see if there might be any other topics I am missing that I could add or any areas that anyone feels are important. Thanks Brock

That is true, but for most people L&S means driving faster which could lead to someone hitting a bump in the road faster than they should. My basic instructor told us about a call he had. His pt had abd pain. they looked and found a large visable pulsating mass. He told the driver to take it easy and go as slow as he could and avoid as many bumps as possible due to the fact they were on a gravel road. I think what I was referring to is that sometimes people get a little lead footed when the L&S are on. brock

EMT Basic here but in my second semister of paramedic school.

I am not for sure I would run him in hot. I am thinking that he L&S may up his pressure which is bad and one nasty bump in the road or a turn to fast and opps. I think I would start a line with TKO fluids, POC , O2 and pray for the best. I am a paramedic student so I would be thinking of a way to lower his pressure. I think running in L&S is a bad thing and this is a time to go slow and easy. Brock I am only in my second semister of paramedic school so I am still learning as well.