buckeyedoc

1. You are wrong. Even the dead have HIPAA rights. 2. Nothing could be further from the truth. Copyright remains the intellectual property of the person taking the photograph regardless of what happens to it. Whoever posted the image online w/out rights permission from the creator, stole the image.

Nah, he's a duck. That's WNL for a duck.

We had some down time and I had my cameras with me. What else was I to do?

Well, my wife sprung the news that we're expecting our 5th kid in September. I called the Urologist and man is a vasectomy expensive. I've come up with the perfect solution. All proceeds will be used to fund my shrink and/or kids' college education.

I agree.

Like most of you, I've been around the block a time or 2. I've been doing this job for almost 17 years now. I have seen the good and seen the bad. From patients, EMTs/Medics, hospital staff, management, the population as a whole, hell, from just about everyone. One of the biggest gripes I have is when a medic thinks they are too good to do the basic stuff. Street surgeons, paragods, call them what you will. The last time I checked, the first 3 initials of our certification is EMT. I hate being called an ambulance driver. Yes, that is part of my job description, but so is wiping butts part of YOUR job description. Can I call you butt wiper and leave it at that? I hate management who has forgotten what it's like to be on the road. Oh, something that really chafes my butt. I hate the medics who bitch and moan about a bad labs run. I've seen WAAAAAAAYYYYYYYYYYYY too many medics throw the patient on the cot and gripe all the way to the hospital only to find out that their Na and K are in the basement and didn't even think to put them on a monitor. Oh, I also don't like medics who don't know common lab values. You see lab values more w/ private ambulance companies than w/ a 911 service, but they are out there. Oh, did I mention that I hate when nursing home nurses (contradiction in terms right there) will wait for 2 hours for a patient to be transported that should have been gone 2.5 hours ago. Or they'll have a patient who falls, hits their head on the crapper and has a hematoma. Yet, they'll pick them up, put them back in bed and call you 3 hours later because of an altered LOC.

I agree that you are being sent out for clinicals too early. The instructors decision to send you out so early is making you look bad. No offense intended at all. My advice would be to talk to your preceptors at the beginning of the shift and explain to them your position. Let them know that you haven't covered the invasive skills yet and that you're only in the first quarter. Also, ask them to teach you something. I wouldn't hover over them all day, but make sure you're close enough so that if they want to instruct you on something, they don't have to look far. Take notes. Either mental or otherwise and ask questions. If the preceptor does something, ask him to explain HIS/HER technique. There is more than one way to perform skills. Don't ask it like, "Why did you do it that way?" and come off like an arse. Say something like, "I've not seen that technique before. Where did you learn it and why did you do it that particular way?" Again, take notes. I've learned more from hands-on experience than from any book. Unless they are a complete jerk (and there are a lot of them out there), they will be more than happy to help out. Just don't ask during chow time.

I usually tear the tip of the glove off of my left index finger. I have big hands and can finish the IV without that finger. That's just the way I am.

I think that something that needs to be looked at is the untoward side effects of phenergan. I've seen WAY too many medics and nurses giving 25mg of phenergan fast IVP. That is not the proper route. Phenergan can cause necrosis and nerve damage. I know. We had a guy in our ER that was given 12.5 phenergan IVP into an infiltrated IV. He lost 4 fingers on one hand. Yep, he's a bit richer now. If I have to give phenergan, I dilute it w/ NaCl and slowly push it over 1-2 minutes. We're replacing phenergan w/ Zofran in our 2008 protocols.

Absolutely, infants are respiratory unless it has a congenital heart defect. We had a 6 week old code a couple of weeks ago. Grandma rolled over on baby while sleeping. I can't imagine the guilt that grandma feels and the anger the parents feel. Unfortunately, accidents happen. My wife and I also teach CPR (AHA) and we're asked all the time about infant AED's. Most people understand, but some still don't get it. I don't think that there will be enough evidence to support infant AED's anytime in the near future.

I precept student and new medics all the time. IV's are a skill that everyone is very timid with in the beginning. Why? Glad you asked. Patients are normally awake and can feel the stick. We're aggressive w/ intubations because the patient is gorked and don't realize what we're doing. Every patient is different with regards to IV's. What I've seen a lot of people do is "go by the book". IIRC, it says to start at a 45 degree angle. That works great of IV dummy arms. Hit the hole the other guy left you and you're in and the "vein" is always the same depth. Attempt the IV at a shallower angle. Say 15-20 degrees. That will help to eliminate going the through the back of the vein. You have to be more aggressive with the 35 year old chain-smoking truck driver because his skin will be thicker and tougher than the 85 year old grandma. Everyone has their "trick" for hitting IV's. Find yours. It's as simple as that.

I used to work in the ER as a medic and know many of the doctors rather well. I've been belittled in front of family and staff for various reasons. I had a doctor when I gave Etomidate to intubate even with it well within our scope of practice and standing orders. I was told that I had no idea what I was doing and that he was going to call our medical director Oh, our medical director works in that very ER. I carry a pocket reference guide of our protocols. I showed him that the patients condition and s/s warranted the Etomidate. He apologized to me, in private of course. I told him that I would accept his apology, but only in front of the same people that he embarrassed me in front of. Believe it or not, he agreed. What it boils down to is a lack of education. Not every ER doc knows YOUR standing orders. Oh, the nurses' jaws hit the floor when I said I had given Etomidate. Nurses and doctors alike are not familiar with pre-hospital standing orders and there will ALWAYS be the mentality of "I'm a doctor, you ONLY a paramedic. What do you know?"

I'll cheat, too. Here's Ohio's. Ohio's EMS Scope of Practice

Ruff, What a great idea. I'm smack dab in the middle of spec'ing ambulances for 2 employers with about 1/2 of the budget provided. You may have covered this, but are drawings required for the unit or only documented specs? Do you need a list of our resources. For instance, if we buy all of our supplies from XWY Medical Supplies, do we need to list that. I could say that I bought LP12 w/ capnography, 12-lead, b/p and a potato peeler for $4000 when we all know that it would cost much more. I think that we need to list our resources. Much like a bibliography for a book report. Just a thought.

former (and future) HM3/8404 Corpsman here.