wrmedic82

What would be different about this product vs. What is already on the market? Life proof cases and otter boxes provide pretty good protection. In our system we do use our phones to communicate with hospitals and supervisors.

Id need a longer strip to be sure but it kinda looks like a mix between 2 rhythms: second degree type 1 and a atrial tachycardia with a block. I cant say 3rd degree because it looks like some of the Ps are actually conducting the QRS. I wouldnt doubt that this Pt is going to go into a fib or a flutter at some point soon. I actually have a good strip of an atrial tach w/ a block. i will try and dig it out later. As far as treatment, I would treat symptomatically.

I was hoping to see if anyone could find me literature or studies supporting the claim of oxygen given to a patient with a spo2 >95% causes harm at the cellular level. Out medical control officers swear by this, however google is not being my friend to research the literature on this subject. Granted, as with any drug. There should always be a rhyme and reason for administering anything. So understand I don't routinely give oxygen unless someone convinces me they need it. (The 4 hypoxias).

Thanks for the advice gives me a starting point to learn more

I just ran my first call with a Pt with an LVAD which I thought at the time was cool as hell. Especially when asking my rookie emt to check a BP. But with anything comes a lil humility as many thoughts raced through my head after the call. Realizing I really don't know anything except lil bits and pieces, I was hoping someone could give me some insight on these devices, potential problems and how to best manage the Pt should the device fail other than cpr. Would ACLS even be effective for these Pt's? Any insight would be appreciated.

https://petitions.wh...mpaign=shorturl Sounds good to an extent, but can you trust the government?. Whats everyones opinion? Time to throw this to the wolves of EMTcity

I like to look at doctors a lot of times to see how they manage, and interact with patients and the patients family. One thing about death is that it is a reality and inevitable. If provided it is safe to do so, I feel it is in the best interest of the family to see what all you are doing, make interface with a physician and be within earshot of the family so that the family can hear the words of the doctor " You have done all you can do, you can terminate resuscitative measures!" That way the family will not doubt that everything was done and done correctly to try and save their loved one, even though a lot of times we already know that the attempt is futile. I feel very strong about in the field termination of resuscitative measures and I know not all share my opinion. My reasoning going even further is Everyone is in a place they recognize Does not give the perception of false hope Allows for the best delivery of patient care ( very difficult to do picture perfect CPR in the back of a moving vehicle) Overall it is safer (no code 3 driving with for lack of better terms a corps) Now will every scene allow you to manage the scene this way. Probably not. But this is what I strive for in code situations in the field. As far as it bothering you, or not bothering you. People respond to stress in different ways. Some can cope really well in situations like this, where others may cry with the family. I wouldn't let that aspect get to you, but at the same time do not be afraid to say something to someone.

CV's ?

Nothing wrong with boobage **coughs** professionally speaking of course lol

Ya'll are too much lol

I have watched lots of doctors and how they approach patients. Couple things stick out to me. 1. A professional demeanor: Professionals don't run in like a bat out of hell. Take the time to look at your patient, look at the surroundings, and begin your assessment just by looking. This takes no more than a few seconds to do. 2. As mentioned Introduce yourself and your partner: You have the privilage to see the patient in their environment. They have no clue as to who you are. This is how you begin to have a rapport with the patient. Don't be like "Hi I'm Will whats the problem today? That lacks empathy. Remember an emergency is perception, and perception is that persons reality. Be professional. 3. Find out the patients name and use it often: This conveys that this is not just another patient. It is personal. You are using their name. This again builds a rapport and will help you along way. The more professional you come across, the better information you are going to get. If you show a lack of empathy, lack of wanting to be there, or come off as immature. The patient can read you like an open book. You come off like this think about how much information your NOT going to get? This is one reason stories change when there is a hand off in care from us to the hospital (not the only one, some people have agendas). Be professional no matter how you come across and you will do fine.

I think a lot of people have dissected this enough so I will be to the point. In EMS your going to be in a lot of "questionable" situations that the decision will be out of your hands, and it is going to tick you off. It is what it is. What I want you to take from this is you only have to account for you. Did you act ethically? legally? morally? Could you have done anything to change the outcome? You have to grow some thick skin and let things roll off your shoulders. Decisions of others (i.e. supervisors, managers, etc) that guide your direction are owned by them, not necessarily you, and they have to answer for good or bad decisions made. If you did what you felt was right, then there is no reason to get pissed. All you can do, is do what you know is right. Whats right for the patient regardless of healthcare status (i.e. hospice), Right for you as a provider, and right for the company you work for. Beyond that let it go. I think I covered everything. If not Dwayne or Artickat will either add it for me, or scold the crap out of me. One of the two lol (just kidding)

Beiber, Thanks for your input on this. I will have to read more about EMS pain management in regards to abdominal pain. It has been beaten into our schools not to give pain meds for abdominal pain because it can skew the Dr's assessment. I will say this. Take for example kidney stones. If the patient has a Hx of kidney stones and says "this is definitely a kidney stone" (quote from my wife who has them all the time bless her heart) I would definitely be more inclined to be aggressive with pain control. But like you said it is very difficult to pin point abdominal pain in the field. As far as your comment on drug seeker vs. person w/o obvious pain. I find it arrogant to "judge" whether or not someone is in pain. So I probably unless they are a known seeker, err on the side of the patient and treat the "pain". Thanks it does help out alot. Good insight.

I heard a long time ago that we as EMS providers are very poor at pain management as a whole. I also was told that when it comes to poor pain management, a feedback loop can occur causing chronic pain. I do not know how true all of this is so please understand Im not preaching the Gospel of EMS. But I wanted to get some advice from some of the more experienced and more knowledgeable providers. ( Bear with me I'm a baby medic) I also wanted to ask, when asked for pain medication. Are you quick to treat the pain, or suffice the "drug seeker" and to err with the patient complaining of pain. Do you when in question leave that to the hospital to make the call on pain management? When it comes to drug seekers, do you suffice at a low dose? or say "No Way Jose!" And now I will ask the question to allow all to get creative. What in a perfect world would you like to use or see used to manage pain? This is my take on pain management as of now (always subject to change with new education and advice from experienced medics) If it is pain that I can alleviate without skewing the Dr's assessment ( i.e. abdominal pain) I have no problem being slightly liberal with pain medication based on what their pain scale is. If it is less than a 4, I may hold off and let the Dr make the call. This of course is provided there are no contraindications to EMS pain management. When it comes to drug seekers I am kinda torn. I do not want to fight the patient, but at the same time I really do not want to be an enabler. And even so, how can I truely be sure they are not really in pain? Even I got accused even after surgery by one nurse of being a drug seeker ( what was funny was I was asking for hydrocodone for pain despite having a dilaudid PCA) I will definitely be open to hear what others have to say which may help clear the air for me on this. It is my patch always on the line and I do not want to put myself in the line of fire. In a ideal world, for pain levels < 4 I wish we could give tylenol PO 250-500 mg provided no contraindications, > 4, fentanyl would be my preference because of the less likelihood of dramatic drops in BP. Dilaudid would be a good alternative (although dilaudid gives me a migraine) I have seen some Dr's use lidocaine or a local anesthetic derivative to do a temporary block for pain management, but would need alot more training to use, and may not always be practical. Great maybe in theory. But most of the hospitals are within 15 min so better done in the hospital anyway. Rural EMS I could see this being of some benefit.

I would have to agree with artickat. But let me encourage you to get good with manual BP measurements. This is a personal quirk of mine I know. But I make students do manuals all the time. They are not allowed to touch the NIBP ( I will put it on the patient during txp not the student). This is not to make myself holier than thou or to belittle the student. There have been many occasions where the NIBP was grossly wrong and if me and my partner had trusted the BP, it would have killed the patient. Even in my own care I want a manual BP as my baseline. When you get out in the field it is completely up to you on how you do things. I know medics that swear and only use NIBP and never do manuals. Just be forewarned and know it can be deceptive.

Everyone, This is a topic that is really near and dear to me. Why? Because this almost ended the career I love. I am hoping to share a little piece of me in hopes that someone reading this might know that they are not alone, and maybe helps someone not make the mistakes I made that almost made me hang it up and walk away. As EMS providers, we all to some degree have this thing called pride. Some more than others. It is something to a degree we all need to keep confidence in what we do. But pride has a funny way of sometimes biting us in the butt. 5 years ago I started my EMT career in Ft Worth with Medstar EMS. it was a high performance system with very little down time. During my time there I wanted to be the best of the best. I wanted to be able to make the worst paramedic look like an all-star by knowing all the drugs, equipment, taking advanced level classes to get on the same page as my medic partner. I will go even as far as to say I wanted to be an equal to a paramedic as a basic. I know that your reading this and thinking this is absurd. You are right. But back then you could not tell me that. I was the best and nothing was going to convince me otherwise no matter how absurd or unrealistic it was. To make matters worse, I loaded myself up with hours. Sometimes working over 120 hrs in a work week!!. With the unrealistic expectations I had for myself, my ego, and the lack of time I left for myself it began to take it's toll on me mentally and physically. I ended up gaining over 50 lbs, I became irritable, argumentative, self-righteous (or foolish). Eventually this trickled down eventually to my patients. Began thinking they 99% were drug seekers or not really worth my time and that it would be better spent on those " real emergencies" where people were really on the verge of death. Not the 2 am run for abnormal labs, or the "I have a toothache". I honestly found myself judging someone else's emergency to some standard in my own mind of what I considered a "real emergency" to be. It really came to a head after I ended up getting divorced, later finding my one true love ( married now for 2 years) and her telling me in a brutally honest fashion how silly I was sounding as I came home and began talking about my day at work. I really began hating my job. I dreaded coming in to deal with the routine bs. Started loving and hating days I didn't have to do patient care. Loved it because all I had to do is drive. Hated it because half the time I felt my partner was inept at best. It was shortly thereafter I made the decision to leave EMS. I took a job as a EKG holter technician with a company called Spectocor. When I started we had 4 Ethiopian doctors who all they needed to do is re-do their residency to practice in the U.S. I took their EKG class and got straight to work. Although I changed scenery, I still brought over my ego and arrogance that I had while still on the ambulance. This became eventually a tug-a-war between my self-righteousness (or foolishness) and the doctors who have been to medical school. Eventually one of the doctors pulled me out and had a candid discussion with me. He asked me why I felt the need to always be right? Why I felt the need to argue over small stuff? And why was I so confrontational? Long story short it came down to my pride, fear of being wrong, and wanting to again be THE best. The doctor then told me some words that I still remember to this day. "When you know what you are doing, you will learn to talk less". This struck me as odd because I thought if you knew something you should pass it on to everyone who will hear. He then told me and I am paraphrasing that when you know something, when it is fresh and new it is exciting and perhaps at times incomplete knowledge, but through experience and practice you learn to talk less, listen, learn,and just do what you are trained to do. This was the turning point for me as a burned out EMT. I had a couple other mentors who began to surround me shortly thereafter who began to teach me to be humble when it comes to medicine. That same Dr that spoke with me earlier began to question some of my field experiences. One of the things he always asked me was " so Will why do you think that was not a emergency?" I never could answer him completely. Even with the stubbed to scenario !! I took 2 years off of the ambulance to allow myself some time to re-focus, go back to school and get my paramedic licensure. During that time in school, I reflected alot about how I thought back when I was running with Medstar and realized the silliness of it all. how dangerous I could have been. And thankful for the teachers that helped me along the way, This entire experience has taught me a few valuable lessons that in closing I want to share with you. 1. Keep a firm grip on reality. 2. Keep pride in the form of confidence instead of arrogance 3. Stay Humble 4. Make the time for yourself, and your family. Vacation time is golden 5. Do not have so much pride that it disables you from speaking up. If you are wearing thin, SAY SOMETHING!!! There is always someone that has been there that will help you. 6. Do no harm!! This goes both for yourself and your patients alike. I cannot wait to join ya'll back in the field as now a new baby medic as soon as I heal from my injuries. If you feel anything I described on here. Feel free to message me and I will write you back and forth or try to find resources to help you. If you have been there and done that, please share your experiences. Again I hope this helps someone who is where I was, and that your not alone.

Their ( The hospital) rational was since they could not consciously sedate me, it would be better to put me completely under. Honestly I didn't complain because I was knocked out and didn't feel a thing when they did the closed reduction. I was just struck odd that the etomidate and versed didn't put me down.

I will say this you were right on the money with tri maleolar Fx. There was also a midshaft fibula Fx that was found later on x-ray. I was intrigued by you adding entonox to your treatment plan and it makes sense after reading up on it. Of course I will admit I was the patient. But I want to use this experience to learn all that can be done when encountered with this to help me once I get back on the rig. I am a baby medic I will admit.

Well if you run into a female paramedic named Jamie Dismuke. Tell her I said Hi and that I still think she is a paramedic bad azz!!!!

We have the technology to rebuild him, make him stronger

Whats your take on why it did not have the desired effect? Not enough drug perhaps? They gave me 60 mg and I am 96 kg. All I felt was tingling sensation all over my body and a Dr pulling on my dislocated ankle and me screaming lol. I can laugh about it now, not so much when it went down. They ending up RSI me in the end.

I think of it as a double edge sword. I spent 5 years as a EMT-B before pursuing EMT-P certification. Getting back to the testing mindset I found was difficult at first. I was able to pull from my experience which helped out a lot. The advantage of going straight through in my opinion is that you don't leave that testing mindset.

I wanted to break up the medical monotony with a simple trauma case. You respond to a local softball field for the report of a traumatic injury. The scene is safe. As you approach the patient you notice a crowd of people around the patient waving you in. Upon arrival at patient you find a 30 y/o/m lying supine with a off-duty firefighter/paramedic holding a obviously injured left ankle. Bystanders report that the patient was attempting to slide into second base when a "pop" was heard from the dugout and the patient was screaming in pain. Pertinent Info: -No loss of feeling in extremity -distal pulses are present -Vitals: BP: 102/60, HR: 120, RR: 30, SpO2: 98% RA, ETCO2: 28 -Pain level 10/10 -Allergies: PCN -Hx Hypothyroidism, OSA -Weight: 96 kg How would you care for this patient?

I wanted to throw this out there mainly due to personal experience. (very recent actually) Has anyone ever seen etomidate NOT work even when combined with 10 mg of versed?