tcripp

100% of the time, my pedi's are restrained. We will attempt to get the car seat from the family that the child/infant is used to. On the off chance that that isn't possible, we carry a harness that adapts to our stretcher. Only 1 time have I taken an infant out of the car seat during transport and, while most likely not the brightest move, it was necessary at the time during an IFT of > 1.5 hours. Also, 100% of the time, family members are restrained as well. (Seat belted in the Captain's chair or on the bench in sight of the patient.)

No, we don't want to break the seal which is why I'm looking at alternative solutions. Now, as to dumping 3 rounds of NTG at the same time, you are the second person to mention this as an option. While we have SL NTG by both spray and tablet, we do not have the infusion on board. But, we don't have a "max 3" limitation for CHF. Question, when you've provided the 3 at once, have you ever had a problem with the BP tanking? Has anyone ever seen this as an issue?

I feel very fortunate to work for a service that I believe is as aggressive as it is.

Why, yes, they are

We have both in our protocols. We use both as long as BP > 90 mm Hg.

Our CHF/Pulmonary Edema treatment plan is CPAP, NTG, albuterol, Lasix, morphine, dopamine and/or zofran. So, question for those of you who have NTG and CPAP in your protocols. Any great ideas for administering the NTG once the CPAP mask is in place? Toni

And to think I was trying to be all PC and everything.

I was afraid my brief scenario wasn't complete enough. But, simply, I was looking to see how you would indicate the guy was fat. Please see my responses to your questions below - in red. Essentially, I'm looking to see how I could have written the description better to convey - fat dude / not a CHFer.

Had a patient who presented with shortness of breath. He was leaning back in a chair showing signs of anxiousness and said he couldn't catch his breath. BP was something like 130/90, and slightly tachycardic and tachypneic. Lung sounds included wheezing in the upper lobes and diminished in the lower, but the patient was a large man with significant adipose tissue. Pt treatment included oxygen, neb treatments and Solumedrol. Upon arrival at the hospital, his respirations, pulse, and ETCO2 were within normal limits although he continued to tell me that he couldn't catch his breath. Now, because of the elevated BP, description of the pedal edema and lung sounds, some suggest CHF might have also been indicated which would have suggested a different course of treatment. Not looking for validation of my treatment plan, but rather…how do you differentiate in your patient description the difference between what might be considered a fluid shift (pedal edema) vs obesity/simply fat ankles? I'm wanting to find a better way to present my patient in writing to get a more clear picture of what I saw. Toni (edited for formatting only)

I don't work FOR A/TC EMS but have worked WITH them as a first responder...have a little insight, but not much. Might be more than nothing. Go to the http://www.ci.austin.../hr/default.htm for details on the upcoming hiring processes and to submit an application. You should also be able to find information on pay, benefits, etc. Austin runs hybrid shifts which, for the most part is 12/12/24. For the busier stations, you will work either a double AM shift or a double PM shift, and then one 24 at a slower station. Austin has bi-annual bid process for shifts/stations and it's usually tenure that gets the good shifts/stations. There are two more hiring processes this year that you would still be eligible for. Otherwise, I'd almost think you wouldn't see another until the first of next year. But...that is simply speculation. As a side note...I did my practicum here and had a blast! Holler if you have more specific questions. If I don't know the answers...I can make it up.

Giggle, I would love to say that EVERY shift I spend time studying, but that would be a bit of a stretch. But, what I can say is this. We have several opportunities each month for continuing education credits as we are given CE classes in addition to a county paid online CE bank. I take full advantage of those items. The one thing I can say I do is research when I come across a patient or a drug or a situation that I didn't fully understand. (Picked up a patient the other day who presented with general weakness / looked like crap / but vital signs were stable with the exception of her blood sugar. Known diabetic who is compliant with her meds but also admits to not have eaten well for the previous 5 days. I would have expected her BGL to be tanked when, oddly, it was high. In researching her meds, at least 3 of them had an interaction which would increase the BGL. Never would have expected it.) I also will run the shifts calls by the incoming crew to get their insight on how they might have handled the call. My own call review if you will. I think by researching after each call helps to solidify my knowledge just a bit better. Just randomly studying info gets lost...for me.

And, see, I was leaning towards the myasthenia gravis.

Was ruling out some type of trauma (possible pinched nerve) which might have included, "well, if I hold my arm like this, the numbness spreads up to the elbow" or "I woke with a stiff neck as well".

No meds, but what about herbal supplements? Has her exercise increased as of late. What brought on the numbness in her fingers? Some type of injury or did she wake up that way? Does anything make it better/worse? Is it all fingers? Does it radiate anywhere? I'd like some detail on this piece of the puzzle.

First of all, congrats on the new degree. Where in Texas will you be looking for work? As stated, most places pay the AAS EMS degreed paramedic the same they pay the degreed basket weaver paramedic the same they pay the shake and bake paramedic. Ultimately, we all have the same skill/knowledge for the job. There are a few places out there who pay a small increase for the LP. I haven't found them yet. Where you will do well will be in your critical thinking skills and moving up the ladder. Maybe, someday, there will be the difference in pay. Toni

While you are waiting for responses, do a search on "interview" on all forums. There is quite a bit there that will get you started. You might then be able to ask more specific questions. We're here for you and wish you well...

I've been watching...and I've not seen anyone let the betadine dry yet. And, up until now, that included me.

I started the Paramedic program at the age of 43 (very soon after turning 44). I graduated the program at 45 that December. In March, I interviewed for a rural 911 service about 1.5+ hours from my home. I tested at the same level (both written, skills, and physical) as the 20 year old. I just celebrated my 1 year anniversary with them. I don't think age is the issue. As a matter of fact, I'm told often that they are glad to see some maturity and stability. Being "green", however, would have been a problem. Thank goodness for my experience as a basic prior to going to school. Toni

I have used both the blue alien looking ones and the Anne's - and I definitely prefer the latter. Just easier to use, in my opinion. As to the AED trainers, I've only used the Phillips, so I can't give you my opinion on that one. However, since you tell everyone that it's a sample of what could be out there, I think you are safe in using whichever fits your budget best.

When I say continued education vs. removal of a skill...I'm talking about this piece as well.

Can't speak to other programs but, in my own, we had several sessions in the OR over the 2 years where we "managed airways" on patients in a controlled environment. We weren't there to "tube", but rather to manage the airway which is ultimately what we should be doing in the field in the first place. For some, I used an LMA. For others, I orally intubated. And, there was even one where I did nothing more than bag the patient for the duration of his (20 min) surgery. What an opportunity to learn how best to work your own muscles during an extended period of time. In addition, I made sure that when it would be one that I wasn't "allowed" to intubate. for whatever reason, that I observed to see the issues and how to overcome them.

I agree with Anthony. I don't think the right answer is to yank the skill from everyone but rather to figure out a better way to get everyone better trained and have an ability to maintain that skill. That is where we are lacking. I find it interesting that, in some areas, we are willing to give an advanced skill to an EMT because we don't have enough paramedics around to do them and then, in others, we are willing to take away skills because the paramedic doesn't get to do them often enough to maintain that skill. After all the dust settles, what will be left for the paramedic?

I can see your side of the coin, but I can see the flip side as well...and that is for the more rural services. We have 4 units cover 950 square miles. We, fairly often, will see all units out at the same time. So, if our individual crews aren't trained on "everything", we could have a unit out with a patient who might not get the care he/she needs. And, even if all units aren't in service, it could take 1/2 hour for another unit to make scene.

Are you relating this statement to NYC paramedics or all paramedics in general? Do you envision a small pit crew of medics who can intubate? How would that work? You'd be on a call and have a need for intubation and so you'd call in that special crew? What if they were not in close proximity and you needed to get that airway established? What if they are on another call? Wouldn't it make more sense to determine that a skill is necessary and then train everyone?

That thought has crossed my mind as well. To go back and audit certain classes now that I have a better idea of what they were trying to teach in the first place.