Dustdevil

Hehe... I would normally agree. I didn't want to get too carried away though, because really, his advice would have been right on the money had Emmy been American.

Okay, I didn't want to poop your party, but now that you've had a couple of days to bask in the afterglow, it's time to get down to business. What did your cursory look tell you this rhythm was? What was your working rhythm interpretation at the time you decided to give lidocaine? By "cursory look," do you mean you gave the rhythm itself a cursory look, or that you gave the machine's printed interpretation a cursory look? I mean, if you actually looked at the rhythm itself well enough to determine infarct, then you couldn't possibly have missed the block. The first rhythm out of fib was clearly a block, so it did not suddenly develop at the time of the 12 lead. I'm thinking you got real lucky on this one. Your cursory look, reliance on a machine interpretation, and getting locked into the v-fib cookbook tunnel vision could have resulted in fatal consequences for your patient. But all's well that ends well. And plus 10 for fessing up before somebody called you on it, so all in all, you break even. :wink:

And can you tell her what to do with that information once they give it to her? Exactly how does she interpret these statistics to come to an intelligent conclusion? (I know the answer. I'm just seeing if you do. :wink: )

Yes, you are going to get heat and a 10 point deduction for failing to read the previous posts, including the original post. No, it is NOT the truth, because she is not in the U.S. Therefore, nothing you just said has any relevancy whatsoever to her. But thanks for playing.

It appears to me that this is exactly what you have done. You listened to some guys at a conference and decided that their word was gospel. Who were they? What were their names? What was their background? Do they have any connection to Dr. Clawson and the EMD bureaucracy? Did they cite references for their statistics? Are they published? Are they scientifically valid? Are they peer reviewed and verified? Did you bother to ask them any of these questions? If not, don't you think you are being more than a little hypocritical with your advice?

Problems. First, those studies are all done by people with a vested interest in the perpetuation of EMD. Second, they establish no objective criteria for defining "reliable." Third, there are no studies at all showing any correlation between EMD and a reduction in mortality or morbidity. EMD is a "standard" simply because Rescue 911 embedded it into the popular culture on television. Ever notice who the medical advisor to Rescue 911 was? Yep... the man who invented and profits most from EMD. Sorry, Bro. You're going to have to give me more than scientifically unsubstantiated hype before you can float that turd. My belief is that EMD belongs in the same scrap heap as MAST, bretylium, and CISD.

Congrats, Fizzy! Definitely an interesting and educational case. This guy was certainly having "the big one," and is very lucky to have survived it. The shock woke up both pacemakers and brought out a CHB, but it appears that it quickly lost the SA node again and went strictly junctional for awhile before the Ps eventually kicked back in. I'm not sure they ever synchronised though, as it doesn't appear so in that final 12 lead. I wish you had a rhythm strip from that time frame where we could better determine the underlying rhythm. As tempting as it might be, post v-fib, I don't believe that I would have gone with lidocaine, based on what I see there. Considering the profound ischemia and infarct that is obvious, both nodes are likely to crap out on you under the influence of lidocaine. Lidocaine and heart blocks are not good bedfellows. It doesn't appear that your patient is any worse off for it though. You'll get to a point to where that "cursory look" is all you need to accurately read a rhythm. EKGs are like a language. And the more you practise, the more fluent you get, until the day comes that you identify the words (rhythms) on sight, without having to actually sound them out letter by letter. A world of stress disappears from your shoulders the day that happens!

It took you a week to look all that up?

Hmmm.... Phil makes an excellent, and often overlooked point. But I am not sure exactly how I feel about it. There is no doubt at all that the maturity and understanding that comes with life experience is an extremely important factor in your ultimate competency as a medic. Half the battle is being able to understand your patient and what he is experiencing, and that is only theoretical until you have lived a little. On the other hand, your ability to learn and absorb didactic education is at its peak right after high school. The pump is primed, so to speak. If you lose that momentum by taking time off, it makes things more difficult for you down the line. Although the more mature medic student may have an easier time translating the theoretical into practice, the younger student potentially has an easier time grasping the theoretical to begin with. And, considering the time it takes to to complete that education in the first place, you already have four more years of life under your belt by the time you have your degree. And I don't see a problem with getting the rest of your life experience while you work your chosen profession instead of waiting. Yes, you will definitely get better with experience and maturity. However, I don't think that makes you inadequate to begin with. Of course, that isn't the only point that Phil was trying to make. The other half of that argument is that youth is arguably not the ideal time to be making career choices. As I attempted to say in my original reply, this all seems quite exciting and rewarding to the outsider at any age, but especially to a young person full of idealism, adrenaline, and... well, you know. But the reality is that it is only exciting while it is new. Then it becomes just as routine, mundane, and non-rewarding as any other job after a few years. At that point, many of us start wishing we had chosen other career paths whose rewards are greater and longer lasting. Especially once a family enters your life and responsibilities. I think my main point is, as I tried to state before, to totally eliminate the temporary excitement, rewards, and "cool factor" of EMS from your decision making process before you choose to study it. Take only what is left -- the hours, the pay, the flexibility, the stress, the risks, the average career length, and the number of available opportunities (how many jobs and employers are there for medics in England, and how many people are competing for them?) -- and decide if that is what you want for yourself and your future family the next thirty years. And anybody who sits here and blows smoke up your arse with comments like "don't listen to the burn-outs" hasn't been in the profession long enough to offer you an honest, total assessment, which is exactly what you asked for. I won't try to discourage you from EMS, because indeed, it can be a great career. But I like to see people come in with a realistic understanding of what it is all about, long term. That prevents serious burn-out. And the fewer burn-outs I have to work with in the future, the better. Good luck!

Multiple studies prove that it does greatly increase the potential for medical mistakes. This is not a scientifically debatable point, no matter how good you think you are. Yes, you should. Because you are not making more than the 48 to 60 hour guy who work's 12 hour shifts, has predictable, regular days off (including three in a row every week), and never has to work when he should be sleeping. He's getting everything you get and more. He's getting a better deal, and more importantly, so is the patient. And that 12 hour guy is more likely to stick it out for 25 years and retire than you are too. Yes, you should smarten up. But your employer hopes you won't.

You wash your ambulance in the nude? :shock:

I do get the gist, and I respect where you are coming from. But I think your math is all wrong on this one. How many runs you make a year has nothing to do with working 24 hour shifts. A man who works 8 or 12 hour shifts, but with the same number of hours per week as you, can run just as many calls as you without having to compromise his physical and mental health, as well as being more alert and prepared to deal with his patients in a more quality assured manner. Staying up all night long without any sleep doesn't make you a better medic, nor does it make you any busier than the next medic. It just means that your employer is knowingly, intentionally, and willingly wearing your arse out so that you won't be able to stay with him long enough to collect retirement. That makes you the sucker for bending over and taking it. I didn't mean for that to sound harsh either, but we've all been that sucker.

This has always been around, albeit by a different name. We always just call it "the guy on light duty." The guy with the bad back or the chick who is 8 months pregnant drives around and dispenses this stuff to the units that need it. Has always worked fine for us. And you have a useful place to put light duty people who you are already paying anyhow. If you are a big enough agency to need something like this, you have people on light duty or otherwise assigned to take care of this. If you are a smaller agency, you simply don't need it and/or can't afford it. This whole machine thing just fills a need that doesn't even exist.

I hpoe y'all all read to the end of the article! I hadn't heard that one about Desi Arnez! I sure remember all the Cuba hijackings though. Seemed like one everyday there for awhile. Those idiots ruined it for everybody. I miss the days when you could still pack heat on a plane.

I do too! That's why I am seriously questioning either your reading comprehension or your reasoning abilities. Obviously, one of them is faulty.

Then why are you still there?

I do. What's the point of getting stuck with an EMT for a partner if you can't make her carry all your crap for you?

Give her a break, guys. And remember, she's in the UK, so let's not overwhelm her with all the negatives from the US system. It's a respectable career that you can actually make a decent living at in the UK, Em. Sure, there are better jobs out there. Better in every single respect. And all the things that make EMS seem attractive in the beginning wear thin on you in just a few short years. What was once excitement becomes stress. And all the "caring" you once had fades into mere "toleration" after being abused for so long. Then it's just another job that you do because it is all you are educated to do. Not really any other jobs you can move to with a Paramedic Science degree once you are burned out with a bad back. And there is also a down side. Can you tell us what aspects of the job are especially attractive to you? It would be helpful to address those in depth for you and make sure we don't miss any. Plus 5 for asking these questions early. Too many people wait until they are halfway through school before bothering to find out what things are really like.

I don't know. But I do know that everytime that happened, I wished I hadn't wasted my time and energy carrying all that equipment with me.

Plus 5 to that school for actually having some requirement for prerequisite knowledge. Although, I still strongly maintain that any school that does not absolutely require two semesters of college A&P and Microbiology probably sucks. And yes, other medics will quickly be able to tell that you didn't have those courses when you get out to the field and start working with them. It's painfully obvious. Back to your question, what do you mean by "basic stuff?" Do you mean stuff you would have learned in HS biology, or just stuff you think every human knows from being human?

A couple dozen firefighters a year go to their graves thinking that very same thing. :roll: And are those guys REALLY grilling burgers indoors? :?

Ha! Well, if they are talking about SEMESTER hours, they *might* be getting close to what is needed. But I doubt it. :roll:

I think you are being a little hypersensitive. It did not appear to me that he was impugning all EMS providers of an entire state. You have to really, really, really stretch it to say that, dude And speaking of professionalism, it's not very professional to make broad-sweeping assumptions either.

The best book is the one with the fewest pictures of firemonkeys in it. 8)

Let me guess... the guys at the company you supposedly "work" for told you that, right? Because otherwise, I'd be real interested in how you, as an EMT student without experience, came to this conclusion. Ummm... if it is the same education, they why is one a joke? Clue: Any "education" that takes place in phases -- like the one you are describing -- is a joke. And so is any company that would hire somebody who hasn't even finished EMT school.