PCP

Good evening to you all. Hope everybody is having a great weekend! I have a quick question which I know I could look up on Google but I would rather learn from the experts! I did attempt to locate the answer in my text but had no luck. I had a patient the other day who fractured his hip. During my secondary survey on the way to the hospital I checked both radials and I found one was VERY weak and the other side was Bounding. My initial thought was there might be a partial occlusion somewhere within the artery? I checked both Brachial arteries and they were both strong and regular. I am not sure but I am going to take a guess at this one. If there was a partial occlusion within the artery it would prevent blood flow distal to the occlusion causing the pulse to be weaker due to the decreased blood flow to the radial pulse. When I mentioned my findings to the nurse she checked and compared the pulses she came up with the same findings but could not explain why the difference between the two radial pulses. If there was an occlusion whithin the arm would it make it difficult to get a Blood pressure reading? Any Ideas? Brian

As a first aider I can administer ventoline by using a puffer which we carry on all three of our jump kits. We have a medical director and when I first started by boss paid for me to go over to Vancouver and take a 1 day course which gave me certification to administer ventoline via inhaler. We can alos administer other meds. as well through this 1 day course. Does your company have a medical director? Is there any courses where you live that you can take which give you the certification to administer certain medications as a first aider? When it comes to using another persons puffer I would probably not use it as it does not follow the 6 R of medication use ( if I was a first aider in town and I knew that an ambulance could be there within minutes.) When you are an hour and a bit from town sometimes you have to go outside of the lines and if that means using some other person's medication to help this person, than I guess I would possibly loose my license. I know that if we did not carry inhalers and someone was suffereing from Asthma and somebody offered their inhaler and I said " No" I am not allowed to use other peoples meds. and this person died! I could not look myself in the mirror knowing I could have done something to help but didn't because of some Rules and Regulations! I am a strong believer in helping people in need no matter what the outcome could mean for me! Brian

I feel that everybody can become a good paramedic no matter how they feel their experience in the class room was. One needs to want to learn and keep learning from reading and from listening to the long time paramedics. My instructor told me that it takes at least 5 years before you feel comfortable in being a paramedic. Not sure if that is true for everybody? I did very well in the practicle side of things but not so well in the book work so I still read my text books especially when I come across a patient that I feel is a complex case. I think it takes time applying what you have learned while in class when doing a street call and figuring out a diagnoses for the patient. This is because what you learned in the class room I feel is always the text book scenario where out on the street it is never a text book scenario with all the classic signs and symptoms. Not sure how long you have been working as a paramedic for? All I can say is trust your self when you make a decision and go with it, ask questions, and whe you get flustered step back and take a deep breath. You can always do what I do if I feel I have hit a road block. I told by one of my instructors that . " IF you are unsure of what is going on with the patient and feel like things are going down hill. D,A,B,C and take them to the Big Green H ". I have had to do that before as I have felt like I was not fully understanding what was wrong with my patient so I made sure that C-spine was taken care of, airway was clear, breathing was good, circulation was good any # had been taken care of and then loaded them up and topk them to the hopital where they have alot more tools in their took kit. I am sure you will do fine and as I stated I feel that anybody can be a good paramedic no matter what their class room experience was like. All they have to do is want to learn and have passion for the job! All the best to you! Brian

I run every call as if it was an " Emergency " I might not think it is an emergency but the person who called does. Yes, I will explain to them if they ask about getting in to see a Dr. faster because they called for an ambulance. I tell them " No" everybody who comes into the ER gets triaged even the patient's that come by ambulance so they may have to wait a while to see a Dr. depending on their complaint. I feel that getting mad is not going to help the situation and explaining to them that we are not a taxi does not go very far besides maybe a 1104 or a 1105 depending on if the patient complains to the Unit Chief about me or my partner telling them that we are not a taxi service. I know we all want to do nothing but exciting calls but we all no that is not how it works. So I do my best to have fun, treat my patient, and not worry about if I feel that the patient should have called for a taxi or for an ambulance. Brian

I work with a lady who lives half an hour from the North end of town where the Kilo car is located. It takes her half hour to arrive at the station or just over. Not a big deal as it is our transfer car!

DFIB I will answer those questions when I get back on Friday. I am sure someone will answer the questions by then but I am looking forward to researching some of those questions as I don't have a clue what some of the answers would be! Brian

Yes my partner checked the pedal pulses but did not mention to me what her findings where. I probably could have asked but I was busy getting information about medications and some more history from the care aid at the time.

No worries Dwayne, I am done my last night shift at the mine site and now I am off for home to be a dad for four days. If I get time between diapers I will check back in and if not I will not be back on the site when I am back at work on Friday! Have a great week everybody!

Yes I agree I am not the best speller and I do need to work on my spelling. I don't take your comment about spelling personal just as a reminder to double check my spelling before posting. Thank you

Okay Dwayne here I go! I am going to take a shot at this first of all without using " google" . question #1 The two systems I was talking about are the " Circulatory system" and the " Gastrointestinal system" question #2 If it is a AAA we would be talking about the " decending Aorta". The vessel runs from the " Left Ventricle down through the abdomen and at the groin area it splits into two and feeds the left and right leg. question #3 I am not sure about this question? If I can remember right the Aorta is attached to the Left Ventricle and with each contraction the " Mitral valve " opens and allows the blood to enter the " Aorta" which then goes up into the " Aortic Arch" and into the " Decending Aorta". Not sure if that was the answer you wanted? No worries Dwayne I understand that you are not attempting to make me feel foolish but to make me think! Brian Not 100% sure on this question but I will give it a shot! Weakened femoral pulses is due to the AAA bursting and the patient having internal bleeding which will cause the body to shunt the blood to the vital organs making the pulses below where the AAA has occured weaker?

Kilo shifts are mostly in the remote stations and I believe the Kilo shifts started when most of the people that worked in the remote stations lived in town so they could carry the pager while at home or doing their regular business. Now any new hire usually starts in a remote station that requires them to travel. I agree and most of us in BCAS agree that we should be paid a regular wage while at the station as well as if you are carrying a pager it should be more than 2 bucks an hour!

Had a patient the other night that had mass located in the center of her abdomen and when she would sit up the mass would protrude outward but when lying down the mass would go away? Vitals signs stable besides the BP which was 220/72 and clammy skin which I figured was due to the high BP. No other complaints besides the mass in her abdomen. My parnter mentioned she thought she could possibly feel a pulsating mass on palpation but was not 100% sure. My partner and I thought possible tripple AAA or Hurnia? No 12 lead capability just BLS level Any thoughts on what may have been causing the mass in the abdomen and high blood pressure?

We only have one car that is 2 bucks an hour while on pager and that is our transfer car which runs from 05:30 to 17:30 but of course you could always work longer depending on how transfers need to be done that day or after a transfer is done we can be used for any calls that may come into dispatch. The rest of the cars we have are full time cars or the Fox shift at just under 12 bucks an hour while at the station. If you want to put your tent up in front of the condo building where I live and can get away with it sure. Maybe by the time you make it to the Island my condo will have sold and I have a house. Just put the condo up for sale a month ago due to my wife and I expecting child number 3 in December. I am always up for fish and dungeoness if that is what you have to offer.

Good point Dwayne. How would we go about picking someone for student of the quarter, or semester? By the number of posts and how strong the posts are?

Welcome to the City! No need for a thrashing. Hemothorax is the accumulation of blood in the pleural space due to internal hemorrhage which is associated with rib fractures as well as laceration of the intercostal arteries, pulmonary arteries, great vessels, or the internal mammary arteries. A Pericardial Tamponade is when there is excess fluid that accumulates inside the pericardium. When this happens the excess fluid causes an increase in intrapericardial pressure that impairs diastolic filling and decreases the amount of blood the ventricles can expel with each contraction. If anybody can explain it better please do so. Brian

Well you are on your way as I see you have made 8 posts now! It takes time getting comfortable posting questions or comments due to not wanting to say something dumb! Well I am over that now as I do say dumb things at times or might not post the best question or post something about how my day went that may not be interesting to others. I find it is very helpful after doing call that you are unsure of to post a brief discription on the site and read the comments to see if there was something you may have missed on your assessment or treatment. It helps me learn and hopefully make me a better Paramedic. Don't be shy and jump in with both feet! Welcome!

Welcome to the City Stephanie. You have joined the right forum if you are looking to make some friends. I am still working on making friends but hell I have been working on that now for 35 years! All the forums on this site are good to post in it just depends on what question you have or what discussion you want to join. Browse the forum read the posts and Jump in to any discussion that you find interesting. Post a question and you will get an answer might not the answer you are looking for but you will get an answer from somebody! Welcome!! Brian

Welcome to the City! It is a great place to ask questions, vent, or just talk with other medics about every day life! Brian

tniuqs how would that work having an EMT Student of the Year award? I am all for it if we could figure out a way of making it work.

Paramedic but not ALS so I guess I would be considered an EMT-I in the United States? Sorry I know we have gone over this a million times but still not sure what level a EMT-B, EMT-I, can practice at. If I have it correct an: EMT-B is equal to what we call a " Emergency Medical Responder " in British Columbia EMT-I is equal to " Primary Care Paramedic " here in British Columbia EMT-P is equal to " Advance Life Support " here in British Columbia It sounds like now we are getting new jackets that insted of saying " Paramedic" on the back they are going to say " British Columbua Ambulance Service" on the back and on the front left corner of the coat is going to say "BCAS" Not sure why this is happening but I guess it doesn't matter too much as everybody from a driveronly to" ALS" paramedics all have the same jacket that says " Paramedic" on the back even if they are a driver only and just have their OFA level three. Which is very rare I just know of two people that work at a station that are driver's only but wear a jacket that say Paramedic on the back. I am pretty sure though that has or is going to change as Now to join the Ambulance service you have to be licensed as a "EMR" I think they should maybe say what level you are on the back of the coat for example Mine would say " Primary Care Paramedic" others would say Emergency Medical Responder or Advance Life Support Paramedic" on the back. That way the public, first responders, and other paramedics in the service can identify what level of care you can give to the patient. Just a thought