FireEMT2009

Hey guys, After working with patients for a while now I have a question. I have noticed that some people have blatent EJ veins but some of the patients that I have thought about attempting the EJ, I have had issues trying to locate and find it even though I know where it should sit anatomically. Does anyone have any tips to find an EJ for the non-obvious EJ patients? Thanks in advance, FireEMT2009

In VA, you must have a NREMT-P certification to receive your initial reciprocity to get your certification. Once you have the state cert, you can let your NREMT-P lapse, it is not required for recert in VA. Your state license will last 3 years, but the CE hours are the same hours, NREMT to VA, so there is really no reason to let your NREMT lapse. There is no Virginia EMT-P exam, you must have NREMT to become a paramedic. The state now has started requiring ALL levels of EMS to obtain their NREMT certification in order to become an EMT in VA. This is a new standard that was put in place this year.

He has never had this type of pain before. It says it does radiate a little on each side, but is substernal. He said it feels like a strong pressure and that he can't breathe. He describes the pain as a 8/10 He hasn't done anything he called as soon as it started really hurting, He said it started a couple of days ago, but has gotten worse over the time period. He had a gravy biscuit for breakfast (It's now 11:30.) His father had one heart attack. 12 lead reveals no ST elevation/depression or T wave depression, Posterior and Right sided are performed with the same result. Lung sounds are clear, heart sounds are noted with S1 and S2 with no gallop or murmurs. No JVD. He states that he has had heartburn before, but this is not heartburn, this is presenting differently. What else would you like to do for assessment? You have IV access with blood drawn (if per your protocols), 12 lead performed without ST or T wave depression or elevation. Vitals remain stable throughout the orthostatics. VItals are as follows: B/P= 182/110 HR= 120, SpO2= 98 RA, ETCO2= 40. No contraindications to ASA or NTG. Both given without any relief, but now he has a headache. What do you want to do next now that your transporting? Quite possibly, continue assessing. As listed above, 12 leads show no abnormalities. You have administered Morphine and the patient states that his pain has decreased from an 8/10 to a 6/10. What's next?

Well, I have been looking into furthering my education, and I understand that some of the stuff we do as Paramedics, mimics what an RT does. And not to mention, the airway/respiratory/circulation system has always amazed me and I would like to continue my knowledge. My question to ya'll is, would my experience as a Paramedic assist me in RT school? and what ya'lls opinion on transferring from NREMT-P to RRT? Thanks for any opinions, FireEMT2009

Dispatch: Caller states that his father is experiencing chest pain. You arrive to find a 30 year old male meeting you at the door saying his father is having terrible chest pain please hurry! Your patient is a 54 year old male patient. You find your patient sitting in his recliner holding his chest, the patient appears anxious. He says he has never had this chest pain before but needs you do something, he thinks he is having a heart attack. Who's on first?

Medicgirl, looking at your original posting compared to your posting just now about your patient being extremely bradycardic, why did you not start TCP? What where the vitals prior to coding? Looking at a pulse of 30ish, that is showing poor cardiac output. Why not place them on the TCP while you were working on the line? In this patient, since they were unresponsive and critical, why did you not start an IO? Not trying to armchair quarterback here, just trying to follow your rationale and train of thought. What were the patient's pupils? How was the patient's blood pressure and Respiration rate prior to coding? Because a mix of hypertension, irregular respirations, and bradycardia would show me an increased ICP. I have seen hepatic encephalopathy before, but not in this severe of a case.

For me, I always try to see if you can see the chest rise and fall, and yes some patients might not have a very noticable chest rise and fall, or they might have some very thick/multi-layer clothing on. If you are sitting on the captain's chair or bench seat you can see respirations looking at the clavicle area, you should see some movement. Also, look at the stomach, some patient's stomach will rise and fall with their breathing. Just suggestions.

Hey guys, I started a new post on this forum to ask about two books I am interested in buying. They are both to help me build on my 12 lead interpretation skills beyond identifying ST elevation and RBBB and LBBB. and Right and left sided deviation. As some of you know I am a new paramedic and 12 leads are my real weakness right now. So here are the two books I am looking at getting: Rapid Interpretation of EKGs by Dale Dubin and The Only EKG Book You Will Ever Need? By Malcom Thaler Pros to Each? Cons to Each? Do they Complement each other well? Additional information and opinions on them. I plan on buying both but am looking for which one I should by first. Thanks FireEMT2009

I started my first week as a paramedic this week. I had to begin precepting to be released to practice. In my agency they place us on a three person medic truck with one BLS provider and one other medic of the same (or higher) FTO with you. Here is my issue: I know what I need to do and I know what to do but my brain seems to vapor lock shut and doesn't allow me to able to think, proccess and act as the medic I know I am and can be. I am pushing to get better but am being told to lead my team including my FTO on calls. I just can't seem to beat back my low confidence and the disconnect between my head and my hands and do and act as I need to. I seem to bumble around and act almost incompetent and I just become more and more aggrivated at my self and I am just completely frustrated to the point of not knowing where to turn. So I am looking for advice for someone to help a new medic work especially when you have a FTO watching every move you make questioning you at all times. Any advice or opinions are greatly appreciated. FireEMT2009

Hello, all sorry haven't been on here in a while. I actually am I new Paramedic myself. I just made the long transition from B to P. My bachelors program skipped Intermediate completely to better give us the patho and rationale critical thinking base we needed for our careers. Anyway, I completely agree with everything being said. I have never been an intermediate nor plan on giving up my paramedic anytime soon that is why I posed this question. I have talked to people that have made the transition through all three and they have stated that it was a lot more pathophys and critical thinking than intermediate was. I posted this to see as what ya'll felt about it. I feel the field is changing in a lot of ways. We now have active lobbying going on in captial hill with "EMS on the Hill" as well as acceptance as a medical profession. I am just looking for good opinions. And Beiber as I said I converted straight from Basic to Paramedic so I never got to experience the joys of an Intermediate class.

Hello all, I would like ya'lls advice on something that I have found to be somewhat immature and more of an ego thing then anything else, but yet it does annoy me. Here it is: In my region there are intermediates and paramedics working throughout. In our protocols here there is not any differences between the two levels in range of skills. There are a couple drug differences where the P's do not have to call for the orders where an I would have to. The big debate with some people is the fact that an intermediate should not be considered a "medic" since they do not have a paramedic certification. In my opinion I do not believe that to be the case. They can intubate, push all the drugs in the drug box, etc. What do ya'll think? do ya'll think that their should be noted differences between the two? Just curious, FireEMT2009

In my limited spectrum of knowledge here I only have a few things that I do in my narrative that made it through my paramedic program and was never asked for clarification. You have a great meat and potatoes now just add some gravy and sides and you will be good to go. The rules I follow are: I never use abbreviations, every career has different terms for different abbreviations, so I follow the cop rule, abbreviate nothing. When I say my patient is alert and oriented times 3, I always put to what they were oriented to such as: Patient is alert and oriented to person, place, and time, but could not identify what event had taken place. That way its there in case it ever gets called to court. I always try to include my SAMPLE, OPQRST at the bottom of my narrative for emergent and non-emergent if possible. So it looks like this: Narrative S A M P L E O P Q R S T Name, EMT-B/I/P That way if it ever shows up in court, you have your Objective and Subjective assessment in there. I always make sure that whoever I recieve or give report from, I always include where I left the patient, who was in the room and what relation/ level of care provider they are, RN, MD, DO, wife, mother, husband, etc. I document all names whether it seems insignificant or not it might be useful later. I also will note whoever gives medication, the amount (1 half tube of oral glucose, 1 tube of oral glucose, etc. that way there is no confusion later. Also, especially while precepting for your medic ask to see your preceptors way of narratives and pick up good points and learn to mix them into yours. On every patient I will always give my ABCs such as: Patient was found sitting in the chair, Patient is alert and oriented to person, place, time, and event. Patient's airway is open and patent without intervention. Patient's breathing and circulation are life sustaining without intervention. Patient is breathing 16 times per minute, equal and bilateral chest movement noted, lung sounds clear. Patient is not experiencing any labored or difficulty breathing or showing any signs of respiratory distress or failure. Patient's pulse is 76 strong, regular, radially. Patient's skin is warm and pink with nothing remarkable. etc. Just my two cents.

Yea that is one of the big pluses that I was thinking of when I had the theory hit me, especially when you get someone bagging with a critical patient that gets caught up in the action taking place or gets anxious and looses rhythm and rate of his ventilations. Anything else you would like to add Kiwi?

I have been thinking about the usage of transport ventilators in 911 response. Not just for the normal vent patients but for patients that are intubated in the field, using them to free up manpower to help with critical patients instead of keeping someone constantly bagging the patient. (Of course this would fall under the proper traning for usage, maintanence, pathophys, etc.) My theory is that it might help free an extra set of hands in the back of a truck and allow the ALS provider to use his BLS/ALS partner in another part of patient care while the ventilator does the ventilations, while under constant capnography, SpO2, etc. monitoring to ensure effectiveness of ventilations. I am just curious on what ya'll's thinking is on this topic. All opinions and advice are welcome. I am excited to see where this thread will lead and what new ideas, or education will come out of it. FireEMT2009

Thanks!

Hey everyone, Sorry for the delay I have been busy at work. I passed all of my practicals first time round an am an "unofficial" paramedic. It's not official until the National Registry gets the paperwork. Either way I'm glad its over with. FireEMT2009

Thanks for the advice. I am definately more relaxed now that the written is done. I know the practicals in my sleep it is just getting the written out of my way so I can have my confidence a little higher for my final stage.

Dwayne, I took it today first thing this morning. It cut off at 80 and I knew as soon as it cut off that I had failed it completely. The only thing that gave me hope was that I had the last question right. After a mind numbing 7 and a half hours they finally released the test results and I had passed. So now the only thing left to do is take my practical on Saturday. Thanks for all support it is much appreciated. I will search prior to posting next time to verify no duplicate posts. FireEMT2009

Will do Dwayne. Thanks. And yeah I have seen and heard on many occasions that this subject had been beaten more than a dead horse in the desert. I thought maybe someone might have some different tips, never hurts to try but does get annoying after seeing it over and over and over again.

It's offical, I take my NREMT-P written test this Thursday and my practicals this Saturday. Any tips for a student who has never taken the NREMT exams before? Any test taking pointers? Thanks for all the continued sharing of knowledge and support. I have learned alot over my short time being here.

Yea we had to write oral station scenarios for my test prep class for NREMT-P and I wrote the one I gave on here. I hope yall thought it was as interesting as I thought it was. I had a lot of aggrevated medic students trying to figure it out.

Southeast USA. You ask the patient and he says that he has not been bitten or noticed any difference in his bodily appearance, such as a rash. Family history- HTN appearance and older age and some history of diabetes. Thats it. Glad I have intrigued so many of you. House stays spotless cleaned once a week but the cleaner makes sure that adequate ventilation is being used at all times during the cleaning process to filter out the fumes and she cleans up all residues. I have the answer to this, but am not ready to give it just yet. I would like to see what else is coming down the pipes. Normal nasal and mucous membranes. No track marks noted. No recent work done. The mother always wants her house clean so she has someone come in and clean it for her. No petechiae. Sorry. Does sound like it but not giving any clues just yet. I inserted my foot in my mouth. He did have abnormal lab values. His T3 and T4 are elevated. I apologize for the mistake.

BGL is 103mg/dl No past medical history. Except for area soccer games none. He has a upper respiratory tract infection that is being treated with the medications from the previous posts bbut other than that thats all the medical history he has. He plays soccer and is in great physical condition.