J306

Oh and that's me kneeling down showing the rest of the class how to put on a tensor bandage haha

Welcome. I'm taking my ACP in Sk right now. I've heard good things about SAIT and PMA.

As mentioned before, without a proper seal, 02 connection, and an OPA or NPA, the rate you ventilate at should be of little concern. Until you get formal training as a first responder, EMR or EMT, you should be activating EMS, like any other lay person, instead of trying to perform procedures without the proper training to back it up.

Since the circumstances of this call make no sense to me right now, to be clear, your ACP partner went back to the ambulance, leaving the you, the lesser qualified practitioner to get the cric and IO kits before knowing that the patient was in cardiac arrest and before even assessing the need for a surgical airway or attempting an IV? This makes no sense.. This must be a hypothetical situation of some sort.

Thanks guys! I only have one tour left and I'm going to talk to my Practicum co-ordinator today about doing the second half of my practicum in the other placement. Great advice, I've already started trying to apply it.

Hey everybody, it's been a while since I've posted, so I just wanted to give a quick update on how my practicum is going and a few things I've learned along the way. I'm almost finished my 3rd tour of my ambulance time and have had a really positive experience! All of my hard work and critical thinking skills I've developed has paid off quickly. During my ER time, the nurses let me work along side them as if I were an RN myself and while porting one of my patients to the OR the anesthesiologist let me start a second line and intubate the patient. I began running calls start to finish my first day back on car and it felt much more natural being able to actually treat these patients acute symptoms instead of sitting on them. It feels great to be able to physically see the treatments you're providing work. One trend that I've noticed and that I wanted to get some insight on is the concept of identity politics, which is when providers try and use their titles as power and to put down others. If there's one thing that I absolutely do not agree with is the attitude that I have seen a lot of advanced providers adopt and project on providers of lower levels. We are all part of the same team working towards the same goals for the best of our patients. Attitudes aren't the greatest at the service I'm doing my practicum right now, and the politics are really bringing me down and effecting my overall experience. I'm trying to stay out of it and busy myself with chores, but the stress levels of the staff are really starting to wear off on me. This scares me, since this has never been an issue for me before. I've alway been able to stay motivated by the calls and by providing the best possible patient care. I was wondering if anyone had any tips on how to keep a clear mind and rise above the politics and negative attitudes. I figure as a student, I should be applying those skills early so while I'm in the field it will not be an issue.

This conversation reminds me of why it is difficult for our profession to advance. It does not matter whether your protocol says it's okay; it's all about what your intentions are, and I think you've realized that your intentions may be misdirected since you are getting defensive. This also reminds me of the medics I've heard about who try and find a reason to practice a skill, not for the benefit of the patient, but to try and boost their ego. I witnessed a paramedic use the new MFI protocol on a patient in the hospital who turned out to have decreased resps/ LOC because of ETOH. This kind of behaviour scares me. Even more so that you don't see a problem with the culture you and your co-workers have created.

Heard your radio beeping, time for a battery change! Are you going to make it for the First Responders Conference this weekend?

After putting in quite a bit of thought as to what I would refer to my "fanny pack" as, if I were required to wear one, would be hip satchel or hip pouch. The only pouches I've seen carried are the ones that the ACPs are required to carry containing their benzos and narcotics. The only equipment I carry on me as an ACP student are my drug cards, 1 inch medical tape, one 4x4 sterile bandage, alcohol swabs, extra pair of gloves, a pen and a penlight. I keep all these in the side pockets of my cargo pants. You shouldn't need much more than that I wouldn't think.

Reading this thread all I can think of is how terrible it would be to have to make the choice between seeking your own medical care and the needs of your family... That's just not right to me.. Lots of work in Canada!

Will be done the final scenario evaluations for Patient Management Integration and will be starting up practicum in a couple weeks! That is... if I don't score another 37% on a scenario for taking a blood pressure on scene and splinting a radius/ulna, and tib/fib # in the back of the unit... Got deducted marks for doing too much assessment and treatment.. Still confused about that.. I deemed it a load and go because of GCS 13 with neck pain and possible # pelvis, but vitals were stable and had no signs of cushings or unequal pupils..

Welcome back, and good on you for looking to finish up your Paramedic course in the next year! Been busy finishing up finals for the first semester of my Paramedic course and starting up my first practicum in January.

Got a response from the college yesterday. They said that the protocols are currently being revised to become less standard procedures and more so guidelines. Within the next couple months they will be introducing a protocol deviation clause, which allows providers more freedom when challeneged with special circumstances in the field. When I asked about the situation above, he said that since it was a relative contraindication that it was a cost/benefit situation and patient dependant, so we wouldn't get nailed to the cross for making an informed, intelligent decision given the situation and acting in the best interest of the patient. In conclusion, another grey area. I was relieved to learn that the college is making steps in the right direction and empowering the providers to make those tough decisions in the field without having to worry about loosing their licence for it.

Tried a few times but couldn't get that movie to play, have you tried playing it recently? Just trying to figure out if it's my computer that's the problem or whether they removed the film but kept the link. Disregard, it worked with firefox.

Welcome, it will be great to have you here! I'm thinking about working 6 months in SA upon graduation of my ACP program, so it will be interesting to read the posts from a SA EMS professional.

Absolutley, that was my interpretation as well. It is very frusterating how we are graded and judged on how we can twist or change the protocols to the "greatest benefit of the patient." I am all for doing what's best for the patient, but administering a drug which even has a chance of causing that patient more harm then good really makes me check where my values are.. I'll send the college an email and post the response to benefit other SK medics on this site.

Being a member of the city for only a year, I have read quite a few of your posts and feel your contributions are both valuable and thought provoking... I think the value of opinions coming from a seasoned medic far outweigh the newest buzz in prehospital care.. It has been extremely comforting knowing that there was a community that I belong to where I could go to and receive some of those hidden gems of information that you can't find in a textbook. My ears have yet to hear much of the knowledge you have to pass on even if it is the odd post here and there. Please take some time to yourself, take a break from the city, and regain that spark and passion that is still down there somewhere. Goodbye for now.

Sure did, even quoted it in my scenario, to which the response was that it was contraindicated in Pulmonary Edema not in AMI... Two intructors have now said that since it was under the Pulmonary Edema protocol it does not apply to the CP1 protocol... Interesting.. I'm still not convinced, but regardless, my thoughts are that we should be striving to "do no harm" so it all comes down to the greatest benefit to the patient.

So in cardiac scenarios today I was treating a patient for and acute MI with significant ST elevation in anterolateral leads with no relief of pain with rest of nitro. Gave him 3 mg Morphine SIVP and brought his pain from a 7/10 to a 4/10. This same instructor throws in that my patient has a 20 year history of asthma that he forgot to mention. Suddenly, the patient presents with a mild bronchospasm with audible wheezes. This increased his resp rate from 18-24 and drop his 02 sats from a 96 to a 92%... The question was asked whether I would now treat with Ventolin... I first said I would switch my patient from a nasal at 3lpm to an NRB at 15 lpm and see how my patient tolerated it and whether the histamine relased by the morphine would resolve in a few minutes...My main reasons for not giving ventolin to an AMI patient was because I wanted the heart to have to work as little as possible, and the beta 1 properties of ventolin would increase peripheral vascular resistance and increase heart rate, potentially causing more damage to the myocardial tissues. Thoughts? I'm still not sold on administering a drug with beta 1 agonist properties to a new onset, unresponsive to nitro, unstable chest pain.

Signed up.

My condolences Trevor, I truly wish I could make it in body, but prior commitments leave me only able to be present in spirit. Thoughts are with you and your family, -Jack

Thanks for all of the responses guys.. Kind of interesting, because I was scoulded by my Pharm teacher for saying I would administer Nitro to a Pulm Edema q 5 minutes while temporarly removing the CPAP mask.. Mobey, I wish that we had Nitro IV on car, during the scenario I said I would give my Nitro either as a nitro patch or through IV infusion to minimize interruptions, but of course it was the program head evaluating me, so of course, he wanted a clear answer as to whether I would take the mask off or not. After reading a few responses and doing some research, I think I just really have to change my thinking as to what is BEST for the patient, and if that ASA is what stops that ischemia from progressing to infarct, I can't stand here and say it would be the right thing to withold that treatment from the patient.

Sorry, duration can be up to 6 hours, peak effects 15-120 minutes and onset 5-30 minutes. Patient had perioral/peripheral cyanosis with R.R at 32 and 02 sats of 77%. I first started my patient on an NRB at 15lpm while auscaltating lung sounds which revealed wheezes in upper lobes with decreased to bases bilat, and no acoustic shadow or bloody sputum indicating mastocytoma/metastatic lung CA. Still quite possible though, the patient was 65 and a pack a day smoker. The patient didn't improve on 15lpm, and has history of COPD, home 02 x 5 years, I selected CPAP to try and increase the traction of the airways and decrease airway resistance by delivering 5mg ventolin through the CPAP nebulizer attachment. Another reason I went with with CPAP is because if my patient did end up crashing and needed to be intubated, from what I've seen it is very hard to ween COPD patients off of the vent once they've been tubed.

Yeah, I could see it being argued both ways; however, I've read that ASA has its peak effects in 6 hours which makes the immediate administration of it go down on my priority list when contrasted with removing CPAP and introducing an oral medication to a patient who is a minutes away from crashing without the CPAP.

Yes, absolutley would be cautious in administering nitro to a patient with inferior wall ishemia, I would have done a right sided 12-lead to get some additional views prior.. I did not give ASA because of the risk/benefit of removing the CPAP device. To be completely honest, I don't really know if it is common practice to temporarly remove the mask to give oral medications.