AnthonyM83

I appreciated its reflective quality (given to it by the song).

I just now saw your reply. I find it almost criminal to have a patient in VFib and not work it. If I was the patient, I would surely come back to haunt you. If you were working one of my family members, I would surely knock you out (no offense) and defibrillate him. As was said, there could be underlying medical conditions. Or a rare commotio cordis. As a side note on penetrating trauma arrests, they have the best survival chances in ERs due to potential for correctable causes. And you won't be able to determine all those in the field (such as pericardial tamponade).

Well, I posted my comment on what I thought on the site. Good song...but the video seemed "all about him"

realpolice.net

Guys, he posted valid information for what he thought I was asking. He misunderstood, admitted it, and that was that. Doczilla must have missed that post, so I'd probably take that into account when replying back to him. Self-resolve it based on realizing the TWO misunderstandings from each side.

I don't know if this would fit with your learning style, but if you're the kind of person who gets a visual image of the page the protocols are written on when you recall them, you might try printing them out in different color inks or at least different color paper. When you're recalling what to do for a situation, you still need to recall the protocol, but it'll be a memory aid in remembering which county it's for.

I have a good amount of articles, but starting to write now, so thought I'd bump this just to see if anything new pops up: I'm researching atypical myocardial infarctions for a presentation. Just wanted to drop by and see if anyone had noteworthy resources or source recommendations. I'd like to include diabetics, females, young patients, non-STEMI, the very old, and other conditions which might mask the typical crushing chest pain radiating to left arm/jaw with ST elevation. The goal would be to educate and help medics in decision-making when deciding if patients should be transported ALS or BLS level (in systems where both automatically respond to the scene). My main source is pubmed and my textbook, but any specific articles or sources that stand out would be helpful.

On the original, I had a good flash. I was able to aspirate blood when setting up the flash. When, I actually taped it down and then tried to get blood, it wouldn't go...so I was thinking positional? Either way, I asked for help (thinking he could help me reposition). The nurse decided it was a good line, though, just couldn't draw blood. Said to leave in place. After he drew blood from hand (2nd site), he did noticed the AC had a bubble. He went to start a new line, though, rather than taking it out. At this point he was running the show. I was in the doorway just watching as he started on the 2nd one, then left (I had seen my attempt as a fail and was going to let him just do it). But like you said the line had my name on it, so I should have just gloved up again and taken it out anyway.

For any techs and nurses out there, I was wondering how bad it is for a patient to receive iodine into an infiltrated IV. Had a crappy event last night during clinicals. Not my fault, but linked to me. IV start was ordered. I poked, but couldn't draw blood. Asked the RN to for help guiding it in. He couldn't, but said it was fine to leave it, and we would draw blood from a different site. I told him she was getting a CT, though, and was getting contract. He said it was fine. The contrast would still go in. I asked "Even though we can't get blood out?" He said yes, as he started on a different site on hand for blood. It still seemed off to me, so asked again, "So, you're SURE the contrast will go in fine, EVEN THOUGH we can't get blood out? Shouldn't we be able to draw blood if it's patent?" Again, he said it would work for fluids in, not fluids out. (It was in left AC). At this point, he's taken over, I'm just handing him needles and wipes. He does blood draw on hand. After, he sees a big bubble at site of first IV and says similar to "Oh, look. Yeah, gotta do another one" and gets to work on right forearm (not quite AC...was told it needed to be actual AC for CT scan?). He's still doing it, and I walk out and go about my other stuff. Awhile later, a nurse asks me if I started the IV in that room. She says they took her to CT, the pushed contrast, and now has huuuge infiltration. Then apparently, nurse put the a cold pack instead of warm pack when he discovered it, which made it worse(?) Anyway, bottom line, I'm worried on this coming back to me. Even if it's not found my fault (nurse didn't want me to remove the IV when I was in room, he noticed it infiltrated, then took over and I left, then patency of line wasn't checked before injecting contrast, and apparent wrong tx for it when discovered), the story is still going to be "yeah, medic student started a bad line and it got infiltrated with iodine" to staff and next oncoming shifts. Heard people talking about it, too...yet no one officially approached me (maybe b/c night shift and no supervisors on the floor?) So, just venting. And also wondering how much chance for necrosis there is. Will body just absorb it?

Damn, Doc. I almost did my paper study on this...until I realized I could educate more LA medics on non-traditional AMI's. I had all my research on the first topic done, too. I'll read it when I'm sober and get back to you.

Which drugs send the blood around faster, though? The blood's already hardly circulating...perfect CPR only gives 1/3 of cardiac output.

Hate to be the smart ass . . . but even if it's V-Fib? Is it due to higher chances of pediatrics getting ROSC? Or why the differentiation?

Going to need to complete results of focused history and physical exam. Complete vital signs, EKG rhythm, 12-lead interpretation, O2 sat, BGL, Lung Sounds, background on the current chief complaint (OPQRST), pertinent negatives/positives, skin signs. What is an "inject fracture" and what does the percentage signify. Same with the coreg increase. It would be irresponsible to decide on a course of treatment just with what we've been given so far. Give us a bit more.

I have not heard of evidence promoting the idea of withholding ACLS drugs to minimize hemorrhage. Doesn't mean it's not a possibility. I do, though, wonder if that mentor based his stance on evidence, personal theory, or if he was taught that by a 'reliable' source. Did he tell you more on the theory? Does EPI/ATR decrease clotting factors? Something along those lines? Is it a vasoconstriction issue? If one is so volume depleted that they went into cardiac arrest, I'm guessing the vasoconstriction is going to help fix the container/volume ratio more than it's going to cause further bleeding from increasing vascular pressure (that's just conjecture).

What's the entire history, allergies, meds, vitals, focused history and physical exam on the chief complaint? All this would play into whether paramedic (not EMT) will administer morphine or other drugs. I don't know what a "restraint carrier ambulance" is. The norm is for all patients to be transported in sitting position on the gurney (and almost always expected to be sitting position for shortness of breath). They can be strapped in without putting pressure on the chest (tighten waist, but not chest straps).

I strongly back up what Mateo said. Yet, I also get what you're saying about EMS letting you come out of your shell and be a stronger person. I started off a similar way volunteering at a police department. Looking back, I did spend too much time there instead of out with friends getting in trouble. BUT it was the guys at the PD who were so the opposite of me, that contributed to my people skills, confidence, sense of fun, and eventual maturity (not because they're necessarily mature, but it was an adult work place). So...I can see you not wanting to get away with that. But heed the warning about the CORE of your life being away from that EMS service. Especially, if even they're telling you similar things (go concentrate on nursing and school, not the volly service). Oh, and as far shielding her from calls. I'm going to assume they're doing that based on her maturity level in real life. I noticed a definite change on how I was treated at the PD and what I was allowed to participate in on the streets. And it was NOT based on time-on-the-job...it was based on my immaturity/maturity level. I could probably consider myself the department's adopted child and 2nd set of parents (providing me with what my real parents didn't)....and they didn't make me wait to "grow up" before exposing me to everything...but did wait until I was ready. Least that's my take on stuff. Now, THERE'S the Dust I remember! FireMedic, you've been here long enough to know that's his thing. Which I picked up also. It's juuust jackass enough. Juuust funny enough. It's a Dust thing. Yes, the fact she's 17 makes it just edgy enough, but it wouldn't be funny if it wasn't. And not sure if you realized it, but by saying he's ACTUALLY hitting on an underage girl (which she apparently isn't, anyway), you're actually firing direct personal hits. One would expect a person to react strongly to this. I'll let you two figure it out, but just throwing in some context/perspective.

WOW. Total spazz, huh? Usually don't like these kinds of "point out the newb" things, but it was pretty good natured, so I approve. BTW... take a deep breath at each scene and force yourself to slow down. Pretend you're going in slow-mo (to everyone else, you'll probably just look regular speed) and your mistake rate will plummet. Kinda sucks that more you have fun on the call, the worse you do. The more you control your excitement, the better you do...but it's not AS fun. Gotta find the perfect balance!

AHA's official statement is that they don't have a stance for or against it, since they do not have sufficient evidence to decide, yet. So, they don't have a specific guideline about it. In effect, that turns into: no, we don't shock those under 1 year of age. A doctor can decide to do it, though, based on what he thinks is best.

Where does that fine come from if the law does not have a max speed limit? You would be paying a fine for something that was not illegal.

Was your partner a medic or EMT? I will say that there was much less of a personal investment in the patient as a basic, since you could potentially do everything close to perfect. And it's almost the same every time (relative to ACLS codes). As an EMT, I was completely detached from my patient. I mean 100%. But when I ran my first code during clinicals, I found myself very committed to the patient. He lost and regained a pulse several times, often not noticed by nurses. I stayed at his side monitoring all the way to ICU...I guess so my "work" wouldn't be "undone"? But who knows, maybe that was just because it was my first ACLS code. I might go to not caring once in the field.* *And to clarify, the reason I completely detach is because they're unconscious. During critical calls, I do a much better job, trying to do a good job for myself, rather than for the patient. It eliminates most of the anxiety factor. BUT if it's a non-critical patient, I'm very touchy feely with them. As far as DOA's, my partners and I have had both kinds. If person is with family, it creates a very sad situation. We just quietly put our equipment away and usually go a few blocks before saying something. If they're by themselves, I don't really feel to sad, since the patient can't be sad.

At the very least, EMT's should know about the drugs they can administer or assist with. Examples: O2, NTG, EPI, MDI's/ALB, ASA, Glucose, Charcoal. In addition to that, it would simply be responsible to learn common home medications that might be regularly encountered. And if one works with a medic, it seems only logical to at least be familiar with his drugs, since it's your career field. Random thing to post . . . regardless, not every EMT will have a medic with them for the entire duration of every call. The "sense" is in being well-educated about your profession and being responsible to your patients. This is pretty much a standard of care (textbooks often make mention of working on becoming familiar with common home meds). Yup. Was just studying up on drugs for clinicals and figured I might review some for NR (which is still a ways out). Thanks for the link chbare. And thanks for the other tips and notes on the NR, everyone else.

I guess you probably could sue . . . If I was them or family, I would probably counter sue you, though... unless there's details you're not telling us. Seems like the classic BS suit that everyone always complains and wonders who would sue for something like that...but turns out to be you. Again, if you give some details, it might be different, but why would you sue them? Sue your company for not having adequate lift resources or your workman's comp for not covering you well enough...not someone who was in an emergency and called 911... Review what VentMedic and Dwayne said...

So, no random drugs on there? Had some friends who took it (who went to a different school than me) who said they saw really random drugs on there they didn't even recognize (I'm thinking they must have been home meds in scenarios if you guys are saying only the basic meds are on there).

Desire to help a new trainee succeed, rather than show how much you know. Being open to different people's learning styles or just general work styles and letting them develop their own way, while still making sure they can get work done and multi-task (this is mainly for the head in clouds personalities). Listens to questions and tries to understand where trainee is coming from, rather than just correcting them. Willing to put in that extra time. If he's having trouble mapping, re-telling him how to map doesn't help much, rather having him walk you through how he does it to find what he's doing wrong in his head. Knows a lot not only about pre-hospital medicine, but about the company. Knows how to be a model employee, as well as a good healthcare provider. Isn't too easy on them and expects a lot, but not so 'chill' that the new employee comes out mediocre.

Hi, Is there a drug list that NREMT expects paramedics to be familiar with? Things that would show up on their tests.