AnthonyM83

While lecturer to student ratio can matter a bit, I think skills instructor to student ratio makes the most difference. You can have 20 students and one skills instructor. Or 60 students, but break up skills time into four or five instructors with better ratio. What happened the first time around?

What was your job description that they could just outsource it? Billing? Or are they hiring day laborers from the hardware store as ambulance drivers now?

Well, found one good source, so far. Finally, getting to read my Peds chapter of Egan's Fundamentals of Respiratory Care. It's the 1999, 7th Ed and I know things change, but the basics and presentations of most diseases will probably be the same...

I'm starting my PICU and NICU clinical rotations tomorrow. Just wondering if anyone had any favorite medical references on pediatrics or neonates. Maybe some topics to research relating to common conditions I might see in PICU/NICU. What are the most common reasons people go there? I'm thinking premature births, maybe respiratory issues, congenital heart issues? Just looking for stuff to study up on, so I can make the most out of tomorrow and relate it to more things (and maybe be able to remember them better, cause I got to see them after studying them)...or stuff to ask good questions on.

I read your explanation, but it does not seem like any justification to leave a student. As others said, EMS is a different environment and mindset. The purpose of the ride-alongs is to get them used to it. Even if you give your 4 rules clearly and they are good, responsible students, they might not be able to keep to them due to inexperience. On my first ride-along, we had an accident on the freeway. The medic told me, "When we get down, you're going tot ride my ass (ha)...stay right next tome". When we actually got out, there were half a dozen patients, active bleeding, cops and FD running around, another medic asked me to give one of the cops an extra pair of gloves b/c he had blood all over them. By the time, he had finished his instructions to me, I had lost my preceptor in the crowd. Yet, I know I'm a good student. I know I can take directions well. I know I can be obedient when learning. And while I had been on MVA's before on previous jobs, I never had to deal with all the shuffling around, student mindset, trying to figure out what's going on, trying to recall stuff from school. What if they had gotten their patients loaded up first and had taken off? You're supposed to be there to teach them those lessons. Later on, if they feel like goofing off, MAYBE you can leave them if endangering patient. But you look after your crew (and guests). You're taking partial responsibility for them. Definitely, unprofessional to leave them, purposefully.

In addition, if he responded like that to someone having a crisis over the phone...I bet he's screwed some people over on the streets who were having a crisis, too. One of the bigger lessons I learned while working there was not to take things personally and realize the people you come in contact with are having a much worse day than you are...if you can help them instead of go head to head with them, they'll much appreciate it in the end (AND it's what they're paying you for). Same lesson has carried over in EMS. Can't count the times a patient or family member was pissed or swearing at me at-scene or en-route, and I still played nice. Almost every time, they apologized profusely one at the hospital saying they were just having a bad day or letting out steam.

Well, LA with the mother may I system that it is tends to give very long reports for each and every call. So maybe as an example of something that's too long...would be same length for any c/c: -Rampart base, this is Squad 51 with a medical run, how do you copy? -Sequence number AB 123456. We have a 45 year old male, with c/c of Sz. Pt found lying supine in living room, post-ictal. Family reports a clonic-tonic sz lasting 4-5 minutes. Pos oral trauma, pos incontinence to urine, neg other trauma. Airway is patent. Respirations are 12 a minute, good tidal volume. Lung are clear bilaterally. Pulse is 100, strong and regular. Skins are cool, pale, and moist. Pupils are PEARL. He is a 4-6-4 (we do E-M-V) on the GCS. His BP is 150/80. Pulse Ox 100%. Shows sinus tach on the monitor. Blood sugar is 108. Pt has a history of sz and high cholesterol. No allergies. Patient takes Dilantin and is compliant. We have this patient in full c-spine precautions, O2 at 15LPM via non-rebreather, and attempting to start a line of normal saline TKO at this time. At this time, you are our closest facility being 10 minutes out with USC being our 2nd closest facility at 15 minutes. How do you copy? -Squad 51, copy, O2, IV, and valium 2-10 prn. Squad 51, feels comfortable breaking down at this point. -Copy Squad 51, out. Aaaaggh. Same thing for a broken wrist. Oh, as far as the radio reports where they need to ask for information, you might consider either doing some live training (one guy on a cell phone and the class listening on speaker phone) to elicit information during critical calls. -Rescue 1! -Rescue 1, go ahead. -Rescue 1, coming in with 2 year old cardiac arrest. Umm, we're doing CPR, came in as a difficulty breathing, degraded en-route...umm two minutes out, uhh, what do you need base? Or a few episodes like that where medic is a bit discombabulated because of circumstances and operator needs to get bare minimum info without asking too much and distracting medics (history, allergies, meds?) You can do the whole panicky voice on the phone, too

Wow. Let me just say, I worked in a PD during high school and they swore WAY more than us teenagers did at the time. How is a PD veteran going to get so worked up over that and even if he did, how is he not going to recognize the possibility of someone dying or at the very least the liability.

Hey Venti, I'm definitely going to read through the asthma protocols...but for short-term resolution, any idea why one of the drug references would specifically say "not for acute bronchospasm" in the notes section? Would that be where EPR-2 versus EPR-3 comes in? You mentioned some don't think it helps in long-term treatment...but any ideas why it would almost be contraindicated in one reference?

But there ARE books that update yearly. It'd just be nice if they were either all updated similarly OR if there was a standard for prehospital care for providers to be on the same page with (so to speak). Thanks for the ipratroprium info.

I was studying this med from three different sources. AHA Flip Booklet Ped section lists: Indications: Anticholinergic and bronchodilator for tx of asthma Precautions: Pupil dilation in eyes Inh. Dose: 250-500 mcg (by nebulizer, MDI) q 20 min, x3 My school's pharm booklet lists: Ind: asthma, bronchospasms associtated with COPD Contra: Pt has been administered Atropine Precautions: Children under 12yro, narrow-angle glaucoma Dose: Adult: .5 mg neb, Ped: N/A This Clinician's Pocket Drug Ref guide I got lists: Ind: Bronchospasm with COPD, rhinitis, rhinorrea Contra: Allergy to soya lecithin Prec: (Preg with inhaled insulin Dose: 500 mcg, but only for Adults and Peds over 12. Note: Not for acute bronchospasm Now, I expect some variation from each source, but this is a bit more than usual. The Pocket Ref is saying not to use it for acute bronchospasm (aka asthma) AHA Guide is saying to use it in asthma, possibly first-line concurrently with albuterol (no mention of kids under 12...and it's in PALS section) School guide only lists under 12 as precaution...and throws in the narrow-angle glaucoma. I'm sure the answer is they are all right at times...but in general practical terms, what should I know about this drug??? -Is it used for acute asthma? (the Pocket ref is supposed to list unofficial indications, too) -Is the kids under 12 a big deal? (PALS doesn't even mention it) -What contraindications do you guys have? Learning about drugs seems so difficult because each source is so different. There's no standard source for paramedics or prehospital care is there?

I would imagine every ER has to do their own ECG at the hospital, just like every trauma center does their own head-to-toe assessment, on top of yours. Having your EKG come up negative doesn't rule much out, but having it come up positive is more likely to rule things in. Our local ER's always redo the ECG's, but in case something has changed or something was missed, but a STEMI in the field would direct us to a cath lab hospital and activate the cath team. Thanks for the notes on the other topics. I'm trying to relate each subpopulation to AMI presentations. I like your pediatric HTN story. while I don't really think kids with c/o CP are having an AMI, it irks me when a legitimate assessment isn't even done on them because they're just 12 or just even just 25. I think it goes back to that screening for zebras, but treating like horses thing.

I was considering some more obscure, difficult, historical, or EMS system related topics until I found out we were presenting to our classmates. Since, I can't count the number of times I've been handed off a chest pain patient because the "the 12-lead came back no STEMI", I figured a chance to educate would be useful to new people going to the field. Ideally, they'd retain at least the main point of the presentation, if not the details, and maybe even share it with their future medic parts at the FD's. SO, coming to you guys. Anyone have any specific suggestions or resources or cases on the topic? I want to have a certain number peer-reviewed journal articles for the paper, but can use many other sources, too. Case studies and anecdotal experiences can be worked into my presentation. I'm good with the basic research stuff, but if you guys have any gems, please let me know. Some topics I'd like to touch on: -Diabetics -Elderly -Young patients (pediatric MI's, congenital conditions, etc) -12-lead efficacy -Field assessments beyond what's taught in basic medic courses -Specific combinations of past medical history that puts patients at risk (other than generic cardiovascular history and atherosclerosis), maybe?

What county?

Gawdamnit, right when I was backing you up, you gotta go say something like that.

Naw. A lot of those exception type factoids just happen to stick in my mind. I think that one was from an ERDoc or Doczilla at some point. My theme in my EMS career seems to not generalizing and contrarian type comments. Anyway, my point is that in this case since we can't fully rely on signs AND we can't elicit even the classic symptoms AND the zebra would be a very very acutely dangerous zebra, we have to consider zebras a bit more than usual. Doesn't mean treat the zebra (like rush code 3 to ER), but rather make sure child gets to ER with parents that day (versus going to personal doctor if it doesn't get better in a few days). Like Doczilla was saying, it's all a balancing act. You treat it mainly like a horse, but juuust enough like a zebra, so that if it is, you can still prevent it from making its kill. AKA sending the CP home with tx for pleurisy, but keeping him in ER just long enough to get labs back. -And naw, haven't gotten to write the exams yet, but did get some questions thrown out...and the daily reference source during lecturers' brain farts (I say that with love if my instructors ever read this)

My opinion is that regardless of job you intend to go into (remember this may change...decide you don't like it...get injured and forced to retire...etc etc), you want your end goal to be a 4-year degree. You can start at community college, then transfer to state. Or go straight to a 4-year. Private, Public. Just end up with a bachelor's. That's baseline (for hireability and being well-rounded and life experience). Then go for your specific job training (whether that's a PhD to be a chemist or a certificate to be a paramedic). Of course, many are successful going different routes, but there's no way to know if that'll work for you. I'm at the age where I'm starting to see friends "stuck" when they realized their LE or EMS careers were not for them and are now trying to get back into real school.

And since Vent Medic brought up the topic, I'll add that increasing the O2 LPM over 8 on a nebulizer (least the kind we use) actually decreases the amount of albuterol nebulized. I was sick at work once and given a little albuterol to help, so got to really mess around with the O2 flow rate from a patient's perspective.

And okay, those two signs you listed aren't complaints. What percentage of the time do they appear? Can you rule it out based on the classic signs of meningitis being absent? Symptoms are important as well.... And yes, Cow Pox should technically be on your mind. Doesn't mean you need to treat for it...that was addressed in the Doctor's post. But I guess I'll let him handle ya

Disguising your comment about the dangers of going 15 MPH by throwing in the weaving part. The weaving part is almost irrelevant to the current discussion.

Apparently I don't have the right windows media player "codec". Said error while it tried to automatically d/l it, then just played the sound, no video.

Congratulations buddy

Gotta call you out there. You tried to make a case against the value of going 15MPH over limit by intermixing "weaving in and out of heavy traffic". Weaving in and out of heavy traffic is unsafe at pretty much any speed. I think majority of accidents I've responded to involved unsafe lane changes. OF COURSE, weaving is counterproductive to patient care.

I think the point of the lesson is always assume the worst until you can rule it out. Similar to assume every unilateral abdominal pain in females to be ectopic pregnancy. Assume every unilateral wheezing child to have aspirated something. Eventually, you can rule it out...but if you can't, you have assume it's the worse, because the consequences are so dire for the patient, especially bacterial meningitis. Having the child wait out the rest of the school day until parents pick him up, could mean that child's death. I guess the best method would be to treat as a horse, but always assume you haven't eliminated the zebras. Make your treatments and decisions based on that mindset.

Well, I'm home sick with the flu . . . so awesome. Sudden onset, felt something in my throat at 7AM, runny nose by 10AM, feeling off and dehydrated by 1PM, exhausted by 5PM, took meds for runny nose and fever(prophylactic) at 6PM, and passed out for the night. Woke up 2AM from crazy ass feverish dreams, sweating. Took more Tylenol. 4AM, now...fever eased up...just have pressure in sinuses/throat. I'm sure it's just the regular flu...but anitvirus would be nice. I'm going to miss out on my medic final written and skills. If I really have to stay home 7 days after recover, I'll be missing out on clinical shifts, too. No confirmed cases in LA. And regular flu kills 36,000/yr . . . of course not sure what percentage of total infected that its and how it compares to deaths vs total infected for this strain. US strain has also bee mild to moderate. Mexico cases have been moderate to severe.