Lytefall

'86 ford tempo '96 Pontiac sunfire '03 Pontiac grand am GT '08 Dodge Ram TRX4 offroad Currently driving a '09 Dodge Ram SLT Sent from my iPhone using Tapatalk

It does suck. Sometimes it sucks. That's all there is to it. One I the best medics I have ever known, who is still working after 35yrs and loving every day, once told me something I will keep with me forever. While we never knew most people in life, it won't be possible to shed a tear for every patient but there will be calls that sadden you and stay with you forever. It's the day that you stop feeling the emotion for those types of calls that you know it's time to hang up your stethoscope and call it a career. We are human. We should feel. We do this to help people. Its as plain as this: when we can't help sometimes it hurts. The best medics I have known are the ones that genuinely care. To me the fact that this bothers you means your hearts still in the right place. Sent from my iPhone using Tapatalk

I agree. There are moments on this job that you wish you could scrub from your memory forever. It's the few and far between moments that actually make us smile that make every day worth getting up and going to work you need to hold on to. Sorry to hear what was quite obviously a very tough call, both in its entirety and in the decisions you had to make. Sent from my iPhone using Tapatalk

I think there is a possibility that this could have been building or days before this LOC. If she's a new mother she may have rationalized Abdo pain away as post partum normality. Since nursing moms are commonly advised to increase their oral intake of fluid age may have also rationalized the polydipsia and polyuria as a normal part of the transition. Any number of factors could have led to this being solely the result of DKA. I do agree with you though kiwi, it is highly suspicious as the only cause so being cognizant of this would be most prudent. Since theres a 2nd unit on scene one can go to pedER and one to adultER. I know that adultER's should be able to care for baby but since pedER is closer and deals with peds more often I think that would be the better choice for baby. Sent from my iPhone using Tapatalk

In addition to the bolus and ongoing supportive care and vitals also prepare for potential complications of prolonged DKA. As far as my scope of practice goes unless anything else pops up its transport and pre-alert receiving facility Sent from my iPhone using Tapatalk

Did we get that blood glucose? Any acetone breath? Mucous menbrane moist or dry? In addition to what kiwi said I think ruling out or in DKA would be a good idea. As for the baby. Not eating/nursing x 3 days would be an easy way for a baby to "look sick" Sent from my iPhone using Tapatalk

I had a similar scenario recently only my patient was assaulted by a skateboard ramp instead of a fist. Kids dad was a dental surgeon and he had put the teeth in milk prior to our arrival so I would say that is the correct answer. Guess your swinging by the corner store en route... Sent from my iPhone using Tapatalk

Scene survey. What do we see? Anything suspicious? Odd? Signs of a struggle? Trauma to the victim? Empty alcohol or pill bottles? Vomit? Anything to indicate a definitive length of time she's been in this position (how many newspapers in mailbox etc.). Cspine control and packaged just in case. Vitals and a blood glucose as well right off the hop. What are the vitals? Temp? Sent from my iPhone using Tapatalk Also, how far post partum are we talking? Possibility of post partum depression for explaining missing child or pp complication for mothers state? Sent from my iPhone using Tapatalk

I agree. I was the first year they switched from a 1yr to 2yr program. I couldn't imagine getting the knowledge base I did with a 1yr program. A lot of the new students now think the knowledge is overrated. Kind of frustrating seeing people coming into this profession who believe knowledge is not important as long as you know your protocols. Makes it easy to spot the people who look at this job as nothing more than a means to earn an income. Sent from my iPhone using Tapatalk

Theres been some decent improvements in the last few years, but I completely agree with you. The knowledge base we are taught vs. what level of responsibility and skillset we are given are way out of proportion. I am glad they teach the way they do though. I think it's important to understand as much as possible as far as A&P and patho is concerned even if it may not affect the treatment you provide. The whole good technician vs good clinician argument etc..... Sent from my iPhone using Tapatalk

Here in Ontario it is rare that people can even get accepted to the 2 year college Paramedic program without prior post secondary education. Most people take a 1yr general health science course prior to. Thats at least 3 yrs college education just to get into the profession. I guess things are just different here. To get to what most of the rest of the world calls "paramedic" we are looking at 4-5yrs college education. Sent from my iPhone using Tapatalk

Thanks for the info. I couldn't agree more on the "dumbed down" texts that a lot of writers put out. I think a lot of them forget we aren't just ambulance drivers anymore. Sent from my iPhone using Tapatalk

My A&P and patho knowledge is pretty solid. I am looking for something to challenge myself. I have had Carol Porths patho book for a long time now. I used it throughout the program in college and have re-read it at least 3-4 times since then. The Bates book looks interesting. I will have to check it out. Thanks Sent from my iPhone using Tapatalk

I am looking for more in depth patient assessment books. Just out of interest. After 12yrs there's only so much you can keep re-reading the same info and I have recently started looking at more in depth patient assessment finding a lot of things I knew, but didn't. By that I mean I always knew some people put a clenched fist to their chest to describe chest pain, i never gave much thought to it consciously and what I didn't know was that it was called Levine's sign. Not necessarily something wholly new but still a patient assessment finding that can be significant to report. Can anyone recommend a good text with patient assessment skills and these types of findings? I am looking for something in depth, maybe like a med school text. I know a lot of them recommend imaging or lab testing as part of the assessment and didn't know if there was anything out there that focused more on actual physical assessment without all the aid of things like CT scanners, blood draws and all the other fancy equipment we don't have the luxury of in the field. Thanks Sent from my iPhone using Tapatalk

We used to use the ferns chairs. I was certified by a ferno trainer to do maintenance and although i was not told this by ferno I have seen many with stress cracks on the upper handles and I indeed was taught some 12 yrs ago now to avoid using the handles as they have been known the break off. We got rid of them a few years ago now and have been using the tracked Stryker chair Sent from my iPhone using Tapatalk

EMS wages in Ontario, Canada have made leaps and bounds in just the last 7-8yrs. When I first started almost 12yrs ago now I was making more working at the grocery store where I worked all through high school and college than I was working EMS. I think that the downtime is fantastic as said above (although it's rare here nowadays - out call volume has nearly doubled since I started. The thing most lay public don't get though is that in my opinion we don't get paid for what we may do (such as down time) our pay should reflect what we may have to do/deal with when we aren't on downtime. The reality is most people would never want to ever have some of the images/smells/feelings that a lot of us carry around with us. That's what our pay should reflect. Sent from my iPhone using Tapatalk

I am not sure exactly what that translates into in the rest of the world. I will give you a basic rundown (not necessarily a comprehensive list) of skills. I would like to know myself what the equivelant is in different areas of the world. Ontario has basically 3 levels which are all called paramedic each with their own little offshoots from each level. There's PCP which is what you graduate with after 2yrs of college, regional hospital drug/defib certification and your 8hr provincial exam (all the basic stuff everyone has like defib etc and then IVs, and admin 6 drugs) then there's what they basically call PCP+ which is service/region dependent (a couple extra drugs, 12lead, more advanced airways like king LT instead of just OPAs, and CPAP). There's there's level 2 (ACP - advanced care) which is another year of school and clinical then oral boards. They have all the PCP skillsets plus other skills such as naso and oro tracheal intubation, needle thoracostomy, IO and EJ lines, cardio version and transcutaneous pacing etc and at least 20 drugs. Then there are flight ACPs (ACP-F) that have additional skillsets like emergency cricothyrotomy, og/ng tubes, foley catheterization and admin of blood products and plasma expanders plus about 40 meds total. CCP (critical care) are level 3 which is obviously more school again and typically flight medics in most places but there are some areas, mostly bigger urban areas, where they are land as well. All the types of skills of the previous 2 plus more such as transvenous pacing, up to 60 drugs (some regions able to admin any drug as long as they are familiar with it) Any level can also work flight with the aeromedical training and exam and aircraft operation training in either fixed wing or rotor. I fall in the level 1, PCP+ category. I work in a mixed urban/rural service that only contains PCP and PCP+ paramedics. Sent from my iPhone using Tapatalk

We are just under $80k CDN/yr for a Paramedic level 1 in Ontario including shift premiums etc. That's generally average for mixed urban/rural areas. Some of the bigger urban centers like Toronto area are making a little more. Sent from my iPhone using Tapatalk

If I don't have to take them off I don't. If there's no worry of spinal precautions I try to remove them without the cut. If the pt is conscious I usually ask them how attached they are to the item of clothing I am thinking of cutting. Most people are more worried about their health than their clothes but if they ask me not to cut I try everything I can do not to. If its unavoidable I explain why. Most people understand. Sent from my iPhone using Tapatalk

I am generally extremely hard on all my students. But never to the point of being a dick like this guy. I am tough because I want them to be good, not just pass the course with the bare minimum of knowledge. My preceptor pushed me hard to constantly improve myself and be better than just what was needed for my certified level of care and I will always be grateful for that. This isn't fair to you or your future patients. This doesn't provide an atmosphere where you can feel comfortable making mistakes which I think is the most important part of clinical precepting. You get to make mistakes when someone is there to correct you and that's how you learn. I tell all my students that the more mistakes they make during precepting the better medic they will be when they go out into the world on their own. Find another preceptor. It sounds like either this medic never wanted a student (I am not sure what service you are precepting in but mine has a clear policy that only medics who want students for consolidation get them), is having personal issues or is just plain burnt out. Any way you look at it a preceptor should be a role model and this is clearly not the case. Sent from my iPhone using Tapatalk