scott33

As far as EKGs go - I read somewhere that if the ST elevation in lead III is "taller" than in lead II, you will probably have a right-sided MI. Dunno how accurate this is, but any googling of "right-sided MI" would seem to show this...

Also known as J-waves, they are the upward deflection between the QRS and the T-wave. Best seen in the V-leads here

Am I the only one seeing Osborn Waves here? What was his temp?

May want to file that in the Paramedics save lives, EMTs save paramedics bin Sadly, for many in EMS, it is a shuttle service to the hospital. Nothing more. ...and as long as some of the more vocal members of the EMS community continue to neglect their education, we will all be tarred with the same brush (see link and cringe) http://www.ems1.com/ems-products/training-...lieutenant-exam

You have to upload it. Curious to know how it could be so long.... Second guess would be a bloody pacemaker of course

SVT with chemical / electrical conversion???

I have been sniffing around EMS and nursing forums for several years. Aside from the often addictive argumentative posts (whether contributing or not) which can be very amusing, there is an immesurable amount of relevant information to be gained from the likes of EMT City and others. There can often be some confusion separating the wheat from the chaff with certain posts, but nothing that can't be sorted by going off and doing our own research. As well as the clinical guidance which is handed out FOC from the more learned members, I have had my entire philosophy of EMS do a complete U-turn in recent years, and I am grateful to certain regular contrubuters for highlighting all the stuff that I didn't wish to acknowledge, when I first started out.

Hmmm. One has to wonder if, given the atypical pacemaker rate, and the atypical delay in conduction between the atria and venrticles, that there isn't a technical issue with the pacemaker itself. May be time for the man with the magnet from Metronic, to interrogate the device

The ST elevation in the lead II tracing would not be indicative of an MI, (no matter how high it was) as it there has to be elevation in contiguous leads (or groups). You may also notice that the gain was turned up on the single lead strip for clarity, which tends to exaggerate elevations and depressions. What this strip was indicative of, was running a 12-lead for a closer look. As you can see, the results are more subtle, but can yield a lot more "other stuff", which should be taken into consideration along with the patient's chief complaint and other findings of the physical exam. The only problem I have with "inf MI" is the lack of reciprocal changes, so I still wouldn't put money on it. Maybe if we get the patient's S/S we may have a better idea.

Sinus rhythm with 1st degree AVB, RBBB (assuming QRS > 0.12s), and left axis deviation. Possible ST elevation in the inferior leads, though would need to see a larger scan so I could go "box counting".

Same here. Can you copy and paste please

And still the personal slurs keep coming. Always a sign of someone losing an argument though isn't it? You and several others clearly have no idea of what I am getting at here. No idea whatsoever, and no idea of who's side I am really taking. I think some people are now just arguing for arguments sake, I can only assume that raw nerves have been touched. I am surprised that no one can see the obvious here. That is, given the sound bite that is clinical time for the EMT, there should be little or no dogsbody work. I haven't said none whatsoever, but it should be proportional to what you are there for. You are there to learn and practice certain key skills; chiefly history taking, and vital signs, and to a smaller (much smaller) degree, get an overview of how the ED functions after you have dropped off your patient. I have tried to be subtle about it, but in many cases the EMT student is seen as a thorn in the side of many nurses, not that I share that opinion. Some of them will pounce on the opportunity to use the extra pair of hands in every aspect other than what they are supposed to. I know how clinical works, and I know the most important thing for many a student is the signature on the clinical form, anything else is gravy. So why should it matter what they do on their rotation? I get it! I always thought things were a little backwards in NY EMS. Now I am grateful to have gone through 3 separate EMS programs, in which the staff made the clinical expectations crystal clear to both student, and healthcare facility. I suppose there are also schools out there that have students lifting the patients too? But that’s another argument

The "S" in my wording patients suggests that I was hinting at interviewing more than one. Now you are just clutching at straws.

And I suppose handing out food trays, doing runs to the lab, and

I think some of you are getting the completely wrong end of the stick, but I make no apologies for trying to encourage vectored learning. Judging by some of the replies, there have obviously been a few people conned into doing much of the mundane tasks that they should not be anywhere near, and clearly that is where the overly-defensive tone of some of the replies are coming from. By some of your own admissions, one or two posters have spent way too much of their clinical time making beds and other tasks not related to the EMT curriculum. Whereas this is no big deal if it is kept to a minimum, it serves no purpose other than to relieve those who chose not to do it, of their obligations. On the typical 120 hour EMT course, in which only a fraction of that time is clinical exposure, bedmaking and piss-pot emptying should not be one of the main expectations of the student. The EMT student is not part of the nursing or medical team, lets get that straight - they are an adjunctive component to the daily running of operations in the facility, not an integral one. Nursing staff who pair up with EMS students are usually hand picked (if they don’t volunteer) and should have an insight into the clinical expectations of the student. Many of them are in EMS themselves, so are ideal in bridging the gap between roles. Others are just very good tutors at any level, so can offer a lot of relevant information on the basics. Unfortunately though, some of them slip through the net, and there will always be those who will see the extra pair of hands as an excuse to have an easy shift, at the expense of the student’s learning experience. I have witnessed this several times. No one likes it to be pointed out that they have been hoodwinked into doing something they really shouldn’t be doing, and perhaps this is why there seems to be a lack of objectivity in some of the replies. Learn from it and move on. Think about it though, would you rather have a clinical experience that concentrates on the key clinical skills as per your curriculum, and as per your classroom studies. Or would you rather be used as a runaround, hand-maiden, and dogsbody doing things which do not reflect the limited practice of EMS work? Sure, what student is really going to object to anything asked of them, as the ED is always an exciting place to be for outsiders. The problem is that it provides zero benefit to the student as an EMT. The "social networking" aspect can best be developed at the patient's bedside, not sucking up to nursing and ancillary staff, some of whom will happily take advantage of the student who just can't say no. This is my job, I hear the stories of gullible EMS / Nursing students all the time, who get used and abused as fetchers and carriers. It is wrong - end of. And before anyone comes back to remind me (like I don't know) of all those jobs which need done in an ED, there is a little-known fact that the more "tasks", a non-staff member is detailed with, the slower the ED will run. The students are operating under someone else's license and with patients assigned under someone else's care. It stands to reason that the combination of the student’s inexperience and an extra pair of eyes upon them, will often make certain things run in "floor time" Those few ED staff who haven't actually witnessed first-hand, the wrong-doings of the EMS students, who take it upon themselves to do their own thing, will have at least have heard the many horror stories. Hey, 5hit happens, but this is why many of the nursing staff flat out refuse to take anything to do with EMT students…it means a little extra work, and a lot of extra responsibility (read accountability) for them. As for occupying time when it is quiet – if I were able, I could spend a whole shift interviewing my patients and developing basic history taking techniques if there was nothing exciting going on in the trauma room. I would much rather see the students even having idle chit-chat with the patient about their visit, than running about with commodes and handing out food trays. Just what "skills" does the latter help to develop, to help the EMT in their role... as an EMT? Some of the offers to assist in the running of the ED, are reminiscent of the overly enthusiastic family member who insists on speaking over her loved one –the patient, by answering all their questions. It just can't be seen from an experienced perspective here. But, going way off topic, so I would suggest to the OP, as well as those who have already gone through clinical rotations, that they review their clinical policy and procedure for their school. I cannot imagine being in a situation where I would need to ask an EMS student to do my dirty work for me if I am able to do it myself. I take the nurturing of the EMS students way more seriously than to do that. It is also something which could easily come back and haunt me if I did so, perhaps even relieving me of preceptor status. It is an abuse of power, counterproductive to the clinical experience, and not what the students are there for. If they are there to learn vitals and lung sounds, then they can usually spend an entire shift doing just that, by repetition, until it is second nature. That, is making the most of ones clinical experience. I would love to see some official evidence of ANY EMT school endorsing or turning a blind eye to this practice - but we all know, none exists. Question for the RTs, phlebotomists, rad techs, pharmacy techs, and medical students here…How many times a day are / were you asked to make beds, or assist with toileting the patients while on clinicals? Thought so.

It is worrying but it does go on, and sadly quite legally. Some medications should just always be on a pump, and Dopamine is a prime example. As for "titrating to effect", it is going to be quicker on a pump as you just plug in your new rate instead of messing about with a clamp or dial-a-flow. There is also the advantage of being able to document more accurate amounts of medication given, and over how long. You can set it to give the patient X amount of medication and no more, which takes care of arriving with an empty bag and red face. What's next - Insulin drips without a pump?

Although it is poor practice, there is little need for 911 to rely on pumps in NYC, given their proximity to the abundance of healthcare facilities which pebble the area. There are plenty of IFT medics who do use pumps in the NYC area however. Transcare, NSLIJ, and Lifestar are just three companies I know of who use them. IVPB Mag and Amio, may not cause a huge issue with just "running it in" using the volume over time formula, but the potential will always be there to cause a bigger problem than you started with. I would much rather see the likes of Dopa on a pump, but as already pointed out, that would involve education.

It just gets better. Transports to the floors In my book, it is called sucking up to the nurse to get a good report, or let go early. Seen it from both ends many times and is completely unnecessary. And it won't get him a better clinical experience, it will get him better at making beds.

Thanks for the lecture. Now show me where in the EMT curriculum it has bed making as a psychomotor skill. Show me the clinical rotation sheet which has bed making, arse wiping and urine emptying as something which needs to be signed off on. It is a complete waste of clinical time to be expected to make "more beds than you can count" on rotations, and if you had bothered to read your clinical itinerary, it may even have stated so. As an RN whos real job is working in the ED of a level 1 trauma center, and who frequently assists EMT and Paramedic students - and as an ALS field preceptor who also has to sign the student off on ALS ambulance skills, I would never expect any EMT student to pick up my or my colleague's slack. Students are there to learn specific psychomotor skills consistent with what has been taught in class, not run around making beds etc. I don't see an issue with one or two bedpans etc if the student volunteers it, or if they are the nearest pair of hands - and volunteering to help with anything will always get the "enthusiastic student" on the rotation form. But take it from me, the hospital staff know that it is no more acceptable to ask these menial housekeeping tasks of EMT students ad nauseum, as it is a patient's family. It is nothing to do with being above making beds and emptying bedpans, it is a matter of getting the most out of ones clinical time as possible, and doing what is relevant to the role of the EMT. At the basic level, that means manual vital signs, lung sounds, patient history etc. As I said, any decent EMT school will have explained to the student ahead of time, to politely refuse these tasks, and escalate if it becomes an issue. Obviously a lot of people have let hospital staff walk all over them in the past. More fool them.

Any good EMT school will have already advised the facility of clinical expectations of the students. This should not include "making beds" or anything similar. Clinical time is sparse enough in EMT school without making it less productive by being used as a skivvy for lazy arse CNAs. I agree with tskstorm - take plenty of vitals, lung sounds etc.

Hi Just read this. Yes it is the "you" I was thinking about. I am the same "Scott33" as on the Uk site and a few others. Just PM me, here or on the other side of the pond and I will help all I can. later...

But of course Hello Kettle? This is Pot, confirm color, over!

Yes, there are many different colors of emergency lights, for those who are allowed to claim certain road privileges in emergency situations, and have received the appropriate training. I can't for the life of me remember the color of light used for "Obstetricians", otherwise this moron would have abided by the traffic laws like everyone else who have been given an instruction to pull over. I assume there was major, major, complications with this birth - otherwise why would he be risking his life, and more importantly, other road users lives? I am sure there were other medical staff (of any status) around to cover while he was on his way in. Not that Doctors are really required at all births anyway. Perhaps it is the cynic in me, but maybe the "emergency" was more to do with his concern about not getting paid, for a birth he was not present at. Would be interesting to read more on this.

Don't encourage him. He is *cough, cough* special. My English friends agree

More importantly is the issue of a visa. Without one you cannot enter the US with a view to commencing employment. If, and only if, you plan to settle down with your GF, i.e marry her, she may apply for a K-1 visa on your behalf which can lead to conditional permanent residency status for you. This may be adjusted to LPR (lawful permanent resident) after a couple of years, providing you have satisfied all the requirements of the USCIS (immigration), which includes staying put in the US for a predetermined length of time. While your adjustment of status is pending, and after you have been approved, you may receive a temporary work permit from the outset. This is restrictive and temporary, but it gets you out working, paying your taxes, building up a credit score etc. Remember, it is your contact in the US who has to apply for a visa on your behalf, and she must prove that you will not be a financial burden to the state. She will have to submit a notarized affidavit of support showing that she earns enough to take care of both of you. Your UK qualifications are not transferable, but that isn't a problem as there are so many medic mills out there, that starting from scratch is not going to be an issue. It will take several years and several grand, for the application process to be completed. Here is where you start... www.uscis.gov If you need any more info, PM me. I am sure I know you from elsewhere