DwayneEMTP

Hey Rockie, I'm a short time professional medic, 2 yrs or so now, and no, I don't plan to stay in this field for the long term. I do know quite a few medics, but I'm unaware of ANY single role paramedics (United States) that plan to stay in the field for their entire career. And the couple that I do know that have been doing it for a long time? No man, you wouldn't want to be either of them...they are not happy campers... Paramedic medicine in the single role world is something that you do until you get bored and find something better to do...that is the evidence before my eyes and ears at least. Good luck with your decision. Dwayne Edited to add words in bold. No other changes made.

Hey all, Hypothetical question... Working a pt with a known down time of 30+ minutes prior to any intervention. Initial rhythm asystole. If you touched this person while the monitor was attached, could your electrical activity show some type of organized rhythm on the monitor attached to the pt? It seems like we've always been warned about this but I've never really given it much thought. May seem like a silly question I guess, but it seems like it should. And if so, would where you were touching in relationship to the leads change what the rhythm would look like? Man, it seems like I should be able to reason this out, but trying makes my brain mushy.... Anyone have any actual information concerning this? Thanks for any help you can provide... Dwayne

Now if we can get the rest of the adult population to get baked every now and then much of our societal angst will vanish as well... Just sayin'... Dwayne

46Young, you are accusing others of having their minds made up, and yet you still continue to spout whatever bullshit makes your point. If you want to be taken seriously in this debate you need to stop using misleading language such as, "survival of the fittest", you're not the fittest if you can take jobs without having to fairly compete. "Corporate takeover", "Increasing market share", those are private industry terms. They are used for people that have to risk their jobs to compete. Those that get to lie and cheat while spending government money have no right to them. I'm not sure now, as I've mentioned this to you several times, if you're simply too ignorant to use appropriate language, or if even you are so convinced of the impotence of your argument that you purposely continue to represent it as something that it's not. Take a chance, show that you can actually think your way through this as an individual instead of an ignorant piece of the fire machine. We have faith in you brother... It does remind me of an old joke though, but I'll have to tweek it a bit to make it work... "What's the difference between a fireman and a shopping cart?" "Every now and then a shopping cart seems to have a mind of it's own..." Use your own significant brain...stop simply flushing the same ol' party line over us that we've heard, and labeled bullshit, over and over.. Dwayne

Nod..what Jp said..

I respect many of your posts and believe that you are too intelligent to make this arguement, though it doesn't surprise me totally because a fireman's ability to justify bullshit often seem endless. I think it comes from believing all the crap you see on TV and newspapers... Of course we want them cut back to reflect call volume! I don't want my city to employ 3 times as many meter readers as necessary either, but that doesn't mean that I hate meter readers. And if they have too many meter readers and the public suddenly discovers this, I don't want them to take aware a fireman's job and give it to them so that they can look productive. One chose to be a meter reader and ended up in an untenable position, the other chose to be a fireman. Once should not suffer because the other chose poorly. But according to your logic, your job should then be taken because a meter reader is certainly a more important position than the average fireman...so fuck em. Right? Correct. And here again you're hoping we'll take this line of bullshit as fact, because you're used to the public doing so. If fire takes EMS jobs to shore up their own positions that is evil. Why? Because they are not required to compete fairly. And you really need to stop using corporate take over analogies as long as the fire service is playing with public money, money that they didn't have to prove that they deserved by creating a profit. If your profession has proved that it can't survive without diversity, that's awesome. But let's quite pretending that they are involved in "corporate America" when they are using my money to screw my neighbors. You can justify it because in this case rape is good for you. Awesome. But at least have the balls to approach the problem honestly, quit with the bullshit analogies, call a spade a spade, as the saying goes. I can't imagine how disappointing it must be to have worked so hard to to compete for a coveted position that allows you money, good retirement, work time leisure, unearned hero status, only to find out that you must now justify stealing from your neighbor to keep it...I hope I never know. I hope I always have more honor than that. And if sharking jobs at any cost is ok, then can you explain the IAFFs attitude in the article below, and the gazillion other's like it? http://www.dearbornf...per%20Woods.pdf Dwayne Edited for grammar correction. No contextual changes made.

It's not about the money. 1.6 million is a drop in the bucket for North Las Vegas, so this is certainly about politics and future financial maneuvering. It irritated me when he said something to the effect, "We just want to be able to get paid for what we already do..." C'mon, the reason fire started responding to all of the calls where they are seldom necessary is so that they could shore up their call numbers and get all of their fancy equipment...You're already seeing the benefit of "doing what you do" in your budget brother... It's a crazy world. I've come to be interested in the argument but have very little hope that there will ever be enough intelligent public debate to prevent Fire from playing these types of games. They have the tradition, the budget, and the media machine to keep the voting public in the dark. They will still be bullshitting my grandkids' grandkids long after I'm gone. God bless our brothers and sisters in the Fire services, but you chose wrong. You've chosen a career that is becoming in large part obsolete and can't survive without raping someone else. When you watch your unions take jobs from those that chose differently I hope that you can see that it's not because you deserve them, but because you picked the bigger bully. When you take their jobs, you haven't competed, you haven't proved that you are professionally superior, you've simply proved that you're willing to sneak in and snatch their wallet while your union is beating their head on the sidewalk. The stories that come from the fire services seem too often to be the same stories coming from the welfare population, they seem so often to be stories of entitlement. "I got this job, and that wasn't easy, so now you have to pay me forever whether you need me or not!!" For some reason firemen seem to actually believe that a fireman unemployed is just so much more tragic then a 'normal' person being unemployed... It's a crazy world.... Dwayne

Actually, I got into a pissing contest with an Aussie (maybe NZ, I can't remember for sure now. (Ak, chicken shit Mike, where was he from?)) doc in Kandahar over this issue. We had one of our drivers begin to react to a new soap that he had showered with. Significant edema where the soap had touched, light headed, slight wheezing. I gained access in the clinic, gave 0.5 epi SQ and was just getting ready to push Benedryl (No oral option) when the doc reached out and stopped me saying, "No! That's for n/v, he needs Phenergan!" Now, I was fortunate that the medics didn't necessarily need to answer to the docs there, as well as having akflightmedic to cover my ass, so I pushed the Benedryl and all was well with the world in a few minutes. We talked about it after, the doc and some of the rest of us, and it turns out that I was used to using Phenergan as an antiemetic and Benedryll for allergic reactions, yet the Aussies (NZ?) use them exactly opposite. (Perhaps because they're on the upside down side of the planet? Who can say.) I'd not really given any thought up to that point as to why we'd push one instead of the other, and am still not completely sure why. Benedryl and Phenergan were our two options there. I don't have access to protocols that say that, but that is how it worked there. At this point I'm going to punt to ak as he's still working with the Aussies in that environment. Dwayne

As a Basic your odds are very small based simply on the size of the employee pool availabe. I can't say for sure, but I'd guess that your odds are much better as a medic, but it will depend on the service. I can't speak to the ease of getting hired, but as to the 'sexy' calls? ER nurses will do much more than you will ever do as a medic. If you're in a system with any kind of call volume you will handle, what, maybe 2-5% sexy calls, as will all of the other crews on that shift, yet you will deal with yours only, the ER crew will deal with the majority of everyone's calls. Doing the sexy stuff as a medic in a hospital? It will depend on your service, but again, I'm being silly even to speak to that as I've not had that experience yet. Go to RN, work an ER, and have the best of both worlds. Work the sexy calls you're looking for and get paid at the same time. The only advantage to being a medic is that you gainthe stress that comes from being in shitty situations with limitted tools and education and man power. Trust me when I tell you that that part of the job is not nearly as sexy as it seems. Again, I can't help you here brother..great questions though. Good luck to you man...it sounds as if you have a great plan.. Dwayne

I'm sure I've not used all, in fact I have no idea how many different ones I've been exposed to, but each of those had spoken instructions with pictures on the pads. But people being people is why I stated 'almost' in my post.. :-) I thought the point of placing AEDs in public spaces, making them simple enough so that a child can easily figure them out is so that the lay public would be able to participate in early interventions of cardiac arrest..? Maybe I'm off in the ditch here though.. And hell, if I thought each policy through before determining that it was idiotic I would have missed out on a whole lifetime of job hunting experiences...just sayin'... Dwayne

I agree with you completely. The reason for the AEDs being almost completely foolproof is so that it is an adjunct to CPR. You don't have to be well trained to provide half assed CPR and you really don't need any training at all to use an AED. And we know, we're not guessing, but know, that the AED is what's going to save most of these folks, right? Unless you're company has a process in place that trains each new hire in the building immediately upon arrival in CPR and AED usage, then I'm completley on board with you. To put a sign on the box that is basically saying, "If you haven't been trained in the use of this 'no training necessary' device then please stand by quietly while the few critical seconds available to save this arrest patient tick away. Thank you for your support." I think you're right on track with your thinking and that a change is prudent and responsible. Dwayne

Yeah, a lot of this controversy could have been avoided if the city government hadn't rushed to immediately kiss the ass of the widow . As Annie said, sometimes people die. He died two days later? Of what? We are so far past the time where we need to reeducate people to the hard fact that sometimes shit happens. There is not always someone to blame. There is not always a villain. To the Mayor that said something like, "You get your ass out of the truck and walk!" I wonder how many emergencies he'd walked to during the storm? What an idiot. And who takes care of the other calls while you have your crews holed up in homes without their rigs, unable to transport? How do you kiss the next ass because your crews are tied up kissing the first ones? Ridiculous...The whole friggin' thing is ridiculous.. Dwayne

I've never really gotten the idea that it's easier to suction with an OPA in, perhaps I need more practice. What I was getting at above was this, that this patient needed oxygenation, right? How do we know that? Because his lips are blue. So if his lips are blue, and this convinces us that he really really needs Os, then what advantage has our pt gained for the time that your partner spent digging out and then applying the SPO2? What information did it give you that you didn't already have simply by looking at your patient? Does your book insist that you apply a pulse ox on all difficulty breathing patients? If so it's very dangerous to be convinced that the machine will tell you more than your assessment... Perhaps I'm trying to make these too difficult, but I've lost track of the basic curriculum long ago, so you'll have to help me out... While you're assembling your suction and your partner is dicking around with the SPO2, couldn't someone simply roll this pt to LLR (Left lateral recumbent) so that some of the drainage would simply drain onto the bedding? That's what I meant by the 'found him in the mall' reference. If he's breathing, slobbery, pukey, I'm just going to roll him LLR and find a fireman to stand by being heroic while they wait for EMS. The point I was trying to make before, and doing so very poorly, was to try and focus your attention back onto your patient. All of your answers are there, every time and always will be. You need the rest of the educational tools of cours, but too often when we get jammed up we turn to our books which often necessitates turning away from our patients... I will try and stay more book focused to the best of my ability in the future however.. Good luck girl... Dwayne

I disagree, for two reasons. First and foremost, your posts make it clear that you're sharp as a tack (For non Americans that means quick witted and intelligent). Second, you not only have room for both, but memorization will be much easier if you attach those things to 'context hooks.' Imagine the pt and imagine your steps as you memorize the facts. The 'what' becomes almost ridiculously easy when you attach it to a 'why.' What have you gained by putting your OPA in place before you suction? What has this done to your visual field as well as your ability to maneuver your suction tip? You had all of the steps, and knowing your attention to detail I'll bet this is the order that the book gave, but doesn't it make more sense to suction first and then put in your OPA? If possible I'm not going to bag this pt before I suction him as I don't want to actively blow more yucky stuff down his lungs than absolutely necessary. Now, I may have little choice, depending on his condition, but he'll need to be bucking and choking for me to decide to bag for the 3-4 seconds it will take me to begin to suction. Also, you should have had your suction unit assembled before you needed it, unless this is an issue somewhere that I'm not used to. Now, again, let's go back to your pt, back to you pt, back to your pt...(That was my attempt at making that echo in your head.) It always goes back to the pt.... A couple more questions, beings you have the CAOs to play... You're assembling your suction. What is your partner doing? Is this the most productive thing he could be doing to improve this pts status? What could he be doing instead? Is there another possibility for maybe helping clear the airway in the short term besides suction? (hint: What would you do if you came across this man unresponsive in the mall?) Good on you for playing! It's uncommon that we get new students that have the confidence to say, "I don't care if I some people don't think I'm smart, I just want to learn!" We had Lisa O starting a few months ago and I was afraid she'd fulfilled our quota for the year..but it turns out perhaps we'll be setting a new quota for next year. Dwayne

Global diaphoresis always brings my little brain to full attention. I've rarely seen it in a sick person where something really shitty wasn't going on, but usually in those with sugar, cardiac issues or decompensating shock. It is hard to develop a differential with any confidence without at least a decent set of vitals. BGL is a must, and I'm guessing it's going to be low whether or not it's the primary issue. Cardiomyopathy secondary to the root canal? It seems like I've heard rumors of this but have never bothered to run it down on my own. But a 12 lead is a no brainer here as well seems to me. Perhaps, and I'm really talking out of my rear now, she's soaked secondary to some type of neural pathology simply because she's old, but I would expect it to be the other way around? I'm also not confident of an allergic issue here due to the time span, but again, I'm not sure if that thinking is solid or not. It would be nice to have a history, but lets get some rock solid vitals, Os, lung sounds, neuro exam, IV so I can manage her pressure, more lung sounds, 12lead, BGL, go ahead and sit her up as Matty said, see if she passes out, trot her over to the ER so the smart folks can figure it out. Just taking a shot, but I'm going to guess that this will turn out to be metabolic and not primarily cardiac, though will likely be a combination of the two. Or...as the other night. 98 year old unresponsive female. Laundry list of meds but the ones that stand out are benzos TID delivered on time, no narcs. Pupils so pinpoint that there is no pupil visible, RR 10/min, HR 56, BP 66/0. Give .5 Narcan IN (Intranasal atomizer) and she's responsive before we finish getting IV access and loading her onto the cot, all vitals improved. I suggest that perhaps her medications got switched but am reassured by the RN that "that's just not possible." So, I'd like to go on record as being the first medic in history to reverse a benzo OD with Narcan. This is what can make nursing home calls tricky. Dwayne

Happy birthday brother... The City is less for you not being here regularly! Get sobered up and come back you prick! Dwayne

I believe both types of answers are correct here. Some have said discontinue and apply your NRB, and this may be correct if they're breathing poorly secondary to say, a seizure or a syncopal episode, as most often they'll come around and breath fine on their own. In most cases though, I'm with Jake. Something made their breathing get froggy and the likelihood is that you didn't correct that simply by assisting them with a few ventilations. Whatever was broken is likely still broken so assistance will need to be continued. I've assisted ventilations many times on pts that were able to talk to me simply because they looked so exhausted that I didn't want them to burn additional physiologic resources with the effort to breath. If in doubt, continue to assist. If it's too much, for too long, they'll simply reach up and pull the mask of and tell you to stop. Sure. But what about your other mechanical options? Why should you use NPAs and OPAs in this patient? Why not? I ask you this because I want you to think about your pt here, and not the book. Each time you identify an issue, decide what you should do about it and then try and make an argument for why you shouldn't do it. In this way you should be pretty comfortable with your decision. In this case for example my little pea brain would work something like this... What does my pt need? To be ventilated. What method should I use to open the airway? Jaw thrust chin lift. But the scene and pt presentation makes trauma a likelihood so I think I'll use the jaw thrust instead. Should I use an NPA? It will likely give me additional air movement with less cranking on the head, so yes. Why shouldn't I? I can't think of any reason. Should I use two? Why not? I can't think of any reason. Should I use an OPA? It seems like a good idea. Why shouldn't I? I can't think of any reason. Now you've got a pt with two NPAs and one OPA and everyone around you thinks you're a complete idiot, until you get into the ER and the doc says, "Nice!" See, he wants air movement and cares not one wit what it looks like or what the book says. We moved air, that was our job, and we used all of the tools we had available to do so, considered all of our contraindications for doing so, and that is our job. Right? Can you rethink this and see if you can explain why this isn't the most logical order of events? (Note, you won't find this answer in your book.) Most wouldn't consider the head tilt chin lift so much a change in position as a maneuver. Why would you change this pts position? Because we're concerned with two things most often when we go to the nursing home. First, this pt will likely have a pillow under their head causing a significant kink in the neck adding to the airway compromise already present because they're unresponsive and their tongue is being allowed to go where it likes. Second, it's likely that this pt has some fluid in their lungs. Sitting them upright will not only put the lungs in a better position to inflate with less effort, but will drain some of this fluid into the bases freeing up some alveolar space. Always, always, always sit your geriatric breathing pts up if there is no contraindication to doing so. This pt may die, but you didn't kill him. You didn't, in this scenario, do everything completely correct, but then, welcome to the world of EMS babe. Sometimes we make mistakes, sometimes they are big, other times small, but often people suffer from them. The sin is not in making mistakes but failing to learn from them and repeating them. Very brave of you to put forth your questions and your answers instead of doing as so many do and asking the questions but then staying safe behind your computer while you get answers from others first. EMS takes cast iron ovaries at times, good on you for putting yourself and your ideas out there to be judged. You did good. Dwayne THANK YOU! Man, I hate this argument, but for the very reason you state. First, you're never going to see this. You're going to hear about it a gazillion times, people are going to swear that it happens to them weekly, but you're almost certainly never going to see it. Second, if you do see it? OMG what then?? As you said, you bag them to the hospital. First week of basic class right? When people warn you about this you really need to call bullshit and be thankful that you got your info from EMTCity instead of from some yahoo wannabe making up stories. Dwayne

I think you misread EMT-1 as EMT-I. I think the issues is finding work as a basic basic not as an intermediate. Dwayne

So Babs and I are watching Human Target last night and there is a beautiful woman as a central character. As I'm watching I'm asking myself, "What makes her beautiful? Why is she more beautiful to me than the next woman?" I'm curious of such things, though not exactly sure why.. Then I realize that part of what I find attractive are (Is?) her 'imperfections.' She has laugh lines around her mouth, crows feet at her eyes, lines on her forehead....Tons of character and the confidence to accept it. I've told Babs for decades that "I don't really trust people without lines on their face." She thinks this is pretty funny, but my thinking is this, that if lines come from laughing, and crying, and worrying, and spending to much time in the sun trying to make a living, then what can I really have in common with those that haven't done such things? And if they've done such things, what can I really have in common with someone that attempts to hide the evidence instead of celebrating a full life well lived? Now, I'm talking about women here for the most part. Men are dorks. I expect them to do silly, shallow, dorky things and in fact kind of like the fact that we (maybe just me I guess) run around acting as if someone snipped our maturity wire much to early. But I expect more from women somehow.. :-) Is anyone else getting tired of waxy expressions? Foreheads that appear to be made out of clay? Movie star after tv star after socialite on the red carpet with their perfect braless boobs with nipples all pointed at the exact same degree of upward tilt? I love boobs. I love everything about them in every conceivable incarnation, but I'm finding that I like confidence and individuality much, much more. It used to be that if I came across someone in jeans and cowboy boots that I'd instantly know that we came from a 'like' subculture. No so much any more of course. And it used to be that when I met someone with character in their face and hands that I'd know the same. Some how it seems that we're losing part of our spirit with these cosmetic changes. We seem to be screaming our developing young people that be that years, and miles, and tears don't matter, that appearance is all. Am I just getting old? Or is our culture getting queered in a bad way? I hope it goes without saying that I'm speaking of those that change for vanity. Those amongst us that have been born or become physically damaged and are simply looking for the opportunity to be able to interact normally in society, well, I hope they get the sexiest noses, the perkiest boobs. I hope they get whatever they need to get healthy, but the others? They are starting to make me a little crazy. Ok. I guess that's my rant, though it's also a sincere question. I look forward to your thoughts... Dwayne

Ok, so AM571 I have to apologize to you. I had a feeling, likely unfairly, based on some of your earlier posts that you were going to turn out to be a butthead wannabe. Posts like this, simple and smart yet that cut to the heart of many educational subjects in one conversation put the lie to my silly preconceive notions. Thanks for taking the purpose of this site seriously. Who's the butthead now? (it's ok, I'm used to it.) Dwayne

Good for you brother! The changes we've seen in you here, the presentation of your ideas, the mentoring of many instead of simply arguing with them, it's truly inspiring. I know it wasn't easy, that you had a lot of hurdles, but we're really proud of you for doing it... Dwayne

As it should not be. Though, as Dust will soon point out if he's not in between countries, this will ultimately turn out to be a taining/management issue. It seems to me that I've considered this type of restraint bad form since before I went to basic school, but then again, not everyone gets a regular diet of EMTCity, so perhaps this thinking isn't as pervasive as I thought. Are there places out there where this type of restraint is still considered 'normal?' Dwayne

Can I ask a huge favor? Is it possible that we can get through a discussion of anything cardiac without the use of 'treat the pt, not the monitor' over and over and over? I mean, we've all heard this ol' saw from our first week of medic school, and many of us from our second or third week of BLS education. The OPs presentation seems to make it clear to me that he is in fact treating his pt, and not the monitor. Why is it when we talk trauma we never hear, 'treat your pt, not the b/p cuff'? 'Treat your pt, not the ETCO2'? For some reason we use each of these tools, as with a monitor, to add to our assessments but aren't considered foolish or medically immature for referencing their data when discussing treatments. Not trying to be a shithead everyone, truly I'm not, but I began to be offended for this poster after about the 3rd or 4th repetition of a phrase that he almost certainly didn't need to hear in the first place. K, off of my soapbox now. I don't really get the logic here WM. So then, do I not get aggressive infact that fell off of the roof onto soft grass, is not 'appearing' hurt and his pulse rate is steady and within normal regulars? Do we not treat the female syncope because she isn't pale, diaphoretic, her pain isn't 'crushing or radiating' and is 'fine now' but 12 lead is showing a STEMI? After all, most BLS providers wouldn't have caught the implications that, in each, the lack of symptoms was possibly a very ominous sign. It seems to me that he discovered what appeared to be an increasing ventricular pathology and was asking if he could have prevented further degradation by being proactive (An attitude that I like and respect a lot) or if waiting to be forced into treating it was more appropriate. Mainly, because I'm a chicken shit, I nearly always choose to be very aggressive where I can justify it as I friggin hate finding myself behind the eight ball when I could have avoided it. I think he posited an great educational question. Awesome advice, but if I may, I believe that at times, if we pay attention, we can give our patients what they need before they really, really need it. Isn't that an example of the very best we can offer in medicine, and isn't that what this thread was really about? Not meaning to snipe at you WM, it just happened I 'got going' on the other stuff after starting to respond to your post.. :-) Dwayne

I can see your frustration man. I think much of it comes from dealing with the fact that sometimes people come here asking for 'medical' opinions when what they are really doing is trying to fortify a lawsuit, and most of us don't like giving trolls a bunch of half wit information they intend to use for purposes not in line with the purpose of this website. My answers, to what I believe you've asked... I think it should have been reported to a coroner. Every death here is reported to a coroner so I'm not sure how it works where you are. I don't understand though, if this was not investigated, with an autopsy done, how then are you certain that she died of an aneurysm? I wouldn't expect this to be outwardly obvious. Not only is there little to nothing to be done prehospital for a pt identified to be in this condition, I can't imagine that this case would commonly be identified prehospital. I might have suspicions in a relatively new onset localized unresolving headache, but I would certainly never have a high level of confidence in my differential. We have a medic at our service that often has relatively severe headaches for days at a time. It's never occurred to me to report her to management believing that I've identified a newly emerging aneurysm. She's full grown, I've asked, as a friend, that she get it checked out, the ball is now out of my court. Unrealistic case? Pt crawls into my ambulance and says, 'I'm a neurosurgeon and have, just moments ago, diagnosed myself with a cerebral aneurysm that I believe may be rupturing, please help me!' I'll but him on my cot, leave him sitting up, start him on Os, get a line, monitor his vitals until I get him to the hospital. Should he suddenly scream and become unresponsive then I'll open up the fluids and watch them run while he dies. That's pretty much it brother...my entire tool chest for this type of patient. Unfortunately, some people are going to die no matter how much we'd like it to be otherwise, and unless this manager is going to force every headache, dizziness, general malaise, cough, shortness of breath, abdominal discomfort, leg cramp, to go to the emergency room, I don't really see what could have been done here, with the information you've given. Not sure if this helps, but I do hope that you'll see that it's my best effort to answer your questions as I believed they were asked... Dwayne