DwayneEMTP

Yeah...I'm a little surprised by those afraid of EJs... I'm not out of clinicals yet and have started three. What's the issue? Prep well, occlude, look for the vein that's about as big as a tree branch, and stick a needle in it...Easiest IVs I've started I think...with few exceptions. Besides, it's big, will take a bunch of fluid, pretty easy to see if it's patent or not with a saline flush, did I mention easy?, and I didn't notice people complaining or showing s/s of pain any more so than with other IVs (If I remember right I used two 14s and two 16.) I would not use it first, mainly because it's a little more difficult to secure, as well as it tends to make some folks a little hinky. But if I need access NOW, it comes way early in the list. And as someone mentioned before I hate leg/foot IVs with the more delicate diabetics. Fire about had a coniption (sp) fit when I was on my second phase and asked that we use an EJ instead of foot when several attempts in the upper extremes failed for a bed ridden 60ish diabetic with multiple other medical issues. I got the "Oh good, a cowboy" look, but I tried to explain that her feet were constantly covered, and that she was already missing several toes, which led me to believe amongst other things, that she had very poor circulation there. I felt that an EJ, in one attempt, would be less likely to be harmed by the sugar, had better circulation, but the most important thing to me, it would be seen by every person that looked at her face while it was healing. (Note that this is my logic. Probably not good logic as I've not seen nor heard it from the experienced medics I've ridden with. But it makes sense to me.) Anyway, we started on the foot with several attempts, and it all worked out in the short term, though I would have loved to see her feet a few weeks later. Ok...I see that I'm rambling again...this seems to happen when I don't get to post often. :? Have a great day all. Dwayne

:? You may think that my "nit picking" is all about me..but I'm hoping you're mature enough to come to understand that it has nothing to do with me. It's all about you. You're too smart to express your ideas in this manner. (Note: There is not one iota of hostility in this post.) Dwayne

Again LS, I'm going to follow your logic here and restate something... If no risk is acceptable, then you, as someone that's been injured, historically will be at a much higher risk to be injured again, perhaps during lifting, or moving a pt, than someone that hasn't been injured in the past. (Anecdotal from a doc, I don't have documents to support it. Besides, the logic stands without docs.) So are you in fact prepared to flush your knowledge and experience down the drain,(or as your argument suggests, should have already done), for the good of the patient? You could become re injured and drop a critical patient at a catastrophic moment, or be unable to help the stroke or cardiac patient be carried down the stairs to immediate transport, or unable to adjust an airway at a critical time, right? Have you in fact shredded your EMS certs and moved on to your next career? It is, after all, the only responsible thing to do. Isn't it? And I still maintain that I would have no issue with an HIV+ person treating me or my family for the reasons stated, ad nauseum, before this. Nothing to do with being PC, or sensitive to the plight of those infected. It's simply good science. Dwayne

Ah, see. That is what I meant. That is a mature response and I'm happy to spend time responding to it. Though I will be happy to argue that the "nit picking" is not "unnecessary". One of my pet peeves is people that ask for advice...and expect the busy, smart people here to take time out of their days to offer help and support, but can't be bothered to present their ideas or desires in a mature manner. They want time out of these amazing people's days to respond, but are unwilling to take the time necessary to proof read what they've written. It seems to me to be a simple matter of respect to give before you get. And my apologies for what you accurately labeled as a hostile response. I also should have taken the time to state my issues in a mature manner...today we both learned to be better than we were yesterday...from each other...pretty cool huh? Thanks for taking the point to heart, and continuing to post. You most certainly are welcome here. Dwayne

I think medic school was around 40ish units with the degree in EMS being either 62 or 72 units, I can't remember and am unwilling to take the time to research it until you learn to post like an adult... I'm around 80 units now I think, and all I really added that wasn't required was cellular biology and an additional psych class...I think... Come to think of it...I guess I don't really know anything... :? Good luck. Dwayne

As one of those that offered constructive criticism, I'd like to say this... I'm proud of you for taking it to heart instead of crying about it. That post was much more mature and certainly easier to read! Now just find your "Shift" key to correct your capitalization and your posts will be first rate. I thought this was a great case study and am grateful that you hung around to post it, posted it as a professional, and showed the guts to do so again after a less than "warm and fuzzy" first attempt. Good for you! And just a quick note...Any case study or scenario that gets AZCEP and any of the Docs involved should make you feel pretty good... Dwayne

Ok...that's it! I'm tired of hearing people say they had a great time in medic school! How the hell did you manage that? I spent a great amount of time and energy at school four days/wk, at least 25 hrs/wk studying, 40 hrs/week (min) at work, and every spare moment either worrying about the above, or freaking out over my B in pharm. (Though I don't really freak out, it was stressful) Obviously I'm kidding...about being sick of it. But I do believe that the one thing that was harder for me starting in my 40s is that I had a very limited tolerance for compromise, an almost manic desire to excel, in a system that had very little respect for either. As an adult you need to be prepared for the fact that school aint like what you remember. The kids...and they are kids for the most part...dress differently, don't show respect in the same ways, value "coolness" over academic excellence...etc. I came to let those things go, but never found a "happy place" in my head for them. And besides..did you really have so much fun in medic school? Or is that what we're supposed to say...I'm truly curious.... Dwayne

Good. When using the mask you can/do lose some around the mask as well as down the esophagus, and as you mention there can be anatomy that interferes with ventilation compliance. When you have a tube, those issues are resolved. Also you are ventilating with a much higher concentration of O2 than is found in the ambient atmosphere. As well, bagging with a tube compared to normal resting respirations create a higher tidal volume, normally. (It seems...though I could be off in the ditch here.) And lastly, and this is my thinking, it's not something I've seen addressed before...It seems to me that the O2 requirements of an obtunded patient would be lower that those of even a relaxed, healthy person. What say you Vent? Is LOC considered when addressing ventilation needs? Not meaning to imply you have a "coma" or "Normal Mentation" button or anything...but is there a documented physiologic difference in O2 demand between the two? And if so, can you predict the difference in the needs of the two, all other things being equal? (Ok, I know they're never equal...but what if?) (I know, I know...where's the education! I'm following the links you PM'd me as fast as I can...I'll catch up...I promise! :wink: ) Dwayne

Actually, I think you did ok...When you don't know what to do, you're right, some Os usually won't hurt. I think you're receiving some criticism from two fronts, and I explain these to help you progress here and in EMS, not to be rude to you, as I have a lot of respect for, not only your being brave enough to post, but brave enough to stick with it even when it is sometimes not a lot of fun. Good for you. First reason...And not your fault, is that though 15L/NRB is taught, it is also a little mindless. I'm not calling you mindless, only trying to explain that as you progress through your EMS education you'll find that often, in fact most often, those rules don't apply. As an almost medic I normally use 3-10L/min of O2 where I was taught as a basic to use 15. Would the other few liters kill anyone? Nah...it's just that I don't get to play by the book any more. I have to make rational, logical decisions about every aspect of my care. Not only the life and death decisions, EVERY, decision. When a nurse or Doc asks "Did he need 15L/NRB?" I want to be able to say, "I had him on a cannula but his color and mentation seemed a little off and his sats had dropped into the low 80s. I didn't get the response I wanted at 10L either, though at 15 he seems to have pinked up and is staying oriented." (Not a likely conversation, but hopefully it makes my point) Instead of saying, "He might not have needed it, but what difference does it make?" When I come into the ER with a patient on a cannula I get a completely different initial response than when I come in with someone on an NRB. If I come in with them on high flow O2 it's assumed I am having trouble keeping his sats up and I get much quicker attention. If I commonly brought in patients on high flow that didn't need it, the tiny bit of respect I've managed to gain would soon be lost as no one would be convinced I was a "thinker". See what I mean? The second place you're having trouble is in your presentation. I'm hoping you're mature enough to take this in the spirit intended.... Your posts appear to be written by a child. To tell you the truth, I've ignored your posts until today, when there wasn't much new to read, because after looking at the first sentence of your first post I was convinced you didn't have anything intelligent to offer. I was surprised to find that you had some good points, but they were lost in the 3rd grade presentation. Many come here with nothing to offer. They come, and soon leave, to the point that those of us that have been here a few days often don't want to bother trying to help them. Your posts make it appear that you are one of those...though the fact that you continued to fight in your thread leads me to believe that maybe you're not. Clean up your posts a bit. Give folks a chance to understand what you think, what you mean, and to take you seriously. I for one would like to hear what you have to say. And try to understand that the posts that offended you came from busy, smart people. They took time out of their day to try and help you be better today than you were yesterday. They were trying to teach you to think, (which you've shown to be capable of with some good logic), not to be an ignorant robot like many...perhaps most, of the people you're going to work with. Hang in there, don't run away, clean up your posts, but most important? Keep thinking, keep arguing, and keep posting. Every day someone is kind enough to show me a place that I'm weak, but wish I was strong. And then they teach me to be stronger, and smarter. It's well worth the effort. You'll see. Good luck to you. Dwayne

See, and once you become a medic you'll come to understand that this only applies as long as your seat back and tray tables are in the upright and locked position.... :wink: Sportygirl, of course I'm kidding, but I wanted to make sure that you understand that Vent talking over our heads is a compliment, not a back handed insult. She assumes that we want to learn above our certification and current education level and is kind enough to give us all the information we need to do so...and we're always the better for it. So if you'll take the time to answer my questions, I'll take the next day or so and figure out the things in Vent's post that I didn't/don't understand, and then we can share! Sometimes new people can get scared away by the very intelligent posts we are blessed with here, but it's important to understand that you're not expected to understand it...you're expected to come to understand it, and then teach it to others...see what I mean? Thanks Vent for your posts...I'm shamefully weak in respiratory physiology outside of my own little medic world and am grateful that time and again you dedicate the time and effort to keep moving us forward...you're a peach...(and were missed terribly in Florida! Though you weren't there in body, you were often there in spirit as part of our conversations and arguments. :wink: ) Have a great day all! Dwayne

I’m guessing that you meant that you were told you were bagging too fast? That is the more common problem. I think you got this backwards. Normally BLS, (as VentMedic mentioned, there are many reasons to change vent rates/volumes (Though I didn’t understand most of what she said either) at cert levels higher than yours, but I think this is what you’re looking for.) with BVM you’ll try for a rate of one ventilation every 4-6 seconds. Once an advanced airway is placed that will drop to about once every 7-8 seconds. Can you break this problem down and tell me why that is? What are the possible differences between using just mask, and using the tube? A “normal” person will be expected to breath between 12-20 times per minute, per your current learning. So if we take the person that is breathing 12 times per minute, and they stop breathing, then intuitively it seems that we should breathe for them at a rate of 12/min, right? But there are several things that change when we begin to breathe for them…what do you think they are? Therein lays your answer….Though I’m happy to help. Let me know what you think and we’ll talk more… Dwayne

As well, here we have four preceptors. I think it's an outstanding way to go...assuming you have good preceptors. We spend eleven shifts with each (132 hrs) and it gives you a good look at what they do, how they do it, but more important, why. Make sure you milk your preceptorship for all it's worth, and if you find your preceptor doesn't also happen to be a teacher, then request a different one. In my very limitted opinion, preceptorship can make the difference between bringing all of your didactic hours into focus, or simply scattering that information to the winds... Good luck to you! Dwayne

This is my favorite place of all time.... You can search by difficulty, rhythm, disease, etc...Pretty cool. Dwayne

Got it. It wasn't my intention to put words in your mouth, I was just having a difficult time figuring out which side of the issue you were coming down on. I see now that you weren't picking a side so much as debating individual misconceptions... Dwayne

As one with microbiology, and not offended by the comment, I just can't seem to get on the same page with you here. I have no idea what Varicella is, and don't have the time to research it now, so I'll address HIV only. In this thread Vent and others have posted data to support the fact that the risks are extremely low, I believe that someone even posted a link claiming that the CDC is ok with HCW with HIV within given, though very broad parameters (I didn't go back and verify these things, I'm pulling from memory), many, as well as myself have claimed that their experience has shown the situations necessary to cause transmission are rare to unheard of...so what is the problem? I know you are not prone to knee jerk reactions, panic in any form, or "jumping on the band wagon" ever...it just seems that in this case you've chosen to ignore the science, which your posting history makes impossible to believe. What am I missing? Dwayne

If, on your first ride out, you handled your assessments well, with focus, intelligence and confidence, then you're a medic pretending to be a basic student. Assessment confidence comes with education, training, and practice, practice, practice. You won't really grasp the essence of assessment until you've had enough education and patient contact to know which "paths" you're trying to follow with your questions...there's no shame on you...it takes time and you haven't had the time yet. The real question is...will you do what it takes to be good at assessment? Will you learn what's needed to be able to focus your assessments? To build a differential with the information you gain? You are at a true fork in the road now. Most will choose to parrot nonsense...and will look skilled to you because they don't seem to faulter when assessing. They are confident, or at least appear so, because they rarely need to think. Others will continue to look clumsy because they need a moment to think between each question, to digest the last answer so as to ask the next 'appropriate' question. This is the hard route, and most won't choose it...but it's the right one. You are right where you're supposed to be. Now you simply need to decided, do you want to look good? Or be good? If you want to be good, then get right with the idea that sometimes you need to think, to pause, even if you think it makes you look goofy, to be sure that you're doing the smart thing...not simply the 'next' thing. Know what I mean? Good luck to you. Dwayne

Wow Dust, thanks a million for that. I will consider the answers before I apply again, but not use the canned answers I've found in the past. I somehow got it stuck in my head that there were the 'correct EMS answers', and was unwilling to parrot those answers, nor was I sure that I wanted to work for a company that placed value on those that would do so. I see now that I misunderstood the process. I've found everything about working in the Springs (CO) to be inspiring. The medics are terribly smart (I've worked with, or around, perhaps 25 of them during my clinicals), very proud to be smart, committed to patient care, but even more so, committed to medicine. I'm not sure if I'm the calibur of medic that they want here, but would like to do all that I can to work in this system. I just want to earn the right to do so without pretending to be something that I'm not. Know what I mean? (I'm still not sure if I would want to be a knife, fork or spoon, in fact.) I can see now, from your post, that there is certainly a difference between preparing via asking myself the right questions and developing my own right answers, and being dishonest by researching the 'right' answers and then burping up what I've found. Thanks so much for taking the time to explain it so thoroughly. You're a gift. Dwayne

So just when I think..."Ok! That's it...the n00bs can friggin watch out for themselves! I quit!" I see.... And then I think..."Ok, I guess I can do it one more time..." For every 15-20 Jinketsus we seem to end up with 1 MBC that's smart, funny, and hungry to learn...It's a fair trade I think. That's just funny there... (Though, point taken as well) Dwayne

If you normally conduct yourself the way you have here, then my guess would be that you are being put down because of who you are, not what you are. In your few posts you shown yourself to be too ignorant to spell, unable to master even 5th grade grammar, unwilling to take a chance on paragraphs, have attacked people you know nothing about, and proven you have little to no grasp of, at the minimum, cardiac patient care. What part of that do you find deserving of respect? You can get respect here being ignorant but teachable, arrogant but smart, intelligent but quiet, loud/funny/educated....and on and on...but a word of advice...? loud and dumb just aint gonna get it done. (This last typed in the style of your superior EMS system for clarity) And truly, in the spirit of my new role as defender of the new folks here...please don't humiliate yourself further with the argument that "I don't need all that stupid book lernin' to be a great EMT!" Just sayin'... Dwayne

Perhaps they should add spelling and grammar to your stellar education... Oh, and I say this so rarely it's difficult to type... You are an idiot. Dwayne

:? Man, here we go again... You know, my new "watch out for the n00bs" philosophy is being tried and brutalizied... Jinketsu, welcome to the City. -5 for the most idiotic, immature, uneducated post we've seen here in quite a while. Perhaps you and your volly buddies can have a good laugh about this stupidity later, but until you learn to think like a professional, and get some type of education, you'll never understand the level of conversation we often have here... Good luck to you though... Dwayne

For those of you that have interviewed... How much weight do you give to good, though obviously well prepared answers? Before I applied with AMR in CA as a basic I looked up all of the standard questions that others had mentioned here in threads past. I found amazing answers, certainly better than the answers I would have come up with if asked on the spot. I know, because I was asked most of the questions I expected, but chose not to prepare with someone else's answers. And judging from the responses I received from the panel, ended up looking like a complete idiot because of it. Normally I make every attempt to learn from history...but that is the same tact I plan to use next time. To prepare with proven answers simply feels dishonest to me. I can see it both ways. Perhaps they see this as a lack of planning/preparation on my part when applying. Or perhaps they see it as an attempt to be honest during the interview process. What do those of you that have hired medics think? Dwayne

Have you all actually seen an asymptomatic ventricular rate of 300+? (I'm not being sarcastic.) I can't really invision the physiology that would allow sufficient filling at that rate. I've had several patients with SOB, ALOC, C/P with v-fib/rvr in the 180s-200s so I'm having a hard time imagining the patient mentioned above... I don't mean to derail the thread...was just curious. Dwayne

Jessica Rabbit... You know...Well...I'm just sayin'... Dwayne

Like the majority of your arguments. Your entire contributions to the forums come in two forms.. "Having religious beliefs is stupid." Or "EMS in the U.S. is stupid." Both of which you run away from like a scared child the first time you're intelligently challenged. At least MBC makes an attempt to express her opinion openly, and continue with them even when they're unpopular. In this, at the minimum, she shows she has bigger balls than you. You should leave her be. But of course you can't pass up the oportunity to pick on the new folks. You've shown on nearly every occasion of your postings that you are unable to sustain an intelligent conversation that involves any type of logical progression or support of what you claim are "facts", unless you're parroting someone before you... When you complete any amount of college/university that allows you to form a rational opinion, express it clearly, and then defend it to a conclusion...come back to me. Until then, toodle on back to the kiddy table. Dwayne