DwayneEMTP

Yeah, I hear you...and cheap shots aren't really your style. With just a few exceptions, you'd have hated this thread. Besides, now that we've taken the fun out of the easy snipes this thread will die... (By the way...What's up with all your new touchy-feeling avitars? I don't have to start being nice to you do I?....) Dwayne

I watched the video on this when this topic came up before...Some said it was done away with 20+ years ago... The first thing that pops into my head is...We stopped doing the Heimlick on drowning victims to expel water based partially on the fact that it encouraged the victims to vomit and aspirate... And many experienced medics tell me arrests often happen immediately following a large meal (urban legend?), wouldn't it seem that this technique would be contraindicated in many arrests? Just thinkin'.... Dwayne

Man, what a disappointment. So many people I often respect taking the easy shots… You know what I hate about these types of threads? Because of the bonehead title, every limp wee wee on the board gets their shot to come out of the woodwork and say, “Until you go to medic school you’re a loser and can’t question anything!” Bite me. I’m a basic. It says so on the only NR card I own. And half the people that posted here don’t have the gonads to defend their opinions to me. I question my family’s doctor about their care, which should stop because I’m not a doctor? I question and argue local and national politics, which I’m no longer allowed to do as I’m not a politician? I’ve questioned the Docs at the City numerous times without once being told to “come back when you’re a doctor!” When the medic I’ve ridden with says for the umpteenth time “Don’t worry, we won’t drop you, we only drop people on Wednesdays! Oooops Today is Wednesday!” I can’t possibly know that that is idiotic because I’m not a medic? You want to know how to tell I’m too stupid to be in EMS? Because I actually thought that those that I would some day like to earn the right to call my peers, would pass up the opportunity to take the easy way, to once again snipe the new person for an error in etiquette that couldn’t possibly be understood with a 4 post history. Many of you like to call up Dust’s name here. You all think Dust would be proud of your idiotic bully behavior? I’ll bet you a months wages he would avoid this Waaaaa fest like the plague before aligning with a bunch of folks that could create a two page thread from a n00b’s post and NOT ONCE EVEN TOUCH ON HER QUESTION! And Doc didn’t invalidate her scenarios, he simply offered alternative possibilities. Ahhh…forget it. Dwayne Edit. Apologies to JPINFV and Jess. After rereading the thread after this little tantrum I see where you didn in fact address the questions.

I'm gonna go out on a limb and say Dust wouldn't hang this n00b if he'd read her other posts...I don't see Dust hating the question, but the ignorance and attitude that usually accompanies the question. A couple of things differentiate this from 'those other threads'.... One, I don't see the attitude of 'EMTs save paramedics'. It appears to me that it's her own ass she's trying to cover here. I'm a medic student and have seen things that seemed hinky, even disturbing, that I've researched after the call and discovered were in fact hinky and disturbing. Asking the question doesn't imply superiority. I don't claim to be superior or even equal to those medics, but having been there, helplessly, makes me hungry to answer the question of 'what to do' before I get there again... And I don't see the ignorance. If you've read her other posts you'll find them helpful, thoughtful, and valuable. At least I did. 15 years is nothing to sneeze at. Before we decide to take the easy shots, let's make sure that this is not in fact a horse of a different color. On the flip side...Do the search Suze...and you'll see what everyone is getting all froggy about... Dwayne

Why is that? I've come to believe that once you've raised the BGL that the proteins are what she would need to plateau, right? (With, as I've learned today, the exception of the OJ) As AZ said, it seems that more straight glucose is going to be metabolized quickly by whatever mechanism is causing the issue now....Particularly with a no transport I'd think that putting something more complex into her belly would be important. :-k Just curious... Dwayne

Hey Josh, sorry about the name confusion! I think getting into your medic books before medic school is a good idea, but before your NR basics tests, maybe not. The reason I say this is that your basic testing will all be about testing your memorization. I don't mean to be offensive, but you WILL NOT THINK during your basic testing, you'll simply regurgitate the things you've memorized. You will not be given anything that wasn't covered on your skill sheets in your skills exam. You will have a scenario that applies directly to one of those sheets. Paramedic training is all about "what ifs". That sounds like the type of learning you're hungry for, but is definitely detrimental to your basic testing. If you attempt to make things complicated during basic testing, it gets confusing, and may give you trouble. Make sure you know your skill sheets cold. Have a firm understanding of the concepts covered in your textbook. Save the more complex medicine until after your basic testing. And as for your assessment skills coming together? It simply didn't for me until I had patients laying in front of me to put my hands on. It made me CRAZY that I had all this information in my head, but couldn't get it to line up in any cohesive manner! Until I started being responsible for patients. Then it was kind of like running a magnet through a pile of iron shavings. The relevent symptoms seemed to line up in my head...then the treatments, and possible complications....And I've found that as those connections are made...they stick. I get to keep them forever. So don't get discouraged. You're way ahead of the curve, you just haven't been given the patient contact or responsibility needed to put it all together yet. But you will... Just my thoughts of course... Good luck! Dwayne

http://www.biblio.com/details.php?dcx=15766108&aid=frg

Hey John! Welcome! The best advice I can give... For skills testing, know your skill sheets. YOU OWN THE PROCTOR WHEN YOU TEST!!! People always freak out and miss simple things. The proctors job is to mark off the little check box when you mention it. If you mark off all all the boxes, you pass. If you look like an idiot, smell funny, pee your pants, vomit...nothing they can do. Each skill sheet takes about 3 of your 10-15 minutes. When they say, "Is there anything else you'd like to say or do?" Start at the beginning and do it all again!! Skills are a breeze... For the National Registry? Nearly every question will boil down to BSI, Scene safety, ABCs. They will try and trick you into picking something else, but eliminate those as a possibility before you consider anything else. You'll get something like; You arrive on scene to find a teenage girl with a large knife wound to her throat, she is screaming and bleeding badly, what is the first thing you should do? And there will always be an answer mentioning putting pressure on the wound. If you failed to answer BSI, or Scence safety if they're available then you failed this question. See what I mean? I'm kind of wierd about these things. I like to use these tests to see what's in my head, so I don't touch a book for about a week before any non-class testing. Before NR basic? No studying and I got somewhere in the low-mid 90s I think...can't remember exactly. Paramedic skills testing...Nope...no studying...passed each station on the first attempt (I had to chalenge one when I disagreed with the proctor, and passed through). And that's saying something. If you spend any time here you'll soon realize I should really be riding the EMS short bus...so If I can do it you can too. Almost all of your classmates that fail will do so because they freaked out and froze. Understand that if you are prepared, you will find these tests almost frustratingly simple. Good luck man! Others will have better advice than mine...so check back! Dwayne

I've decided I'm simply going to keep adding to this thread as things occur to me...It's just to big to figure out all at once... A couple that just occurred to me tonight. People have given me way too much credit for being brave...I often feel like the biggest twit at the City. But being brave here is learned I believe. There are a ton of obvious folks that help us out, but some that seem to slip under the radar, and they shouldn't. Fiznat. Completely fearless when he's posting case studies. It's obvious that he puts things out the way they happened, regardless of whether it makes him look brilliant or not. I have read his posts and thought, "Oh hell! I would have lied my ass off about that!" But not him. Learning always comes first. His, mine, yours...everything else takes a back seat. If you haven't read his blog by the way, you're missing out! Medicine is not his only talent. EmtAnnie...I just read one of her posts. Smart, funny, kind, inquisitive! All the things I'd like to be...I'm going to try and counterfeit her attitude, I swear! And suzeg487, a newcomer that I hope will be here a long time. She only has a few posts so far but her experience shines brightly through. She seems to define the attitude that I love at the City, right from the start. I'm not sure if she's asked any questions, but has spent her time giving thorough, thoughtful answers to other's questions...pretty cool. (Though the whole WelshMedic connection continues to make her suspect!) Chbare. If I'm brave it's because of people like him, and the Docs. I can put my two cents into a thread, they will respond with 15 things that I wouldn't have thought of if you combined 50 of my best days, yet leave me feeling like they never would have thought of them if I hadn't brought it up. Terrible smart, amazingly kind, completely unbaitable! They are truly a gift to the City. Ok...that's it. I'm back to the forums to spread some hate and discontent! Dwayne

Good for you girl! Not that I had any real concerns.... Chin up for your surgery. I'll be sending you happy thoughts! (My experience with Chip-n-Dale dancers is limited, so I'll have to send thoughts with flowers and smiling kids instead! Watch for them!) Let us know how it went when you can...OK? Dwayne

Great post... I too try and keep joking to a minimum, though I think the 'getting up to go to the bathroom' joke is perfectly appropriate... The only time I've used humor consistently is with 5-12 year olds or so...If they're scared I'll say, "So is your husband/wife coming to the hospital with us?" To which they nearly always laugh and reply, "Hey! I'm not married! I'm only eight!" The only other dialog I've fallen in love with is with cardiac, trauma, or breathing difficulty patients...Once I'm sure that immediate life threats have been dealt with I'll say something like, "I know your scared/in pain, and that's perfectly understandable....but let me tell you what I KNOW right now. You're color is good, lungs sound good, pulse ox shows good saturation...so I know you're moving good air...Ok? The monitor tells me that your heart is working strong as a little engine, so I don't want you to worry about that right now...vitals are in a good range. All this means that you got scared, and that can put things out of context for a bit...but all the important systems are doing just what I'd like them to do...OK? Do you have any questions?" It only applies to appropriate ages of course, but people seem to trust me more, and have more confidence than when I just said, "You doing fine, try and relax." Yeah...it seems sometimes this is where you'll get most of your 'real' information. Shoot, I didn't think you ran on at all. I'm grateful that you'd share your experience. As many know...I've barely popped my cherry...I'm just approaching 300 pts that I've been responsible for in my clinicals, so I'm not pretending to 'know' anything...just some of my thoughts so far... Dwayne

Hell...

So this was your first seizure then? Any idea what cause it? When folks are in a postictal state they are awake, but not completely oriented. For example, one lady asked to use the bathroom before being loaded. A pretty lady, very feminine. When she was gone for a while, I asked if she was alright, and got no answer. I let a few more seconds go by, knocked, asked again, again with no answer. So I opened the door and stuck my head in...at which time she screamed "I'm trying to take a f*cking sh*t! Will you close the f*cking door!" And then, after being packaged, and loaded, she spent much of the 20 minute transport asking, in the most perfectly ladylike manner, why I had attacked her in her bathroom? I don't know for sure, but would be willing to bet if you asked her today she would mention the medics that attacked her in her bathroom for no reason and took her to the hospital... See what I mean? She would not be lying, but would not have access to the full story, nor be able to put the parts she had in proper context. It's imprtant you make sure that's not what's happening to you before accusing people of being inappropriate. As Mobey said, if you have questions, you should persue the answers, just do so with all the information possible at hand. Dwayne

Great points Mobey...I completely spaced the fact that he's canuk! Dwayne

No need to apologize. How do you define a "pelvic"? It is hard to say without being there, but a couple of things to think about. If you had a grand mal seizure, it's possible your perception of the things that happend directly afterwards are a bit queered. If you've had them before you know what I'm talking about. With the cut, you complalining of sever neck/back pain etc, it's possible they needed to rule out other injuries. Pretty hard to do with your clothes on. You say you were conscious during this process, but are you familiar with the difference between consciousness and a postictal state? The difference is important. Did they go to far? Possibly. If someone in your family had similar complaints, would you in the future prefer that they left the clothes on and hauled them to the hospital with a broken leg, or other untreated injury? I know I wouldn't. And are you sure you were treated by medics? Just some thoughts...I look forward to your reply. Dwayne

Man, I love these threads. It reminds us that we’ve come to mean something more to each other than simple entries on a forum. That’s important I think. What I’ve learned… Being wrong is OK. Staying wrong because you’re afraid to ask for help is not. I like to post questions with the information I already have in my head, without researching it first, just to see how my logic stacks up to the smart people here. Without exception, each time I’ve said “Oh hell, they’re going to kick your ass for being an idiot this time!” , I’ve been wrong. We squabble at times, but at the end of the day I leave here smarter, and sometimes more humble, than I came. We are a team here, and I need to continue to earn my place on this team. I don’t have to be better than someone else to earn my place, but I must be as good as I can be today. That’s what’s expected by those that I respect here, and I’m grateful for the benchmark. Many come, and most go, but the core posters here share a common soul, we watch out for each other’s ideas, concerns, education, and mental well being. I can’t think of a single person that posts regularly here that would consider it a favor if I failed to point out a weakness in their thinking. We don’t come her to cry, or whine, or feel sorry for ourselves. We come to be better, and to do what we can to help others to be better. Sometimes we cry, whine, and feel sorry for ourselves, and that’s ok. But that’s not our community goal. Ok, to specifics… Dust and AK convinced me a couple of years ago that I would be sorry if I went to a 9 month school instead of pursuing a degree. The sacrifice has been tremendous, at times almost too much so, but it’s now 6 weeks away. When my preceptors introduce me to the other crews as “My student Dwayne, he’s just finishing his AAS in EMS” and 20 year medics say, “DUDE! That’s hard core man! I wish I would have done that!” I strut like a peacock! Thank you guys. Michael. I don’t know what the hell he’s talking about half the time, but he brings a dimension to the board that was sorely lacking in his absence. He’s kind, funny, smart, yeah..smart,…ok, too dang smart! But he reminds us that not all is EMS, sometimes we have to think sideways and backwards, and THEN reminds us that thinking sideways and backwards is a big part of being good at EMS. I wish I had better words to describe what he means…I like to call him my friend…that will have to do I guess. Kaisu, Eydawn, chaser, becksdad, hell, a ton of others. They remind me to be kinder, gentler, not to make every point with a 2x4 when a Nurf bat will do. They are the heartbeat of the City, without them many threads would seem dry and angry whether they were or not. Scaramedic, asysin2leads, Dust, AK, Any of the Docs. They don’t always dress things up pretty the way some folks would like but when you see their name in a thread there is absolutely no doubt that you will be interested in what it has to say. I consider it a red letter day if I can contribute to a thread that any one of them is involved in. As AK said, this could go on forever, so I’m going to reserve the right to recall this thread as the subject has time to percolate through my brain. The City is a special place. It’s changed the way that I think about so many things. People here have directed my career, cried with my family, spent time to learn who I am, warts and all…It’s a precious thing. We should guard it dearly. God bless all…(if that’s your thing) Dwayne

Hell, we use D25 and D10 with peds...It should have occurred to me that it might hurt the fetus... Thanks for explaining. Dwayne

Good God...The Docs are killing us...Cool! Here's my thinking. Bubbles in the blood = damage to the larynx. Damage to the larynx = edema in, spasming of, or displaced anatomy which = go straight to the cric. That's my best guess as to why you'd ask that... Having said that I'm thinking I'm still going to attempt to intubate. I can't offer any intelligent reason for this. My only thought is I need to see what's going on before I decide what to do. I can look with my blade and then decide to cric, but it doesn't make much sense to do it the other way....does it? Now, having said both of the things above...I can't imagine you would have asked in the first place if the answers were that easy... :oops: I am curious though, as the only indication I've seen/heard of for using cric as a first line airway intervention is complete destruction/obstruction of all or part of the airway superior to the site of the cric, which with the scanty info we've gotten so far might not be the case.. Dwayne

Wait...before we get to far gone... Is there a precaution for pregnancy and D50? I can't seem to come up with anything...and my little pea brain is ringing any bells when connecting the two...So what gives? Dwayne

Shoot, you can do even better than that. Get knocked up then DON'T get married and you'll get books, tuition, plus $2500.00/semester! See...Easy. :wink: Dwayne

See, now those parts are particularly relevant... Thanks Michael...You're good for my soul... (HA! A whole new conversation!") Dwayne

Edited by me for a breach of Dawn's Law. (I was having a sideways moment and sniped another post...tsk tsk) What happened to the Delete button? Dwayne

Man, great question Doc...And me difinitive answer is...I don't know until I see the anatomy involved. Having said that, and having never really thought of this before, with a gunshot wound and the resulting cavitation injuries, perhaps there are going to be issues surrounding the trachea that won't become obvious until I've begun to make my intubation attempt...hell. Thanks for the thought Doc...My little pea brain so far has been prone to thinking "I WILL gett the tube. No question. But if I don't I always have my backup airways." But what if I don't....Man, I don't know. I guess it boils down to this. If my unresponsive patient it asperating blood directly into his trachea below my dressing, I have to stick something down his throat. Even if I feel my chance for failure is high, making the attempt, having another competent medic standing as well, and having my rescue airways prepped is his only chance I think...Right? What are the odds I can secure my tube directly through the wound as long as it still allows for adequate bleeding control? Dwayne

I mean this in the kindest sense Connie. This should be a temporary condition. Your weight may convince some shallow people that you are unworthy of respect, but if that thinking remains after the first 30 seconds of knowing you, then your personality is part of the problem. We teach people how to treat us. If you are consistently treated poorly than I think you've come to believe it's because of your weight, but ultimately you will find the answer in your behavior. Good. Finish getting tired of it, and then stay tired of it. Getting sick of it will be the first step in figuring out how you allow, or perhaps more likely, encourage it. You are doing what you believe SHOULD earn you their respect, but it doesn't appear to be doing so. You need to take a hard look at yourself, or perhaps look through the eyes of someone you respect and trust, and figure out what's missing. There is no good reason why, but I think you'll find there is a logical reason why. I believe you'll come to find that it has little or nothing to do with your weight. Something else is going on here, but as long as you convince yourself that you're being treated unfairly because of your weight, you'll never find it. Try spending some time assuming that your weight has nothing to do with the way you're treated and I believe you find some other things you might want to change. Be strong girl...You need to get to a place where you truly feel that you deserve to be treated better to work this out...I have faith in you. Dwayne

Really? :shock: