DwayneEMTP

Yeah...quite crying...I've seen threads go for pages with... "Your so stupid! Haha" "No...You're so stupid! lol "Oh...You're so cute! Hehe "Well I think you're cuter!! rofl" "Man...Your naughty!" etc...etc. And on and on and on minus the correct spelling. Post something...it can't be worse than much of the flirty dribble that gets posted that really belongs in PMs...and go chat. It's not rocket science. Dwayne

What I find reprehensible is all of the blind hatred... Everyone wants to scream “String this animal up!” Or “She's a beast but she'll get off on some technicality” The one that makes the most sense though I've changed the context is “why do we put up with this?” There is a question we can sink our teeth into. Why are the majority content to scream for blood, when historically this has not appeared to lower the occurrence of these types of behaviors? (My opinion, I can't back up the numbers with research) Why are you satisfied to be outraged at the pain of this one child (and I would say the mother as well) yet not scream for the research necessary to attempt to protect the next child? We don't protect the next child by stoning this mother to death. We do so by studying her and finding out why/how/when she became broken. And then preventing the same damage to the next potential mother. (And please, if you've had no psychology, don't put forth the “she's just a bad person” argument. You can't sustain it.) If you want to make a difference, stop screaming for her blood and start screaming for her data. Have a great day all. Dwayne

The oral station is the one everyone stood in the hallways sweating over. There was one 15 yr medic I respected a lot, as he seemed to know EVERYTHING and would break it down, very humbly, for anyone..basic, medic student, didn't matter. He stood outside the room pale and visibly shaken waiting his turn. ( I gave him hell about it later and he told me he has serious issues with "make believe", his mind just doesn't work that way. I believe him) It turned out to be about as challenging as applying a KED. The seem to want you to ask about the environment simply from the point of view of covering your "additional resouces" concern. Is there a crowd? A bunch of steps? Bariatric patient? I simply asked "Are there any issues to ingress or egress or any reason to believe I will need additional resources?" and that seemed to cover it. You can get the proctor info off of the NR site. What's allowed and what's not. One thing I found interesting (per a classmate) was that they can deteriorated a patient's condition, but can't take them to a point where you can't recover them. So if they go down a slippery slope...it's a very, very long slope with lots of time to recover. I also won't mention my scenarios as we're asked not to...but I will tell you they were amazingly straight forward. No tricks, traps or ambiguities. Take lots of vitals. A trick one of my MD instructors taught me (though I didn't use it...I hate tricks meant to allow me to be lazy or foolish) was "I'd like Person "A" to take a set of vitals, repeat them every 5 minutes or after any interventions and report those findings to me" Supposedly that can CYA in case you forget to take a set at some point. Mainly, don't stress. If you passed ITLS (or one of it's incarnations) and ACLS, have a handle on treating common respiratory issues...then this will be nothing more than a simple story telling session. Good luck! Dwayne

I don't know if this help but... I decided before I did my skills testing that I wasn't going to take any tests at all. It seems to me that the information I cram before a test lasts juuusssttt long enough to pass the test! And then much (most?) of it is gone. So I decided to view the testing as a benchmark instead. I didn't want to know if I could pass, I wanted to know what I knew. So 4-5 days before the tests I put my books away, didn't study, didn't review, I just tried to get everything EMS out of my head, curious to see what would come out during the testing. I got right with the fact that I was going to have to retake every station at another time, which was a small price I thought for having a decent idea of what information I owned, and which was just circulating around in the front of my brain soon to be forgotten. There was no stress, because there were no tests. I went in, followed the logic trees (whithered though they may be) that had naturally grown over the months in my little brain, said the next thing that seemed to make sense to me...and flew through without issues. I'm not sure if that would work for you, or anyone else, but I passed all the stations, plus left knowing that at least some of what I was insecure about being able to access when I need it had actually taken up permanent residence in my head. Good luck to you! Dwayne

The KEDs we had at school had the torso straps color coded, green (top), yellow (middle), red (bottom). I'll let you guess at the order they are asking for...after that, the order mentioned by others. Dwayne

Yeah, we were taught that the sternal rub works fine, but pinching the nailbed with your thumb nail is less noticable and will have a like affect. This whole story is just depressing in it's stupidity. I wonder what her success rate has been for beating an unresponsive patient into responsiveness? Concussion, blurred vision, partial hearing loss? Sounds like the morning after my honeymoon...what's the problem?

Actually this case brings to mind, (was it AZ?), that said something to the effect "you will find that stable patients can be much scarier than unstable patients" If this gentleman had been in just a little worse shape (positive stroke scale, positive cardiac findings, less mentation, etc), many answers would have floated to the top, allowing you back into your comfort zone. Being just slightly off seems to have made things much more difficult by cheating you out of a clear cut (or even fuzzy) set of differentials to hang your hat on...Pretty interesting...I hadn't thought along those lines before...thanks for your post! Have a great day all. Dwayne

Prayers from the Womacks in Colorado. Dwayne

PCTtiff and Eyedawn in the same thread! Hell, my spelling and grammar will never pass muster.... Man, I've been missing both of you! It's exciting to see you posting again! I didn't mean to highjack your thread Tiff, I just wanted to say hi! I'll try and post to your question before bed... Have a great day all! Dwayne

It's the scene from Passion of The Christ (I think that was the name) where Jesus gets beat nearly to death with several different types of lashes, set to Devo's "Whip It" ....

NYC-EMS, nobody here is soapbox crazy about censoring art, or thought, or controversial subjects...but surely you can see that the vid upset some people...Is that what you were going for? Most of us here have done something we thought clever only to find it was taken in a completely different light than intended. I'm not sure what your intent was, but the smart move here is to say " Sorry all, that didn't get the response I expected, I'll ask admin to remove it" and move on... I despise everything about that video but am willing to give the the benefit of the doubt that maybe you weren't trying to be a dork... Do the right thing, let's get back to business, and welcome to the City! On the flip side, I am equally offended by those that want to lock these threads based solely on the fact that they didn't like what they saw. He was in bad taste to post that video here but at least he made his thoughts public. The "I don't like it so NO ONE will discuss it further" attitude is arrogant, as well as dangerous to all thinking people. Have a great day all. Dwayne

Prayers and best wishes from the Womack's in Colorado. Dwayne

I need to clarify I think. When I took the ACLS class we watched a few vids, did a bunch of CPR, but had no instruction (If I remember right, it all gets kind of mashed together in my pea brain) in rhythms, drugs or treatments options. When I said X nurses/ X medics failed, as Rid stated, I was mistaken. When we ran the mega codes, which we did in teams, they told you right away if you passed or failed, but I didn't realize that the people that failed were held back, and retested later, (which I verified this morning) I had assumed we all got our gear and headed home... Same with the written test. After it was graded they told everyone that scored 85% or better to go home, the rest to stay. I assumed they were being instructed on where to retake the class, as we were told in our medic class that it wasn't retakable on the same day... My apologies for claiming my assumptions as facts. Perhaps if everyone else knew that's how it worked, that would explain the retests...I wouldn't have gone crosseyed learning the material in a few days if I knew I could just retest until I got it! (Yeah, well, I probably would have, but you see my point) Have a great day all. Dwayne

I'm not sure what you're asking here... Dwayne

I'm curious about something in the nurse/medic debate... In our ACLS class (two day) there were 10 medics/4 nurses. 7 medics passed/ 0 nurses passes. PALS 10 medics/ 3 nurses 6 medics passed/ 0 nurses passed. Our medic class had no special prep for these courses, the nurses had just as much notice as we did of the upcoming classes, perhaps more as they were organized by the hospital... I'm fully on board with the difference between the educations, some of my study buddies are nurses...so what gives? Dwayne

Ok, my first jump into ALS territory in an attempt to cement my status as the world dumbest medic student... On the NR dynamic cardiology I was stopped for mixing drugs. My teacher claims I was told a million times not to do that, but I must have been asleep for those million seconds, because I don't remember it. I had a normal sinus rhythm with a PVC (single ectopic beat) occurring irregularly approximately every 4-6 seconds. I was taught that this should be suppressed chemically, even in an asymptomatic patient, so that it doesn't degrade to Vtach or Vfib. I gave 0.5 mg/kg lido with no change in rhythm and then another bolus of 0.5 mg/kg lido, which again had no effect. Then I said, “I'm going to consider amiodarone”, at which point the proctor stopped me. He said “you might have failed for two reasons (They aren't supposed to tell you if you passed or not). First, you never, ever change drugs on the same rhythm. Second, you should have started a lidocaine drip at this point.” So my questions are these. Why would I hang a bag of the same drug that has already shown to be ineffective on this rhythm? Why wouldn't I change to another drug that, arguably, has the same or higher probability of correcting this rhythm when the two are not contraindicated for each other? (that I can find) Note: we were taught lido first simply based on the fact that most systems (at least in this area) don't carry enough amiodarone to hang a drip if it should prove successful, as well as the shorter halflife of lido allows the hospital more options if needed. (If I remember correctly, which is doubtful). Ok...to the 1.5 people foolish enough to actually believe I could become a decent medic, I apologize if this question embarrasses you...but there you have it. Thanks for your thoughts all... Dwayne

I just took mine for the first time on Monday, and it was a hoot! The one thing I seemed to notice though about the experienced medics was their unwillingness to 'bend' to the NR standard. Understanding I only had conversations with 4-5 (there were perhaps 40 medics/students testing) of the experienced medics, but the attitude seemed to be “This is how I do it, and they're just going to have to deal with that.” My personal experience has been that the NR doesn't really have to deal anything. They make the rules, hold all the cards, etc. I got to proctor for the basic NR, and I was telling some of the waiting students “There's nobody dying here today, no real emergency. The proctors don't care if you look good doing what you're doing, they just want to know if they can mark each box on your skill sheet. It's just a real life video game! Run through, pick up all your points, and go home.” That's pretty much the way I viewed it. I just chilled, (hell, you can have three tries per station) thought about it as a game, tried to steal all of my Wanka points from the evil proctor, and went home. Passed all stations first time through (with one protest on dynamic cardiology). The experience medics, all of who were kind, funny, and much smarter than I, seemed to have a need to buck the system, and I think it hurt many of them. They sure as hell weren't to dumb to pass, just had a real life approach to a bunch of fantasy problems... Just my thoughts. Have a great day all! Dwayne

http://babymedic.blogspot.com/ From Fiznat's blog: ..."I have worked a long time to earn the right to wear this patch on my shoulder. I am finding, though, that there is much more than title. Once this becomes normal, once people become used to seeing "paramedic" under my name, my reputation will again come to rest on my character, my knowledge, and how I choose to carry myself. The title means nothing without justification for it. I have a lot to learn still, not the least of which is figuring out exactly how I will fill this uniform." I wonder sometimes where this attitude comes from. It seems that we see it so seldom here at the City, rarely in the real world, and never in my medic class. It's the attitude that got me interested in EMS, and the lack of it in the majority of providers I've had contact with that make me question if I've made the right choice after all. If you're newer to the field, or maybe not so new, you would do yourself a favor to visit this blog. It's inspiring, but intimidating at the same time! Reading it I can see the draw to remain a basic forever. Amongst my basic peers I was an over achiever...sharp as a tack! Unfortunately I'm now firmly on track to becoming the world's dumbest medic. I guess what I'm wondering is this. Do you see Fiznat's attitude in your coworkers/partners/classmates? If so, or not, who deserves the credit or blame? Teachers/peer pressure/management? Just taking a break from studying, thinking back on my week, going through some posts on the City, got me a little melancholy and wondering. Did I spend the last two and a half years to enter a career where the majority of providers can't even be bothered to make an effort to spell, dress, or speak in a professional manner? (Yeah, I know all of my grammar and spelling mistakes will come to light..that's ok!) Or, more likely, did I get tired (between work and school I'm at the end of 60 hours trying to finish up clinicals) and post with my head up my arse, perhaps just seeing things a little slanted at the moment? Not sure which, it just got me to thinking.... Have a great day all! Dwayne Note: Fiznat's blog entry posted without permission. So if I wake up tomorrow and find I've made an ass of myself, he certainly wasn't party to it.

From the peanut gallery... What makes this older video less interesting then one made yesterday? The nitro question was still valid and interesting. I thought they might as well have not bothered with the compressions...they were so shallow as to be useless...might as well have spent time on something else... Just picking at it for the sake of argument...waiting to run scenarios... :wink: Have a great day all.... Dwayne

GhostRaider, I think the reason you got so many stupid answers is that you failed to define a question. The forums are great ways so gain information, but it's generally accepted that if you're unwilling to put forth the effort to formulate a question, seldom will anyone put for the effort to attempt to guess what you wanted to know. How long have you been married? What kind of hours do you work? What kind of issues are you having? For how long? Is it you, or your wife in EMS? etc, etc. Hijacking threads with crap that belongs in PMs is becoming endemic at the City, but if you ask a better question, there are many mature people here that will attempt to answer it for you. Good luck. Dwayne

fiznat, You're my hero. Two things about you stand out. 1) It takes major brass testes to march yourself out here naked time and time again. Often I think "man, he could have said that a little different, it would have still been the truth, but he would have looked better!" But you never do that! You just march out, warts and all...If this site can give people nothing else, just one simple tool, it's to see the educational value in that. You've inspired me in many ways, I hope I am brave enough to do the same when the time comes. 2) I can't remember (though I didn't run back your history here) a single thread that you've been involved in that wasn't completely focuse on improving yourself, and the rest of us, as a medics and professionals. Thread after thread shows you to be kind, focused, and to always have your eye on the ball. Amazing. Plus (bonus point) I hope you notice that only the smartest people on the board reply to your posts...that speaks volumes to me...thanks for what you do. I return you to your previously scheduled thread... Dwayne

During ACLS I asked the the instructor, who is also a Doc, what AHA considers a save and was told that their research defines a save as discharge plus 1 year. Not sure if this helps, and didn't attempt to verify it... Dwayne

http://circ.ahajournals.org/cgi/content/fu...24_suppl/IV-136 "For unresponsive patients or those in arrest, endotracheal intubation is appropriate. Intubation serves 2 purposes in the management of hypothermia: it enables provision of effective ventilation with warm, humidified oxygen, and it can isolate the airway to reduce the likelihood of aspiration. ACLS management of cardiac arrest due to hypothermia focuses on more aggressive active core rewarming techniques as the primary therapeutic modality. The hypothermic heart may be unresponsive to cardiovascular drugs, pacemaker stimulation, and defibrillation.9 In addition, drug metabolism is reduced. There is concern that in the severely hypothermic victim, cardioactive medications can accumulate to toxic levels in the peripheral circulation if given repeatedly. For these reasons IV drugs are often withheld if the victim’s core body temperature is <30°C (86°F). If the core body temperature is >30°C, IV medications may be administered but with increased intervals between doses. As noted previously, a defibrillation attempt is appropriate if VF/VT is present. If the patient fails to respond to the initial defibrillation attempt or initial drug therapy, defer subsequent defibrillation attempts or additional boluses of medication until the core temperature rises above 30°C (86°F).9 Sinus bradycardia may be physiologic in severe hypothermia (ie, appropriate to maintain sufficient oxygen delivery when hypothermia is present), and cardiac pacing is usually not indicated. " Have a great day! Dwayne

I believe in the new ACLS is says CPR (2min), one shock if indicated, then CPR without further shocks until the body warms to a core temp of 30C. And no adjuncts for the above stated reasons... Have a great day! Dwayne