DwayneEMTP

Usually have time where ever I'm working, but not always internet access... Thanks Babe... Hey! It's so good to see you sticking around and participating! I have a feeling that you're going to be a really strong medic. But, fair warning, everyone is all touchy feely now because you're a cute girl, but as you go along our betters will push you..always for your own good, but not always with sunshine and rainbows. Make sure that when that happens that you see the love in it and don't freak out, ok?

Yeah, being onscene is the key to saving arrests. When I used to keep track, which has been several years back now, I had over 50% of patients that I got pulses back on, but none that I'm aware of that ever left the hospital. On arrests that we've transported secondary to getting pulses back I've tried to keep it a secret until after getting in the ambulance. And man, a system that sends BLS who then calls for ALS, I hate that so bad. Why does a lower level of care decide whether or not a higher level is necessary? Send the medics and then allow them to downgrade the call to BLS for care and transport if they want...but the other way around? That just seems like insanity to me.. But, it sounds like there is a lot of interesting stuff going on with cardiac arrest resusc, save rates in the 30%ish, I think that I've seen in some experimental groups...Be interesting to see how they come along. I hope they hurry up..I'm getting old...

Ice and elevation were both part of many/most protocols before, but neither are now. I believe that the thinking is that it's better to get the toxins diluted into the central system instead of keeping them concentrated locally. Antivenin doses are going to range widely based on type and patient presentation. I know, as I'm an expert from watching that snake bite doctor show a couple of times. :-) But we'll never be giving it likely. It seem that some believe that you give antivenin the same way that we might give epi for anaphylaxis, one dose does it for pretty much everyone. I get the feeling that snake bites don't work like that at all... Coolidge, welcome to the City brother...

Welcome to the site! I've also worked with quite a few SA providers and find them great... Jump in Brother, we can always use input from someone that keep their nose in current educational standards!

Man, to tell the truth, it never occurred to me to get a follow up. I'd assumed that once it was resolved that it was like a cold, that it was over. I have mitigated the risk factors significantly since that time (Not for age of course, but compared to those that existed leading up to this episode.) No drinking on long haul flights. On this particular flight I slept for about 10hrs straight. I don't sleep any more so that I make sure to get up and move/walk around at least every few hours. (This particular flight, scheduled for 16.5 hrs ended up instead 19.5 hrs..grrrrr), wear compression stockings (man, how old does that make me feel?) plus I pay very close attention to my hydration status. It wasn't my intention to be macho, but instead I was operating under the uneducated assumption that before I could get to anywhere where 1st world care was possible (several days at least) that the issue would be resolved. I know that walking away to go and be evaluated seems like an easy choice, but when faced with the loss of my job, significant hospital bills "to check for problems" and the idea that it would be resolved before I could get anywhere...Leaving didn't seem, at the time, to offer any significant benefit. It was a pretty scary time. Later the night of the call the pain had increased, maybe 7/10. I was laying in bed doing all that I really knew how to do at that point, worrying, when suddenly I felt a tiny "pop" and the pain immediately dropped to 2/10 or so. I thought, "God damn it...here we go!" I grabbed the sheets and started to hyperventilate (A well know mitigation factor for terminal PE) and waited to see if I was going to suffocate. After about 5 mins I was halfway confident that I wasn't, and went to sleep in the hopes that if I was wrong at least I would die in my sleep instead. The next day my inner thigh was sore...I'm assuming related to the same issue...then over the next several days resolved... I'm still pretty angry about this episode...The reason my my still discussing it so many months after...thanks all for your help!

Oh man, there's no apologies necessary...I'm flattered that anyone cares.. I'm willing to bet that there were plenty here waiting for me to drop dead.. :-) Thanks to you all for your help... But, I don't think that I still answered the question...how fast can/will they develop from noticable to dangerous? And no Kaisu, I've not been evaluated since that time, but have had no further issues that I'm aware of..

Hey all... Man, I'm sorry about the confusion...Though I am a stupid son of a bitch, I'm not suffering with this issue now. This is still interest from several months back, I'm fit as a fiddle now, but if I wasn't I can certainly see the reason for your comments. And I'm grateful for the love and kindness behind them. For future reference, I will in fact leave next time. I considered leaving the time that I had the problem. But it's at least three days (24hr) home, and to get into the hospital in Lae, thirdish world, would take at least as long, and I assumed, though I've no idea why I was comfortable making such an assumption, that I would be resolved or dead by then...Know what I mean?

Hey Brother, Welcome to the City! I moved this from 'students' to 'instructors' not because you'd placed it poorly, but because I thought that you might get better information here. Good to have you! Dwayne

Hey all, I can't remember if I posted here or not about my DVT issue. Several months ago I got a DVT during my international flight. It's possible that sleep and tequila may have had something to do with it...(Don't you judge me!!) Anyway, while dealing with our medical team in another country by phone I was pretty much told to piss off... While on the phone, being told that I should go to the hospital, though this isn't an emergency, because my company insurance covers emergencies. (hospital was not possible without the company's help), I was asking the online doctor... What can I expect from the DVT at this point? (pain 5/10 x 12hrs, very slight swelling, slightly febrile at site (Popliteal vein) How can I expect it to progress? What are the chances that it will simply self resolve? What might I have on site that would mitigate it? What are the odds that it will become a PE? In what time frame might I expect it to become a PE (and thus die?) While the only significant medical care for many miles, the last two were of course the most on my mind at the time. To tell the truth I was pretty freaked out by this. I've transported, that I'm aware of, 5 PE's, and they all died really badly in the back of my ambulance. Thinking of going through that process alone was pretty horrifying...and I don't horrify easily. (Why going through it not alone might be better, I don't know, but it seems like it would be) Since then I've tried to find answers online to the above questions, with little to no luck. Does anyone have any kind of significant experience or data on this subject? Thanks for any help...

Fair enough all... It looked bad in a snapshot, but I stand corrected...thanks for that...

Thanks chbare, I don't doubt you that many use 12 leads, I've not not bumped into them yet I'm guessing...

Yeah, well, I'm guessing plenty of us know how I get after I've been here for a bit... Like it or lump it..it doesn't appear that I'm going anywhere anytime soon... :-)

Doc, is that the thread where we got into her being too emotional? Yeah...Saw it, but again, don't see why that was such a barn burner, instead of reason for debate.. Maybe some of you that remember threads that I may have missed might PM me the links? I'm sure I'm missing something, but don't have time to read through all of his posts right now to try and find it...

I'm not pretending to know all of their educational standards either, and I truly went into remote medicine expecting to be the educational/intellectual stepchild. I've worked closely with medics from Aus, Britain, South Africa, Canada, hell, I don't know...all over the place, and have never felt even a little bit intimidated. I've often wondered why this is...Though they have more college time, supposedly, (I've not looked it up myself, only heard from others) are their college standards different? Do I only run into the 'lesser' medics where I work? You know what I mean? I'd not be afraid to enter into any kind of intellectual medical debate with any of those countries. As anywhere, there will be plenty that would hand me my ass...but generally speaking, I've not found any reason to be ashamed of our educational standards for paramedic where the world is concerned. And the same applies to nurses from other countries. Though very often we've talked about things that I didn't have a grasp on for it being too far out of my normal scope. But anatomically, physiologically, etc, I've seen no noticeable gap. But of course I'm not quizzing...only working with/near, so perhaps I'm not getting an accurate picture for some reason. As far as reciprocity, it's not really necessary with the type of medicine that I do. None of the countries that we serve have their own EMS system, and the higher ranking certification for each medic's home country suffices to allow us to work where we do. For my company it's NREMT-P (Often nurses too), ACLS, PHTLS, etc...Other countries have their own standards that line up more or less. I was pretty shocked to find that I've not run into medics from any other country that read 12 leads. Some collect them and then send them to the ER, but no other country that I'm aware of make decisions based on that information. And I've heard about the depressing education in the U.S., but man, I can tell you, that as I travel around, my general impression only, is that I see no sign of it whatsoever...

For a few weeks...and not only sheep...

Going to interject despite not having time to participate fully, as well as being really late to the party. Something I'd like us all to think about...miscusi. Man, we've kind of taken to being rude to anyone that doesn't share our opinion, or that we feel superior too..particularly if they are foolish enough to 'try', thus risking giving us a big stick to hit them with. Often insecurities are temporarily mitigated with bravado and false self confidence...but there are still real people under the facade. I'm pretty confused by the responses to him/her. It sounded to me like s/he was saying, "This patient has been alive more than a month since the surgery and two days since the metal episode, so all things considered I'm confident that he will live regardless what I do, for the next ten minutes until I can drop him at the hospital." What would be a more productive, realistic attitude if you work in a 'do nothing, just transport" type of system? If that is your system, and that is what you're used to, then what other things would we have liked him to have said? Granted, he didn't get the way that these scenarios are played, but it appeared to me that he tried over and over to explain his point, and it seemed pretty clear to me, but too many had already started to celebrate that "He gave us a stick and now I get to be him with it!" Not knowing how scenarios work didn't use to be a sin. I guess what I'm saying is, what if you'd have tried to see his point of view instead of just insulting him out of the thread? What if he gave those answers because that's all that he knew how to do? Was he, or us, or the thread improved by continuing to tell him how stupid he is until he finally quit? Where is the joy or the challenge in that? Isn't the joy and challenge in helping that type of person, exactly that type of person, to move forward? Leaving them better than we found them? I've given plenty or reasons to be called an idiot, and give more in almost every post, yet my friends here always find a way to push me back onto a productive path...It breaks my heart to see how this thread went early on. I am confident that if even a small effort had been made that his point of view could have been seen and appreciated..it just didn't seem that complicated to me. I'm not saying that I've never had my ass kicked here, nor participated...I guess I was bothered by the extra exclamation points during the insults. It seems like I see more and more here that we protect our brothers and sisters that have been here for a while, but often are wicked hard on the newbies...I can't prove it, I'm not even sure that I'm right, and perhaps this guy/gal has a history that I'm unaware of that has earned them that type of disrespect from others...I just hate to see it. And it does appear to me, from my way of reading, that he wanted to stay and participate, that he wanted someone to give him the slightest reason to change..but he was asking too much. Again, to my reading, of course I could be dead wrong. All comments as just me, not as a mod...I love you all, consider nearly every regular poster here to be my friend, but sometimes it seems like we accidentally, or on purpose, act like a group of bullies and that type of behavior represents, in my opinion, the very worst of EMS at all levels.

Welcome to the site! It sounds like you've got some plans...Jump in Brother...

IStater, you're a girl? Man, I have to pay better attention to the left side of the screen... Say, when you say that American nursing standards are low compared to the rest of the world, how do you make that comparison? I've heard that here since my first day, about paramedics, but have certainly not found it to be accurate in my travels. I've not had to hang my head around medics or nurses from any of the many countries representing medical in the places that I've been. In fact, I've always felt really strong around non U.S. medics, and certainly around the nurses from other countries. I'm just curious where the comparison comes from, from you and others that feel the same. Thanks for participating...your posts rock.

Starting your first IV the first time, that's pretty cool. But I'll be a believer when I see you start your third on the same patient. There's nothing like a miss, and then another, on a critical patient with a million people watching to make you really, really wish that you did something else for a living...And do you know why the pressure is so high? At least for me...the bullshit belief that, "If I was a good provider I'd have hit that." Whatever.. But, truly. First IVs are good...but where you see if you have the balls to do this well or not is if you choose to make excuses as to why "you don't really need one that bad" before your second attempt..and, God forbid, your third. The majority of paramedics that I've worked with would choose the excuse. Strangely enough, almost none of the basics have hesitated. Second stick on a baby with the family watching, or a critical patient while the firemen are wanting you to get goging instead of screwing around with all of that silly medical stuff. When having students in the ambulance that was kind of a big deal to me. If you miss your first and then look to me to take over...Grrrrr. Miss your first and start to immediately apologize to your patient while moving your tourniquet and starting to look for your next site...Yeah, I'm in love then. Nothing makes my nipples hard like seeing someone calmly attack their fear. And, maybe others were different, but I'm pretty sure that I can remember every third stick I've ever done (Meaning that the first two failed)...I hated it that bad.. Really cool to see you so excited. Stick it out here for a bit, ok? It takes a few weeks to really get a flavor for things, but once you do you'll never find another resource to match it.

You will respond to my bed? You work at my most favorite EMS company ever!! "It's been this way for over four hours...and it's painful to drive...I just might need me an ambulance!" Now, you know what's most hilarious, is that I posted my last post before I read this one...It just gets funnier and funnier... :-) MariB, there seems to be something about EMS pants that puts you in a randy mood...

Man...I spent a lot of hours freezing my boys off running up the river on snowmobiles from Mora to St. Cloud to chase girls...I even caught a few...I love the corn fed MN girls!! Ask the program that you're going to if they might have some hosemonkey freebies left unused. (Many programs set aside scholarships for firemen that never get used.) My first year as a medic student I think that they gave me one worth $2,500.00 or so. Good to have you girl...Welcome to the club...

We can always find the exception...The old beater car with a race car engine in it, the thin kid that can lift more than the muscle head, etc. But betting on that usually isn't a great idea. Is a $2,000.00 class going to be better than a $200.00 dollar class? Almost certainly. Will there be exceptions? Sure. But the books for EMT B and an instructor's time will be worth more than $200 for the time it takes to teach a class, and if they're not, then, no, I wouldn't bet on the quality of the program. I pay over $100/month for the gym that Babs and Dylan (and me when I'm home) go to, despite there being one right around the block for $30/month. Ours has personal trainers, several hundred free classes per month, a cafe, pools and water slides. The other has a bunch of weights. Quality costs money, it really is as simple as that. Might the next Mr. Universe or gold medal winner in the next Olympics come out of the gym around the corner? Could be, but when I checked it out I certainly didn't see anyone that struck me as terribly ambitious. My guess would be that you might find the same different in classes at opposite poles of the financial spectrum. Can good providers come out of cheap, easy programs? Sure. Can good providers that began looking for cheap, easy programs come out of cheap easy programs? I'm not betting my family's lives/health on it. I also agree that accelerated is doable for those with an appropriate background in the material being sought. But again, when 'accelerated' and 'cheap' are desired, without quality being one of the criteriu querried...it's pretty hard to get onboard with such an individual. Particularly when they choose not to participate in their own thread. I was exactly such a person. I was going to take the AMR $5k (I think) zero to hero paramedic course but was talked into a degree program instead by the folks here. I still look at that as my person 'dodged bullet.' I'm also really, really glad that I didn't run away when I didn't get the advice that I thought that I wanted...

Heh...catching up on the thread and it cracked me up when you said, "No sense writing a blog if you have no followers..." Man, I'm glad you didn't tell me that a year ago!! No followers, but man, the mental exercise, the time spent thinking of and/or revisiting topics that are important to you...they become so much more clear, at least for me, when written down.. Sorry so long since posting, but had a long rotation last shift and not enough time home with my family before having to leave again... I'm happy to see that you're feeling better Lady. Do you watch Ninja Warrior by any chance? Was watching a recorded show with Babs where they showed a kid that had been run over and dragged by a car. Showed pictures of him in the hospital, and this kid was completely f*cked up...It was 4 months before he was back to fighting in mixed martial arts and competing in one of the most severe competitions in the world...Pretty inspiring... And if your uniforms are depressing every time you see them hanging in your closet, then why are they still hanging in your closet? You won't need them for a few days, wash em, put them away somewhere, and stop that happy horseshit, ok?

Actually, I don't necessarily equate emotional inexperience and immaturity with stupidity or trolling. I was thinking the same thing until his last response. I can tell you, from someone that grew up cowboy redneck, that emotional maturity isn't something that you choose, but learn. I remember yelling at one of my early girlfriends because she "tried to win every argument by crying!" It truly never occurred to me that she was really upset at those times, I just couldn't see it. I mean, in a world of redneck fighting, screwing, drinking and working, crying, obviously, was something to be scorned for it's display of personal weakness. Now I cry at the end of nearly every Undercover Boss. (God damn it...) One of the best nurses I'd ever worked with in the ER SOBBED at every death. Beautiful, professional, wickedly smart...yet when all was said and done she'd find a private corner and bawl...she'd get done, feel better, and go back to work. It seemed to be a really healthy way for her to cope. I do wonder at this point Girl if talking to friends, coworkers or even those here is what's best given that you are still so effected (affected?) after so much time has passed. It may be time to consider sitting down with a professional. And to our not yet fully developed Brother, if you need more ammunition to justify cutting up my man card, not only do I cry every time I leave my family for the airport, most times that I consider my son's future, a few times over things that I've seen, and even done in EMS, but I've also several times in my young life sought professional help to re-calibrate my emotional compass. Despite all of that pitifulness you'll still be hard pressed to find anyone willing to say that I'm too big of a pussy to work in EMS. (Sorry ladies...it makes the point...no offense intended) Holy shit Girl..we're only human. It's not being human that get's us all screwed up, but trying to pretend that we're more than that that puts us off into the ditch. Get healthy...Ok?

One of my more proud "kind of" catches was a 60ish year old woman who's daughter had called in regards to her difficulty breathing. Before arrival the issues seemed to have resolved. I found no evidence of breathing/lung issues, but during my exam she would sometimes use the word 'dog' inappropriately. "Really, I'm feeling fine now, I was just dog for a few minutes." She didn't seem to notice it. Her diction was crystal clear, balance fine, perfect grammar with the one exception, educated vocabulary, middle/upper income. No obvious physical issues, stroke scale negative. The only other symptom was that she was unusually 'cuddly.' When I held her hand while talking to her she leaned in and gave me a chaste/motherly hug. When I asked her daughter if either of these things was usual her reply was, "I don't think so..but I'm not sure." I convinced her to be transported for observation, a tickle in my brain that it might be a stroke, but far from confident. Stroke was her ultimate diagnosis. It's a silly point maybe, but one that's important to me...which is that I think catching such cases has as much to do with your attitude going into a call as with your level of education. In the lady above I'm confident that none of my coworkers at that time would have transported her, in fact, it's likely even noticed the issues. Not because I'm so much better and smarter than they are, but because listening, noticing movements, types of speech, patterns of speech, inappropriate anxiety levels, both decreased and elevated from the expected, etc have just always interested me. But more importantly that I went into the call intending to help instead of clear the scene. Provider attitude, it seems to me, is a very much overlooked aspect of competent clinical evaluation and diagnosis.