DwayneEMTP

Excellent advice from P_I.... One important thing that I see that hold many students back is their, fear, lack of desire or inability to get out of 'student mode.' Being a good student while doing clinicals is vital, but you must remember that this is where you cut the cord. You have to learn as much as possible while all the time practicing to lead. During clinicals most of us, when uncertain and under stress, will/would choose to be more respectable and submissive, assuming that we should 'step back and learn while the really smart people take care of the hinky patients.' This is just really bad thinking. Your clinicals will be much shorter than you will need them to be. Knowing every drug and procedure is great, but on nearly every call there will be something that you don't know. Now is the time to learn to lead when you don't feel qualified, as very often you will feel that way when loosed on the streets. Seldom am I the smartest person on scene, but unfortunately it's not uncommon that I am the only one willing to put my little pea brain's limited resources into action, take ultimate responsibility, and attempt to move forward in a logical manner while attempting to create best outcome that I can see for each call. You will be the leader on each scene that you're responsible for. Shouldering that responsibility in a kind, professional, responsibly aggressive manner takes practice. Learning to use your resources without wrongly deferring to their intelligence instead of yours when you're uncertain, likewise. I've never seen a student that came to clinicals with the intention of growing to be separate instead of showing how competent they could be if only allowed to 'watch for a while.', nor was I such a student...but I wish that I would have been. It can at times be a fine line. You're posts always seem to show your great spirit and intelligence...just make sure that the stress of clinicals doesn't cause you to want to be regressive and submissive...in that way lies monsters... Good on you Girl...If your previous posts are any indication I truly believe that you are going to be a really, really good medic. Dwayne

It looks like I'm going back to Kandahar for a while. And that's ok. Though I was talking to another medic that had worked there, and had worked with the Afg Nationals...he said, "I fucking hated it there! Everyone smells like ass!" You see, they don't wash much, as there's not much water...I wanted so badly to tell him, though he'd have never understood, "They don't smell like ass...they smell like war, and desperation, and fear...and, believe it or not, joy. It's the smell of people that have had to tweezer shrapnel out of their children and watch them die. There is a reason you don't smell like them. It's because you're blessed to smell like soap...a gift that many people in the world may never know." That is my wish for all of my friends and family for the coming year..May you realize the joy, and freedom, and safety that comes with the smell of soap and water...That men, women and children at least as good, and kind, and Pius, and as worthy as you may know it only once a year, or perhaps even more seldom... When you shower, notice that smell and know that it is smell of the privileged... Happy New Year all.... Dwayne

Happy new year Richard...all the same wishes for you too Brother.... Dwayne

I didn't...but now that you mention it, maybe that's why I was so confident that he's broke and in no way getting laid regularly with that face...Subconscious pattern recognition? Dwayne

Happy new year man.... Here's to another year of bickering, debating, learning, and making new friends at the City! Dwayne

Heh...Yeah. I try to remember that we're not seeing a representative cross section of 'everyone' when working with patients, but a relatively small subset of a certain mentality. Here's a test I run, a game I play, when I begin to feel jaded and frustrated. When you go to the supermarket, go to an Isle like meats, or baking or such, baking works really well. Pick a product, find the meanest, grumpiest person that you see, and ask their advice about it. See what happens. I got started on this, (I know it's idiotic, but I like it still), when Babs asked me to pick up flour for biscuits at the supermarket. Me, being me, had no idea that there were 400 kinds of flour and I didn't want to call her back and illuminate my ignorance more than necessary, so I asked an older lady that was nearby. Man, she had an opinion, another lady overheard and had an opinion, a big fat guy that turned out to be a baker had an opinion, and soon there were a half dozen people in my little party laughing and swapping baking tips...just because a stranger had asked for help. Truly, I know this sounds stupid, but I find that it helps me stay real in this EMS world. Go by the steaks, find the shittiest, angriest looking man and ask him if he has any ideas on the best way to BBQ your steak for you and your wife's anniversary. Jack Welch when speaking on business said something like, "I've come to believe that most people need two things for success. You have to show them that it's possible, and then you need to give them permission to succeed." I think most people are the same emotionally/socially. They aren't brave enough to reach out, as rejection is a pretty salient punishment for most, but if you give them the tiniest permission to reach out to you they are truly kind, loving people that will do a lot to help. I dare you to prove this to yourself.... Anyway Doc, I know you didn't ask for any of this shit...but it's the end of the year which tends to make me introspective, so....there you have it. :-) Happy New Year Brother! Dwayne

Yeah, loss of consciousness is the new 10/10 pain I think. "Hey, that's a pretty specific question, and a lot of people have asked me that, I'll bet they'll take me more seriously, and it will look better in court if I say yes." I've abandoned asking patients if they lost consciousness and only ask if they remember everything about the incident, before, during, and after, and then quiz them on those events if it seems necessary. It seems to make it easier for those with syncope, that sometimes don't really seem to know if they were ever 'out' or not, and the internal dialog with the bs fender benders seems to become, "You bet your ass I remember everything! Every last detail! It was horrible!" (As I'm staring at the swipe in the dust where the kid ran into their car with a bicycle.) which becomes "Neg LOC" on my PCR. Dwayne

I've little doubt that he made some people sick, but he's 51, not that good to look at and doesn't strike me as someone that is packing a giant......wallet. (Yeah, you thought I was gonna say something else didn't you? Perv!) The point being that he is mentally ill, as suggested not only by his claim to want to kill people and making the effort to convince the police that he's a bad guy, but more so by his claim to have infected 'thousands' of women over the last few years. Really? He wants to be famous, and it looks like he's gonna get his wish...But bullshit stories are still bullshit stories... At least that's my take.. As far as losing faith in mankind? That's easy to do if you take most of your evidence from the media. This is one douche afloat in an ocean of amazing, kind people...He's an anomaly, and certainly not representative of either being common, nor a man. Dwayne

I'm guessing you mean fake seizure instead of pseudo, as, though an unlikely mistake for you to make, I for years thought that they were the same thing... I get your point though. For some reason, out of all of the shit, the fake seizures had the power to irritate me more than just about anything..not sure why. Maybe because I'd only seen it used for manipulation... Dwayne

Sorry Cutie, I guess I missed the smiley at the end of the sentence my first time through... Also, I have no idea what 'kludged' means...but I'm assuming it's bad... Dwayne

Benhard, as always I respect your opinion, but could you do me a favor? Along with this opinion can you answer the questions that I posed to 9OrangeLetters? I'm curious as to your thoughts. Dwayne

Hey Brody! Welcome to the City man... Dwayne

"You know, They say that x is going to happen soon" with 'They' being an obviously reliable, intelligent, though unidentifiable, source. "Recent/all the studies show that...." coming from someone that I absolutely know gets their most up to the minute information for daytime television. And to those that hate, 'it is what it is', should you ever choose to do remote medicine you'll find that sometimes that statement is all that keeps you sane. When it's windy and dusty and cold, your clinic is leaking, your patient has shit running down their legs and you med restock hasn't arrived as promised...you can hate life and spend your days complaining that "I shouldn't have to work like this!" and writing letters that will be ignored, or simply accept the world you're working in and get busy...sometimes things just are what they are...but your choice of perception can be paramount. Edit: An excellent example being a situation at my last gig. Before I arrived they had a camp wide food poisoning. One doctor and an untrained driver had 80 people on IV fluids. Does it suck? Oh yeah...but it is what it is....Time to roll up your sleeves... Dwayne

Do your protocols really need to tell you that? Chris, you obviously have a bone to pick here somewhere. Why not just lay it out so we can discuss it? Did you get jammed up for not transporting a LOC trauma to a trauma facility? Dwayne

One of the greatest songs ever...with one of my favorite lines of all time... "I see friends shaking hands, sayin', how do you do? What they're really sayin' is "I love you..." " And yeah, that's exactly what I meant...Thanks Brother... Dwayne

When the 'cop killer' song came out and was viciously attacked in the media I dedicated myself to listening to nothing but rap music for a few weeks, so that I would have my own opinion instead of accepting the sound bites from the talking heads. And you know what I discovered? A bunch of horrible, soul eating stories told by kids from one type or another of poor, dangerous, dehumanized neighborhoods. They were terrible stories, but stories that absolutely had a ring of truth in them. I once trained police dogs for officers in the LAPD. One of the LEOs that worked the ghettos told me one day, "You want to know our deep dark secret? Every cop wants to shoot someone before they retire. We get so fucking tired of putting up with shit from those animals every day, having our cars shot without being able to retaliate, that everyone wants just be able to shoot someone." I get his attitude, but I also get the attitude it breeds in those that are writing these songs. Instead of spending our time and effort figuring out how to ban the emotional/intellectual products of those that live in an American war zone, how about if we instead work to create a society where they will be unable to have such tragic stories to tell? Flaming is unable to see any problem, or solution, that doesn't involve hate and anger. But we can't hate these problems away. I tend to believe that the solution begins best when they're founded in love, but I don't believe that that is even necessary. But a process that demands measurable accountability would certainly be helpful. Dwayne

Hell, the true insanity in your post? Deciding to become a medic instead of a nurse... I agree with the others, I think the GC is a douche...I'm no expert, but I've not heard of a couple of driving misdemeanors being an issue with nursing school, particularly if there is no alcohol attached to them, though from the classes you had to do it sounds as if there was. If they were going to bounce everyone that had a couple of driving pings they'd empty out the colleges in a hurry. Get your card, stay away from that GC and go to nursing school and rock. See? Easy! Good luck man. If you'd come here reporting a 2.5 GPA with the same story I'd tell you to go and screw yourself...but if you truly carry a 4.0, I have a lot of respect for that... Dwayne

Exactly why the question was regarding whether or not those methods were based in logic or just urban legend passed down from grandmothers. You would expect all of that in a pt that's 99.5F? As they are hyperthermic, right? Are you not interested in localized hyper/hypothermia then? How does your tympanic thermometer work when assessing cellulitis without global hyperthermia? My guess would be not very well. How about the soldier with numb toes who's CO needs to know if it's ok for him to continue in the field or needs to be removed? Is it then still voodoo to assess temp to touch? I would expect some, or all of these symptoms as well, and if fortunate to have a reliable history would feel very comfortable treating them based on touch, and I do often deal with antibiotics, though would rather have a finite number to record in his/her records. When in the clinic I always have a reliable thermometer, in the field almost never. Fair enough. Let's say that you have the above hyperthermic patient, what treatment alterations are you going to make based on a digital number on your thermometer? Will you choose not to actively cool this patient if the thermometer reads 99F? Would you choose to run emergent to the ER if your thermometer reads 106F yet your patient is cool to touch globally? How about if you have the exact patient above...what will be your different treatment plans be if your thermometer says 99F, 101F, 103F? How will you treat each of those patients differently? I absolutely got the tongue in cheek tone of your post, and thought it was very well written, expressing your opinion very well...Your opinion is just very narrow minded. Thanks for participating. Dwayne

Merry Christmas Brother...

Unfortunately, as usually happens in these threads we're now talking only to ourselves. He's not looking to be a professional EMT. He came for the magic bullet to pass the test without understanding the material and has no interest in participating further. I really, really wish I had a trick for hooking these folks. If I had the right words to make them understand, like many here did for me, instead of chasing them off then I think I might actually do some good. I think that that is the challenge, and should be the goal for all of us. To hook and then try and help improve these posters instead of making the climb the giant ego endangering mountain that begins with "You're an idiot!" We've seen many, many, (what appeared to be) experienced medics that couldn't do it. I thinks it's foolish to assume a noob basic is going to manage very often. It's easy to say, "Well, if they can't stand a little criticism then they don't belong in EMS!" But they are entering the field with or without the help of the many really smart folks here. So that battle cry, no matter how passionate and sincere rings hollow when we judge it's potential to be productive, right? But, how to be honest and productive without being at least a little bit intimidating? Yeah...man.....I have no idea. Dwayne

It sounds like this is a redneck, knuckle dragger volly service, and if that's the case then it can just be a mess. You have people in positions of authority that don't even belong near a rescue vehicle, so logic often won't mean anything... But as was mentioned in different ways above, the issue isn't the respect that you aren't getting from others, but the respect that you don't have for yourself. You need to figure out why you are doing this job and why you are willing to be treated in such a manner. Then you need to fix it and make it stop. If you are willing to beg to be allowed to be a part of something that makes you feel like shit for no pay..well, you're lost Girl... Just the fact that shithead is walking into calls without equipment tells me that he's an idiot and a poser. I'm guessing that he's an EMTB? You know what they call a paramedic at an emergency without a jump bag? A spectator. An EMT or a first responder are even worse as they usually don't have the self control to stay out of the way. He's an idiot and you need to spend little to no time trying to earn the respect of people that aren't respectable to begin with. And as Herbie said, if you're running calls when exhausted then you're part of the problem, not part of the solution. It takes maturity to be a productive, important part of an EMS call, and it sounds as if no one there is showing that they've got any. Step back from this Babe, figure out why you do it and if you truly want to be a professional or simply another wanker driving fast. If you choose professional, and begin to act in that manner, you won't have to ask for anyone's respect ever again. Dwayne

Yeah...When I was in clinicals we had a positive Cin Stroke Scale and the medic asked the pt to stick out her tongue and move it from side to side, and she was unable to move it to one side, or move it well if I remember correctly. I've used it since but have never seen it be so pronounced as in that patient, and have never verified that it is a valid marker for stroke, or anything else for that matter...it's just one of those things that kind of stuck.. Dwayne

He only had one reason for posting...so that he could use the term 'kiss ass' as I'm sure he believes it sounds really gay. He's a poster that can't make even the most simple of points so it comes as no shock that he wouldn't understand Chris' post. Had the presentation sucked I would have been grateful for it simply because expending the effort shows so much of what I hope that the City can be someday... I'm going back to calling bullshit on Flaming's medic status. He's most likely a clever basic that can't get past his medic envy but doesn't have the balls to pay his dues and actually step up to the plate. He's hoping that he can somehow win it instead in a lawsuit. And for the record shithead, no one was questioning whether or not the fluid was damaged by heat but by the seemingly common knowledge that microwave ovens in particular create an issue. Should you ever actually make it medic school, please choose one that demands at least a 5th grade level of reading comprehension. But, you don't have the stones for it....there, I just saved you two years to do something productive with. Dwayne

So I'm watching some show last night and notice that the nurse, like always, checks the pts temp to touch with the back of her hand. I've seen this done, have been told that it is the correct way to do it, but why? My fingers have almost half of a century of experience checking the temp of things, the back of my hand almost none. I wonder if it's a holdover from checking the tempt of baby bottle fluids? But then one's not really looking for a true temperature but only comfort/discomfort. I'm a pretty good judge of a patients temp as far as too low, somewhat low, relatively normal, somewhat high, burning up, with my fingers, but the back of my hand is terminally dysfunctional for this purpose. What do you do? (Yeah, I know, everyone but me has a thermometer, and only wankers would ever use their hands...) and why? Dwayne

In a well shaken, comfortably lukewarm bag of saline, does it matter if it's body temp, 5F above, or 15F above body temp in a truly or relatively hypothermic patient? I've never measured the temp and haven't noticed any side effects other than the patient appearing and reporting feeling warmer. Though, having nuked a few bottles of milk in my day I've also been pretty obsessed with making sure that it's well mixed and rechecked before delivery. A few degrees to cold seemed intuitively obvious as unimportant, and I screwed the pooch on that, so am wondering if I'm simply screwing a different pooch with warmed fluids. Dwayne