jkc

Failing anatomy is not necessarily a college issue. Admittedly, some instructors have different methods that you might find helpful, but at the end of the day it's up to you to spend some time with your notes and textbooks and make sure you get it. Echoing what Curiosity said, many people in my program needed to come back a second time to make it through one course or another. If you go back, you'll have the benefit of some experience, and can hopefully stay ahead of the workload and study hard. This an opportunity for some personal growth: look at is as a chance to be a better student, not to find a better college.

I'm with wolfman: I think lactate and WBC could be very useful. Not for transport decisions, but there's a lot of literature supporting early sepsis treatment with antibiotics and aggressive fluid replacement. And this is ideally before the patient is hypotensive, so field lactate would be a great indicator along with the rest of the clinical picture before you have significant vital sign changes.

Thanks Arctickat. I can't take credit, though, that tip was passed on by an excellent college instructor. J306, as far as briefly removing CPAP and patient compliance with CPAP, all my recent CHF calls have required intensive efforts to get the patient to keep the mask ON. It's quite uncomfortable, and I can understand why patients feel the large CPAP arrangement (filter, ETCO2, Boussignac valve, facemask, headstraps) is even more smothering than an NRB can seem to some anxious, hypoxic patient. Not to mention the unaccustomed positive pressure itself.

With a bit of coaching you can maintain CPAP's positive airway pressure during nitro admin: Go through the nitro admin procedure with the pt before removing the mask. Unstrap it while holding it on the face manually. Remember you don't want the pt inhaling SL nitro, and you want the pt to lift their tongue to the roof of their mouth. So if you can coach the pt to hold their breath for a moment, put their tongue to the roof of their mouth, and then quickly take the mask off and spray, the pt's glottis should remain closed maintaining airway pressure - and airway splinting. It's not perfect, and you need to be fast and have a compliant pt, but I've had a run of CPAP calls in the past 6 weeks and it seems to work.