Jaymazing

ABC's, general impression, and oxygen. Let's start finding out whats going on and how it all started? If I have enough hands, I want a set of vitals and a 12-lead, too

First off, don't worry about being older than your classmates. Life experience is vastly important in this industry, and you'll find that age will offer it's own particular benefits when it comes to communicating with your patients in the future. Secondly, keep on 'nerding it up'! Enthusiasm is a trait that some of the more bitter, jaded folks in this industry might scoff at, but truth be told, this profession needs more people who are passionate about healthcare. Never lose that spark, and remember; find a job you love, and you'll never work a day in your life. Welcome to the city, and welcome to our community.

I don't know where to start with this...

Thanks everyone for your comments! Except for you, Mikeymedic. I don't know why you chose to comment at all, since dismissing the question and discarding other peoples responses is neither productive nor helpful to me. You clearly operate under a completely different set of personal guidelines than I, and while I'm sure you're MUCH smarter than me (you've clearly demonstrated that), I can in fact think of situations where this is pertinent information to have, and thus am admittedly still trying to improve upon my patient interview skills when it comes to broaching the more tender topics. Maybe where you work is different than where I work, but I can easily say that at least 80% of my calls aren't really "emergency settings" by most standards. And perhaps my tendencies to address my elders as "Sir" or "Ma'am" are outdated where you are. But I'm supposing we live in very different worlds. On a brighter note, I really like the bra-strap-auscultation idea, MariB, and I'm going to store that one in my toolbox for next time I need it!

Welcome to the city. I'm going to take a stab at deciphering this. I think he was trying to be friendly, not condescending, but maybe I'm just reading it with a different shade of sunglasses (the writing is indeed poor). I think what he meant was first, "congratulations on the good call, and performing good patient care", then second, "We are all human. I've had 12 *years* of continuous patient care (at various levels) and never had that happen, which makes that even more impressive". And then I think he was asking for a history, because he thought this was a scenario....but I'm being hopeful. Obviously a complete Hx gets put on the backburner when you haven't passed the 'C' of the ABC's. I'm not ashamed to admit, I've struggled to find carotid pulses on people who I knew were alive. And I wouldn't be ashamed if I couldn't find one on someone who I thought was dead, either. I hope that nobody thinks that makes me a poorer practitioner, but if so I'd remind them that it's only when we acknowledge our shortcomings that we can truly improve upon them. This sounds like a fun call, did you get to bust out Mobey's Magills?

So, I'm sure we've all been in this situation to some extent at some point in our careers, and I'm curious to find out the best way to go about handling it. Those patients who you just can't tell if they're a male or a female. How do you go about asking? Is there a polite way to do it? Maybe a subtle trick you use; perhaps in how you phrase questions? Or is it all about being blunt? For the sake of eliminating a few of the obvious answers, lets say the patient is in their early twenties, average weight, doesn't have a wallet (and therefore no identification or paperwork), has a unisex name, is wearing bulky winter clothing, and has a voice that keeps you guessing. The balls in your court. And yes, that was a pun, and no, I have no shame.

On slow days when we have EMT students, I like to get them to experience being strapped down on a spine board in a moving ambulance. It's a weird feeling, even for a healthy person, especially when the vehicle turns a corner. It certainly makes me feel dizzy, too. Sometimes tilting the board for a while helps alleviate the dizziness, and as a plus you'll also be ready if the dizziness turns to nausea. You can also try dimming the lights, that's worked for my patients in the past, but of course this is only really useful when you don't need the lights on.

I'll take a stab at this! I'm just bouncing idea's around, so let me know if I'm out to lunch here. Phosphaturia! And if I had to guess some mechanisms, maybe an increase in serum calcium 2ndary to the trauma and #'s, leading to increased excretion of phosphate, leading to milky urine output. Or maybe the patient just drank a lot of milk or milk-based alcoholic beverages before their high-speed-collision. But that doesn't sound as cool as phosphaturia. Bailey's anyone? As a side note, if you market "Mobey's Hybrid Selective Comfort Spinal Motion Restriction", I'd like to create a jingle for advertising. M-H-S-C-SMR rolls so nicely off the tongue...

I like jumpsuits for the simple fact that I don't have to keep re-tucking my shirt. I hate jumpsuits as soon as it's time to poop...I've put serious thought into implementing a "trap door" system on the back. The 2-piece uniform on the other hand offers ease of access, and a traditional look that I like. But when one item fades in the wash faster than the other, and you end up having two different shades of navy blue, it's not what I would call "fashionable". For me it boils down to what phase of the laundry cycle I'm at in my tour.

I enjoyed this scenario, even though I didn't participate. It got a little sidetracked, but I learned stuff nonetheless Thanks for sharing it!

Chest Xray is negative for heart failure, enlargement, pnuemonia, pneumothorax, effusion, and aneurysm . Ultrasound is not available. There's some limit to what I can say for the labs, as I don't recall what they were! I didn't get to see them for more than a minute... But I also know how the scenario ends, so I can give you some idea what the results were (or would have been) to keep you on track. (I apologize for the lack of data here). CBC will be within normal ranges, electrolytes are normal, creatinine and eGFR show slightly decreased renal function (nothing dramatic), Trops are negative, ABG was requested but never performed (actually). INR was slightly prolonged. I don't want to make up the numbers, so I hope this manner of giving you rough answers will suffice for the sake of this scenario. I'll keep going as best as I can. We can certainly try! An ABG was requested at one point, but oddly enough no one seemed to do it! D-Dimer negative For sake of discussion, can you think of anything else you could use to bring down HTN in this situation? What would you like to do for the rate? Is there any other symptoms present that we can treat right now? And the last Q to ponder; what came first? How did this cycle begin?

They have a nasal cannula with end-tidal c02 measuring on underneath the NRB, and it's picking up an ETCO2 of 32mmHg

Too fast to count, but it seems to correspond with the QRS complexes on monitor. Bounding, grossly irregular. Very good point dont apologize! this is how we learn! I'm glad you're participating It was dispatched as a BLS transfer, but as I'm sure you know, dispatch information can vary immensely from actuality. Unfortunately, air medevac is not available. You're more than welcome to be an ALS provider in this scenario. I apologize for not making that more clear in the initial information. I wish I knew what AMFYOYO meant haha I like the diffDx! get those gears turning. Adenocard administration showed brief asystolic pause, no flutter waves visible, with prompt resumption of tachycardia. This was the same for both 6mg and 12mg doses. And I'll let you intubate, but you may wish to review some of the new information first.

First and foremost, I have to apologize for the incredible delay in me getting back to this scenario! I wont make excuses, but I've had a very interesting week to say the least. But without further delay, Getting back to it! For those requesting ECG's, I have several for you. Following an initial 6mg, followed by 12mg Adenosine administration, this was the rhythm. No flutter waves were witnessed. http://i3.photobucket.com/albums/y59/Jeyface/ecg/photo1.jpg For anyone who might want to see an ECG from yesterday, you don't even have to ask.... http://i3.photobucket.com/albums/y59/Jeyface/ecg/yesterday.jpg

I'd like to just note; it's a BLS transfer, but you don't have to be a BLS crew if you don't want to be. It's a scenario! Let's have some fun!

You'll have to excuse the typos. For some reason I'm not able to go back and fix them....I dont have permission.

You and your partner are working in a rural community, about 2 hours from any major centers You are called to your local health center for a BLS transfer of a 60 year old male, going for a Head CT. It's a patient you've already been acquainted with, since two days ago one of the other crews brought her to the nearby stroke facility (~75 km away) for a suspected CVA, and after being given TPA and receiving 24hrs of monitoring, you and your partner brought her back for continued care. It's been ~48 hours since TPA was given. Thrombolytics were unsuccessful, and the patient was left with right-sided paralysis and significant aphasia (he can only say "Yes", "No", and something that sounds like "bipisa"). When the nurses came this morning to give the patient his AM meds, the patient was found to have lost the ability to swallow or chew (new finding), and seemed increasingly confused. The attending physician has now requested a repeat head CT at a center ~1.5 hours away. When you arrive at the nurses station to receive a report, you find that all of the nurses are missing. When you look around, you discover that all of the nurses are in the room where your patient currently is. They're moving around frantically, and they've just finished administering adenosine. The patient appears significantly distressed, is not responding to questions, and appears acutely ill. He's on a NRB at 15 lpm, has a 20g IV in his left wrist running at 75 ml/hr, and has cardiac monitoring showing a rate of ~190bpm. What would you like to know? What would you like to do? What do you think is going on?

By golly, I believe you're correct! One of the most advanced cases I've ever seen in my career. The prognosis is grim...Unfortunately, the best treatment is still prevention. Open and shut case, my good man

This isn't even a question worth cheating on. Seriously? You've picked the wrong profession if you can't do this on your own

First off, congratulations and welcome to the industry! Secondly, advice for school. I'm going to have to agree with the people commenting before me; if you can, get anatomy & physiology down, and to add to that start brushing up on your introductory pathophysiology. My next piece of advice, don't let anyone take away that spark you have! You're motivated and passionate, and for the rest of your career you're going to have bitter, jaded, crusty old medics try to make you as bitter, jaded, and crusty as them. Fight the power, rock and roll, and keep on trucking in the free lane, my friend. You'll do great in school, as long as you continue to love what you're learning. Good luck

I'm in the same boat as Island, Dwayne, and Mike. If it were me, I'd rock a shirt+tie with dresspants, and the jacket I'd have to play by ear depending on my understanding of the company I'm applying for. I'm glad that you're so passionate about being seen in a professional manner. Our industry needs that. Good luck on your interview. Rock and roll.

Happy Canada day, indeed!!!

That's okay. Won't hold it against ya, bud.