Eydawn

Seriously. WTF do you do "BLS" that you'd have to "keep sharp" running as an ALS provider? (I'm a BLS'er, by the way.) BLS/ALS is a really ignorant way to think about medicine, and it's unfortunate that it's been institutionalized into our perception of EMS providers. That's what a lot of us are trying to say. What are you going to do, simply "open skull, remove brain" when you're working with your BLS agency? Just because you can't initiate ALS interventions doesn't mean you can't apply your knowledge to more effectively figure out what's going on with your patient and then communicate that to the higher level you are delivering to. If your ALS practice is such that you don't use "BLS" skills while working as an ALS provider, you're not building your knowledge base very well. You simply have more physical options in the toolbox as an ALS provider; your thinking, based on the education you should be getting, should be building from your initial understanding of things and integrating things you didn't understand previously. Therefore, it shouldn't matter whether you're working under your BLS licensure or ALS licensure... there's nothing you should be "keeping sharp" between EITHER of those. Nobody cares that you want to practice as an EMT-B with one agency and then practice as a paramedic at the other; that's not where people's frustration is coming from AT ALL. Now, to answer your initial question... I generally take a lot of shelf-stable munchies with me. Baggies of pre-cut veggies, tupperware of hummus/ranch, wrap sandwiches, fruit slices with nut butters, dried fruit, pita chips, granola bars... ready-to-eat soups that just need a microwave are good as well. Roasted almonds or other nuts are a good bet too. Tuna salad kits are a tasty change. I'm used to taking stuff in my SAR pack, that can sit there for quite a long time (packets of tuna, candy bars, CLIF or similar bars); then I throw in some fresh things when I launch for a mission, like a quick PB and J sandwich, hard boiled eggs, etc. Bento boxes are a fun way to pack lunches and keep stuff separate- ever heard of them? There's a livejournal group that posts up pics and ideas pretty frequently. Good luck and happy eating! Wendy CO EMT-B

Welcome to the forums! And thank you so much for putting the idea out there that we need to approach our patients holistically... that addressing psychological and emotional needs are just as important as some of the physical needs we care for. I think sometimes we can lose sight of that by focusing on the "clinical puzzle"- yeah, that's important, but I've been utterly dumbfounded at what kind of information patients will tell you if you gain their trust and learn to ask questions in a way that empowers the patient and makes them feel like a part of their own care... Also great points about staying in your lane... it's hard to process information and integrate it into what you're doing as you "level up" and I think a lot of people (myself included at times) make the mistake of equating "Oh, I recognize that new bit of info I recently learned! Hey, I think I got it!" with "I know EVERYTHING and I got EVERYTHING! I must be God!" Welcome to the forum, and don't listen to Dwayne's whiny self-belittlement... the fact that he knows you (and didn't try to shoot your nuts off on your first post) is definitely a plus for many of us here. ;-) Wendy CO EMT-B ADN-RN Student

You see this limb? It's got a foot, AND A HAND! It's a beautiful kludge... no? (Kludge is slang for mashed together/mixed around/united in error or intentionally for comic effect) I was more wondering at the motives behind starting the thread, without some explanation of said motives... there are some topics I find really sensitive, this being one of them, and as the OP appears to be gathering information for a purpose, I really wanted to know more about why... most people don't just throw up a poll expecting folks to share whether they've been hurt or not without giving more background in my experience, so it made me a little wary. That's all. And, then, assuming it was just for informational/discussion purposes, I wanted to comment that it's not broad enough to really get into it. That's all! Wendy CO EMT-B

Where did I say the scope seems wrong? I said I can't read the intentions, and as this topic is one of a highly sensitive nature that can be used to target or manipulate once someone knows your history, I really didn't see fit to post much... I also want to re-iterate one of my main points, that if we're going to talk about sexual assault, gender binaries are way too limiting and therefore, in the interest of having a truly fair sample of discussion, it needs to broaden a touch... Just saying.. I think you kludged my post with someone else's in your head... Wendy CO EMT-B

Generations write songs about what's happening. There've been songs about wars, sex, drugs, politics and so forth for ages... school shootings and bullies/bullied kids turning deadly violent is an issue from my generation (I was 13 when Columbine happened.) So, someone wrote about it. Big whoop. Actually, what I find REALLY interesting is that it's so catchy... it blends into the background... you don't even really notice what it means... and then people freak the hell out when someone points out what the lyrics are actually about. Kind of how nobody notices or really pays attention to the bullying... it's just part of the muzak... and then WHAMMO, holy shit, how did I not pick up on this before??? Nifty, if you think about it... a musical, lyrical subtext that blends into society's consciousness and further illustrates the very point of the song... Shall we burn poetry, ban books, and censor movies? Ick. How Farenheit 451 (Bradbury), how Orwellian (I think both of those authors were banned at various points, ironically). I think I'm a product of my generation, but I'm a fan of more open sharing of information and concepts, even if it does mean a little more vulgar language or sexuality on TV. Hell, they've been showing full nudity in Europe for years, and I don't see those kids turning out totally whacko... (any more so than the average bear, so to speak...) On a related note, maybe I can't speak to it because I wasn't there, but I absolutely HATE chain emails extolling just how f*king wonderful the 1950's were. Kids played on the corner, drank outta the hose, and.... etc. Nobody talked about how it was still not technically possible in our legal system for a woman to be raped by her spouse, everyone put on the big fake happy face to fight the commies, people didn't address emotionally absent fathers... yeah, that sounds pretty Disney-perfect to me... sure, the TV may have been clean and kosher, but life never is and never has been. The only difference is how tightly we clamp down people talking about it and how we allow expression of it... life is messy, and that's kind of where the wonderful bits emerge in my opinion... Wendy CO EMT-B

It's rather subjective all around here. You're performing a subjective assessment of relative temperature on your patient, so I would think that the method utilized doesn't matter a heck of a lot. I do know that I can differentiate a skin-to-skin temperature difference much better with the inner or outer surface of my wrist as opposed to fingers (yes, I check with both usually...) so I usually go with the observation I get from the wrist sensory input... Would I initiate active warming or cooling based solely on patient's subjective skin temp? No... but I certainly would in absence of an absolute measurement if other symptoms indicated otherwise. Ya know... lack of sweating, diminished interaction, hx of loss of consciousness in the heat altered individual (I actually did some standby at a trail marathon back in October... 80 degree day... and had one collapse on me at the finish line... boy, was he a mess! His skin actually felt cool, because he'd had some water dumped on him about 300 yards back, but he was waaaay overheated. Ice pack to the back of the neck and armpits, cool water to drink, and a full assessment by the local EMS folks on standby with me and he was good to go about 30 minutes later...) As far as hypothermia goes, evidence of exposure, diminished interaction/confusion, violent shivering or shivering that ceases... they're getting warm nuggets wherever I can get them stuffed and wrapped up in a nice sleeping bag burrito... I've done this many times doing Boy Scout standby. Did I always have access to a thermometer? LOL! No. Did I know they needed active rewarming? Yep. So, I guess the long winded answer, Dwayne, is to each their own. I do a comparison with fingertips and back/inner wrist, so if you like your fingers, put 'em to good use... ;-) (I wouldn't be using them as an internal probe... we're talking just superficial here... *sarcasm sludge slips off the words...*) Wendy CO EMT-B

Work word: Erythema, referring to localized redness and swelling. Can be used to describe a hive-rash (erythematic eruption), or an infected area ("that lower extremity demonstrates erythema and edema") Non work word: schlepp. As in, I am a go-fer, therefore I schlepp... let me schlepp my textbooks over to the library and we can study for that damn exam... my poor hubby's been schlepping me all over so I don't have to drive tired... :-) I like this thread! What a nifty concept! Wendy CO EMT-B

What book? Who wrote it? It sounds really familiar. I've read so much sci-fi it comes outta my nose... ;-) Wendy CO EMT-B

I also wonder... what's the purpose of this thread? For all of us to look around and see how broken we are/were? Does psychological abuse surrounding the issue of sex count? What about people who have been assaulted, but have processed it and are now OK with their past? Just wondering where we're going with this, tbh. I don't want to answer the poll until I get a better idea of what this is all about. I also don't want to write much free text, either... Also, the binary is a little too constricting ;-) What about folks like my friend who is transgender, female biologic, male psychologic/gender identity? Just sayin'... Wendy CO EMT-B

Nice exploration of different moral and social concepts in this thread! I don't know as I have a whole lot to add. Gay accent: I call bullshit. Perhaps the gay individuals I know speak much more ebulliently... but then again so do some of the caffeine fiends... and there's no tonal or dialectical difference. Gay body language (aka, what trips the "gaydar")- absolutely. Now, to qualify this, let me first say that I have gay, bi, asexual, and transgendered (with varying sexual attraction identities) friends. I have known so many different people who are bisexual or homosexual sexual orientation that I must have learned different body language cues... because I can call it 80-90% of the time with someone I've never met before. It's just something I am unconsciously aware of, like realizing someone has brown hair or blue eyes or whatnot. I would say it's probably not so much an accent as it is a projection of self that registers through body language that is alerting some of Flaming's patients/patient parents to his orientation status (am I close? Or is it really an accent thing, man?) Obviously, he is very self aware and conscious of being gay, and how it is perceived... so I would guess that may in turn cause him to "project" more than someone who relates to their orientation status differently. I see it a lot in environments where homosexuality is not readily accepted; either people bury very, very deeply so as to avoid notice, or they feel they must be true to themselves and their body language reflects that, causing others to more easily recognize them. Just my thoughts. Wendy CO EMT-B

Dwayne. For the love of God. CO2 is carbon DIOXIDE. The shit that kills you is carbon MONOXIDE. CO. That's why it can attach to hemoglobin. Sorry. That one kills me... had to nail it. Now I'll finish reading, and THEN I'll make a substantial reply... ;-) Wendy CO EMT-B First of all, to Flaming: Man, it would be great if rookies got paired up with someone who knows their current practice AND had the experience of practicing before we had all these extra assessment tools available. That would be ideal, as long as the providers were up on current practice. Unfortunately, my experience was that I was paired with a medic from the 70's whose opinion was "we don't need none of that book larnin. Stick an IV in em and let's take em to the hospital." And a lot of the older providers I encountered, who were preceptors, just simply didn't approach clinical practice very well. They gave medications without understanding them. They bullshitted a lot. So I would have to disagree with this model, based on my n=1 experience. Now, as to the question of using the devices or not; I say absolutely, you need to be using every assessment tool available to you. It's your own dumb fault if you fail to integrate all parts of your assessment, including what you see, hear, smell, feel, and have as data output from your machine. If you just go with the numbers you see, and don't use critical thinking, then you're up the creek. Get a number you don't trust? Do a manual assessment when applicable and/or change machines... Now, if you get a result on two different machines that you can't reconcile with your other assessments, file that contradiction in your brain and make sure that info is available to either medical control or whoever you're giving handoff to. It's a lot more simple than 'treat the patient, not the monitor' or 'I don't need to do that because I have a monitor to tell me XYZ'- there can in fact be a happy medium, it just takes a little bit of work IMHO. Wendy CO EMT-B

Resurrection is appropriate around this season, no? Or am I thinking Easter... Wendy CO EMT-B

Wait, I'm confused. He's in a skilled facility, but he's non-med compliant on all the controllers? You get booted home if you don't play nice where I'm from. Was the cephalexin IV as well? How does the IV site look? Last oral intake? Breath and ABD sounds? Hm. Odd. Did he start the cephalexin and steroid upon d/c from the ED for PE workup? What was the indicator that sent him that way in the first place? Wendy CO EMT-B

Define: Degree of faith. Let's start there. I'm very well educated. Many here would say I'm intelligent. I developed my faith during my education, and it has gotten me through some really tough things that I might not have otherwise been able to cope with. I question my beliefs, I allow myself to be challenged and challenge others... but I am passionately, devotedly faithful to God and my Christian beliefs... I simply don't choose to look at the world through cotton wool... or explain everything that I do not understand by "God did it." I am less verbal in some forums about my beliefs, and respect the right of the individual above all when it comes to health care... you don't want my religion in the mix, that's a HUGE patient right.... Wendy CO EMT-B

So, you ever coming back? Just curious... Wendy CO EMT-B

Yea.... I don't get where you hopped on him. His statements actually helped me to think through more of what was going on with this lady, since cardiac is something I haven't had a chance to sink my teeth into yet. I thought his statements were reasonable, and the treatment idea in line with what the general consensus seems to be, which is no antiarrhythmics for this one. Also, a thread isn't "dead" until we've hit 17 pages and someone starts swearing at the troll, or it's locked, or it's been SEVERAL MONTHS. 10 days is nothing; some of us don't check the forum every day all the time... so when we float in and out, we find threads that most folks are done with, but we might not be yet. Just my thoughts. Wendy CO EMT-B

Anagrams thought up at age 13 for the win... W E N D Y A E Y D A W N It has been my 'net handle ever since... Wendy CO EMT-B

My current routine sucks. I'm not eating well (stress, school) and not finding time to exercise with such a screwy schedule between work and school. Hence, I'm on my way to gaining the nursing school 30 at the rate I'm at. Not what I want to be doing at all... working slowly to getting myself into a better routine. I really need to cut back on the coffee and the beer. I love me some beer, but there's a lot of empty calories there. I kind of justify it by saying I don't drink soda, but it's not any better for me really than if I did drink soda... at least I haven't joined the Diet Coke crowd... I also need to cut back on the sweets. My sweet tooth is definitely my downfall! Lots of stress eating going on with the sugary stuff. I'm trying to do better by bringing healthy things to snack on during class and work... like mini bell peppers, snap peas, greek yogurt, cucumber slices with salsa, raw broccoli and ranch etc. I need to get better at packing lunches again, I have been relying on the nasty cafeteria at school way too much lately and it's showing. I also feel like crapski eating the way I have been. When it comes to work, working overnights, I don't always pack a lunch so I go all night without eating, which I know can't be good since I'm already messing my internal clock by working awake nights. Wendy CO EMT-B

I have actually found some of my learning to have been better suited from online and hybrid courses than from "traditional" in-class settings... when I am able to not worry about class attendance, and have adequate venues for discussion of the material online, I do much better than dragging myself half-asleep to courses where an instructor reads me powerpoints and then assigns random "group activity" discussions that don't really facilitate much in the way of learning... I would think, however, that paramedic courses are much more difficult than say, A&P or microbiology or developmental psychology... how is this setting treating you? Do you feel like you're getting a good in-depth understanding of the material, or are you memorizing to the test and not absorbing? Wendy CO EMT-B

Wow. Dare you to watch it without crying! It got me... Korean kid who's been through hell sings on Korea's Got Talent and just blows everyone away... Wendy CO EMT-B (Guess I'm in a video sharing mood!)

I dunno, but Squint linked it around to the obit thread as he resurrected it... Was nice to read his comeback post, tbh. Wendy CO EMT-B

https://www.getup.org.au/campaigns/marriage-equality/love-story/watch-the-video This video sums it up for me. People are people, and marriage is about way more than sex. People who get freaked out by the idea of homosexual orientation make me laugh... how many "normal" hetero couples do things that would freak many of us out in their bedroom, yet their rights are taken for granted? Love this video. Go Australia. Wendy CO EMT-B

Bieber! I'm gonna kick your arse. Smoking?! Shame! Lol... Wendy CO EMT-B

Definitely sounds like you need to work through and process this one. They tell us over and over again in nursing school, there's going to be patients that push your buttons, and that this is TOTALLY OK AND HUMAN. It seems like EMS has this mentality of "can't nothing getcha unless you let it and if you do you're a pussy. " This is erroneous, and shows poor understanding of psychology. I would definitely speak with someone... if this is interrupting your sleep, or making it hard to concentrate, you need to help it work its way through your brain to a nice storage space where it won't hurt you anymore. It's not that you need to "overcome" some disadvantage; you just need to let your psyche heal from something that was painful to watch, and that affected you emotionally. Rom2012- I agree with your interpretation of HLPP's post, FYI. If this doesn't affect you on some level, even the cognitive level where you can go "wow, this call would mess with someone... it's really sad... I'm OK but damn... shitty call..." then you need to rethink your approach, as empathy is so important to medical care. Wendy CO EMT-B

Have you done any prep books? Do you know what portions of the exam are causing you to fail? How'd you do on written exams in your paramedic course? Test anxiety/Learning disability diagnoses? Just for a start... answer those and I may have better suggestions... Wendy CO EMT-B