Eydawn

To be fair on the use of the term "contract"- I have heard this used in reference to one's entire contract of service coming up on renewal or about to end. "How much longer does he have on contract" is a question I've heard recently, from folks in a few different branches... just sayin'... As far as being sent to a shit ton of different schools and ending up with a lot of classifications, again, gotta say it's possible. Probable? Maybe not... but possible definitely. Got a friend who's in the Army who's been to a LOT of different schools because he kept getting jerked around and put into incomplete units that never got completed... so he killed a lot of time in a 5 year contract going through EOD, tank driving, electronics, etc... Wendy CO EMT-B

In response to Lone... Scenario 1: The male participant is also underage, and therefore unable to give legal consent. So they both failed to give legal consent. Does that mean they both raped each other? *scratching head* Sounds like there's no actual crime here other than underage sex between two minors under the age of consent... and it sounds like there's a no-fault issue here so there's no potential prosecutable issue... I would be contacting *local* legal advice on whether or not it needed to be reported. Better to take an extra few hours to figure things out than to do the wrong thing. In response to others... Scenario 2: Are the cops on scene with you? If so, pointing out something you may not be sure of could be very appropriate. If they're not on scene with you, and you have no need for them in order to facilitate your care, then there's no reason to call them. You're not legally bound to report what happened, at least in my neck of the woods. As a matter of fact, I seem to remember being taught that part of my phrasing for asking about illicit drug use could be worded as "I'm not a cop, and I'm not going to tell the cops, but I need to know because this may be contributing to your current acute health crisis" or some variation thereof. If there were mandatory reporting, this would be a really unethical tactic, as I would be lying to the patient to get health information and then turning around and doing exactly what I said I wasn't going to do... Wendy CO EMT-B

Hey all... PM me with your name (if you want to release it), a picture of you (if you feel comfortable sharing that), your age, your educational background, how you got into EMS, what setting(s) you currently work in, aspects of your personality that you feel contribute positively towards your working "self," any educational roles you currently work in, and what the biggest challenge you feel you have faced/are facing in EMS is. Also, any shout outs you want to give to specific mentors or people who have helped shape you into the provider you are. Whaddaya think, all... does that cover it? I'll try to put together bios soon... nursing school is kicking my ASS on time right now (especially since I'm still working 30 hours/week). So it may be a few days. --Wendy

So nifty! Can't wait to see who wins. I volunteer to do the journalistic bios on winners... ;-) I do have my BA in English, after all... Wendy CO EMT-B

Question for you instructor types. My nursing class is having some issues. Material is not necessarily always being presented correctly, and sometimes we're given an answer with "that's just the answer" and things don't go so smoothly when some of us try to figure out the "why." When you as an instructor present something incorrectly, do you feel threatened when a student points it out? How do you handle this kind of situation? Just trying to get a feel from the other side... Wendy CO EMT-B

I'm just barely taking my baby steps into pharmacology (and they won't give me any details yet, the bastids) but to my understanding it would be beneficial to carry both for several reasons. 1: Fentanyl has a short half life, making it effective for use in situations where your physician may need to assess pain as part of their diagnostic process. So, you get to give your patient some pain relief, but have it wear off soon enough for the doc to do what needs done, and then re-dose with Fentanyl or another narc. Also, if your patient is sensitive to narcs, and the Fentanyl snows them, it can wear off quicker making your need to use Narcan or similar less imminent... 2: Isn't morphine more often used in cardiac situations for reducing pre-load? Since Fentanyl doesn't have the same hemodynamic effects, wouldn't that make it fairly useless in cardiac related situations? Or am I off in left field? In any case, you would want to have the morphine available... 3: Fentanyl is less likely to cause a histamine response, no? This could be a good thing. 4: Different patients metabolize drugs at different rates and have different subjective relief... do you really want a patient to come back and state that your standard of practice was lacking because you were being a cost-miser, so they had to endure a transport of XX time in 100/10 pain... you see where this is going? It's all about dodge the lawyer and cover all bases here. Just my humble thoughts. Wendy CO EMT-B Student Nurse

Definitely one to turf to the ethics committee for final say-so, but I'm going to say no intubation. She has a valid DNR order (which should really get updated every year or so to avoid any confusion), and spouse (legal control, yes?) says to uphold it, as does her father (next in line as next of kin). Sad situation, definitely one that makes you think... 'zilla, when can we have the pathophys and other details? ;-) Wendy CO EMT-B Student Nurse (am I a dork for updating my sig like this?)

Chbare, what leads you to doubt the diagnosis? Can you let me in on your thought process? Wendy CO EMT-B

I completely disagree that having a pocket reference or wanting one makes you inferior. Far better to know your own limitations and to act accordingly than to just roll with it and potentially make a mistake. Especially where drug calculations are concerned! I have dyscalculia. You can bet your sweet ass, if I find something that helps me with calculations, I will use it without shame and encourage others to do so who are struggling in similar ways. I would much rather take the time to punch something out on a calculator or pen and paper where I can triple check it than rely on something I calculated in my head, especially if there are trailing zeroes or decimals involved. I flip digits around decimals like you wouldn't believe. As a result, I have become hyper-paranoid (the mistakes are more frequent when I'm tired or my blood sugar is low). So... does knowing that I will have to figure this out make me a poorer potential provider? I don't think so... at least I know where one of my issues lies... Wendy CO EMT-B

Haven't had any cardiology to speak of, so I can't really read the strips other than to go WOW! Could it be wide complex V-tach that I'm seeing in the three lead? As far as the 12 I won't hazard a guess at what else may be going on... but that's my first guess based on the three lead, based on the presence of regular peaks of the same size and width apart (too wide but really fast rate). Wendy CO EMT-B

When you first get on scene holler for anyone with first aid training to come to you. Give them jobs as described above my personal favorite being moving anyone not injured to another area. If you have more helping hands one helper to each patient and tell them to start getting a history from their person and just keep them talking. THEN you can do triage and then call medical control. You have to be loud and confident. Sometimes your first phrase needs to be EVERYBODY FREEZE! THIS IS THE AMBULANCE! LISTEN UP! You would be surprised at how well that works. Be firm but polite. It isn't easy to settle out a fustercluck like that one! So what was the actual scene? Wendy CO EMT-B

Oh my gosh. I am printing this out and keeping it! For the first time it totally makes sense. Thanks chbare! I AM SO STOKED! That has been bugging me for quite some time. Wendy CO EMT-B

Why is the perfusion 5L and ventilation 4L? The concept as a whole makes more sense now thanks very much!! I guess I am asking why it isn't a perfect 1:1 ratio. I told you I hated my patho text... lol... Wendy CO EMT-B

Man why couldn't I have worked with you guys prehospital... my thinking exactly about cardiac monitors. Damn my luck lol... Great thread! I am still learning about VQ mismatch... that whole concept is very fuzzy to me. Wendy CO EMT-B

Congratulations on passing! Also major props on seeking feedback on this very tricky ethical dilemma. As you can see there are many things to consider, the most important being right of refusal. This is a patient right that frustrates us and drives us crazy because we know our patients aren't making positive choices and yet we can do nothing about it unless they are deemed legally incompetent. Always step back and realize that you have all the pieces except what is inside your patient's head... and it is your responsibility to protect their right to their own bad decisions no matter how much you may disagree with them. Wendy CO EMT-B

What state are you and your wife coming to? That is really the most important first question because then we can give you specific resources to look into. I would not necessarily bank on being able to get into critical care transport (interfacility ICU) because that often has very specific experience requirements. It all depends on how your licensure is viewed here and unfortunately I don't know enough about Spain to be of much help there. Are you sure that you have to repeat residency? Where did you get that info from? Also what is your specialty there in Spain? In any case good luck to you! Wendy CO EMT-B

Loco, you should have just PM'd someone and had them post for you saying "from some unnamed member". Some brand new name with no other posts with an opinion now is gonna be really easily flagged. I'd not say anything now if I were you. Wendy CO EMT-B

Chbare- explain that statement a touch, would you? Wendy CO EMT-B

I always chart like I'm going to have to defend myself with it in court. I'm a lot more verbose than some of my compatriots... and there's very few acronyms that I use. PCP for personal care provider, NOC for night... BM for bowel movement... and that's pretty much it. I write it out so that anyone else reading it could see exactly what happened. It's amazing how you learn to phrase things... like "found on floor" is totally wrong... (you found them? So they were lost, eh?) lots of little things that can trip you up. Wendy CO EMT-B

Professional appearance: Clean, well fitting clothes, and professional demeanor. I could care less if you're wearing a polo shirt, a nice T-shirt or a button down... and I'm telling you, you could be the purtiest damn medic in a button down and if your medicine is crap and your behavior sub-par, I'm not going to be impressed in the slightest. My SAR button down is actually a hunting shirt with patches sewn on it. I need to find one that fits me better, mine is way too big (that, or get the one I have tailored.) My more informal shirt is a bright orange T-shirt or a navy blue T-shirt with our patch screen printed on the left breast. I'll tell you what I know I look better in and am more comfortable wearing... the T-shirts. Does it fit? Can you move in it? Is it clean? Are YOU a professional in how you comport yourself? Awesome... carry on... Wendy CO EMT-B

Chem and bio lay the foundation for understanding what's actually going on in A & P. If you don't understand basic chemistry and biology, the material is much less readily understandable and less deeply absorbed. For example... the concepts of hydrophilia/phobia, acid/base relationships, cellular functioning and the electron transport chain... all of these come from basic bio and chem. Sure, they get covered in anat and phys... but if you've already learned it in basic bio and chem it then becomes easier to understand. As far as asking whether or not microbiology is useful for someone in a medical field, what a redonkulous question. Seriously. Absolutely microbiology is useful! How else will you begin to understand the difference between gram negative and positive bacteria, biofilms, antibiotic resistance and how it develops, viral illness mechanisms... there's so much in there that is amazingly useful to any medical provider. Human nutrition... once you understand how important many different nutrients are and how significantly they impact health, you begin to see just where deficiencies cause or significantly contribute to many of the illnesses we see. You need to start thinking as a holistic provider. The whole body, even down to these microscopic levels, is what we treat. If you don't understand all these microscopic levels, how can you hope to treat the macroscopic level? Wendy CO EMT-B

Herbie-- Just for the sake of argument, consider this position... Human sexuality is one of our most basic and strongest drives. It comprises a huge portion of our psychological being. You, as a heterosexual individual, can bring to fruition your sexual desires in a fashion that is encouraged and supported by society and current tradition. Let's flip this for a moment; imagine that homosexual relationships are the *only* approved sexual relationship, and you have been born hetero. Could you decide to only engage in homosexual relationships, even though you feel no sexual drive towards the same gender? Could you decide to live a life of celibacy in order to conform with someone's idea of proper society? Would that be psychologically healthy for you, and would you be able to live a happy life? I want you to really sit there and really think about this. Very hard. Imagine yourself in this exact situation. How does that idea sit with you? Because that's exactly the situation that anyone of homosexual orientation is in. Imagine everyone getting in your business and calling you a malfunction, damaged goods, should just be able to CHOOSE not to have sex with the opposite gender because it's just plain wrong... imagine facing discrimination because you want to marry the person you love and wanting to start a family... fear for your job, fear that people will beat the hell out of you just for being born the way you are... Not so easy as being in the majority and secure in your position... Wendy CO EMT-B

It is here, at this URL. I created it so I could start chronicling my experiences with life as I go through nursing school... please take a look and critique (anything from layout to color to content would be appreciated!) http://eydawn2.blogspot.com/ --Wendy

That does it. He's a troll. Post reported.... time for you to crawl back under the bridge... Wendy CO EMT-B

Holy shit. Science fiction isn't fiction anymore... this Iphone app will translate written text in real-time from Spanish to English and vice versa. So, you've got that "no habla" in your truck and you really want to know if they've got any allergies? Pen and paper, and show it to them through the Iphone lens... and vice versa, have them write information down and you look at it through that lens... Not a perfect system by any means, but a damn sight better than having to guess! What do you guys think? Wendy EMT-B