Lone Star

Obviously, mere 'medic students' aren't allowed to play "Guess What's Wrong With This Patient". Just let me know where I can pick up my cheesy parting gifts as I leave the stage. I asked two specific questions, and neither were acknowledged, let alone given an answer.

Is the patient complaining of the sensations spreading to other parts of the body, or is it localized in just the distal lower extremities?

Brian, I have to say that I am impressed with your attitude throughout this thread! You've posted a question, provided possibly damning information; and throughout it all, you accepted the criticism as well as the encouragement without copping an attitude and resorting to personal attacks. You've owned your mistakes, and apparently have learned something from them. I see great potential here! I can see that you've got great empathy for your patients, and you're concerned about learning more. This is the precise attitude that is needed for EMS. There are far too many that become complacent after they get out in the field, because they mistakenly think that they now know it all. This is not the case with you. EMS is known for its ‘tough love’ attitude, and there are many of us that strive to not only be the best that we can be; but work hard to advance EMS as a whole. Being new on the trucks (regardless of your level of licensure) is a tough spot to be in! We’ve all been there and some of us will ‘be there’ again. Ultimately, it’s what you do with it that decides if you’re going to make it or not. I’ve seen people excel under the pressures, and I’ve seen people fold and quit. I don’t see you as one to throw in the towel and walk away. This site is a great learning tool, if you let it. There is quite possibly hundreds (if not thousands) of years of experience that is available to you. You’ve already shown that you’re willing to speak up and ask questions. Good fortune to you, sir! LS

Since the link isn't working for me, is this the girl that y'all are referring to? http://www.youtube.com/watch?v=IVpLTvQIICs

You stay away from my pony tail! Thats for the 'cancer kids'!

Gravitational edema in the lower extremities? Is the patient coughing much? If so, is the cough productive or dry? How would you describe any sputum production? *edited to add additional questions*

In every service I've been involved with, the higher license level is the one 'in charge' of the call. Ultimately, it's their decision on whether to upgrade the call or not. As far as the equipment failures, that is on you and your partner. Shame on you both for not checking your equipment and supplies (extra batteries that are fully charged included). Every service I've run with (even for my clinicals) the first order of the day was to take an inventory of what's on board. In every instance, the state has set a minimum level of supplies and equpiment that MUST be on the truck, otherwise the truck CANNOT be put 'in service'. If your equipment/supplies are not adequate, then YOU and YOUR PARTNER are at fault! There is NO EXCUSE for not checking your truck! As an EMT-B, I wasn't educated in the different rhythms, but I knew enough to know how to apply a 5 lead and record a 'strip' if necessary. The use of lights and siren should be used only in the situations where the risk of expedited transport has significant benefit to the patient. Not all calls require the use of lights and siren, and sometimes the use of these devices has a negative effect on the patient's well-being. The general public knows already that if they hear the sirens and see the flashy lights, something is seriously wrong somewhere; whether it's where the patient is or it's the patient on board. There are times where the patient hears the siren and figures that they're 'done for'.... I don't see anything in the vital signs you listed as particularly alarming. Yes, the patient was complaining of chest pain, but as has already been pointed out, not all chest pain is an MI/AMI. I would have looked at additional vital signs before becoming 'worried' and upgrading to 'code 3'. Skin condition, was the patient well hydrated? Lung sounds? Let's not start with the 'poor me' B/S... EMS is known for "eating it's young". What it sounds like to me, is that you siezed on a couple key words and somehow twisted it into a 'dire situation'. We're not busting your chops to drive you from the field, or to make you look/feel bad. We've pointed out that there were a bunch of errors made here and hopefully are setting you in the right direction so that it doesn't happen again in the future. If you think this is a 'beating', you should surf the site and see where the true 'beatings' have taken place! You're not the first one to have made these mistakes, and you certainly won't be the last one to make them. What's important here is that you pull yourself up, dust yourself off and LEARN from it.

What was the patient's original reason for calling? Were there signs of cyanosis? Was the patient on supplemental O2, if so,what was the rate/delivery device?

I had to delete my previous post due to the fact that in my near brain dead condition, I mistakenly gave the praise to the wrong person. What I meant to say was: Great job Herbie! You and your partner must have had a 'pucker factor' of at least 10+! This, ladies and gentlemen, is why we do what we do. No, this won't happen every time; but it sure is great when it does! As far as your comments to the parents, Herbie; I'm sure it made their day to have their efforts recognized and validated like that. After seeing some of the horrors I've witnessed at ECF's and some 'home care' arrangements, it's people like this that still give me hope for the families of 'special needs' people. As Chris said, when you can return the patient to the condition that they were in prior to the event that led to your intervention is considered a 'save'. A 'save' isn't only restricted to cardiac events. In this case the efforts of the responding crew prevented a cessation of life functions. How much more literal can you get with the word 'saved'? From what I read in the original post, this child surely would have expired had not Herbie and his partner been 'in the right place at the right time', and had they not done what they did. Rather than argue the semantics of the term 'saved', it would be better that you give them the kudos that they deserve.

And understanding covalent bonding, or other electron bonds really helps increase the survivability rates of cardiac arrest or trauma patients,… how? How does knowing the proper order and number of electrons in each orbit will help our respiratory arrest patient in what way? I agree that knowing an acid can be neutralized by a base is a good thing. But honestly, how is knowing whether a microbe is gram positive or gram negative, or which color stain is used to prepare the slide really going to help our patients involved in an MVA? How many slides are we really going to be preparing and viewing in the back of the truck? Since we neither diagnose nor prescribe, how is the knowledge of how a virus or bacteria develops a resistance to certain antibiotics going to really do anything for our patient? Before I get branded as ‘anti-education’ again, I want to make this perfectly clear: I am NOT against education, however; I’m more of an advocate of RELEVANT education. As an example: one of the required courses that I’ve had to take while pursuing my degree was “Computer Concepts and Applications”. While the course dealt with the differences between program and system software, and suggested ways to perform an internet search, I really found nothing that can be actually applied in the treatment of my patients. I don’t see how knowing how to create a spreadsheet, insert charts or how to format a paragraph in Microsoft Word is going to magically make my patient ‘all better’. Knowing the definitions of ‘shareware’ and ‘freeware’ and the differences between them isn’t going to benefit my patients either.

While I can see the logic in these classes: Algebra (for critical thinking skills) A&P (for obvious reasons) English, Writing/Composition (for intelligible PCRs and other forms of communication) Psychology Sociology (both for obvious reasons) Chem, Bio,Nutrition and microbiology: Maybe you can explain to me how they're actually beneficial in the field. Unless you're planning on working in the lab, or becoming a dietitian; I see no practical purpose for field applications. If you're interested in the effects of the medications and how they affect the body and interact with other medications, wouldnt organic chemistry be more relevant than just Chem 101?

Oh ye of little information! The following information would be slightly helpful in answering your question: Location Level of education Current certification/license level EMT-I 85 or EMT-I 99? Are you planning on going on to medic? I can tell you this....acid/base will drive you insane! Hypotonic/isotonic/hypertonic can get confusing You'll find that in EMT-I, there is not alot of 'new information' being presented. As long as the NREMT keeps it's focus on 'minimum hours required', your EMT-I class will be woefully lacking in new material, and severely lacking. I would suggest that you bypass EMT-I (unless its integrated into your EMT-B class), and go straight for your degree in Paramedicine. Not only will the degree make you more marketable, but there is a wealth of education that is required along with your paramedic course (ie: Anatomy & Physiology I/II).

Since you've obviously already set a goal of getting into nursing school, by all means full steam ahead. I DO have to ask this though.....with all the people who want to become nurses (and I don't think that theres a thing wrong with that), why in the world are y'all wasting time getting an EMS education? I highly doubt that it will be of any great benefit along your path to becoming a nurse. It's this kind of action that makes EMS look like nothing more than a 'stepping stone' to something else. It's also just another factor as to why EMS cannot get respect and recognized as a true profession!

How does becoming an instructor teach 'humility'? In fact, it could work just the opposite. Think about it: You've got a medic who clearly has a higher license level, better education and a wider scope of practice teaching those who are just begining; most will have no prior medical education and upon graduation, will have a very narrow scope of practice. This leads to a feeling of superiority, which is counterproductive to humility. In Michgan, you have to have at least 3 years of 'field experience' before you even qualify to begin the courses to become a licensed EMT instructor. In the State of Georgia, you have to hold a current/valid State License to even be selected as an adjunct instructor. I think there's even a clause in it that says you have to be actively working in the field as well. Instructors should be those that choose to do it, not doing it because it was forced upon them. This leads to the "I'm only here because I have to be." mentality, which doesn't bode well for teaching. Even preceptors are in the program because they were selected and chose to do it. Not every EMT/EMT-I/Paramedic is selected to be a preceptor. In the state of GA, (at least to the best of my knowledge), you have to hold at minimum a BS to be able to teach paramedics, and an EMT with an Associates Degree cannot be an EMT instructor.

You say that we shouldn't assume things based on a name, but yet you willingly chose to exercise such a juvenile attempt at humor. What other conclusions are we supposed to make based on it? Obviously, the use of capital letters and the phonetic alphabet (whether you choose to use the military version or the civilian version) makes it VERY clear what you were trying to spell out. Many will not be amused. There are many of us on this site that are working hard to improve the already poor image that EMS has, and it's stunts like this that negate the work we're trying to accomplish! Since the opportunity to make a 'good first impression' has passed; I, for one, can only hope that the quality of your future posts will not reflect the immaturity level of your choice of screen names. LS

And here you thought the movie, "The 40 Year Old Virgin" was just a work of fiction.....

EMT-I is not ALS per se; it's ILS (Intermediate Life Support) or LALS (Limited Advanced Life Support) at best. This is NOT the same as ALS (Advanced Life Support. If it were, then there would be no difference in the scope of practice between EMT-I and EMT-P. When the hiring requirement is ALS, they mean Paramedic, not the lower license level of EMT-I. Unless your state combines EMT-B/EMT-I, there should be no reason to waste time or money obtaining your EMT-I. Go get your Associates Degree in Paramedicine.

It's funny how it works like that, Ruffles....I lost mine about 20 some-odd years ago, and havent been able to find it since... One must ask though..is it REALLY 'premarital sex' if you don't plan on marrying them?

5/5 or 5/10? Might I suggest Math Link as well? ROFLMAO

When I worked in Detroit, those that were deployed out of the main station would wash the trucks inside and out, take inventory at the begining of every shift. Those that were deployed from the 'outstations' were usually allowed to return to quarters between shifts. They were expected to wash their trucks daily as well. The station I worked out of was the 'Detroit hit car', which meant that any call within the city limits of Detroit, any suburb or long distance transfer. We washed the outside of the truck as often as dispatch would allow us to get to Station 1. The interior of the truck was cleaned at the begining of every shift and between calls at the hospitals. One of the really cool things about working in the Metro area is that the hospitals usually took care of the EMS crews very well. A clean truck not only reflects well on your service, but the on duty crew as well. Cleaning the interior is a matter of sanitary concern. If you don't clean/decontaminate the inside of the truck after each call, you risk cross contaminating your patients, and yourself as well...

Did you actually put any thought into your post before submitting it, or did you just submit anything just to see your name on the website? The bottom line is this, Paramedic skills are not only better for your patient, but they are also more marketable. I've noticed a trend lately. EMS seems to be nothing more than a 'fill in' career choice until people can get their education in other fields. This puts EMS on the same level as waiting tables and flipping burgers. No wonder we aren't taken seriously as a profession! For those of you that know Dust, I'm going to quote him. I know, I know, there's a shock right there.... Dust used to say "If you're gonna go, go big; or keep your ass at home." I used to get aggravated that he would say that, and not continue the debate any further. As I continue my education, I can actually see his point. No, it's not to flaunt his higher education, it wasn't to act like a 'Paragod'...it was his passion for the profession of EMS, and what was actually best for the patient. If you look realistically at EMS education; you’ll realize that it’s woefully lacking in critical information starting even at the Basic level. Another expression that used to aggravate me is paraphrased in ERDoc’s signature: “It's not what you don't know that will kill your patients. It is what you don't know that you don't know that will kill them.” If you’re truly interested in the EMS profession, it’s time to stop treating it like a hobby. Either commit fully and go as far as you can, or get out. People’s lives hang in the balance, and you as a prehospital care provider are doing a great disservice to not only yourselves; but to your patients as well. To the OP: You mentioned your quest to obtain a BS degree. In what field are you actively persuing your degree? Is it even EMS related? If your degree is in some career/profession other than EMS or medical field, why are you even in EMS? LS

It's not that I've had too much eggnog...I've just been running around like a cat trying to cover sh*t on a marble floor. I just found out that I somehow didnt get the link posted. Grammar Test

That looks like a cool 'toy', but at $200.00 a pop, is it something that the average EMT is going to be able to afford to have bouncing around in the back of the truck? Another question I have is: Even with this device, unless the patient is supine, wouldn't trying to use this to hit the AC end up putting the cath in the wrong direction (flowing distally as opposed to flowing proximately)? I saw one from Acculite, but needs an RX to be able to purchase. Even though this one is 'non contact', I don't see how it would have applications in EMS. It's not like we've got an overabundance of places to establish a base for it.... I've never heard of this technique, but I haven't been in a position to start IV's very long. Is this a common practice in the field?

That gives us all time to go down to the local 'Medievale Shoppe' and get a spiked mace and one of those cool ass 'cave man clubs' with all the spines sticking out of it! *Edited by Lone Star to fix an ugly spelling error*

*Lone Star hangs his head in shame, goes to the corner after writing 100 times on the blackboard, "I will NOT feed the trolls."*