Lone Star

Unfortunately, prospective spouses don't come with a 'compatibility list' to ensure that it's a perfect fit. I was married once, and found out within the first 18 months that she was a lot like Will Rogers (Never met a man she didn't like; the problem was, she 'liked' them better when I wasn't home!). Sincethen, I seem to find women who either want to make me 'pay' for the sins of their exes, or who can't stop playing their stupid school girl games .....(stupid 'tests' to see how faithful the guy is by having their friend make a pass, sleeping with someone else out of 'curiosity'...you get the idea)... Hell, I've been dumped because they thought I wasn't 'emotional enough'.....

You may be proud of who or what you are, but is it REALLY necessary to make it your 'defining quality'? How many avatars do you see that proclaim other's pride in being (insert reason here)? Also, I noticed that your 'test' was pretty slanted against being classified as anything BUT homophobic and intolerant.....how very classy! If people want words like 'the N-word' to no longer be used, it MUST be unilateral, not just 'wrong' for 'some people' and not for others... The whole double standards thing needs to stop. There are those who profess that they are yearning for acceptance/equality/respect, but are also NOT offering those same attributes; this makes them appear as hypocrites and their entire quest loses credibility... You want respect/equality/acceptance? You've got to be willing to give it as well! *Edited to correct a glaring spelling error.

I've only got one tattoo (and I keep it covered), and my long hair is for a noble cause.....

While I've met some very attractive women in my travels (school, work, etc)....I'm not usually in a position to cheat because I keep getting that look from females that says in no uncertain terms "I can do SOOO much better than you!" Even if I DID find a 'willing partner', I'm know I'm too stupid to do it without getting caught. Since getting caught would cause WAYYY more problems that I really don't need, I find it very easy to not put myself in that position. Before anyone comes up with the conclusion that I would do it if I thought I could get away with it, think again. I don't do it because it's not the "right thing to do, and it's not the right way to do it." (Thank you Wilford Brimley!) I've been on the other side of this equation, and I didn't like how it felt, so WHY would I be willing to subject someone else to that kind of hurt?

When I had to do drug profiles, I figured out how to adjust the settings in Microsoft Word so that I could type them out. I then printed them off in (my printer didn't like me much after that!). All that needs to be done is load the cards (5x8 inch) correctly (I used cards that were blank on both sides ). Just load the cards into the printer so that the 5" side is your 'top' and 'bottom' and then slide your paper guide all the way to the side, just like you would do for a stack of 'regular paper'.... The cards are set up for drug name (centered across the top of the card), Classification, theraputic action, indications, contraindications, precautions, and both adult and pediatric dosages. Some drugs took two cards to complete. I researched the drugs online, n my books and even went to the pharmacist at the local Walgreens and CVS to get drug information. I've got enough paper on drugs to make a document that completely maxes out the extra large binder clips. The pharmacists thought I was some sort of nut case asking for all these profiles.....lol The drug name is in 16 point bold, each category is 14 point bold and the text is in 12 point. Each drug card looks something like this: ALBUTEROL (Proventil) CLASS: Sympathomimetic bronchodilator THERAPUTIC ACTIONS: Relaxation of smooth muscle of bronchial tree. Decreases airway resistance, facilitates mucous drainage, inhibits histamine release from MAST cells; reduces mucous secretions, capillary leaking and mucosal edema caused by an allergic response in the lungs. INDICATIONS: Relieve bronchospasm in patients with reversible obstructive airway disease (asthma, COPD, emphysema) CONTRAINDICATIONS: known hypersensitivity to drug, tachydysrhythmias PRECAUTIONS: Blood pressure, pulse and EKG should be monitored. Use caution in patients with known heart disease (Due to B1 effects) SIDE EFFECTS: Bronchospasm, chest pain, tachycardia/palpitations, tremor/nervousness, hyperkalemia, hypertension, headache/vertigo, nervousness, insomnia, cough/hoarseness, sore throat, rhinorrhea, stuffy nose, dry mouth/throat, muscle pain, diarrhea DOSAGE: 0.5ml (2.5mg in 2.5ml normal saline over 5-15 minutes), repeat PRN as needed (2.5-5mg) PEDIATRIC: 0.15mg/kg in 2.5-3.0ml normal saline, repeat as needed.

When I was working for a private carrier in Detroit (in the mid 90’s), one had to be an EMT-S or EMT-P in order to be considered ‘eligible for hire’ by Detroit EMS. The reasoning behind this was because Detroit EMS was converting to an ILS-ALS only system. As far as not being able to give glucose to the hypoglycemic patient, Oakland and Wayne county protocols allowed for this, so explain to me how they weren’t able to treat the hypoglycemic patient appropriately. Granted, the EMT-B couldn’t perform a ‘finger stick’ because it was considered an ‘invasive procedure’, if hypoglycemia was confirmed by ‘assisting’ the patient to check their own BGL levels with their own equipment, there was no reason they couldn’t treat the patient appropriately I personally know of more than a few incidents where the Detroit EMS crews were ‘milking the clock’ by dropping off patients and hanging around the hospital (either in the ED or sitting outside in their trucks, putzing around so they didn’t have to take that next call waiting. Another factor in Detroit EMS being such a mess was the transporting crews ending up being investigated for theft from the patients. How is this different from what a crew from any other private carrier faces? If a crew from Universal, Community EMS, or any of the others can do it, why should Detroit EMS be any different? You must be in the DMC. Hutzel, Detroit Receiving and a couple other hospitals are usually inundated by ‘walk ins’ that they are ‘Status C’ more often than they’re not on diversion. If Detroit EMS is going to do IFT’s, then they need to utilize their resources better. In private carriers in Detroit (like Community EMS and some of the other smaller services), the EMT-B crews are the primary source of the IFT crews.

Well said! Respect isn't all that terribly difficult to give, and it means worlds to the person on the recieving end. There is no real reason that our patients (despite their geographical location, socio-economic class, etc) shouldn't receive respect, especially if it's being withheld based on those criteria.

Definately saves on the 'surprize factor'! When you come around the corner unannounced and wearing a badge...in a uniform that looks a LOT like law enforcement, you tend to get an unwanted reception....

You both have validated what I've been saying in your own ways.... CPhT by acknowledging how rough those areas are; Herbie by your advice. The last tour of duty that my station (Station 16) was a 24-hour statation, we pulled a whopping 38 calls. Most were nothing more than IFT transports, but each time we were called, we had to deal with a PERSON. I get so peeved at people who run down the elderly, the homeless and those who are less fortunate. Yes, I worked in less than 'ideal situations', and many 'unsavory areas' on a daily basis. I treated each patient with at least the respect due to any human being, and lo and behold, I rarely had any issues that involved law enforcement having to intervene. Another factor in my favor is our uniforms didn't look anything like law enforcement; (different colors, no badges, etc). Just because you're in a 'bad part of town' doesn't mean that your scene is guaranteed unsafe. Some of the nicest people have been in those areas of town. With the time I've spent in EMS, I've seen too many providers dismiss people as inferior or insignificant, simply because the provider was in uniform or because the patient/family lived in 'that part of town'. It is this attitude that tends to make an already tense situation, (because of the fact that a family member is in need of EMS' services), much worse than it needs to be. Another thing is to cultivate your relationship with law enforcement...don't bring them out for back-up simply based on your geographical location, or because of the chosen profession (or non-profession) of your patient. As Herbie pointed out, even the 'gang-bangers' can provide more assistance than they're normally given credit for. Maybe during my time in Metro Detroit, I was extremely lucky and didn't walk into 'bad scenes'; or maybe it was because of how I dealt with my patients/family, I can't say for sure. All I CAN say about it was the fact that a little respect goes a long way... CPhT, I'm sure your instructor could tell you tales that would keep you on the edge of your seat about his time in Detroit. I never worked for Taylor Ambulance. EMS is a major 'gossip mill', and according to 'Rumor Control', things for Taylor got REAL bad before and during the acquisition by Laidlaw. Ask your instructor about American Ambulance and their 'welded cots'....

Having been an EMT for 12 years before finally letting my license lapse because of CE issues (long story). I then had to start over, and got into a program at my local college which combined both EMT and EMT-I. From there I went directly into my Paramedic program. With that being said, I can tell you from personal experience that the biggest issue with 'gaining experience/get your feet wet' concept is that it only makes it more difficult to break the bad habits that you're sure to develop. Since you have expressed your intention of going for your degree in Paramedicine is a bonus. You'll find that in addition to the core classes, you should be required to take at least Anatomy & Physiology as a prerequisite or at least as a co-requisite. The degree level A&P classes will help you understand how the body works, and how our interventions will affect the patients we treat. Your algebra requirements aren't to find "X" (ever notice how many math instructors can't seem to keep track of things? They're always asking you to find "X", "Y" and all the other variables in those problems. If they'd just develop a better filing system, they would know where those things are!) they're designed to develop critical thinking skills, which will help you when you have to play 'detective' (especially in your medical patients). The English credits will help you with your narratives on your PCR and develop effective communication skills. If you've passed all your tests (school and state), there is no reason to hold off going into paramedic class. If you're THAT concerned about 'getting your feet wet', pull some time in the truck while you're attending classes. Sure, things will be tough, but you'll be able to kill two birds with one stone this way.... The biggest 'differences' between your clinical rotations and 'real time' on the trucks is that in 'real time', you're going to be expected to know what you're doing, why you're doing it and then getting it done. During your clinical rotations, you had someone else that could step in if you were floundering.

Oh, the trash that gets posted when people realize that their already poor reputation can't go any lower...... *edited to remove multiple instances

Even when you don't hit the 'post' button only once, it happens to repeat the content severa times in one post. As far as being 'retarded'....I MUSTbe...Who in their right mind wants to get back into a field with low pay, exorbitant levels of stress, irregular hours, coupled with having done time running into burning buildings.... Added together, it doesn't say much in support of 'mental stability' and 'normal psychological growth rates'.....ROFLMAO B.F. Skinner would have taken many beatings for how he derrived his results. Not only were they turning the world of psychology on it's colective ear, but at that particular point in time, wasn't bound by all of the rules and laws we have now about ethics and such. In fact, other psychologists like Milgram, Watson, et al were responsible for the enacting of may of the ethical and moral limitations that the medical and psychology fields operate under.

Oh, I get the pounding headache and the 'grouchiness' as well, but my mind is just bouncing from one thing to the next with little getting done. I find on the days that I don't get my 'theraputic levels' of caffiene, I'm easily bored and on the prowl to find the next thing that catches my ......oh look! Shiny thing!

I worked EMS in the Detroit area in the mid 90's, and from what I saw about DEMS, their reputation is well deserved. They were continually being investigated for theft (material possessions, patient's meds etc). They also were in the news for not going into places like 'The Cass Corridor) unless they had PD back up. They were even investigated for poor patient care/negligence on more than one occasion. Yes, Detroit has some 'unsavory areas, (like Ferndale, the 'Cass Corridor', Highland Park and Harper Woods), but a lot of the problems encountered by Detroit EMS and some of the other private services were 'self inflicted'. Take the incident involving Taylor Ambulance ... their crews thought it was great fun to pull up behind people in Highland Park and while going down Woodward Ave and hit the lights and siren just to watch the people in the cars 'freak out'. One day while they were posted at Detroit Osteopathic Hospital in Highland Park, someone pulled a 'drive by' and pumped 5 rounds from a shotgun through their truck. Funny thing is, that was my 'base station', and our truck was never touched (simply because that our crews treated people with the respect that they deserved). We didn't pull the stunts that Taylor Ambulance pulled, we didn't harrass people on the PA system in the truck, we didn't drive down the streets like we were the only vehicle allowed to be on the road; you get the idea... Detroit EMS had a habit of dismissing people who weren't in EMS as insignificant, and their paramedics wouldn't talk to anyone of lower license levels than them, unless they absolutely HAD to. I've worked areas up and down Woodward Ave, Gratiot, Telegraph and all along the Lodge Freeway and never had an incident that even came close to what Detroit EMS, Taylor Ambulance (later Laidlaw) and others had. We were continually called to the 'Cass Corridor' (affectionately known locally as 'Blood Alley'), Harper Woods, Highland Park and Ferndale.

I was diagnosed as ADD/ADHD as a kid. I was put on meds (Ritalin). I don't know if the dosage was incorrect, or if I was being overdosed, but 30 years later, I met with my aunt who was amazed at how far I'd progressed with my 'problem'. When querried about what 'problem' she was referring to, I was informed that most of my extended family thought I was mentally retarded. I know that drugs like Ritalin are actually psychostimulants; and in people who have ADD/ADHD, it actually has a sedative type effect....it slows these people down to help them concentrate. In those who do not have ADD/ADHD, Ritalin is a big-time upper and will have them bouncing off walls in no time. I don't remember a lot of my childhood (is it from the drugs or is it because it was a really bad time for me and I've blocked it out?), but I do remember being 'bored' in classes most days. I qualified for programs for 'gifted students' on several occasions, and remember failing in certain projects (like book reports) because I was a victim of trying to make things grander than necessary. I think to a degree that I still suffer from this, and tend to make things harder than they need to be, simply by rying to learn all I can about a subject. I'm pretty much a 'coffeeholic' and find that on days where I don't get my usual 'dosage'....I feel like I'm running 800 miles per hour and getting nothing done. When I have access to all the caffiene I normally take in, I'm calmer and much more mellower (I usually have a cup of coffee in my hand all day long). I think that ADD/ADHD is overdiagnosed, but I do not discount that it is a true disorder.

This scenario was one of two that I was recently handed in a homework worksheet. When I saw that there was a recent hip surgery, I was considering that it might be an embolus from possible clotting. I based this conclusion on the fact that it was hip surgery, and the fact that the patient discussed wouldn't be doing a lot of moving around due to the possibility of being in a lot of pain from the surgery. That being said, I suggested placing the patient on oxygen, establishing an IV of NS (or even the insertion of a saline lock), application of at least a 5 lead monitor (simply beacause we haven't learned how to apply a 12 lead yet) and administration of 325mg ASA to help with anticoagulation. I further questioned the usage of beta agonists, because of the vasodilation properties. If it was an embolus (either PE or coronary), wouldn't vasodilation allow the possible embolus to migrate to the cerebral vascular system and potentially cause a stroke? I think dobutamine was also mentioned for its dromotropic properties. Like I've said before, I can follow the cardiac conduction pathways, I can explain what should be occurring during each segment of the EKG. Part of the problem occurs when I've got to start interpreting the rhythms..... Obviously, when the dysrythmia is atrial in nature, the P wave is either going to be absent, or look screwed up and the PR interval is gong to be either longer or shorter. If its ventricular in nature, then the QRS complex is what's going to be affected. With that being said, one would think that when you throw a 6 second strip at me, I should be able to identify disrythmias pretty quick...right? Well, to furhter complicate things, lets throw in 'flutter waves', 'fib waves' and the ever popular delta waves, j-points and ectopy.....AAARRRGGGGHHH! Oh, lets not forget to stir up some 'regular'/'irregular'/'regularly irregular'/'irregularly irregular' rythms, and the ever popular "Just because it's below 60 beats per minute or greater than 100 beats per minute doesn't necessarilly mean that it's brady/tachy"..... This is all off a simple 3/5 lead strip. I looked at a 12 lead printout and thought that it looked all screwed up! Just as I'm trying to wrap my pea-brain around statements like "When you see this:" (i.e. p waves preceeding every QRS complex implies a sinus rhythm)....someone throws in the qualifier "Except when you see this:" (i.e. PR intervals greater than 0.12 seconds), because that means ..........." It seems that every time I think I see an approaching "AHA! moment", one of those qualifiers gets introduced, and that "AHA! moment" decieds to wave bye-bye......and that nagging vioce of doom/failure jumps on the loud speaker.... I've always been in awe of those who hold a license level above mine, based on what you most of you guys/gals can do, and how impressive it was that y'all could keep all this stuff straight in your heads. Now that I'm trying to step into your world, I'm feeling like the village idiot who is nothing more than a poser. I understand that this is all new information, and I'm not expected to know this without the attached education; but at this point, I don't know if I'm just trying to 'overthink things' or if it's that I simply "just don't get it"........ I've suggested that we start forming 'study groups' so that we can help each other along, but so far it appears to be falling on deaf ears. I don't want to wash out of the program (y'all know that I had to drop out once because of that motorcycle wreck). This is why I'm reaching out to people here. I know I've aggrivated alot of y'all with some of my viewpoints (from "I don't need a degree to be a great medic!", to some of my unpopular personal beliefs). I know there's really no one on this forum that WANTS to see me fail (ok, maybe there's one or two....), but the place I'm in now; I feel like I've bitten off more than I can chew this time....

And this is exactly why cardiology is going to be the reason I fail out of medic school! Its disheartening to think of all I've been through to get to this point, only to get washed out by a damn squiggly line.... I understand what each segment represents (which is definately a step up from where I used to be), I understand that changes in the 'averages' usually has significant implications. The problem appears to be when all the segments are put together repeatedly that it all falls apart. I dont know if I've got enough fight left to try this 'one more time' if I fail............

This is a senario that was presented to me in my cardiology homework. I thought I'd throw it out here, just to see how others would handle it and see if they could explain WHY they chose the treatments that they did. I was initially going to put this out as a running scenario, but decided to just post it in its entirety. You and your partner are called to the scene of a rural residence where you find a 57 year old male who is complaining of chest pain. The patient reports a history of recent surgery which was performed to repair a fractured pelvis. Approximately 2 hours ago he began to experience “tightening of his chest,” chest discomfort and shortness of breath. He now reports that he feels nauseated. 1. What would be your primary assessment considerations with this patient? Your partner records the patient’s vital signs as follows” BP, 180/120; heart rate, 140; and respirations, 32. When you connect the patient to the ECG, you see a wide complex tachycardia (uncertain type). When you contact the base hospital, your medical direction physician instructs you to follow the ACLS algorithm for wide-complex tachycardia and to keep him informed of the patient’s status. 2. Prior to initiating drug therapy, what questions would you ask the patient? 3. What is the most important step in the initial management of this patient? 4. Five minutes into your management of this patient, his BP drops to 130/74 and he exhibits a decreased level of consciousness. What would you do next?

Obviously, you've never seen how a drowning person will try to climb up their rescuer. I don't have statistics to prove my point, but what good is a drowned rescuer? People trained in water rescue are trained to deal with this sort of occurrance, I am not. Just because they're ten feet from the shore, doesn't tell you how deep that pond is......for all you know, that 'pond' was part of an old rock quarry, and it just happens to be 60' deep. *edited to add last paragraph.

Is this why mom always said "Don't run with scissors!"?