jwiley40

And what justifies being called a "routine ALS call?" I have thought all ALS calls were more than routine. At least that's the way I do it. Having seen the back of an ambulance from the cot, I think if a transport is treated as "routine," something may be missed. I try to treat all calls as if whatever I have to do, is in the best interest of the patient and is not based off of something that might seem "routine." That just might come back to bite you.

I have to agree with the Captain. You're not going to be interviewing a patient over the internet. It's going to be in person. This is how you learn your interpersonal relationships and find out how you create a rapport with a future patient. That, for me is one of the most important things about being a medic. It's not all about the medicine; it's about people. They will know if you're fake or not.

Nope that would do it for me.

Or the patient that is allergic to Narcan because the call before, it was used and took away his "high." Ummmmm....right!

Nope, nope and nope! I'm local. It very well could have the Fort but nope there too.

I literally talked to myself while going over all of the practical exam sheets. As for the written exam, I bought a couple of books, took numerous practice exams until I felt I couldn't shove anymore information into my head. It took me twice to pass the practicals and twice for the written, but IT CAN BE DONE! Just keep going over it and over it and asking questions and looking things up. You can do it! And I'll tell you the same thing I told my wife when she took her Certified ER Nurse exam: Go with your gut. 9 times of 10, you will be right. She passed first time out. Hang in there, brother. You'll get it. I have to go through the NREMT testing again too cause I'm an idiot and let it go.

No, Captain we have our own little "dutchy." Fair example of fuedal life in modern times.

Captain, your preaching to the choir! Unfortunately, I'm a minion. I have a policy since I started as a medic student: keep your sharps in front of you at all times. Second policy: announce to your partner, whether stationary or not, "I have a sharps out!" I found by doing this, it makes my partner drive better and more steady on these horrendous Missouri roads! I have another question that somewhat follows this thread. I treated a pedi with hypoglycemia. Pt is 7months old, male. Blood glucose, WITH LANCET, was 38mg/dl with pt reacting with Mom. I have been tearing up the internet trying to find the normal range of blood glucose for a pedi under 12months old. I have come up with everything from 30-110mg/dl to 40-170mg/dl. One of them was from mayocliniconline.com. The one that makes the most sense is from the University of Iowa Health Care that gives range of 65-99mg/dl, defining it as 1 month to adult. It's more along the range of what we normally see. Needless to say, my little guy was sent to higher level of care because his bgl never got above 74mg/dl and he was acting normally, according to Mom.

I hate to say it, but no we're not. Money saving venture by our administrator. She did splurge for Autopulses and new powered cots and the Zoll E Series monitors (which I'm not too fond of) but we still have the nonsafety needles. A friend of mine here got stuck by a catheter that was somehow jabbed into the bottom of the monitor case. When he went to move it, he got stabbed. No one really knows where the catheter came from, but it still had the catheter over the needle. Still had to go through the needle stick protocols though. He ain't too happy about it. Now he works move for a service that has safety catheters.

For anaphylaxis Epi 1:1000 0.3-0.5mg SQ then 25-50mg Diphenhydramine IV slow push. Maintain patent airway and monitor. However, I have never heard of anyone being allergic to epinepherine. Even a PA (he's deceased now) looked at me like I had a "horn" growing out of my forehead when I told him about this one. Still trying to figure that one out, considering the body makes it naturally.

The little old lady that says "My doctor says I'm allergic to epinepherine." Really? So you have an allergic reaction everytime you get startled?

Well, Captain....I am enrolled in a course that will certify me to teach EMT-Basic and Medic. I start Wednesday! And when your married to a CVS ICU RN, you better know your sh**! She looks it up and so do I. We have som lively, entertaining conversations (just not in front of the civilian population like in restaurants! Nothing like inducing nausea in other patrons!) at home and with other medical providers.

The information I found can range from 10mg/dl to upwards of 17mg/dl above or below the normal range. That's a very wide range. My question was just that I want to know which is better. I looked into the hospital readings and found they look at plasma, just as you stated, paramedicMike. I realized after I put this out there that I probably sounded like an idiot and people reading this are thinking "He's allowed to practice?" I'm not an idiot, but I am always looking to make myself a better provider, so if I sound like I don't know what I'm doing, let me know by giving me information that I can use. I also researched the glucometer my service uses and it is calibrated for capillary use only, so I have to let my partners know to not get the readings from the IV cath. I have no idea what the range is on ours. I am trying to make sure that all of my interventions are appropriate and effective. If I am taking a reading that says the result is in the normal range and in reality, it's not, then I'm failing my patient. This is why I come here. I have gathered some awesome information from this site. Talk about a wealth of information that helps! ERdoc, I have to deal with dr on nearly every shift. Last thing I need is him calling my administrator every time I bring in a patient. And normally, he's not a douchebag. I have never had any issue with him. He's actually a fairly good doc, so that's why I was so blown away.

I have a question for all here, but first, a little background: A few days ago, I had a patient that was a diabetic, type II. We had treated this patient before, but this time, instead of treat then AMA, she needed to be transported to the ED. When I reported the blood glucose results, the dr asked if it was finger stick or from IV catheter. I told him I catheter. He proceded to lambast me for my "lack of diabetic treatment intelligence" (his words) and that if I ever reported doing blood glucose testing via IV catheter again, he'd report me to the state for "improper practice." This patient was bradycardic post D-50 administration, with a rate of 40-45bpm and somnolent. Yes, I gave 0.5mg Atropine when a fluid bolus didn't help, and she turned right around. I was hestitant to give a bolus but I was following protocol. Here is my quandry: I have watched every single paramedic that I trained under and those that I was partnered with, perform this test exactly I have. Many of these medics have years of experience. When I first started, I would perform the finger stick only to be asked why I was doing it that way. They told me there was no difference in glucose level, whether venous or capillary. I have done my research on the subject, found that, depending on what site you go to, the answer is different. I know that hospital blood glucose, when done along with the rest of lab tests, is done the same way (venous) and those test results are accepted. I did speak with my former instructor and was told to follow my training. So, as it stands, I will start going back to what I was trained to do, finger sticks, until I can find definitive evidence as to which most appropriate.

Go in, do our jobs, and go home to the one we love. Sometimes it's the best way to do your job.

On this day, 12 years ago, I was a staff sergeant in the Army, training future leaders and officers on the day we were attacked. For several hours, I was the only one on the range that new the horrendous events were happening. I alone was the one that had to break the news to the officers, some of which were from Saudi Arabia, Lebanon, and Jordan, that terorists had flown planes full of innocent civilians into the Twin Towers and the Pentagon. I watched the horror on their faces as they realized this great nation had be attacked on our own soil. And I watched the total fear of the Middle Eastern officers, wondering if they were ever going to see their homelands again. And I watched an American officer, whose father worked in the towers, not knowing whether his father made it out alive or not (he did, by the Grace of God!), stand next to him and tell him "You didn't do this. We know who did, but it's not you." Honor amongst brothers-at-arms stood proud that day. Today, as I have a quiet day off from my life as a medic, husband and father, I think back to those friends that fought for this country, gave part of themselves, or sacrificed it all for the country they took the oath to defend. While I mourn their loss, I honor their courage and dedication and I will never forget that, while we may be a little stained and jaded today, we are still the greatest nation on the face of the Earth, willing to fight for the rights of freedom and liberty, and to defend those that cannot. God bless all of those lost to the attacks of September 11th, 2001 and to the Soldiers, Sailors, Airmen, Marines, and Coast Guard personnel that fight everyday to keep us free. And God bless the families of those brave men and women of FDNY, NYPD and the Port Authority that lost their lives to save the lives of those in the Towers. God Bless the United States of America!

The biggest intersection in town is prety clear. I can se over hunder fifty feet in all directions. Let me put it this way: if we have traffic at 0200, it's either us, fire or LE. The 24hr convenience store will have employees standing in front because they have no customers. In a town of 1500+, not much going to happen. If we have more than three cars at the main intersection, it's a traffic jam!!!

To me, it seems like common sense should take over. While I know that there is the need to run code three to calls because of our protocols, would you do in the small town a 0200 and wake up the ENTIRE town? I found that, while the protocols are there for a reason, so is common sense. I will have the lights on, but only use the sirens when it really is needed. At 0200 in a sleepy little town like mine, I don't.

I got a call from him and he asked me what the protocols said. They read "Do not give unless cardiac arrest as occured and the first line of drugs have been given." He said that as long as I follow that prototcol, I would be backed up by his licensure. "Make sure you have fully documented the use of the first line drugs from the AHA algorhythm and the service's protocols," he told me. "By doing that, you will be fully covered. However, be careful when you give it. Don't give it because you are not sure of downtime. Given only when you exhausted the first line treatments." So, by that, I will be much more judicious in my treatments of cardiac arrest of unknown downtime. The more I thought about what you wrote, Captain, the more I realized I put my license on the line when I should have been more thoughtful of my treating my patient appropriately. Thanks for making me open my eyes! Made me a bette medic in the long run, I'm sure of it. Knew there was a reason for coming back to this site!!

I don't either. I actually have been going through our protocols and looking to see when they allow for the use of bicarb. I put in a call to my medical director to get his take on the use of bicarb in cardiac arrest of unknown downtime. The last thing I want to be known as is a rogue medic.

I did read the information that you linked. I know that only a couple of studies related any improvement during recusitation and others said there wasn't really any positive effect. As far as being speaking with our medical director, he hasn't responded. AHA doesn't have in the algorhythms, but as I said, ER docs have told me they would rather I tried to use it instead of not trying it. I am looking for other links to more information so that I can really have the informed decision when, and i mean when, it happens again.

In our service, the protocol is that if you called out from a 911 dispatch, you run Code Three. I have gone to the nursing home, which is 3/4 mile away from the base, (how convenient?) and faced a patient that was acting totally normal. However, we tend to always to take them to the hospital simply because they called us. The staff obviously had a reason so we do what we get paid for. And if you are dealing with a PT that is already cognitively impaired, then you really can't know if that PT has an injury without CT or X-rays. On more than one occassion, I have responded to the nursing home and taken a PT that was injured and had been living that way for a few days and the staff couldn't figure out that because they don't look for it. I transported a pt with a tib-fib that the staff didn't know about because they just didn't examine her. Scares the crap outta me!

Does she have a gag reflex? Yes, I want a patent ariway with agonal respers. Head to toe: Any head injury? Neck: JVD? Trachea midline? Chest? Breath sounds? Does she have rales, rhonchi, wheezing? Diminshed? Abd? Pulsing masses? Distended? Skin? Diaphoresis? Cyanosis? Peripheral cyanosis? Lessions, sores or skin infections? Extremities? Pulses? Response to pain?

Thanks paramedicMike! I actually gave it one time before this last code and actually got a pulse rate. granted, he never went home (died at a nearby trauma center after cryo treatment) but I know it can help. I spoke to a doc in St Louis last night, after dropping off a pedi and he told me he would rather his responding medics give it NO MATTER HOW LONG THE PT WAS DOWN because you really don't know how long unless the arrest was witnessed. I'll just keep trying to explain it to the administrator and with the information you sent me, at least I have some evidentiary information to back up my practice.

I have a question for the EMTCity crew. I worked a code recently and, without knowing with reasonable certainty how long my pt had been down, during the resuscitation efforts, I gave Sodium Bicarbonate for an acidotic heart. I have done it before, with doctors and and ER nurses saying it was an appropriate intervention. Today, my administrator questioned as to why I would give this medication. I looked in the protocols for our service and AHA algorhthyms and found that it's not listed in either. My question is this: was I wrong in giving this medication for the acidotic heart or should I have gone ahead and given it? I don't want to be giving a medication that isn't going to help.