Callthemedic

The more one learns, the less they should feel they know everything. There is always something. Medicine is dynamic. One of the qualities that attracts me to it.

Prehospital and hospital patient care are different. Nurses give nursing care. Medics give medical care. It's in the name. Either profession would have to train in the other to do the job. Not much of a leap. One textbook for a para program? I saw the P students books from my booklist for B. It was more like 4-5 I think. More than one anyway. That would have to be one big book.

Don't any of these producers think of ER's model of medical accuracy? The way the characters and their interactions are portrayed as people that might actually exist in an ED somewhere? Here's another example of what I think this show is going to be like to medical professionals, Grey's Anatomy. They never study, or work patients, they are too busy gossiping and porking each other. They are emotionally unstable and probably should be on some kind of medication too. The public wants a show about a dedicated professional so it can step out of their world and into theirs and zone out on the tube. People that are above this soccer mom pandering portrayal of a vulnerable, tortured, nice guy.........*sigh* formula once again, will be watching something else. I know. They can just log on here.

Good points. Facial fxs causing swelling, allergies(secretions), bleeding, polyps and yes........*sigh* boogers.

Either I wasn't clear, you don't understand, or you are misleading people that don't know. Graduate nurses can not go through one program that grants them a license under the BON in all of those. I was comparing it to a type of medical training anyway and it's not. Nursing is a unique field. There is no comparison really. That's the strength of nursing. Nurses regulate themselves because the training is non-medical. Only nurses can regulate the unique nursing practice. That makes perfect sense now and it made perfect sense when it was concieved. The question is, can it cross-over into medicine? I think nursing practice and medical practice are too far apart to be blended somehow. This is not a question of skill, dedication, IQ, or breadth/depth of training, nurses go through all of that. This is a question of medical training.

Yes NPs can specialize.........in one area only. PAs can practice in any 26 subspecialties, well, because they are trained in them. IF you had gone to the trouble of getting into a PA program, you would have known that. NP licensure is only granted in one setting. If it is really true that they have more autonomy, that would be nice I think. If you are happy with it that's all that matters. As I said before, I personaly know NP ex-students as well as NPs that agree with me about the curicculum. As to why the careplaning and contrived psychosocial etiology of disease was in their advanced programs and not yours, well, who knows. Look, you've obviously worked hard to get where you are. The BON is strong and the fact that they have so little to do with medicine is a great advantage. More power to you. It doesn't mean I won't get angry when they say......."we can't be regulated by the AMA, we don't practice medicine"...then pull this paramedic gig out of their butt. Can't nurses just be nurses and be happy with that? I could write more but it is not worth arguing really.........not really, right? The differences between nursing and medicine are obviouse to us but others that haven't experienced them don't know. This is on the OP though.

There is a HUGE difference between nursing and medicine. That's how nurses got their own licenses under the BON. The difference between the nursing-model and the Medical-model is like night and day. A careplan(nursing) takes great pains to distance itself from any kind of medical-model diagnosis, EXCEPT for the name......Nursing Diagnosis. You are misleading people, along with the BON, to believe that nursing simply "blends" the Medical-model into the Nursing-model. Compare this to a careplan: This is the medical-model. It is clearly defined. The skill of differential diagnosis is gained through clinical rounds through ALL the medical subspecialties. There are 26. One general area of training can not prepare a person for differentials across the board. I did a short search on ask.com and came up with this. "The medical model differs from the psychosocial model in that the "disability" is viewed as "inside" of the person, rather than the result of barriers or attitudes of society (or employers). There are four key components of the medical model. They are: 1)Symptoms 2)Evaluation/assessment 3)Differential Diagnosis 4)Treatment (and prognosis) Example of the Medical Model with a Clear Medical Disorder Symptoms You take you daughter, Jill to the doctor because she is not feeling well, she is coughing, complains of a sore throat, and just feels achy. The symptoms are: Sore Throat, Achy, Cough, General Feeling of being sick. Evaluation The physician will take Jill's temperature, listen to her heart and lungs, look in her ears, nose and throat. The physical may also order tests. She may order a throat culture, maybe a blood or other ests. Differential Diagnosis The physician will use the information and data from the evaluation to make a diagnosis. Possibilities in this case are a cold, streep throat, or some other virus. "Differential" indicates the need for the physician to decide between two or more possible diagnoses. Treatment (and Prognosis) Depending on the diagnosis the physician will develop a treatment plan. The treatment may include medications, rest, change in diet, or other interventions. Once the physician has a definitive diagnosis, she will have an idea about the typical "course" of the illness and what is likely to happen to Jill (this is the prognosis). For example, if Jill has a cold, the physician can predict that in about a week Jill will be feeling better." This is clearly not the psychosocial-model of nursing. How many hours of clinicals in medical subspecialties do NPs do? For that matter, how many do they do period? I know how many hours PAs do. I have compared them. I made a thorough investigation so I could decide whether to throw away 2 semesters of nursing (the prereques for nursing won't transfer to the medical side). I made my decision based on the medical-model. Now, the guys I know that went to NP programs. One quit when he saw that it was the psychosocial model all over again. One thinks the training is "a joke" but can't turn his back on the money and the power of the BON. Maybe that's a skewed example but it's the only one I have. I don't know anyone, including my NP who couldn't answer some simple questions, that thought NP school gave them enough medical training. Meanwhile, I will take 4 years of real science courses and basicly the 1st and 3rd years of medical school curicculum then log hours in all the medical subspecialties in clinicals. I don't expect someone who is a nurse to think any differently than what they've been indoctrinated with from day one in nursing classes. I don't blame you a bit for your opinion, but do not accuse.

I did look at the curicculum, hell, I took some of it. I know NPs. I know paramedics that went to NP school. I think I have plenty of information The programs I saw had about 15 hrs of medical-model type courses. I'm going by experience of how psychosocial nursing-model and medical courses are titled and how medical ones are. I have also brought this up with NPs, and looked at the curicculum and spoke with an NP student who was in my platoon. It doesn't matter how long one attends school. The content of the curicculum is all that matters. The only way I can judge other programs is by the course desciptions. They don't seem to describe the medical-model. My contacts say (about the medical-model training).....I am quoting...."it's a joke". Isn't that really the point though. Nursing isn't medicine. Aren't they proud of that? I would have thought a nurse would like shunning the medical-model. My nursing instructors always belittled the practice of medicine saying it was "too simplistic". So, I've known students and NPs, I have been treated by an NP. I have researched the curicculum for masters programs. How do I not know what I'm talking about?

I took a semester of Nursing. I've also worked in a hospital setting from the ED to rehab in another role with nurses. I can't see a comparison between general nursing and paramedicine at all. If one was certed to do IVs after a nursing degree, then that one skill compares. The nursing-model of care is nothing like the medical-model, yet somehow, nurses are moving across into medicine. I thought nursing bit off more than it could chew with NPs having only a semester of medical-model, now this? If the trend continues, there will eventualy only be different kinds of nurses. :roll:

A cannula is dependant on breathing pattern and turbinate patentcy. If the pt has a cold you could actualy rest it on his bottm lip as a last resort. I have done this with the most difficult 02 refusals with a rise in sats. With the pt refusing the NRB and approaching resp inadequacy, doesn't this begin to cross over into assumed consent? After all, clostrophobia doesn't have as high a mortality rate as resp failure, right? After informed consent of a pt on the + side of LOC, you have no choice but to give him what he would tolerate anyway.

Although I treated COPD pts for 5 years and worked with them from the ER to the last code, I never witnessed or heard of any pts that had their hypoxic drive affected by administered 02. Not a story during breaks, not as an anecdote to a lecture, just therapists rolling their eyes when the protocol would come up. However, When your boss or any other paper jockey is leaning over your shoulder they are looking for compliance of endless protocols so they can go back to their paper piles and check the appropriate boxes. Sometimes they know it's bs too. Sometimes all they do know is the appropriate box to check. The fact is that most know that hypoxic drive isn't even a zebra of diseases, but is more like a magical freaking unicorn that nobody except tech-nerds that drool over collections of medpubs while sitting on the toilet believe in. Even the tech-nerds rarely claim they might have seen one. Facts do not deter the folks that write protocols in their dungeons of wailing and nashing of teeth called office cubicles. They run on fear, not logic. They need magical unicorns to write about to keep their jobs. They must produce boxes to check asap! What I'm saying is, let them check their box. You give the care that you think is appropriate, but will also get the box checked. My thinking is if it's going to exacerbate, it's sure as hell not going to be from lack of anything I have to give. If that happens, I am wrong. As long as I'm right, the box gets checked.

I used to go to the NY ER site. That had scenarios if I'm not mistaken. I'll need to check out trauma.org after drill weekend. Ridryder, sounds like you are always reviewing for something or doing it with 100 hours a week. I really like to teach. I will probably do that once my para and all the certs are done. That seems like a really good way to stay with the material without it becoming too mundane.

Good point about internet stuff. I looked for an EMT refresher course around here ( Fort Worth), but couldn't find one. The thing about keeping up skills is that you can't get hands-on from a book. I need to be working with the equipment again at some point. As a medic one just uses what one can carry in the field.

All, This weekend at drill my Guard unit is performing skills testing. Normaly we train all the time, but not "by the book", it's normally more like "hey, you want to stick IV's?" or we challenge eachother with a question. Most of the training is done at home with whatever the soldier can get ahold of. My resources: emtcert CE website LearningCenter CE website Brady's Prehospital Emergency Care Brady's self test books EMT-Basic Review Manual (Rahm) A few CD-Roms came with the texts but they just have some test questions. I have looked for something to challenge me on CD-Rom with scenarios but haven't found anything. I bought a tutorial for EKG from Mad Scientist Software but I haven't been into it because I don't need to know it yet Oh yea, I started reading The 60 Second EMT. I'm going to get my index cards out after finals and absorb that material. I read it before going to sleep, but it's more entertainment right now. I guess I might as well admit it right now, I have a paramedic videogame called 911 Paramedic by Legacy. It's not that hokey. Some of the stuff is pretty funny. Anyhoo, What does everybody do to stay current?

This calls for a related thread about how we all keep ourselves current.

A written test with 4 similar answers does not test competency to take actions when appropriate. The test is simply a measure of a student's knowledge of doctrine. Knowing the "best" answer, or rather, the one they want you to select says you're a good test-taker, not a good EMT-B. I got a good score and passed the test the first time, but I don't think it says I'm a good EMT. I have a good GPA in my college science classes, I know how to prepare and study for a test. I also can spot the tricks test developers use to distract from the "right" answers. The test in the field is the one that counts. I study for that often. I grade myself with a critical eye looking for a way to improve on it. I do my CEU's, stick IVs on other medics at drill when we're not doing anything and challenge them to ask a medical question I can't answer.......so that I can find the hidden flaw. Now, if someone who took a few times to pass the NREMT does the same thing, they're good with me. If they think they can pass a test and be a good EMT, well, then I have a problem with that. I know that you were refering to the person's initial didactic experience, but this is what came to mind. I think you were just questioning what you think is a symptom of a weak program. Consider this: I went to a school for respiratory therapy that offered an occupational associates. The school was so lame that it was forced to close 2 years after I graduated for losing it's accreditation. None of my 60 credits would transfer. There were no labs in the core didactics. I didn't know the difference between the mechanism and actions for Albuterol, Alupent, Ipatropium bromide, Acetylcystene. The physics of a closed ventillatory system were mostly vague. I learned most everything in clinicals, but not because of some great preceptors, they despised us, it was my DESIRE to know. I passed the CRTT on the first try.

Hypoxic drive is a concern of end-stage COPD only. These are patients that have chronic high Co2 levels and are what you think about when you think COPD. Their sytem has long been ignoring CO2 levels to affect ventillatory drive. These patients will have obvious barrel chests and "clubbed" finger tips in any end-stage process that is a concern for hypoxic drive. End-stage COPD patients will already be on O2 and probably smoking a cigarette through thier trach or stoma. Auscultation is a dead give away. All you would get is pretty much crackles and you wuld be moving your stethescope all over to try and get a well defined breath. The cyanotic appearence of nailbeds and mucosae will be normal for them. Your asthmatic on the other hand would have appeared more "pink".........well, hopefuly still a little pink anyway. I think an appropriate course would have been a nebulizer with Albuterol/nss via NRB. An asthmatic responds to the air in his enviroment. You could have relieved his bronchoconstriction and his hypoxia all at once. Just remove one of the one-way valves and stick one end of the neb in the hole. Tape the other end of the neb "T" and your good to go. You would need to have an adapter or another gas source for the neb. Taking a sat is a dreadfully inaccurate science. Something as simple as a soiled finger can throw it off. Auscultation on the other hand can tell you the reason for the dyspnea. If the wheezes are pronounced that is good, if they are decreased that is bad. One means air is moving, no matter how poorly, and the other means you had better have a beta agonist via ET tube or venous handy because the droplets from the neb will not reach much tissue. You observed the dyspnea and the pulse ox and you treated the patient giving him some level of comfort and preventing him from stressing into ventillatory collapse. You got him to the ER better than you found him. I know you weren't holding you breath waiting for my response, but I don't think the O2 was the issue. His airway was narrowing and he was freaking out. He breathes harder and harder, further irritating the airway. Neither O2 or Co2 is in balance but one only needs 5% of the O2 they inspire at rest. On the other hand, you need to get rid of all your Co2 in that same volume. If you have a disease process they are still directly proportional. Anyway, can anybody come up with a patient for which O2 is contraindicated in the prehospital setting? Demand for it goes up during stress to the tissue's metabolism. Damaged cells can consume more, right? Gawd, I wrote a frickin' paper. I just like the pulmonary stuff because I used to be a CRTT.

If you want to work in Ft. Worth, you should start applying at MedStar now. I don't see why they would hire a Basic since they are just about the only employer here, and as such can dictate wages, but you have a slight advantage with the intermediate. As far as I know, there are no intermediate programs here that I can tell. They have no good reason to pay you more than a Basic. They have no good reason to keep you happy either, but there will be plenty of hours if you want them I'm sure. Dallas has a denser population and the traffic is a pain, but that is where the work is. Fort Worth is more rual but there is no rush hour here and there are clusters of businesses that provide anything that Dallas has without the crime..............which is why the work is in Dallas I guess. Something to think about is where you will be living if you decide on Dallas. There are many factors so seek advice.

Start from the physiology and work towards mechanisms. Beta 2 receptors do what? What fits in the receptor that is agonist or antagonist Histamines do what? Same follow-up All the pieces of annaphylaxis fit like a puzzle, literaly, at the receptors. Of course, if you just want to know contraindications, they are always in the box the meds come in. It wouldn't hurt then, to find out why by getting into some physiology and drug mechanisms.