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Do you love to teach? If so then it is a no-brainer. -Trevor

Josh, For a nice pharmacology primer, try "Basic Concepts in Pharmacology - a student's survival guide" by James L. Stringer. ISBN 0-07-145818-2 Most Paramedic texts will include some sort of basic pharmacology coverage as well. Between the pharm section of the text and the aforementioned book you can probably get the jist of what is going on with respect to 'pharm. Don't forget to look on your own for texts on this (and related) subject(s)...part of the fun of self-directed learning is window shopping the materials. Most large and local bookstores will have at least some useful stuff - when in doubt check the nursing section. Have fun! -Trevor

When it comes to the meds, I would start off by reading up on general pharmacology to get a good baseline of the concepts first. You want to get an understanding of what the various classes of meds do and what systems they work on. There are a lot of good basic texts out there; I've had the best luck with ones intended for med and nursing students. These are simplified enough to get the basics in an easy read. When you are learning at this stage don't fret yourself with dosages and the like; those can be memorized later on when it becomes necessary to do so. Frankly I think more emphasis should be placed on Pharmacology in EMT-P but just as it is in EMT-B there are concessions that must be made for time and content. -Trevor

I like your attitude, Josh. It's always great to encounter someone who learns a little and then gets hungry to learn a whole lot more. ...And from what I've read in this thread I think that is what is going on for you. Now I can only speak from my own experiences here...and in my experience the difference between my EMT-B and EMT-P instruction was fundamental: in EMT-B I was trained, and in EMT-P I was educated. For me at least, EMT-B wasn't comprehensive enough to cover much more than your basic "alphabet soup" type questions. In EMT-P you cover a lot of pathophysiology. As you learn the pathophysiology the kinds of questions you should ask to rule in/out different issues become a lot more evident. This education builds on the interview and assessment techniques you learn in EMT-B to put together a better clinical picture. You are on your way through A&P so you are already ahead of the game. Once you learn how it works (A&P) you are better prepared to understand how and why it doesn't work (pathophysiology). My advice: get yourself a Paramedic text book and start reading on your own. Chances are you will find many of the answers there. You can also supplement in some other materials such as nursing or even MD-grade pathophysiology texts too (get yourself a medical dictionary as a supplement) but keep in mind that a Paramedic text is designed to address your level of learning and will probably be the best fit for right now. Now the caveat: I would treat the goals of obtaining your EMT-B cert and learning the additional info you seek as separate issues. Testing out for EMT-B is really down to regurgitating what you have been taught or shown to do and many folks tend to get into trouble when they "overthink" questions or situations. The classic mistake is the person who rushes right into treatment before establishing personal and scene safety. Depending on the type of person you are, you might wind up making the immediate goal (getting your EMT- a little harder if you've read ahead with the Paramedic materials. Sooo.....shop around for a text (or try to find a lender from someone) and then hang on to it until your exam. Take the EMT-B exam and then find yourself a nice quiet spot to crack open that EMT-P text and start finding the next pieces of the puzzle you are working on. 8) Good luck! -Trevor

Even if they don't understand why you like what you do..so long as they understand (and support) you it's all good IMHO. I've known my wife for almost 20 years. The day I got my first crotch-rocket sport bike she looked it over, climbed up onto the passenger seat for a moment, got back off and said "Nope. Not for me. Have fun and don't kill yourself". She said much the same thing when I got into EMS. -Trevor

Feeling overwhelmed is part of the experience! For concept-type stuff: One of the things that helped me was to find someone (not necessarily a fellow student) and try to explain the material to them. If I can teach someone how it works then I probably have a pretty good understanding of it. When I was successful at making someone else understand something it would boost my confidence. This helps with the sensation of being overwhelmed. Terminology stuff: It helped me to write the terms down a few times. These terms are not ones used in everyday speaking so we've not often used them in our lives and therefore it is not so easy to recall them on command. If you have the concept down but not the proper name then write down the proper name for the term and a (sufficient) conceptual description to go along with it. For example: Masseter. One of the muscles used for chewing, aka mastication. Chances are you never used the words masseter or mastication much before A&P class. Write that little sentence down a half-dozen times and see if you cannot call it up more easily. The description need not be super comprehensive...just enough to get you thinking in the right direction so you can wing it from there... masseter...chewing...chewing involves the head so the masseter is a muscle of the head or face...chewing involves movement of the lower jaw aka mandible...so the masseter probably acts on the mandible. <- the masseter originates in the temporal bone of the skull and inserts into the mandible. As for pathophysiology, the best advice I can give you is this: I once read a very thick patho book and when I was done realized that patho seems to fit into one of three categories most of the time: the body either has too much of something, too little of something, or attacks itself for some reason. Odds are one of those three processes are key to understanding whatever you are learning. Good luck and have fun! -Trevor

If your final is anything like mine was you will find yourself wondering if they switched the one intended for lay persons with the one intended for health care professionals. My pretest and final were worlds apart in terms of content. BUT Study like the final will be twice as hard as the pretest was. Study like a 100 is the minimum passing grade. Study like you would if you wanted to be an ACLS instructor someday. Study like your life (or someone else's) depends on it. -Trevor

I am thankful for those little moments in the middle of a call where I realize that I am exactly where I am supposed to be and doing exactly what I am supposed to be doing. I am thankful that these moments are so frequent. -Trevor

So what's new in his life? New foods, new habits, changes to living arrangements lately? How does the residence look when we arrive? Any evidence of an environmental change (i.e., recent construction to home, etc)? How about an old trauma (sure we'll go back as far as a few months). BTW what does this guy do for a living? Perhaps in the privacy of the rig we could ask if he's had any recreational substances lately that the wife may not be privy to. Is he suffering from one of these headaches when we arrive? if so what is his behavior like? is he photophobic? Having any problems with neck stiffness, etc? Anything interesting in the family medical history? -Trevor

IMHO you can't really say you know something until you have proven that you can teach it to someone else. Although many of us wouldn't consider ourselves as teachers, there is little difference between being the teacher and being the student who helps a fellow student learn or understand a concept. The main difference between the two roles is that you as the student need only work in a one-to-one environment while the teacher needs to work one-to-many. Teaching isn't easy. It forces you to rethink and rephrase things over and over again until you find the right way to present the information. When this happens you get to "see the lightbulb go off over your student's/partner's head" and it is a very rewarding feeling indeed. But there is more to the reward than just that feeling. Each time you refine your information and present it to your student/partner you commit a little bit more of it to memory. Maybe you recognize that you didn't really have that concept down after all...and so you are forced to check your facts. Sometimes your student/partner will ask you a question that you yourself should have asked when you were learning. Some students or partners will pick up the ball and run with it, moving on to become really good providers. Some of them just won't get it and will fail out no matter who helps them. Regardless of how your student or partner turns out, recognize that the effort you make to help them learn can only benefit both of you and so it is always worth the effort. The tougher students/partners are actually the best ones because they will make you a better teacher....and therefore a better provider. Sometimes you need to look at your situation and ask yourself if things are really conspiring to hold you back or actually going to wind up benefiting you down the road. More often than not I believe we find things to turn out in our favor when we try to help someone else. Good luck with your learning, -Trevor

Take an orange with you to your next shift. Then ask the medic to let you play around with a few spare needles during some downtime. First have the medic explain to you how the needle "works" (cath, retraction/protection device if it has one, etc) if you don't know how already. Have him or her show you how to handle one safely. Then get used to taking them out of the package, handling them, and, when you are ready, stick the orange a few times. If you have a full-blown phobia this might take a while to accomplish. If not then it will likely just be a matter of getting used to the tool and its use. I do not like needles either. For many years I would get lightheaded whenever I was stuck. The first time I stuck someone in Medic class I learned that sticking other people doesn't hurt a bit :wink: and that helped me on my way to getting over my needle issues. Good luck! -Trevor

Here's a cute one: Dispatched to a chest pain call. Elderly female, way hypertensive, with anxiety issues. Between the time of call and the arrival of our unit she realizes that her problem may just be heartburn. She is a nice lady. When we arrive she is apologetic for "dragging us out here" for her problem. She agrees to go for eval nonetheless. As we are packaging her up she keeps apologizing for all of the furniture and knick-knacks that are taking up floor space around the stretcher. The conversation as we head out of the residence goes a little like this: Us: "Thanks for agreeing to go get checked out". Her: "I'm so embarrassed about this. Does anything look wrong with me?" Us: "Well your EKG looks unremarkable and your lungs are clear. Your oxygen levels look good but your blood pressure is definitely high". We'll check a few more things along the way but the Doctors will be able to have a much more comprehensive look at you." Her: "So my heart looks OK then? Good. Good. I think this all might just be heartburn. Do you think it could be heartburn?" Us: "It's possible, but it's best to get it checked out by the Doctors." Her: I feel so foolish about all of this. I think it's just heartburn. I'll die if it's just heartburn". Us: "No you won't" Her: "Oh yeah. That probably wasn't the best way to put it, huh?" (laughs all around) -Trevor

When the crew finally performed the extrication was it a "rapid" type straight to the board or was the patient first put into a KED or short board, etc? Based on the patient complaints and the way you describe the scene/wait time it sounds like a KED would be the best/right way to extricate this patient...but then I don't know what you had available to you or what your protocols dictate so I am not sure if that was an option for you. Supposing the KED was available: If I were arriving on scene and found the patient still in the vehicle but immobilized in KED and ready to come out nice and easy onto the long board (with the board right nearby and all set up for the transfer) I would have no problem at all with what I found. The KED would help keep the patient stabilized in the vehicle and also reduce the potential for injury when removing her from the vehicle. Your crew would probably have the extrication plan worked out prior to my arrival ("we're gonna bring her out feet first and these two firemen will help hold the board") so the transfer from car to board should take up a trivial amount of time. -Trevor

Thanks for the scenario!! -Trevor

Thanks! 8) If there have been no changes in meds (other than the addition of the Levaquin) then I assume the guy is still on Plavix? Perhaps a bleed is the culprit here? Let's do a few things: (1) If we haven't already, can we check the BP on both arms to see if they are congruent. Are pulses good in all extremities? (2) See if the guy looks pale. Ask the staff if he looks any different than normal. While we're at it let's take a look at the conjunctiva too. (3) Find out if the vomiting is something new or if it has been happening all along. If anyone saw it I'd like to know what it looked like. (4) Let's perform an abdominal exam. What are the findings? -Trevor