Timmy

No change in the story, no meds, no histroy. Skin: clammy and diaphoretic 02: 98 on 02 Lungs sounds are fine, clear bilat. Abdo: Nothing to report on, nill distention.

BP: 90/60 Pulse: 60, weak Spo02: 95% RA Resp: 14, shallow BGL: <3 GSC: 4 A nurse who is a parent of another player comes in to help, you both decide that the oral glucose is the best thing you have at the moment. You apply a tiny amount under his top lip. A few mins later he slowly opens his eyes, is not able to talk but you communicate but yes/no questions by asking him to squeeze your hand. You have time to ask a few basic questions before he goes unresponsive. He still wasn't concious enough to comprehend putting anything in his mouth. His eyes kept rolling back into his head. What questions would you ask in that time frame? It has been quiet warm all day and another player informs you his been at a party and has vomited at least once whilst on the field.

He is breathing, quiet shallow and slow. You have quiet a lot of trouble getting him out of the cubical, his quiet a well built kid and his half wedged up against the wall and door, damn those inward swinging doors! His airway is clear, no noise on respiration. ALS road crew is on the way, ETA 30 mins. His on no prescription medication, you went to school with this kid and can be pretty certain that rec drugs are no issue, but you never know. Pupils are 3 PERL BGL comes up as “low” meaning it's bellow 3mmol. He has no history of diabetes. His normally a fit and healthy kid, no medical issues apart from a recurring ankle sprain. Equipment: 02 bag w/ suction, OPA Spinal gear First Responder bag BGL monitor Sp02 monitor BP cuff and steth Meds bag with nill invasive... No IV gear. You have oral glucose, paracetamol, salbutamol ect.

You’re an EMT at a local football match. Though out the game you have noticed one of the ‘star’ players acting a little out of sorts, he appears quiet from his normal energetic, bubbly self. At half time he approaches you asking for some pararcetamol for a minor headache, he states he has not received any blunt force trauma to the head, is able to answer all your questions and states he hardly had any sleep the night before but he feels fine. With that you administer 1000mg pararcetamol buccal, encourage him to keep up his fluids and you keep an eye on him for the rest of the match. He is not pallor, has good coordination and everything leads to him just feeling tied (not unusual for the players to show up like this on Saturday morning) After the game you’re attending to the minor injuries, bumps and icepacks when another player screams out your name from the showers, upon arriving you find this player up against the wall, in a semi recumbent position near the toilet, you note about 200mls of emesis on the floor, the player is unresponsive. What next?

In Australia we have Intensive Care Paramedics, Remote Area Paramedics and Extended Care Paramedics on top of the normal Road Paramedics. The scope of practice and programs differ from state to state. Generally an ICP is able to initiate a lot of treatment that may happen in the Emergency Department, there only called to the sickest of the sick and rotate in a fly car, to a full ICP transport vehicle or medic/ICP. Remote Care Paramedics may run the medical clinic and ambulance in a remote area and Extended Care Paramedics can look after a lot of minor complaints that you commonly receive calls for that result in non transport. ECP: [web:0cfc048da0]http://www.ambulance.nsw.gov.au/media_publications/2008_pages/080829ecp.html[/web:0cfc048da0] I cant really find any good information in regards to scope of practice or job descriptions for the ICPs and RAPs.

I dont have these books but I have seen it in the Hospital Libary: Pathophysiology Concepts of altered health states Microbiology and infection control for health professionals This Diagnosis book sounds intresting.

Just The Facts - Emergency Medicine by the American College of Emergency Doctors? I think it depends on what area you wish to read about. I have: 15 Nursing books. 4 Paramedics books. 40 Powerpoint presentations on USB from lectures. And 10 folders full of handouts and lecture notes. 3 Books I scabbed via instant messenger in PDF I don’t use books much… I like using the internet and find in exams they’ll use information from the powerpoints and lecture notes more so than text books.

**RANT** I have a volunteer who is a veteran, he has no interest in EMS but it gives him something to fill in his day I guess… His very much into radios (which he is very good at and retains quiet a lot of information) maps and banging on about old war stories. I must say he is not into lights or sirens or carrying things on his belt ect. His clinical skills are less than desirable, I have no confidence in him and dread to think of the outcome if he was in a position were he had to work as an individual. I remember being at a festival, I had gone for a walk to see a band on stage and left him with the truck, I received a radio call from this member in quiet a panicked tone to immediately return to the vehicle. Upon arriving 3 children and parents had presented with substantially minor injuries, minor abrasions and blood noses from unrelated incidents and environmental conditions. He was extremely overwhelmed by the whole situation and was unsure as to which one needed to be treated first, the parents were also going though the turn out bag trying to find dressings and assorted items to clean up their kids and control the epistaxis. Needless to say within 5 minutes all the kids were fine and I’d managed to make a few jokes and got the parents on side as they were understandably quiet upset. I can’t even rely on him to call for paramedic assistance or help, he gets so worked up that a patient needs paramedic assistance that he can’t string a word together and gets so pedantic about the map referencing and the exact location of were we are. He can’t even document simple observations or history on the PCR, the wording is horrible and I think he suffers from some sort of illiteracy. He does mange to get the personal details and waits for me to finish treating so I can fill out the clinical side of things. I fear that if he did fill out the clinical part of the form and there was a coroners inquest (god forbid) or some sort of repercussion that we wouldn’t have a leg to stand on. Every time I’m partnered with him to do a Motocross standby I become weak at the knees. When I see riders fly meters in the air, bike going in each direction and officials franticly waving the medical flag I become nauseous and begin to have tremors myself as I know if something serious has happened I don’t have any backup and would get more sense out of a monkey than my partner, but Elsa I do the best I can and pray to god that someone’s parent is a nurse or someone who can offer some form of assistance. On many occasions I have told him to go do something else but he generally lets me do my own thing and carries my bags, gets the stretcher ect. They keep pushing him through the re accreditation and courses because we have such a lack of volunteers. Don’t get me wrong, not every standby I do is like this and he generally can handle the bandaid and ice pack requests. Some of our standbys are quiet remote and help can be quiet some time so like to have another member with me if his coming along.

I don’t know what happens in America but Paramedics in Australia certainly don’t transport every intoxicated kid, it’s more of a police issue. At the spring racing carnival in Melbourne (horse racing that attracts thousands upon thousands of punters) my volley service runs first aid posts, a field hospital and welfare areas. These welfare areas are for intoxicated individuals to come lye down, rehydrate, work out how there getting home safely, sort out there relation problems ect. There might be 50 camp beds set up in a tent filled to the brim with drunks, I’d imagine a very minor majority (if any) of people admitted to this area receive medical treatment. These centers aim to relieve the pressure from police, security, transport paramedics, emergency departments and patients that actually need first aid in the posts or the field hospital. There staffed with a hand full of first responders and security and stocked with plenty of emesis bags and bottles of water. There implementing this program at bigger concerts/raves and in the Melbourne CBD on Friday/Saturday nights.

One year under a clinical officer.

No, no lol! It’s not a common problem but it can happen anywhere. It’s literally in front of your eyes. While you’re waiting for the doctor the rash appears to be getting worse. The nursing staff consult and decided the rash appears hemorrhagic. The Grade 5 nurse immediately nurse initiates ceftriaxone IMI to be on the safe side. The doctor arrives, you immediately inform him of the abdominal pain, rash and medication administration. The doctor then has a good poke around and gives him a good physical examination. After consult with the nursing staff we come to the conclusion he has hepatomegaly.

We were always told if someone sets upon us give them a swift kick in the genital area and run. Fortunately I’ve never been in a situation were the crew have been assaulted (touch wood), we’ve had some verbal abuse directed at us mostly from drunken, drug effected larrikins. Plenty of paramedics have been assaulted in and around Melbourne and I know of a few fire crews that been set upon. When I was going to uni in Melbourne we went out in the CBD on a Saturday night. I’ve never been so fearful for my safety, intoxicated, drug effected gangs roaming around looking for a fight. Coming from a little sheltered life in a slumber, rural town I was amazed that some people go out just to be in a fight. I was there to have a good time but walked around looking at the ground with my tail between my legs, some people will bash you if you even look at them. Just goes to show the bleak view the world now holds…

Colour of urine is unknown. His had general myalgias so he has had pain from head to toe. A good physical examination reveals nothing apart from the rash on abdo. Nill vision problems. Sleeping habits have been normal. Bed @ 2200 Awake @ 0400. Last tetnus shot was years ago, unknown. His fully alert, telling you there is nothing wrong with him. You notice on your 15mins vitals his pulse and BP are ever so slowly decreasing, again still within normal limits. You’ve called the doctor and his 30mins away NACI running.

Temp is 39.8 C You notice a rash on his stomach when you go in for the abdo assessment. Abdo - Increased pain on palpation right hypocondriatc region. Nill recent injury Nill wounds And he states there decreased urine output. Your out in the sticks, little rural hospital... wana call the doc?

You’re on duty at a small hospital in a rural town when a 40 year old male dairy farmer presents to Emergency complaining of generally feeling unwell. The patients has a clean bill of health, no substantial history, no previous hospital admission, some general practitioner visits for the usual (coughs, colds, aches and pains) over the past few years and is very hesitant about receiving treatment. His reasons for presenting is he feels as though his “been hit by a truck” and this is unusual for him because his “never had any medical problems in his life” He then went on to assure us that his sure he’ll be fine but wants a quick “once over”. The wife is also present and is concerned, they have the little kids with them as they live out of town, its 2315 and you need to make the assessment quick, write a prescription for him and he’ll go pick it up after milking tomorrow morning. The patient states he exhibited flu like symptoms (sore throat, very minor cough and myalgias) this lasted for 2 days. Patient is asymptomatic for 4 days then presents to emergency today feeling extremely fatigued. On assessment vitals are all within normal limits apart from being febrile, when you conduct a Nero exam you find some jaundice in both eyes. ** I know it’s not an EMS call but it turns out to be very interesting all the same**

Is there any prerequisites for this course? How many people do they knock back?

In Australia it is illegal to use your cell phone whilst driving.

I did standby at a funeral one weekend, the church was concerned due to the large amount of older people, the hot weather and some were quiet ill the potential of one “going down” was quiet high. Nothing happened of course, we just handed out cups of water and offered reassurance and a comfy seats to those who felt a bit overwhelmed by it all. We drove the ambulance right at the rear of the procession (trying hard not to cause a scene), its not common in Australia to block the roads, everyone gets there when they can. Although, I've never had some many people come up and thank us for being there and the food was great. I also recently went to a funeral as a medical escort, the patient was monitored and had an IV infusion running so we didn't get to cemetery or wake. I just stood outside with the other nurse for the most part.

When I started my 3 month stint of placement in Aged Care I thought I would hate it with a passion, after all it certainly isn't trurma or a rush lol... I was amazed at how much clinical knowledge is needed in such an area. Old people are so polypharmacy it's beyond a joke! Some of my residents are on 17 different medications per shift, its insane, a pill poppen party lol. It takes quiet a lot of study to even scratch the surface of the medications tree in there. I thought it was going to be full on in paramedic pharmacology until I started nursing, there has to be at least 80 different medications in our drug trolley that the medications nurse dish out. They all have a MIMs PDA thing so they can look up the medication information but after doing 5 shifts a week I'm sure you'd soon become pretty fimilar with the different types of meds. The organisation, planning, responsibility and knowledge of those medications is quiet huge. In EMS you might only have a few patients per shift that need medications. Here you have a full 8 hour shift of medications with only two 15 minute breaks, all the ressies need there meds at a certain time and there's only 2 of you between 40 patients. There's soooo much room for error. When you sit down and read though a residents medical history only to find they've got 6 or so conditions/diseases/syndromes that you've never even heard of let alone pronounce. I normally pick one per week and do some reading on it. Have you ever nursed a patient with a decubitus ulcer? The amount of time that is spent on research into what dressing is best, how many times they need rolling, how you roll them and into what position, is there any creams that could be beneficial ect ect. I haven't had an emergency patient or been on any EMS calls for about 3 months . Since I've been in aged care we've had a cerebral arterial bleed, a non diabetic resident go unresponsive from hypoglycaemia, a diabetic resident go DKA, an AMI and plenty of falls with injury. I now hate anyone who thinks aged care is boring, it's just a stereotype that its branded with and no body seems to look at the bigger picture. You can be a hygiene nurse or you can use your time in a more productive manner, there is certainly no shortage of clinical information and learning in such a place. Although, I do admit, I miss the good old adrenaline rush and being under the pump, doing the front line care and dealing with all the uncontrollable and stressful situations in EMS.

It always amazes me how different parts of the world have such a vast variety of clinical levels available to there citizens. Some places staff there ambulances with emergency physicians who have 10 + years training to emergency nurses with 4 years training to paramedics with 3 year degrees and volunteers with 120 hours training. Go figure lol…

I agree with everything that has been said here. I know this is irrelevant but in Australia (in most states) we have full time, paid ALS paramedics who hold a 3 year degree. We do have BLS volunteers (with medications endorsement) based in extremely rural areas were it is not finically viable to have a full time paramedic due to only having a hand full of call outs a year, they are co responded with the closest paramedic truck. You guys have quiet a substantially greater population than us. I don’t see why America doesn’t deserve the same level of care?

:?:

Lol thanks AK, much appreciated! How negligent of me! I forgot the most important part, its instant coffee. What sort of nurse am I going to make! I should also double check to see if I’m not diabetic. Wouldn’t want to send my self hyperglycemic from the packet of sugar now!

lol @ Clown!! hehehe So True... I wonder if there ambo can play Mr Whippy

As part of my nursing training we have 30 hours of lectures dedicated to Occupational Health and Safety as well as numours assessments and oral presentations that form the module. Let me enlighten you to my teacher, what a bundle of joy and an inspiration she is to us all! This teacher is a qualified nurse turned OH&S junkie, she now runs her own safety business working as a consultant and safety adviser. She was a nurse in the meat factory industry this sparked her passion for safety. She is the only women I know who has multiple post graduate degrees in OH&S. She has ‘nurses back’ thus it was appropriate to build her house in such a way to allow ease of access and to conform to every aspect of safety. She has told us that the kitchen benches were build to her height, they made a ramp into the back yard so she can wheel her clothing basket to the clothes line, she has a mark in her bedroom floor so the children do not sit to close to the TV, she reads the manual before driving any car and so on an so forth. Sitting though her class is an indescribable joy, simply orgasmic. It makes me jump for joy getting up in the morning knowing I have to endure 8 hours of touchier, stories from the meat factory and generally blowing safety out of the water. Contemplating suicide seems so easy as her whining, monotone voice drills into my eardrums. Anyway, to the point. As part of our assessment we have a 50 page workbook which composes multiple, irrelative questions that have no meaning to healthcare what so ever. Deep within the workbook I have stumbled across a question that stumps me and I need your humble assistance. The questions reads as follows: Activity 2.4 – Job Safety Analysis. (Performance Criteria 1.2, 1.3, 4.4) As an individual discuss the following point in a written submission. Document a job safety analysis for “making a cup of instant coffee” (whit with one sugar) There is a table printed bellow it reads: -Task -Step -Hazards -Safe Work Method Apart from the hot water and some form of minor soft tissue injury I have no clue as to what else to write. I have 10 spaces to fill. Can anyone enlighten me to a further 8? As far as I’m concerned this book is a safety issue! I literally have pain from neck spasm and a throbbing tension headache after 4 hours of flicking though a voluptuous manual based on legislation and nemours legal requirements within the workplace. In true Timmy style I have left this assignment till 3 days before the due date and so far 4 hours has dug me in 10 pages deep. 10 pages of 50… Looks like tomorrow will have to be a 12 hour effort! Oh happy day!