becksdad

OOOOOPS!!!!! I think I just posted in the wrong thread. But there was a thread here somewhere in this forum where someone suggested that they got to take vitals and the only time they got to do "real" EMT work was when a code came in. I've seen that complaint before, and that's what my previous post was addressing! I must have this special gift for inspiring confidence when I don't even know which thread I'm posting in, huh?!......Sorry

I beg to differ with EMT's and Techs that consider vital signs a "menial" task. These are not just meaningless numbers that you write down and hand to a nurse. They are central to assessing your patient, and recognizing abnormal vitals can be paramount to your patients care. You also have the opportunity (actually the responsibility) to begin forming an initial impression of your patient as you begin vitals. You get to learn what "sick" looks like before you even put on a BP cuff. Tachypnea,diaphoresis, other skin conditions such as pallor or cyanosis, pupillary response are just some of the myriad thing you can recognize in the first seconds with a patient. These lead you to investigate further in keeping with the patients cheif complaint. It is also a time to begin good history taking, as this also provides important information about what the current problem is. Not just past medical history, but HPI (history of present illness/injury). Medication lists are important, and can greatly assist you with both past medical history and HPI, especially if you are dealing with a poor historian or there is a language barrier. All of this can be accomplished within minutes, and is of the utmost importance in where a physician will begin looking and testing him/her self. Also, this is the time to begin to gain a rapport with your patient. You can gain or loose trust very quickly depending on how you "size up" your patient. Some patients respond well to humor, others to a serious professional demeanor, etc., etc. So INMHO taking vital signs is one of the most important tasks in patient care, and ALWAYS involves more than just recording random numbers.

You make me laugh, Michael! Although that is just about what it looks like now! I just can't understand why my girlfriend insists on not sleeping with it!

However, Michael, I was able to save that blue teddy she was wearing. Still have it to this day...... If MaryJo were here, she would tell you thatI tried repeatedly to get her out. That's when the blue teddy ripped off........ yeah, that's the ticket!

aklandrews, we always called that one TACHYLORDIOSIS. Happens a lot after dey done fell out from not takin der peanutbutter balls (phenobarbital).

Agreed you did a good job not only assessing, but documenting. I will always maintain that good assessment and interpretation of findings is the whole basis for good patient care. Documentatation supports anything you did or did not do. So I don't get your Stuporvisors problem........ Big words? Too medical sounding? Perhaps they could provide some paper documents with the really WIDE lines and some big, fat crayons to write with.

Michael, that was a burning car we were talking about...... Sinking cars are an entirely different scenario. No fire, no burning desire....... At least not to do the right thing anyway. How ya been Michael?

I am truly amazed at the level of debate produced by the original question - which was ridiculously insufficient in content. Way too open-ended a question. But the debate has been good. First, it seems all agree that practice outside scope is nearly always a mistake, not to mention dangerous. I wouldn't want some rogue who makes all his/her own rules all the time practicing on me or my family. But there are circumstances...... One of the best examples I've seen here was where Ruffems spoke of reducing a dislocated knee with longstanding circulatory compromise. I have never been in a position where I felt I needed to manipulate a dislocated joint (except for my own toes). But faced with the same circumstance Ruff was faced with, would I have done the same thing? I think so. I would be uncomfortable and unsure of my ability, but I would try because I know that the patients limb is in imminent danger of being lost. As for the burning car scenario - IF I could get close enough, yeah, the leg would go and the patient would come out. But I think we need to remember that we are speaking of circumstances so incredibly unlikely, that protocols, SOP's, and scope of practice are practically useless. These are simply HUMAN circumstances being referenced, not just MEDICAL ones. That being said, I watch people practice outside certain "scopes of practice" every day. I work in an emergency dept. now, after several years on the road. In the ER, physicians order all diagnostics and treatments, nurses and techs carry out those orders. Do you think it really happens that way? Nurses routinely order tests and initiate treatments. Hell, even I order tests sometimes before a Doc has even seen a patient. Usually the physician is consulted before actually performing a test or treatment, and the physician NEARLY ALWAYS approves this. Of course, this is in a situation where the staff have all worked together for a long time, and a great level of trust and confidence exists. I know that this is an entirely different discussion than has been going on in the thread, but it kind of underlines how open ended and inflammatory the original question was, doesn't it? So, in my typically over-worded way, I guess I am agreeing with AKflightmedic, who so succinctly answered the original question ("would you work outside your scope of practice to save a life?"). Maybe. By the way, if I was the person caught in a burning car, tethered only by strands of tissue from a nearly amputated leg: I would rip the leg off myself, get the hell out of the car, use something to tourniquet my leg, gee, maybe I could even find some strands from the steel-belted tires and suture my own arteries closed. Then I would look for some help. That's what I would do in that outragously unlikely circumstance while folks sat around debating whether to save my ass or not. All tongue in cheek there, folks........ It's been a long time since I've been around the city, haven't had a computer for over a year now. I live in the stone age mostly....... but it's good to be back. Hi to all the folks I have missed.

Panda Bear, the most abundant jobs in ER's for EMT's & Medics are Tech positions. Responsibilities in these positions vary between geographical areas and facilities. There will be a great deal of non-glamorous tasks such as changing beds, stocking supplies, emptying trash, placing foleys, etc. But these things are required in nursing and EMS in the field also. Every position nearly everywhere includes tasks you may not like. Oh, well. But there is plenty of patient care, too. Assessing patients, wound/orthopedic care, blood draws, possibly I.V.s (depending on the facility), etc. I also know several Medics who do sedation in hospitals for procedures on pediatric patients. The list is nearly endless. But if you are in school now, the possibilities expand even further. Since you are interested in being a Paramedic, You could pursue Respiratory Therapist. RT's do probably the closest things that are attractive about field EMS. Where I work, RT's do not only updrafts, vents, and all things respiratory, but 12 lead EKG's, ABG's, and more. The whole medical field is wide open and in demand. If you are in school, the choices are almost endless. Again, good luck in your pursuit!

Panda Bear, AKflightmedic gave excellent advice. As Dwayne previously said, I lost a career in field EMS because I had a seizure while on duty. In Florida, you must remain seizure free for 5 years before you can work on emergency vehicles again. If you have a documented seizure disorder, I think this would disqualify you from field work. And if you think about it, it makes sense. Thank God I didn't seize while behind the wheel of the ambulance! Also, you probably know that strobe lights can induce seizures in those prone to them. At any rate, like AK said, there are so many alternatives to pursue, having a seizure disorder certainly doesn't bar you from a career in EMS. I now work in an ER, and it is as good an experience as I had in the field - just different in some ways. In a lot of ways, I have gained more experience in a shorter period of time because we deal with many patients at once, all day long. Good luck to you! If you really want to work in the medical field, I gaurantee you can regardless of having a seizure disorder.

I don't understand what you mean when you say that finding paid EMS work elsewhere would defeat the purpose of being an EMT there. What is the purpose? Beyond that, though, I think it will be very difficult to get and remain sharp without frequent patient contact. Training is fine as far as it goes, but training rarely takes into account the infinite variables of any situation. It is almost as if it remains only theory until you experience many similar situations first hand. Education is much more a key I believe. If it is within the realm of possibility for you, go to school. If you return to school to become a Paramedic, do the degree program instead of a tech school type curriculum. I gaurantee that you will be MUCH sharper after school (running no calls) than you would be running 11 calls in 10 months with only monthly VFD training sessions. Education, experience, and continued training are synergistic in developing a good provider. So if you really want to become a good provider, set yourself up in a situation where you can get all three.

Dwayne, I can't help but feel for the situation you find yourself in. But DO NOT, under any circumstance, diminish your standards and expectations! The vision you hold for EMS is what can help us progress. I can't help but think that Medics who offer smart-aleck responses to serious questions either don't know what they're talking about anyway, and/or they are afraid of someone else excelling and making them look bad. Hang in there, my man. I know you will find good Medics that will be good mentors, and knowing your judgement, I know you will choose your mentors well. As for your "preceptor" stating that no one should become a Medic the way you are doing it, I assume she means going straight from Basic to Paramedic. That's pure bullsh!t! I wish that I had done things the way you are doing it. Several years of experience as a Basic has done absolutely nothing to further my ability to be a good Medic. I could have gotten those same years of experience with the education you are gaining now. As it stands, I'm still a Basic. I'm with Dust on the idea of hiring you if it were an agency I was responsible for. Only I wouldn't fire your current preceptor right away. I would let you precept her and give her a chance to remedially train for excellence. With the attitude you describe, though, I doubt she would make it.

Respiratory Acidosis - Ok, I'm going to answer this only on what I have seen with this, so it won't be very in-depth. Hopefully someone will expand on it beyond anything I can say. It is a respiratory pattern characterized by very rapid, very deep inspirations and expirations (as opposed to the rapid, shallow respirations of hyperventilation). It is the body's attempt to blow off ketones (and maybe other acidic compounds?) trying to restore a Ph balance. After a better discussion of Respiratory Acidosis, how about: EPIGLOTTITIS

I think we need to take a great deal of responsibility for this lack of perceived professionalism ourselves. Ems as a whole in the U.S. is filled with people who perpetuate a negative perception. We have the whackers who simply get off on lights and sirens and "excitement". I know plenty of professionals in this field as well, and not a one of them is infatuated with any of this stuff. We have burned-out providers who bitch and moan about every single call, who attempt to talk patients out of going to the hospital with them - sometimes with disastrous results. We have providers who apparently don't have a clue as to how to assess different patients, or how to interpret assessment information. Lack of education? Let's talk about that next.... It's impossible to argue against increasing education. But many of us CHOOSE ignorance! EMT's who never want to learn anything beyond the basic 120 hour course. Providers who only meet the minimum CEU requirements in the easiest possible way. Hell, the agency I worked with for several years utilized an online CEU program for both Basics and Medics. When I did the Medic programs, every single question on the tests were BLS questions!!! Impossible to financially afford or have time for formal education? How about educating yourself? How about being interested enough in this profession to learn as much as you can? Even if the things you learn address issues that are beyond your scope of practice. It can only make you a better provider and patient advocate. And it will certainly make you better at assessing patients and communicating with other healthcare professionals. I really think that if we individually elevate ourselves, we will slowly begin to attract the caliber of people who will perpetuate professionalism. To a great extent it is up to us. As established providers, we need to promote all these things to newer people. Newer people - choose your mentors wisely! There are in fact many excellent, professional people within EMS. I wanted to say more, really, but I'm at work and need to go. But just a final thought: Regardless of anyone's perception, I consider myself a professional. I want professio0nal partners, and mostly I have had them. If you act and strive for professionalism, you are a professional. So do it.

Why does she take Prevacid? Was it originally prescribed in response to prior GI complaints? Or concomititantly with the ASA as prophylaxis?