scubanurse

gotchya... I was just going to a handout I got in wonderful nursing school I have since learned to double check these things...hence why we get orders from smart doctors like yourself first

Doesn't it also kind of depend on the type of dehydration as to whether you would want hypotonic, hypertonic or isotonic? Like symptomatic hyponatremia would get more of a hypertonic solution like 3% NaCl?

Welcome

In my experience every hospital has a different set of rules for students. One of my rotations we basically sat around and did nothing, couldn't chart, couldn't do much at all. Now on my current rotation, I have pyxis access and I am able to chart on the patients medical record under my own account. This is at the RN level, but it carries everywhere. It's all up to how the hospital perceives students and their past history. One clinical site we have doesn't allow student rn's to give any meds even with our preceptor because a few years ago a student was stealing drugs from patients (giving 1mg instead of 2mg etc). Did the trauma center allow you to ask questions and explain things at least?

It could also have to do with all the fluids run into the patient diluting their blood... 9L of fluid even D5 or D10 is a lot of fluid for a person and the hyponatremia could be caused by that.

Welcome to EMT-B clinicals.... by caring for them what did you think they would let you do? I'm just curious because it's sounding like you were expecting to be able to fully care for them while in the ER and that isn't what EMS is... By observing you'll learn a lot of what happens once you drop the patients off not how to care for them in the pre-hospital setting. I hope you continue to learn and stay excited, just be careful about expectations.

How far out from an ER are you guys when you're treating hyperkalemia in the field? I haven't heard of it as a field treatment before and I'm really curious. I'm on a cardiac tele floor now for advanced med/surg and pretty much all of my patients have hypokalemia so it's something I am studying right now.

DC EMS has been a nightmare for years. There are plenty of amazing providers out there who I would trust with my parents lives. It's the management that is really killing EMS.

I think it is important to note that there is a difference between combative (drugs/ETOH) and suicidal/mental illness. They should be treated as two different issues. Drug and disorderly is much different than suicidal and hopeless.

http://www.firehouse.com/news/10889639/injured-dc-officer-transported-by-md-ambulance It was only a matter of time before this happened in DC. A motorcycle officer was in a collision with a car and had to wait for a PG ambulance to respond because DC EMS had no more available units.

Sweet! How is the school/housing hunt going?

Open body gestures can be helpful. If they are shouting the best technique I have found is to really whisper. It throws them off and has been very helpful in calming a shouting patient down. Lower your voice and almost switch to a monotone, slow cadence. If they are creepy and calm, then I find making them think is helpful. Get them thinking about what happens if they don't succeed in killing themselves. Unless you have had specific training in disarming someone with a firearm or knife, then your chances are very slim you will do this successfully. I would have tried to chuck the jump bag/o2 cylinder at the guy and bolt for the door while he's recovering, or throw a chair at him to knock him off and get out of there. This situation is likely not going to end well for anyone involved.

After the immediate I'm gunna poop myself thoughts, I would use open armed gestures, reassuring statements, validate his fears, and all of the techniques I've acquired through the years of EMS and hospital security work. Not a whole lot you can do if he's set out to die, but you can possibly talk him into letting you two go.

Big difference between Indiana and Indian though. Good luck!

That's great... We rarely get follow up on patients we see so it's awesome that it was a great outcome

wow... why hire nurses then???

What is the "Indian department of homeland security?" You may still have problems, but your time with the USCG will only help you, so long as your service record is spotless. Not many can give you a lot of advice on this since it is really up to the individual employers insurance. It's not good but it's not the worst either. Also, "check'd" and the other various spelling and grammar errors are not going to help you much in EMS. Proper spelling and grammar is a big component of documentation and effective communication.

Congrats! I hope you learn a lot and enjoy!!

Have you looked around UMBC at craigslist houses?

How's it going? Do you have any specific questions I can pass along to my uncle about the schools? Baltimore has so many beautiful aspects to it, Camden Yards is a great baseball venue, Fells Point, Inner Harbor, all wonderful areas with lots of activities on the cheap for kiddos.

That's a dilemma we faced a lot where I used to run just outside of DC. We had two major flight services MedStar and MSP. We had protocol on when to call for flight, but even then, we were rarely far enough from a trauma center to call for them. Some of the stations out in the booneys would call for them but they would sit around on scene waiting for them to get there when they could have been halfway to a hospital. I did a a few ride alongs with MSP and once we were called to a fairly urban area for a pedestrian struck. She had no big traumas, mainly road rash, and the entire ride to the trauma center the medic grumbled about how she should have gone ground instead of them waiting 20 minutes on scene to get there when a trauma center was 25 minutes away by ground. It's a tricky situation and I don't know what the right answer is. We have no way of knowing the full extent of a trauma in the field, but neither do the flight teams really. What does everyone else think? Is the risk worth the benefit?

Prayers to their families, friends and department...

That's a really good idea I've been adding greek yogurt and plain granola in the mornings to help give me that boost of energy for the first few hours of my 12 hour clinical rotation... But hadn't thought much of bringing it with me for the mid-day rush. I know a lot of the guys in my class use protein powders to substitute a whole meal when they're on the go. I think this brings up a good point though, how do we as busy providers continue to eat healthy when really busy? My metabolism isn't what it used to be and I know many are in a similar situation. I've gone to the grocery store and bought celery sticks to eat with peanut butter. The truth is, there are days as a student I literally have no time to even pee let alone sit down and eat a proper meal.

I do my best to eat a well balanced diet but with my schedule, sometimes a shake is easier to have then a healthy meal. I'd rather chug down a protein shake than a handful of chips while inbetween patients.