Snowball Studying: Instruction by example

[FL_Medic]

Snowball Studying

This is a term that I use to describe the method in which I study. I began using this method back in paramedic school when I felt I was losing focus while studying new information. The technique as described in it's name uses the snowball effect to gather information. You end up focusing on a single subject but expand your topics as you learn. If you take one new piece of information, you find the next topic within that piece of info, and continue your research/studying from there. I will give an example.

You run a call, and find that the patient has a prescription for Lisinopril. Time to look up that new drug.

What you find:

is an ACE Inhibitor used for the treatment of HTN(hypertension) and CHF(congestive heart failure).

Before reading on, you should have a complete understanding of what you just read. Start with ACE Inhibitor

II. ACE Inhibitor:

A.) ACE - angiotensin converting enzyme

Inhibit is similar to block, so we know Lisinopril inhibits(blocks) the angiotensin converting enzyme

III. What is angiotensin converting enzyme?

A.) Converts angiotensin l to angiotensin ll, a potent vasoconstrictor).

B.) It is involved in the inactivation of bradykinin, a potent vasodilator.

so now we are learning why it is used for Tx(treatment) of HTN

IV. What is angiotensin?

A.) Angiotensin: causes blood vessels to constrict, and drives blood pressure up. It is part of the renin-angiotensin system, which is a major target for drugs that lower blood pressure. Angiotensin also stimulates the release of aldosterone from the http://www.youtube.com/watch?v=ZMFK6x-gYe0. Aldosterone promotes sodium retention in the distal nephron, which also drives blood pressure up.

V. What is bradykinin?

A.) Bradykinin is a nonapeptide that causes blood vessels to enlarge (dilate), and therefore causes blood pressure to lower. A class of drugs called ACE inhibitors, which are used to lower blood pressure, increase bradykinin further lowering blood pressure. Bradykinin works on blood vessels through the release of prostacyclin, nitric oxide, and endothelial-derived hyperpolarizing factor.

A lot of info there, gotta look some of it up.

1.Prostacyclin (PGI2) chiefly prevents formation of the platelet plug involved in primary hemostasis (a part of blood clot formation). It is also an effective vasodilator. Prostacyclin's interactions in contrast to thromboxane (TXA2), another eicosanoid, strongly suggest a mechanism of cardiovascular homeostasis between the two hormones in relation to vascular damage.

2. Endothelium-Derived Hyperpolarizing Factor or EDHF is proposed to be a substance and/or electrical signal that is generated or synthesized in and released from the endothelium; its action is to hyperpolarize vascular smooth muscle cells, causing these cells to relax, thus allowing the blood vessel to expand in diameter.

Bradykinin is a physiologically and pharmacologically active peptide of the kinin group of proteins, consisting of nine amino acids.

3. Nonapeptide - An oligopeptide containing nine amino acid residues

4. Oligopeptide - Consists of between two and twelve amino acids

5. Peptides - Are short polymers formed from the linking, in a defined order, of α-amino acids. The link between one amino acid residue and the next is known as an amide bond or a peptide bond.

VI. What is the Renin-angiotensin system?

A.) The

system (RAS) or the renin-angiotensin-

system (RAAS) is a hormone system that regulates blood pressure and water (fluid) balance.

When blood volume is low, the

secrete renin. Renin stimulates the production of angiotensin. Angiotensin causes blood vessels to constrict resulting in increased blood pressure. Angiotensin also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the tubules of the kidneys to retain sodium and water. This increases the volume of fluid in the body, which also increases blood pressure.

1. Aldosterone is a hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys. This increases the volume of fluid in the body, and drives blood pressure up. Many drugs, such as spironolactone, lower blood pressure by blocking the aldosterone receptor. Aldosterone is part of the renin-angiotensin system.

Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the distal tubules and collecting ducts of the kidney to cause the conservation of sodium, secretion of potassium, increased water retention, and increased blood pressure. The overall effect of aldosterone is to increase reabsorption of ions and water in the kidney.

Its activity is reduced in

and increased in Conn syndrome.

a.) Mineralocorticoids are a class of steroid hormones characterised by their similarity to aldosterone and their influence on salt and water balance.

b.) Addison's disease (also known as chronic adrenal insufficiency, hypocortisolism or hypocorticism) is a rare endocrine disorder in which the adrenal gland doesn't produce enough steroid hormones (glucocorticoids and often mineralocorticoids). It may develop in children and adults, and may occur as the result many underlying causes.

The condition is named after Dr Thomas Addison, the British physician who first described the condition in his 1855 publication On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. The adjective "Addisonian" is used for features of the condition, as well as patients with Addison's disease.

The condition is generally diagnosed with blood tests, medical imaging and additional investigations. Treatment involves replacement of the hormones (oral hydrocortisone and fludrocortisone). If the disease is caused by an underlying problem, it may be possible to address that. Regular follow-up and monitoring for other health problems is necessary

c.) Conn syndrome is characterized by increased aldosterone secretion from the adrenal glands, suppressed plasma renin activity (PRA), hypertension, and hypokalemia. It was first described in 1955 by J. W. Conn in a patient who had an aldosterone-producing adenoma (ie, Conn syndrome). Later, many other cases of adrenal hyperplasia with increased aldosterone secretion were described, and now the term primary hyperaldosteronism is used to describe Conn syndrome and other etiologies of primary hypersecretion of aldosterone (eg, adrenal hyperplasia). Currently, primary hyperaldosteronism, especially Conn syndrome, seems to be the most common form of secondary hypertension.

MRI in a patient with Conn syndrome showing a left adrenal adenoma

You can continue on this path and the learning will be endless. There is always some new information out there for you to find. You could go back to the top and look up adverse effects of Lisinopril, proper dosing, so on and so forth. Try this by looking up one patient med a day(from clinical or ride time) that you don't know anything about. Let the snowball grow!

As a side note, I stuck to Wikipedia with all this info. Make sure to look up images and even videos. I learn best from videos myself. Click the links in the post to find some cool videos that I added.

Edited March 13, 2009 by FL_Medic

[VentMedic]

The advantage to having classes such as Pharmacology, Chemistry, A&P, Microbiology and Pathophysiology as pre or co-requisites to an EMT or Paramedic class is that looking up a term is just a refresher. There is a clearer understanding to the whole picture than trying to figure out how one word at a time fits in when learning applications for a health care profession. Medic mills often rely on snowballing since there are few or no prerequisites to program. Unfortunately, few even bother to look up the terms and just move on by memorizing a word instead of learning what it means.

But, whatever works to get (or got) you through Paramedic school....

Edited March 13, 2009 by VentMedic

[FL_Medic]

Well I agree that learning the term for a moment isn't ideal, but that is not what I am suggesting. There are quite a few schools, including the state college here, that don't require such pre-requisites. This method actually helps you learn by repetition. Call it memorization if you want, but you are presented with a term, and then instead of just reading on, you look it up. You aren't satisfied with just looking it up either, you then have to understand the definition of that term. I know this method works for some, because it did and dose work for me. Not just through medic school, I still learn this way. Nothing beats experience, and school though.

[VentMedic]

Well I agree that learning the term for a moment isn't ideal, but that is not what I am suggesting. There are quite a few schools, including the state college here, that don't require such pre-requisites. This method actually helps you learn by repetition. Call it memorization if you want, but you are presented with a term, and then instead of just reading on, you look it up. You aren't satisfied with just looking it up either, you then have to understand the definition of that term. I know this method works for some, because it did and dose work for me. Not just through medic school, I still learn this way. Nothing beats experience, and school though.

You are taking or took your Paramedic at a State college (4 year) in Florida?

In Florida, there is not a degree requirement nor do many of the schools even require science classes in addition to the core. Unfortunately, the community colleges have arranged their curriculum to be "medic mill like" to stay competitive and have dropped the college level sciences form the cert program. That is a very sad, sad situation for EMS in Florida.

[FL_Medic]

I am a paramedic. I attended community college. I couldn't agree more, I did, however, take A&P. I am also working on 5 degrees. One at a time of coarse AS. in EMS, AS in nursing, AA in general, BA in public safety and BS in nursing.

I agree with these eductation-lacking courses being substandard. I think the paramedic program should be getting longer with an increase in scope, not shorter and accelerated. They have an 8 month program somewhere here in Florida, can you believe that?

I think you should have to apply and be accepted after obtaining a good GPA in the classes you mentioned. Then I think you should have to work as an EMT, and second paramedic before being credentialed anywhere. Of coarse, what I think doesn't matter.

[VentMedic]

I am a paramedic. I attended community college. I couldn't agree more, I did, however, take A&P. I am also working on 5 degrees. One at a time of coarse AS. in EMS, AS in nursing, AA in general, BA in public safety and BS in nursing.

I agree with these eductation-lacking courses being substandard. I think the paramedic program should be getting longer with an increase in scope, not shorter and accelerated. They have an 8 month program somewhere here in Florida, can you believe that?

I think you should have to apply and be accepted after obtaining a good GPA in the classes you mentioned. Then I think you should have to work as an EMT, and second paramedic before being credentialed anywhere. Of coarse, what I think doesn't matter.

Darn, we actually have a certificate program 8 months long? Yes, a few of the community colleges that haven't gone "academy" do have programs that are 2 - 3 semesters long. Since Florida only requires 700 hours for the Paramedic, many medic mills are less than 6 months. They had been much shorter but the State cracked down on clinicals done on ALS engines as "sleepovers" for 24 hours.

If a 2 year degree was required for the Paramedic, the time you are in school getting your degree would be more than enough working experience. There is little an EMT will learn in Florida except the bad habits of their partner and how to drive for the Fire Medic. Few will take advantage of learning histories and medical conditions of their routine transfers or will not have the education to know what they should look for. At least if they are still in school learning A&P, that knowledge will enable them to seek out more information.

You are taking the long way around in education. With an A.S. and the A.A. classes you can get your BSN. With just a few extra core classes in your second major, you get another Bachelors. Or, if you have your sciences with the Public Safety degree you can get an entry level nursing MSN degree. Right now I can not remember which of the west coast schools offer it.

There are quite a few schools, including the state college here, that don't require such pre-requisites.

If you are talking about Edison, every health care degree EXCEPT EMS has most of the prerequisites I mentioned.

[Dustdevil]

For some reason, you are stuck in this trap of doing things back-arsewards.

The only good reason for getting an ASN is if you absolutely have to get into the workforce quickly for financial reasons. You don't. You already have a good job. Don't waste your time with an ASN. Go straight into the BSN programme. You will be a better nurse for it. And optimally, you should have done that before paramedic school. You would have been a better paramedic for it.

You need to grow up and get some focus. Quit trying to be everything you want to be all at once. Do one thing and do it well. Then move on to the other things later, once you have achieved a measure of success in your primary interest. Since you are already in medicine, I would assume that is your primary interest. You try to patch together an education randomly like you laid out above and the results are sub-standard and chaotic. I suspect that if you simply bare down and work on your BSN now, you'll gain more focus and realise that all that other fluff is not as important to you as you think.

[FL_Medic]

Let me explain. I am a teacher at Edison. Yes you need those classes for an AS vent, but not for your paramedic cert. So since I am an instructor I get free classes.

I only have one class left for my AS in EMS. Coincidently the classes I needed are pre-reqs for the accelerated RN(for medics and lpns). I have a few more pre-reqs for the RN program and then I will finish that within a year. I can go straight into that or get my AA and enter a bachelour program first. Since I get the classes for free why not get all the education I can? The masters in nursing is disappearing and NP will be a PHD in the near future. I am grown up devil. I am not doing this backwards, I am hoping to work as an RN PRN. I can do that by the end of next year if I stay on track. If I just go for my bachelours in public safety I can advance in my current career. I am juggling both ideas. How did this post become an attack on my education path? Haha.

[VentMedic]

The masters in nursing is disappearing and NP will be a PHD in the near future.

Masters for NP is now pretty much the standard. There have been PhD (Doctor of Philosophy) programs for RNs for several decades as have the DSN or DNS (Doctor of Nursing Science). The PhD is more beneficial for teaching and some research.

The Doctorate of Nursing Practice (DNP) has been around for about 15 years. Yes, NPs are looking toward that to advance their professions.

The entry level MSN program I am talking about is for those who already have a Bachelors in another profession. If you ever have the desire to teach for a nursing program, you would need no less than a Masters. Unfortunately EMS still allows those without even an Associates to teach which is why there are few educated mentors in the programs for the students to have as role models.

This is not an attack on your education. You did use the word "I" several times during your original post. It is also refreshing to read about a Paramedic who is enthusiatic about education.

Edited March 14, 2009 by VentMedic

[FL_Medic]

I've been told by current NPs that there will no longer be a masters anymore. You will have to aquire a doctorate/PHD. I believe they said 2010 was the year this would be in effect.