Pocket Guides/References

[fiznat]

If you need a guide, you have not studied enough....

I very much disagree. If you are in a situation where you are giving a medication that you haven't given in a while, or a situation that is new to you, I think it is FAR preferable to look things up rather than rely on memory. I carry a small reference guide in my pocket, and I have absolutely no issue with looking something up if I am unsure. I care about getting it right, not showing off the depth of my memorization. The same goes for drip calculations. It is VERY easy to make simple calculation errors in the middle of a call. Write things down and use whatever resources you can. The patient is far more important than than your ego. And guess what, doctors and physicians do this too.

I carry a miniaturized version of our protocols that I made at Kinkos, and also a ScutMonkey brand drug reference guide. When I made the protocol book at Kinkos I added some printouts of dripcharts that I made in excel. They have been lifesavers on a few calls.

Edited January 15, 2011 by fiznat

[Richard B the EMT]

Back in those dark days when my ambulance was pulled by amoebas...Make that the spring of 1974, when I was taking my very first EMT class, I had an instructor who stated that it was more important to have an EMT Textbook, to refer to when in doubt, on the ambulance, than a map.

Nowadays, I hold both to be important, less so the map, due to GPS, and the text, due to iPADs or similar.

[Eydawn]

I completely disagree that having a pocket reference or wanting one makes you inferior. Far better to know your own limitations and to act accordingly than to just roll with it and potentially make a mistake. Especially where drug calculations are concerned! I have dyscalculia. You can bet your sweet ass, if I find something that helps me with calculations, I will use it without shame and encourage others to do so who are struggling in similar ways. I would much rather take the time to punch something out on a calculator or pen and paper where I can triple check it than rely on something I calculated in my head, especially if there are trailing zeroes or decimals involved. I flip digits around decimals like you wouldn't believe. As a result, I have become hyper-paranoid (the mistakes are more frequent when I'm tired or my blood sugar is low).

So... does knowing that I will have to figure this out make me a poorer potential provider? I don't think so... at least I know where one of my issues lies...

Wendy

CO EMT-B

[DwayneEMTP]

Yeah, I'm going with the 'Yay' crowd as well.

I used to carry one the I purchased but found that it was too big and a pain in the ass, as I never looked at it. Like you mentioned, I didn't need it to tell me everything, just the more complex though rarely used things. So I make my own, laminate the pages and then staple them together. This is usually good for about a year and then it starts falling apart and I make another one.

I also agree that sometimes having a superstitious talisman in your pocket can be a good thing. I don't tend to be superstitious but I read a book once where the detective in the novel used Tarot cards on his tougher cases. He didn't believe in the supernatural but believed the using the Tarot logic forced him out of his normal lines of thought and that that was a good thing. I believe that if a cheat sheet makes you 'feel' more confident, whether or not it should, that that is a good thing. (Though my stethoscope does have magic powers and can hear things that others can't. Just sayin'. And that's not superstitious it just obviously true. An no, non believer, I don't want to try and prove it.)

;I believe that most of us, maybe not Crotchity, but normal people, have some moments of insecurity. I rarely look at my cheat sheets, but I look at it like this; It makes me feel more confident knowing that I can look at it, confidence leads to calmness, calmness leads to clearer thinking, clearer thinking leads to me having no need to look at my book, and therefore my book is an obvious necessity. See? Simple really...

As medgirl? (can't remember) said, the phone numbers for you local hospital, you supervisors, flight service are good. I keep ped dosages for all meds and adult dosages for meds that I use uncommonly, for example I'm pretty sure there is a calcium channel blocker in my kit somewhere.. :-) Drip calcs for almost everything that I might want to mix. etc. See, just uncommon stuff. But you put in whatever you need into your medicine bag, whatever makes you feel better, calmer, more confident.

Awesome question...but of course we've come to expect them from you.

You know, I was going to put here, "You should just take whatever Fiz and Medicgirl, Eydawn say and use it. They just have obviously good insight." But then thought, that though that wouldn't have been bad advice, you really are in the same category too. (Of course there are many others, but in this thread we have an awesome representation.) You're logic is terrific, your medic spirit is obvious, and you're confident and intelligent enough to throw your ideas out for review even when you already know A good answers if not the only good answer. (Another plug for Fiz's blog. If you've not read his Baby Medic blog, it should be required reading for all medic students and new medics. http://babymedic.blogspot.com/search?updated-min=2006-01-01T00%3A00%3A00-05%3A00&updated-max=2007-01-01T00%3A00%3A00-05%3A00&max-results=11)

In the last few years I've overcome much of my insecurity and have felt good and productive trying to act as a mentor here when I could, but it's truly exciting to see that the kids (in the EMS sense, not chronologically) are passing me up again. That each passing month I have less and less to offer yet more and more to gain! Often now it's more productive for me to shut up and listen then to talk. (Most likely that has ALWAYS been the case but I'm just now catching on.) and what an amazing thing that is to see happening here.

Thanks to all of you that take time out of your days to participate. That are brave enough to subject your ideas to assault so that I have the opportunity to learn from them. For showing those of us that have been here a few days, and those that started yesterday, that the EMS spirit is alive and well and refuses to be drowned in ignorance regardless of the efforts made by some to do so.

I applaud you.

Dwayne

[JTpaintball70]

When I first started I carried a green spiral bound paramedic drug reference and the Informed ALS field guide usually in my pack just in case I needed to look something up. I see no problems carrying one to refresh you memory on something that you don't use every day. I see a problem if you have to refer to the guide for every call even on simple things however. But something you don't use often on a call at 0300 is a good time to look it up to double check that you're giving the right doseage or drip rate (I do this wiht Flumazenil almost every time).

I know now that I use an Android phone I have one 'home screen' setup for work use. It's got phone number shortcuts for PD dispatch, county hospital, city hospital, along with Epocrates, Informed ALS app, Skyscape med-calc, and a few other apps so that I can get to them at work quickly, and not have to carry those books around.

If you're worried about carrying those books, and you use a smartphone (Droid, iOS, BB) consider looking for the Informed apps in your app store. Those and a few other apps all on your phone means you've got all the reference you'd need at your fingertips in one easy package that you probably already carry around on all your calls anyways.

[DwayneEMTP]

...Those and a few other apps all on your phone means you've got all the reference you'd need at your fingertips in one easy package that you probably already carry around on all your calls anyways.

You know, I don't disagree with this, as I did it for a few weeks. But what did you do about decon? I found that I spent way more time with my hands on my phone than I liked and wasn't confident that it was even possible to decon it in anything other than a feel good sort of way.

Plus, I could find things in my cheat sheet faster..grin.

Dwayne

[JTpaintball70]

My HTC hero stays in an otterbox, so decon is relatively simple. After every call it gets wiped down by cavi-wipes just like my steth. And every week or so the box here pulled apart and soaked in bleach water mix for an hour or so. And since we use personal phones to call the ed anyways, its almost always in my hand for a call

As for finding it faster... maybe. I know when I finally get my medic I'll probably at least make up a little bound flip book at kinkos with at least drip charts on it, and have it laminated so I can right on it with the sharpie I carry.

You know, I don't disagree with this, as I did it for a few weeks. But what did you do about decon? I found that I spent way more time with my hands on my phone than I liked and wasn't confident that it was even possible to decon it in anything other than a feel good sort of way.

Plus, I could find things in my cheat sheet faster..grin.

Dwayne

Edited January 16, 2011 by JTpaintball70

[Linuss]

Nothing wrong with having a cheat sheet, especially for things such as a commonly prescribed medication list, a drip calculation list, lab values, and stuff of that nature.

Really, the only stuff that needs not be in your pocket guide that you NEED to know back and front are the "OH SHOOT, I NEED TO DO THIS NOW" medications, stuff that the situation does not lends itself to peaking inside a book.. You need to know the dosages of the emergent medications we carry. without thinking about it. You need to know Epi 1:1 for an allergic reaction. You need to know the dosage ranges of your ACLS drugs. You need to know your RSI ranges. Pediatric Epi dosages.

Other things, such as Solu-medrol, the drip rate for Tridil, the rate for Mag Sulfate, stuff that is a bit further down the line, and not as often used, can wait till you can look it up. Pediatric dosages can wait until you double check them, especially with a Broslow tape. You are not less of a medic for not memorizing every damn word in your guidelines / protocols. There's a reason a copy is in the back of every ambulance.

[fiznat]

Thanks for the kind words Dwayne. It's been a long time since I've written on that blog. I should pick it back up one of these days....

[Bieber]

Thanks for all the kind words and advice, everybody. I've finished my guide and gotten it laminated and ready to go in time for my first shift as a paramedic this Sunday. Hopefully I won't need it, but like Dwayne said, it definitely makes me feel more comfortable and more confident knowing I have it right there. Of course, working my first shift as a paramedic with my former preceptor might counteract that confidence, haha!

The format of my guide ended up like this:

Medical Triage/Transport Criteria

Glasgow Coma Score

Trauma/Transport Triage Criteria

Burn Triage/Transport Criteria

OB Triage/Transport Criteria

Drug Formulary with the drugs, dosages (adults and peds) and number of repeats by standing order and under which protocol we can give them by standing order highlighted (if applicable) along with a lidocaine and dopamine clock for me to review from time to time (I currently feel comfortable with those, but it helps to look it over every now and then since we give both of those drugs so infrequently.

APGAR score.

Nothing wrong with having a cheat sheet, especially for things such as a commonly prescribed medication list, a drip calculation list, lab values, and stuff of that nature.

Really, the only stuff that needs not be in your pocket guide that you NEED to know back and front are the "OH SHOOT, I NEED TO DO THIS NOW" medications, stuff that the situation does not lends itself to peaking inside a book.. You need to know the dosages of the emergent medications we carry. without thinking about it. You need to know Epi 1:1 for an allergic reaction. You need to know the dosage ranges of your ACLS drugs. You need to know your RSI ranges. Pediatric Epi dosages.

Other things, such as Solu-medrol, the drip rate for Tridil, the rate for Mag Sulfate, stuff that is a bit further down the line, and not as often used, can wait till you can look it up. Pediatric dosages can wait until you double check them, especially with a Broslow tape. You are not less of a medic for not memorizing every damn word in your guidelines / protocols. There's a reason a copy is in the back of every ambulance.