things they didn't teach you in school

[Just Plain Ruff]

Ok, my biggest mistake is this one

About ayear out of medic school. Had a patiet in a paced rhythm but no pacer spikes visible on the lifepak 10.

Gave 100 mgs of lidocaine and they nearly arrested.

Was humbled in front of the physician at the ER.

One more - I didn't have to learn this lesson but I saw it in action and it nearly cost me my job. Take responsibility for a mistake.

Three man crew. 2 medics in back for a eclamptic patient. She starts to seize. I pull the narc box out per the medics orders. I open it for him. He then proceeds to give what at the time was Valium 5mg.

She eventually stops seizing and we arrive at the ER.

Go in the ER, give report and return to the ambulance. EMT says "Why did you guys give her morphine?" I said we didn't.

Medic who gave the med looks at the syringe and goes white. I imagine I'm white as a ghost too. Medic says "Let's get out of here, I'll take care of it later"

I went NO FREAKING WAY, that's a med error and we need to report it. He refuses says I gave him the wrong syringe. I tell him he's full of crap. I walk into the ER, find the doctor and explain what happened. The doc says "no wonder she has pinpoint pupils".

I return to the ambulance and the medic is way pissed. Silent treatment all the way back to the city. I request a meeting with the supervisor. WE meet up at headquarters and my medic partner blames it on me. The supervisor asks who pushed the med and the other medic said that he did push it. So into separate rooms we go, one supervisor for the medic in question and one for me. Our stories don't match.

In the end, the physician called the station and said that they had a honest medic on staff (ME) and that the patient suffered no long lasting effects from the error. The Emt said that the other medic just was going to "fix it" and that really sealed that medics fate on this incident.

The other medic was removed from duty and ended up getting fired for something else that I cannot remember. We never worked together again and he never talked to me again. Not a very big loss if you ask me but had I not have stood up and took responsibility for my part and the other medic refusing to take responsibility for his part, it could have ended up very differnetly.

Always take responsibility for what you do, your integrity is very easy to lose and nearly impossible to get back.

So personal responsibility is not taught much at all.

[hatelilpeepees]

1. That D50 can be given P.O. (by mouth).

2. Never get a refusal on a drunk, especially one that has endured any form of trauma (even minor).

3. That glucose machines are not always accurate.

4. That some drug ODs actually present as hyperventilation, until they quite breathing about 15 minutes later.

5. For every flight of stairs you are climbing, you can add another 100lbs to the patient, same for every foot of space-width that is lost in a mobile home hallway.

6. When patients say "I am dying", they are usually right.

7. Treat the patient, not the monitor, some folks have some ugly rhythms, but it is what they live with everyday.

8. Always check your truck completely, the day you dont will be the day you are missing a piece of equipment, at the worst possible moment. Especially if you work a busy 24, cant tell you how many times I have had to go to the last call location or ER to get equipment that was left by previous shift.

9. Never leave a patient that has called 911 more than once in a day, it is bad to have to explain why a patient called 3 times, was not transported, and died.

10. To combat the medication errors mentioned before, do not put medicine vials that look identical right next to each other in the drug box (albuterol and Atrovent), put medications that are potentially deadly (Heparin, Dopamine,) in its own separate ziplock bag and label with magic marker so you have to be a double dumbass to grab the wrong bag. If you have meds that are almost identical, switch the vendor on one so you get a different color box or size of ampule. Ideally, you should have a dial-a-flow or pump on medications that can be deadly.

11. Not all doctors graduated at the top of there class, and many ER Docs are not ER Specialist, but may be a dermatologists who is working part-time (especially the more rural you get), sometimes you have to step up and be a patient advocate.

Thats a good starting list.

[Richard B the EMT]

This is the stupiest thing but I have had 2 newbies do blood pressures and go "I cant get it" Then I turn on their stethoscope.

Newjacks with electronic steths? I'm 37 years experience, and only seen one nurse with one, and he was wearing a hearing aid, which explained the need.

[Just Plain Ruff]

Newjacks with electronic steths? I'm 37 years experience, and only seen one nurse with one, and he was wearing a hearing aid, which explained the need.

Seriously, not knowing to turn on their stethoscopes???? Are they being deliberately stupid? They shouldn't be allowed to have that type of technology until they have proven they are out of the toddler stages.

[croaker260]

Things they didn't teach me at uni:

Fatigue management

Stress management

They dont teach you how to look after yourself

This was going to be my post Bushy...Dam You!

OP: Recommend reading Grossmans "On Combat" for more on this and its impact on People like us.

[Cougar]

You guys are wonderful! Keep going! They never told me that kidney dialysis could tank blood sugar. I was very confused by my first dialysis patient back in my basic days who had eaten beans and steak an hour ago (yes, he kept it down) no diabetic hx and a BGL of 12.

I act as a volunteer in an EXTREMELY rural area. The other day I am first on scene by ten minutes with 4 pts. A screaming one yr. old in a car seat. A bloody, sobbing unseat-belted 8 year-old, a too quiet curled up 5 year-old complaining of right LQ pain and a shocky adult. Damn, that magic jump kit is lacking a lot. I elected to put the only O2 on the 5 year-old and prioritized her as #1 with adult #2, 8 y/o #3 and baby #4. When we met with the pros they sent the adult out by copter, took the rest to the local ER and ended up airlifting the the 5 year old out with a liver lac. I hate quiet kids. Bless the screaming ones! You city dudes don't know the luxury you have of having hospitals close by and never being alone at a scene. Sometimes the wild west is scary.

[Richard B the EMT]

I hate quiet kids. Bless the screaming ones! You city dudes don't know the luxury you have of having hospitals close by and never being alone at a scene. Sometimes the wild west is scary.

An old mantra I was taught, and still follow is, "If a child is quiet, something is really wrong".

I have been known to respond with a personal kit for stuff I see in the street while just driving my personal van, hense, I've been solo on scenes awaiting the on duty crews. And even in a city, where the nearest ER is usually 15 minutes or under away from load and go, yes, it can be frightening when one is flying solo, no matter what the local geographics.

[BushyFromOz]

This was going to be my post Bushy...Dam You!

OP: Recommend reading Grossmans "On Combat" for more on this and its impact on People like us.

Sorry man.

We always crap on about some obscure patient presentation or some kind of cool intervention that you *might* get to do someday (i seriously want to try a beta bloker OD with glucagon), but seriously, we never talk about, or does it form any part of our education (that im aware of) about looking after ourselves physically, but more importanlyt, psychologically.

I ground myself into the ground within 2 years of hitting the road and its taken a bloody long time to work myself to being content both with work and with home.

Im surprised it hasn't been mentioned more often.

Oh, and there was a book by some chick (cant remember authors name) but it was called "streetsense", and had some excellent advice in it.

Edited August 11, 2011 by BushyFromOz

[Happiness]

Newjacks with electronic steths? I'm 37 years experience, and only seen one nurse with one, and he was wearing a hearing aid, which explained the need.

Nope just the run of the mill steth.

[DFIB]

An old mantra I was taught, and still follow is, "If a child is quiet, something is really wrong".

I have been known to respond with a personal kit for stuff I see in the street while just driving my personal van, hense, I've been solo on scenes awaiting the on duty crews. And even in a city, where the nearest ER is usually 15 minutes or under away from load and go, yes, it can be frightening when one is flying solo, no matter what the local geographics.

The scariest thing to responding as a civie is that there is no possibility of transport. What you walk up on is what you got until the bus arrives. Scary.

All emergency calls will wait until you begin to eat, regardless of the time.

Any patient, when given the option of either going to jail or going to the hospital by a police officer, will always be inside the ambulance before you are.

In any accident, the degree of injury suffered by a patient is inversely proportional to the amount and volume of agonized screaming produced by that patient.

Always assume that any Physician found at the scene of an emergency is

a Gynecologist, until proven otherwise.

11. Not all doctors graduated at the top of there class, and many ER Docs are not ER Specialist, but may be a dermatologists who is working part-time (especially the more rural you get), sometimes you have to step up and be a patient advocate.

What do you call the student with the lowest GPA in Med. School?

Ans. Doctor

Edited August 11, 2011 by DFIB