fakingpatience

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fakingpatience last won the day on May 6 2013

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    Paramedic
  1. Funny EMS Picts

    Not toe pain but transported a patient for gum pain x4 months, already seen a dentist for it, no new changes. Oh and it was 0200 and she was a block from the ER
  2. Differentiating AVNRT from really regular Af + use of adenosine

    Our protocols specifically said that if you aren't certain if it is SVT or other rapid atrial rhythm to give a trial dose of 6mg adenosine, to slow the rhythm down for diagnostic purposes. Personally the a-fib RVR pt's I've had have been fairly irregular rates, so it wasn't needed, however I did have a pt in a regular a-flutter (1:1 conduction) undecernable to SVT at the rate. Gave 6mg of adenosine, and the rhythm slowed for ~10 seconds, long enough to see the flutter waves and determine a calcium channel blocker was needed (didn't carry cardizem there so opted to not treat and wait till we reached the ER as pt was stable).
  3. Studying in California

    1. What sort of education do you have? I have a bachelors, along with a separate associates for my paramedic certification. 2. What was your career path from college to present? Why did you decide to follow this career path? I started volunteering as an EMT my last year of college, and decided that I liked the field more than what I was getting my degree in, so once I graduated got a full time job as an EMT, then went to paramedic school 3. What are your basic duties performed during a typical day? Week? Month? Do you have a set routine? What are the major job responsibilities? Trying to describe the basic duties isn't easy! Respond to 911 calls and transfers and take care of patients. Also as everyone else mentioned, inspect the truck and other station duties (cleaning up). Don't have much of a routine aside from attempting to check the truck first thing, as you never know when you'll get a call or how long it'll take (we do LDTs also which can take us ~6 hours at a time) 4. How much variety is there on a day-to-day basis? Generally it varies a lot, you never know what you are going to get. 5. How many hours do you work? ~60 6. Does the typical EMT have a set schedule or are the hours flexible? 24 hours on, 48 hours off 7. Which skills do you feel are most important to acquire? Learning how to interact with people. Assessments 8. What types of technology are used and how are they used? How often are changes made when it comes to new technologies? Cardiac monitors, laptops. Frequent changes in terms of new supplies. More then changes for new technologies it is changes in keeping up with current research in best practice. 9. What educational program do you recommend as preparation? What kinds of courses are most valuable in order to gain skills necessary for success in this occupation? College level EMT course (usually 100 level) 10. What degree or certificate do employers look for? What kind of work/internship experience would employers look for in a job applicant? EMT certification. Some places also favor volunteer experience with local ambulance service. 11. How can a person obtain this work experience? Most areas have places that will hire people without experience, to get your first "foot in the door" job. Just remember if they are always hiring and willing to hire brand new people, there is probably a reason for their high turnover. 12. What entry level positions are there? EMT- basic 13. What steps besides meeting educational and experiential requirements are necessary to "break into" this occupation? Make a good impression during school and clinicals 14. What are opportunities for advancement? To what position? Is an advanced degree needed? (If so, in what discipline?) Becoming a paramedic (1-2 years of college), management 15. Is there a typical chain of command in the field? Completely dependent on the agency you work for. At my agencies we have a shift supervisor on duty each shift who is our direct supervisor. Some trucks are run basic/ paramedic, and at some agencies the paramedic is considered in charge of the ambulance. 16. What are the different salary ranges? Depends where you live. For emt-b I have seen hourly rates range from $7.25 to $13 17. What other kinds of workers frequently interact with this position? PD, fire, nurses, doctors, aides 18. What are the main or most important personal characteristics for success in the field? Willingness to learn. Able to take a joke (you will be teased by your coworkers, but not usually in a malicious manner). Comfortable with people. 19. What are the satisfying aspects of your work? I love my job, getting to help people in their times of need, even if the help just consists of comforting them. 20. What are the dissatisfying aspects of the work? Is this typical of the field? Low pay, long hours can take a toll on you. Lack of respect from other agencis 21. How would you describe the atmosphere/culture of the work place? Friendly, however there is frequently a lot of gossip 22. Is there evidence of differential treatment between men and women EMTs with respect to job duties, pay, and opportunities for advancement? Depends where you work. For the most part I have not experienced any differential treatment, but there will always be 1 or 2 assholes out there. 23. What do you feel are the toughest types of problems and decisions that you must make? Ethical dilemmas when it comes to patient care. Not second guessing yourself 24. What are the demands and frustrations that typically accompany this type of work? What are the greatest pressures, strains or anxieties in the work? As said above, long hours, low pay, lack of respect from other agencies (police, fire, drs, and nurses) 25. What do you know now which would have been helpful to know when you were a student? Realize that what you will learn in school is important, but the real learning (especially for EMTs) begins in the streets. 26. Any other important questions that I have not asked that would be helpful in learning about the job or occupation? Thank you for your time.
  4. ED Wait Times

    Once we are on hospital property, the patient is technically the hospital's patient. We are waiting inside a hallway of the ER for a room, the only equipment we have with us is the cardiac monitor (which some supervisors encouraged us to turn off once we had been triaged and were just waiting for a room, to "show" the hospital the patient was their responsibility... I refused to do that). We were not allowed to further treat the patient, as they were no longer "our" patient, and as the patient was not in an ER room and being seen by a dr, the hospital would not treat them either. On 1 call I was able to give my waiting pt additional pain medication that I had left over in the vial (was going to waste) with permission from the attending Dr, but this was an exception, not at all the norm. If we had fluids or anything running we would continue that while waiting, but not start anything new. Now typically we were not kept waiting with "critical" patients, however on occasion we have been (such as the a-fib w/ RVR patient, another patient on CPAP... both of these were at the same hospital) Believe me, I know how bad for patient care this sounds, thats why I got out of that system as soon as possible (started my new job this month!)
  5. ED Wait Times

    My longest wait time was 6 hours. Average was an hour or two. I saw 2 major problems with the hospital systems (not counting the fact they were taking an ambulance off the street), 1, they wouldn't let us put BS patients in the waiting room (I got told "I already have to many patients out there, that won't help me any" when asking the charge nurse if we could put our patient there). And 2, occasionally we were waiting the extended times with actually sick patients, who are then not getting any further treatment, as we are on hospital grounds and can no longer treat them; a few weeks ago I waited an hour with a patient in a-fib w/ RVR rate ~170, after telling the staff numerous times my concern for her. The hospitals would have us stay with patients even if they had open beds, if they didn't have enough staff to "open" those rooms. I considered this using us as extra staff, why pay to have appropriate staffing when you can just keep EMS crews there to watch the patients for you? Officially we weren't supposed to be kept waiting longer than 30 mins, but no company in the area would let the crews put the patient in an open bed and leave, as this would anger the hospitals, and their main concern was keeping them happy to keep to contracts.
  6. Food poisoning and antiemetics

    I tried to find some research on this but didn't see anything, so I'm hoping someone here may have some insight! If you have a patient you believe has food poisoning, and is nauseous/ vomiting, should you still give an antiemetic? Or is it better for the body to allow them to vomit to get rid of the "poison".
  7. NIBP

    Going off of this, which cuff does everyone find to be more accurate on our "large" patients? I alternate between using the maroon large adult cuff on the upper arm, or the regular blue one on the lower arm, but don't seem to get reliable results with either one. My problem with the larger cuff is I thought the blood pressure cuff is only supposed to take up a max of 2/3 of the length of the upper arm (don't quote me on the number, but I think it somewhere around there), but the larger cuff is not only longer, it is wider, so it ends up covering almost all of the upper arm. What these patients need is a cuff that is longer, not wider.
  8. EKG - What is it and how do you treat

    I wish I could say I have an idea of what the EKG is, but I don't. The initial strip is bradycardic, with what I think may be a PJC causing the irregularity. 1st 12 lead appears to have a RBBB, but it looks more like a LBBB in the 2nd EKG. I'd want to know if his pacemaker is constant or demand, and what it's limits are set to. Bottom line, it's an ugly looking EKG. I'd advice the pt to transport to a PCI capable facility, and fax both 12 leads to his facility of choice (if he is reluctant to a PCI center, I'd send the 12 lead to the closest facility and see if they'd even be willing to accept him, they are known for transferring everything). I'd start by treating his GI symptoms, IV w/ NS fluid bolus once his D-stick is normal, 02 titrated, zofran for persistent nausea. As far as him being persistently bradycardic, I'd want to know why his pacemaker was implanted initially, what his base problem was, as perhaps that is what is causing his current bradycardia (along w/ potential malfunction of pacemaker)... Interesting case!
  9. Midazolam vs Diazepam

    My agency only carries valium, can give 5mg, then a second 5mg, have to call for any additional dosages ... This area isn't so big onto the whole "progressive" thing (also only morphine for pain, no other narcotics). So far I haven't been impressed with the valium's ability to control seizures.
  10. Officially finished paramedic school!

  11. Fake Seizures

    Respiratory rate became somewhat irregular, and it looked like she may be aspirating, so I put in an OPA, suctioned, and assisted ventilations. This was after witnessing her seizing for ~10 mins and 5 of valium IM (slight delay on scene for an ambulance, as we were in a fly car). The seizures did not have the "violent" flailing... I was also told that if you touch an unconscious pt's eye and they have no response/ eye does not attempt to close to that stimuli, it is a good sign they have no gag reflex. Was true for this patient at least, can't speak to it as a rule though.
  12. Fake Seizures

    How reliable is this? I had a patient I am 99% sure was in status epileptics, elderly lady seizing 10+ mins, seizure would occasionally break, for max 10 sec, where pt would have some response to pain, then would begin seizing again, eyes deviated, no gag reflex, no change in seizure activity with valium. But her pulse ox remain high 90s the whole time (although we did have her on supplemental 02 from the beginning).
  13. Viagra and nitro hypotension

    Would you be concerned with too much fluid for this patient? I only ask because I had a similar patient during paramedic ride time (he felt dizzy and vomited, so he took 2 nitros, which bottomed out his pressure, 60 something systolic on my initial assessment). My preceptor wanted me to be cautious with fluid administration, because he said that once the effects of the nitro wears off, and the patient vasoconstricts, they could go into fluid overload if you gave them excessive amounts of fluid. I ended up 500cc, which along with low semi-folowers (was sitting up on toilet initially) brought his pressure up into the 90s, and resolved his dizziness. So obviously not as severe as the pt you are describing, but I still wonder if that would be a consideration.
  14. Dear paramedics: Please remember to be nice and respectful to your basic partner... we are people to

    1. uglyEMT

      uglyEMT

      Let me know how that works out for ya. LOL I feel like a door mat most days