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fakingpatience

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About fakingpatience

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  • Occupation Paramedic

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  • Website URL http://fakingpatience.blogspot.com/

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fakingpatience's Activity

  1. fakingpatience added a topic in General EMS Discussion   

    California employment requirements
    I'm moving to California, and trying to puzzle through all the required documents to apply to work at AMR.  I received my state california card through reciprocity, but to apply for work I need
     
    *   CA Drivers’ License
    *   H-6 DMV Print out of Driving Record (Online printout not acceptable)
    *   Ambulance Driver’s License
    *   Medical Examiner’s Card
     
     
    Getting a regular CA driver's license I assume will be a fairly straight forward process, just turning in my other state's license.  
     
    For the Ambulance driver's license, it says I need to take a test... Does any have information on what is tested?  Is there a book available, like there is for regular permit tests to study from?   Also, it says a medical examination report is required... Is there only 1 of these, or is there a separate medical examiner's card I need to get also?  
     
    Thanks in advance for any advice! 
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  2. fakingpatience added a post in a topic 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
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  3. fakingpatience added a post in a topic Accelerated/Cheap EMT-Basic in Colorado   

    Some community colleges offer EMT-B during the summer semester. Not cheaper, but definitely less time then a regular semester. Mine was around 2 months long, we met 4-5 times a week for ~3 hours (I could be really off on the numbers though, it was a while ago). It was worth 9 regular semester credits through the college.
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  4. fakingpatience added a post in a topic How old are your ears?   

    Hmm according to this my ears are over 40 years old (I'm in my mid 20s)....  I thought my hearing has been worse lately! 
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  5. fakingpatience added a post in a topic Scenario: Another boring transfer   

    Out of curiosity, is there a reason everyone wants a beta blocker instead of Cardizem?  
    Capnography shows "sharkfin" waveform, but his etco2 isn't high, but I'm wondering if that is due to his increased respiratory rate compensating for that.  
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  6. fakingpatience added a topic in General EMS Discussion   

    Israel
    Does anyone on here work EMS in Israel?  
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  7. fakingpatience added a post in a topic 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).  
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  8. fakingpatience added a post in a topic EMS CT scanner?   

     
    I honestly don't know what training they are planning on doing.  
     
    While it would be nice to say that the hospitals will trust our interpretation, honestly just like 12 leads they probably will not and will still do their own exams.   For us it would be useful in destination decisions, and if a patient needs to be flown to the big city.  Also at a recent training I learned that the ultra sound can be used to determine if the patient is hypotensive due to low volume, or poor cardiac output (helping determine if pressers or fluids should be given).
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  9. fakingpatience added a post in a topic New Partners   

    Sorry I have been absent from this thread for so long, but glad for the discussion it has generated.  
     
    Believe me, I am fully aware that the problem is me, not my partner; its not his fault that he is new, he can't change that and he does want to learn, but it is my fault that I am impatient.   I have many faults, both as a person and a medic, and before was lucky to have understanding partners who helped me "mask" them at work.   Thank you all for the various advice.  
     
    To answer some questions, I am a new medic (less then a year), and new to the company (just a few months), but was a full time EMT at another agency for 3 years prior, so I'm not brand new to the field.  
     
    I agree with what some of you said about it being a partnership, not the medic "in charge."   I don't like being "the boss" on the truck, am used to working more in partnership with my partners, but up till this point I was spoilt with really good, experienced partners who I could trust (both as an EMT and as a person), and whom I just clicked well with.  I didn't need to worry about simple things like even them knowing how to park the ambulance...  I've always (including before I got my medic) disliked the saying "An EMT saves the medic," I think that a good partner saves their partner, regardless of the skill level of either.   
     
    My partner and I had it out after our last call, both spoke our minds and pointed out quite bluntly some of the problems that we were having with one another.  Hopefully having it out in the open now will help us both to be more mindful and work together better, I suppose only time will tell.  I know for my part I am going to be more conscience of how I speak to my partner on calls, and trying to take time before and after calls to explain things.  
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  10. fakingpatience added a post in a topic Hypotension   

    Sorry for the long delay in the resolution of this case.  
    I ended up giving this patient 1 L of NS fluid on the way into the hospital, along with 100mcg fentanyl and 4mg zofran.  He was much more comfortable with the pain medication.  Stayed alert and oriented the entire ride, in fact joked with me "Its a good thing I'm talking to you, otherwise you wouldn't know if I'm alive!" when I was having trouble palpating a pulse.  His blood pressure was 74/41 when we arrived at the hospital, so no significant change with the fluids.   In hind site, I don't think I would have given him the L of NS, would have gone to a pressure much earlier.  
     
    Like many answers, a AAA was top of my list of differential diagnosis.   However that was not the case.   His abd was distended from ascities.  Had 7L drained off in the ER, and they could have drained more, but his pressure kept tanking.  Got put on a levaphed drip and antibiotics and admitted to ICU.  I was told he was diagnosed with peritonitis and that his "levels" were off (sorry, don't have any specific values). 
     
    I am curious why some of you would have held off on giving fentanyl, I though it is safe for hypotensive patients as it does not vasodilate like morphine would.  
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  11. fakingpatience added a post in a topic Hypotension   

     
    Crappy weather, no ones flying, sorry!
     
    For pain/ anxiolytic drugs you have fentanyl, morphine, dilaudid, ativan, valium, versed, and etomidate
    Your pressor options are dopamine, levaphed, or mixing an epi drip
     
    Out of curiosity, why are you wondering about an amnesiatic agent? 
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  12. fakingpatience added a post in a topic Hypotension   

    Aussiland:  Thank you, yes the medication is lactulose which causes his chronic diarrhea.  
     
    You start asking the patient more about his pain, he says that it is in the center of his abdomen, radiating into his back; "feels like it is ripping me in half."  Pain is 10/10.  Try as you might, you cannot feel any pulsating masses.  As mentioned before, his abdomen is extremely distended and rigid.   No molting noted in his extremities, just very very pale.  
    Attempt to lay the patient flat, but he develops a panicked expression and tells you it is much more difficult to breath.  You settle on a low semi-folwers position.  
     
    As DartmothDave suggested, when you ask this patient about his blood pressures, he says running in the mid 90s systolic is not unusual for him.  His BP was last checked after dialysis treatment 2 days ago and was in the mid 90s; was 120s systolic pre dialysis.  
     
    You have your second IV, but all you could find is a 22G in his R hand (did I mention your partner was a wizard for finding the aforementioned 18?) 
     
    Place the patient on nasal cannula at 3 lpm and his spo2 improves to 99%
     
    Start Normal Saline fluids running wide open and hit the road.  Oh, did I mention you are ~45 mins away from the nearest hospital?
       
     
    En route you go to take your next blood pressure using the autocuff and  you hear a loud hissing noise from it; the autocuff just broke (gotta love technology!)  Grab the manual blood pressure cuff, but you are unable to hear anything.  No palpable radial pulses, no palpable brachial pulses.    Patient is still Sinus tach ~110 on the monitor, AAOx4.  
     
     
    How much fluids do you give this guy?  
     
    Any pain medication? (you have morphine, dliaudid, and fentanyl at your disposal)
     
     
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  13. fakingpatience added a post in a topic Hypotension   

    Full set of vital signs:
    BP 68/42
    HR 110, sinus tach
    RR 18
    SPO2 92%
    Skin Pale, cool, diaphoretic; no jaundice noted (sclera white).  Decreased cap refill.  Good turgor.  
    Temp 36.8* C
     
    Pt c/o severe abd pain, increasing over 24 hour period.  
     
    Doesn't know what brought on feeling unless; is ill frequently, attempting to get on list for liver and kidney transplant.  
     
    Vomited 1x today, small amount, mainly bile.  
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  14. fakingpatience added a post in a topic Hypotension   

    Lung sounds have a trace of rales in the bases, otherwise clear.  
     
    Didn't get abd sounds, sorry!
    Abdomen is extremely distended, rigid, patient tells you it is normally large but not this large.    You can feel a non-pulsating mass in the upper R quadrant.
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