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Aprz

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About Aprz

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  • Occupation EMT

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  • Gender Male

Aprz's Activity

  1. Aprz added a post in a topic Metoprolol IV for Heart Attack   

    I was researching REMSA in Reno, NV because I wanted to do my paramedic internship there. I know that paramedics can administer 5 mg Metoprolol IV x1 in STEMI if SBP > 140 and HR > 100. Critical Care Paramedics and Registered Nurses may administer Metoprolol x3 in STEMI if SBP >90 and HR > 60, may be given with nitroglycerin infusion.

    http://www.remsa-cf.com/remsa-protocols-aug-2012.pdf
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  2. Aprz added a post in a topic How to discharge a patient in 2 easy steps(and get sued in the process)   


    This is probably why Crew Resource Management (CRM) is being taught in the healthcare industry now too, primarily due to people not questioning bad decisions or speaking up.
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  3. Aprz added a post in a topic Atrial vs Ventricular origin of wide complex tachycardia   

    Tried it on myself after I read http://sixlettervariable.blogspot.com/2011/02/highlighting-atrial-activity-on-ecg-s5.html (Christopher's blog from ems12lead), and I felt like I failed.

    I tried it first without normal lead placement, and I was like "Pff.... the p-waves are small and I can see the ventricular activity big time." I then placed the leads in the normal spot to compare, and I had big time sinus arrhythmia/vagal down to a junctional rhythm I think, lol, which I confirmed by pulse palpation. It was weird... That's the only time I tried it.


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  4. Aprz added a post in a topic Canadian Temperature Scale   

    I laughed when I read


    I live in CA. Where I live particularly in CA, I joke that we find a nice warm corner to curl up into, and die, when it's below room temperature At least I know I would if it ever got that cold..
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  5. Aprz added a post in a topic Time lapse of VF   

    Awhile ago I tried figuring this out, and AHA only mentioned that there was insufficient evidence that delaying defibrillation for 2 minutes of CPR benefited the patient/increase likeliness of ROSC, which they still say, and that the medical director could put it in their protocols. I don't recall them mentioning that he right ventricle enlarges, but I guess now they do looking here.

    Thanks for bringing this up. The right ventricle enlargement and stoney heart is a new one for me.
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  6. Aprz added a post in a topic Just started at a new service, minor gripes. Documentation.   

    True that, lol, if he denied it, he denied it. I guess at that point I would say it's odd, and I think it wouldn't be useful if the patient hurt his finger, you asked him "do you think you broke it?", he replied "nope", and you wrote "patient denied breaking his finger", lol.
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  7. Aprz added a post in a topic Just started at a new service, minor gripes. Documentation.   

    I think sometimes people do inappropriately use the word "denies" like "denies having a broken finger" I think would be inappropriate. I would say that it should only be used on subjective things like feelings, and also objective things that you could not check e.g. "The patient is complaining of abdominal pain, denies having blood in his stool" sorta deal.

    For some reason, I find a lot of people who are in charge of training don't really know a whole lot. I volunteer at concerts as an EMT occasionally, and I was put with one EMT who was in charge of my group and one CPR-trained person (who also had ECSI First Responder training, but it's useless in the area). I decided that I wanted us to go over box strapping (we don't use spider straps in the area) so if we have to do it that we'll be in synced with each other. He told me "I don't know how to box strap". I said "No problem! I'll show you how." I wanted to just show our group, but he insisted that everyone volunteering at the concert learned it too. As I start demonstrating it, he all of the sudden started narrating what I was I doing and criticizing me, and then he wanted to do it with me, he started messing up, and he started telling people the wrong things. 10 minutes ago you told me you didn't know how to box strap. Now you are criticizing me and telling everyone else how to do it. I can only imagine this guy doing the same.
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  8. Aprz added a post in a topic Please help me improve my narratives   

    I think it's all right. I know you gave an example so I am not sure if it was purposely left out, but I'd write the last name and level of training from people who you received and a report from and who you gave a report to.

    "Received a report and paperwork from Smith, RN."

    It's really not that hard to ask them for their last name or look at their name tag, and be honest "Can I have your last name so I can write down who I gave a report to?"

    Like names, I think it's nice to include the department and room number (e.g. ER room 12) of the hospital too.

    I used to write non emergent too, but the company I currently work for recommended that I did not write that. They prefer that I write "without red lights and sirens" or "without warning devices" or priority/CODE it is. Something about even if it's without red lights and sirens, it could still be considered an emergency, but one that doesn't require red lights and sirens. Since you are mentioning that you transported without red lights and sirens, you minus well mention how you responded too (even though to us, it's a given that you didn't respond with 'em).

    In your first example, you forgot to mention the patient's position on the gurney.

    I think it's standard to say the medication name, dose, route, who it was administered by, when, and how the patent tolerated it. I think it would be easier to give an actual time rather than saying one hour ago "1 mg Dilaudid by Smith, RN at 1400. The patient said it reduced her pain from a 10/10 to a 7/10". At least a name, dose, and time in case your patient begins to crash during transport and you have to transfer your patient to ALS or give a report in the ED. It's no fun saying "I don't know" or "It's in the paperwork" when you are giving a report in the ED or to ALS.

    Do you have a section to write down your vital signs? Reading the PCR, it sounded like you only had one set of vital signs. It's nice to get the last one from the hospital (write a note like "VS prior to transport at sending facility by Smith, RN done at 1400 HR 72, BP 120/80, RR 16, Temperature 98.6F orally, SpO2 100% on Room Air", even vital signs you won't record that you can at least relay to the receiving facility (in my area, we don't regularly check temperature and EMT's are not allowed to do pulse oximetry so we don't have a section for it on our PCRs), a baseline set of your own on your own equipment, and at least one more to watch for trending. I believe medicare requires at least 2 sets of vital signs.

    In my area, AOx3 would be considered confused. Anyhow, you could be specific to what they were alert and oriented to "alert and oriented to person, place, time, and event". Ah, I actually see you did it in the second narrative. Yeh, just like that... I liked how you mentioned incoherently. You could also mention if they talked fast/slow, soft/loud, and if they were clear/distinct. "Speech is slow and words are mumbled."

    You said that the patient had an unsteady gait, but later on you said she can't stand. See a problem? If the patient can't stand, the patient can't gait . Is the patient unable to stand physically, is standing not recommended by the patient's doctor, does pain increase when the patient stands, did the patient refuse to stand?

    Mention if there were any changes during transport.

    Captain ToHellWithItAll is right, I don't see a physical exam in there. I don't see any physical assessment on the right leg at: Can the patient move it? Is there a scar from the incision? Does it hurt when the patient moves or stands on it? Is circulation, motor, and sensory intact? What is it like compared to the other leg? Any edema? Warm to touch?

    I think we act like witnesses and should support/verify other documentation on the patient. In other disciplines of the medical field, your documentation represents how good of a provider you are. I think that some information is considered worthless if it's partial e.g. saying "RN" instead of "Smith, RN". I'm not suggesting you would go to court over a transport like that, but if you did, I am pretty sure the court would be interested in names rather than just level of training. It's difficult for me to explain what I think would be excessive for a PCR. Like I think if the patient told me about their 4 grandchildren during transport and how one of them is really good at dodgeball, I think that is worthless information to include on a PCR, although writing about the patient being able to talk clearly and coherently, how loud or soft they spoke, how fast or slow they spoke, etc is important (especially when transporting a patient with dementia). See what I mean? I think you are on the right track with your narratives.
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  9. Aprz added a post in a topic Audio Study Guide?   

    A popular med student one is goljan's audio lectures. I dunno how well you understand it, but it's free I think, and he has a good sense of humor/keeps it entertaining.
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  10. Aprz added a post in a topic Cardiac Arrest, Hypothermia, and Resuscitation Science   

    I am gonna take a chance and do it. What's the worse that can happen?

    *one month later* They stole my wallet, took my cert, I'm homeless, and they also took my liver. I have a couple of hours to live. Oh, and they hurt a puppy.
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  11. Aprz added a post in a topic Cardiac Arrest, Hypothermia, and Resuscitation Science   

    So it's completely free and done online? It seems to good to be true.
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  12. Aprz added a post in a topic Infant/Child Restraint - Techniques and Equipment   

    I work on a dedicated critical care transport unit for an interfacility transport company, and we've had infant/pediatric patients that have not been in the best of conditions, and we still use 'em. They are really easy to use. If you took your time putting it on, it'd probably take a minute or two. There are three black seatbelts that look like gurney straps. You seatbelt it to the gurney. Then there are three gray straps that is used on the kid.

    Boring Youtube video:



    By the way, for the top part of the stretcher, make sure it is behind the bar so it doesn't stretch out/loosen when you adjust the head.
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  13. Aprz added a post in a topic Infant/Child Restraint - Techniques and Equipment   

    We use Ferno Pedi-Mates which can handle 10-40 lbs.
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  14. Aprz added a post in a topic How skilled are Paramedics when it comes to response driving ?   

    In the area I live in, the 911 units record and rate how you drive. For a brief overview of it, go to http://paramedicsplu..._Final_2012.pdf and scroll down to page 7 on "Road Safety Demystified!" I have been unsuccessful with getting hired on with that company, but I hope to someday.

    At the current IFT and previous IFT company I worked for, they have GPS units on the units so dispatchers are able to see how fast you are driving, whether you are going CODE 3 or not, and your location. I am unsure of the other information it provides. Unfortunately, it doesn't seem like they actually watch it too much or care. At my previous IFT company, I feel like they encouraged speeding. A dispatcher once joked with somebody that they were driving like a grandma when they were driving 10 mph over the speed limit.

    My partner from the previous IFT company used to speed all the time and he would complain about how slow I drove. He asked me "What if you were driving CODE 3?" I told him I'd drive 10 mph over the speed limit or slower if I felt 10 mph over wasn't safe. He then proceeded with "But the person in the back is dying. Wouldn't you drive faster for them?" I told him no. He asked "What if the paramedic told you to drive faster?" I told him nope, wouldn't drive faster. One time returning from a call and on our way back to base to clock out, he was telling me to drive faster because he needed to be somewhere quick afterwards. I continued driving the speed limit. Unfortunately in my area, I think people think it's acceptable to speed even if they are in an ambulance not going CODE.

    The only good thing they had at my previous IFT company to prevent speeding was some sort of mechanism that prevented us from driving >82 mph. Unfortunately it was also used as a method to speed on long distance transports people would regularly just press all the way down on the pedal and that was it.

    I'd like to say that age does contribute, I do believe a lot of younger people like to driver faster and feel more immortal. I'm not saying all, but I do believe a lot do. I really like what Paramedic Plus did and I think that's a really good idea. I like the GPS idea too, but it needs to be monitored better and enforced. Driving with a senior could be good, but they could be like people at my previous company who I felt encouraged speeding instead (my partner had many years on top of me, my FTO also felt I drove slow and told me to speed it up, and I've worked with supervisors/other employees who had just press their foot all the way down on the gas pedal for those long distance transports... we certainly weren't told by the company that the limit was 82 mph/we found out emperically).

    To answer the question, I think the ones in my areas aren't very skilled at all. A lot of IFT companies don't even offer EVOC or limit the number of who take it, FTO training is minimal at those companies too, employees (including supervisors, management, dispatcher) seem to accept speeding as something okay, police/high patrol doesn't seem to pull us over, I think it all adds up to no, EMTs/Paramedics are not very good drivers.

    I don't mean to hate on the guy who has two accidents on his records and I am probably setting myself up/jinxing myself (karma will get me), but don't you think two accidents in a couple of years is a sign of poor defensive driving? You don't just need to be good at not causing an accident, but also preventing/dodging them. It probably can't always be prevented, but I think two is either pretty unlucky in what I assume is less than a couple of years apart (like 1 or 2 years) or not defensive driving.

    I was in the same boat as you. Wouldn't get hired because of my age. The standard here is 21 or older cause of insurance. Recently a company moved in that hires them 18 or older, it's the first time I've seen it. Some places did hire 18 or older, but it was hard, and they teched only. This company new to this area hires them and allows them to drive which is amazing to me.

    Edit: Hi Kiwi!
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