emt322632

I wholeheartedly agree. I myself was taught when taking the basic class, that we as EMTs or Medics do not diagnose in the field, and we were actually made to repeat this at some length. After getting my medic certification, you can't help but realize that you HAVE to make a diagnosis in the field, whether you're a basic or a medic, you HAVE to know what your patient needs, whether they truly need ALS, or whether they truly need that breathing treatment. The unfortunate thing is that Basics are still being taught this around here!! I make it a point however whenever I'm teaching them, in the back of the bus that is or during training sessions, that all that is basically B.S. and that we do in fact diagnose, and not to be afraid to put 2 and 2 together. Where I primarily practice, so many people are afraid of change, but I guess that's how it is most places, I wouldn't know I have very little experience in different regions. It's like Dust said, get on board with the future or get out altogether!:-)

My tx would have been along the same lines as all the others. O2, IV, monitor, IV benadryl 25mg, we don't carry solumedrol up here (yet, it's in the works so I've heard) keep the epi handy just in case and transport to the hospital. Any new medications this guy is on? No itching or symptoms before eating the offending cuisine? We already established the Benadryl wasn't working...no severe airway compromise so in our region we hold on the Epi unless airway compromise is noted... How's he doin otherwise? any new symptoms? tingling in his throat gotten worse? any worsening of the SOB?

I've often said something along the same lines, except it's "pain let's you know you're alive..." what I don't say is that in most situations, pain is often the result of patient stupidity. However it is our duty as healthcare professionals to attempt to make the person as comfortable as possible while we have them. We can't pass judgment, as was noted before, and if we have the capabilities, we should attempt to make the person as comfortable as possible while they are in our care.

Thanks guys, learnin alot here that I already knew but didn't know I knew...if that makes sense...basically, I just needed a little review lol...those articles are great by the way, thanks...

This is actually more of a question than a comment, I'm new to the ALS game, only had my cert a month or so. In question to Buckeyedoc's post about giving Albuterol/Atrovent to a pulmonary edema patient, I was taught by my preceptor that this was a huge no no. I understand that Lasix and NTG can cause hypotension, and with a BP of 102 I'd probably consult medical control before initiating treatment. My question is, wouldn't an albuterol/atrovent treatment potentially exacerbate things later? This is what I was taught, although I was never exactly told why it would do so...Something to do with the fact that it only dilates the bronchioles and such and does nothing for actually removing the fluid from the lungs... Just curious...someone help:-)

Wow...listening to all this sounds like a fairy tale land of magical chocolate lollipops lol...My primary squad is ALWAYS butting heads with the fire department over who should do extrication. Perfect example, today we had a 3 car MVA, and our first truck out the door was our extrication truck, no ambulances...the extrication truck. With one extrication certified person on board. This doesn't make much sense to me, especially since the Fire Department was able to muster a much better response for its rescue than we were. Only a handful of people on our squad are certified to do extrication, namely 5...and only 1 of them shows up half the time. It bugs me that this is how the squad operates, more willing to send a crash truck first out than an ambulance. But that's the way the higher ups want it, and that's how it has to be done...

You totally did the right thing. As a BLS provider we train to go on assessment over fancy toys. Even if you have the Pulse Ox, and you can see this guy is having obvious difficulty breathing, give him the mask. If he can't tolerate the mask, then it's a cannula. As someone said, 6lpm is better than no O2 at all. And honestly, if your boss can't tell when someone is having a hard time breathing, he needs to be refreshed, badly. Also, with the other guy there, if he continued to be belligerent, it would have been fun to have him hauled off by cops...just my opinon, but i like pissing people off so...:-D

Work is "Caring Professionals" Volunteer company is "Hope is on the Way" Incidentally someone at the volunteer company switched the screensaver on one of the computers...it now reads:"When seconds count, we're minutes away..." Kinda got a chuckle outta that..:-) Also, here's a good slogan for an ambulance "We see dead people" Can't believe no one thought of that lol

I asked this same question about 6 months ago when I started doing IVs in my Intermediate class. I was so freakin nervous!! It seemed I missed every IV in the field too! However, the more IVs you do, the better you'll get at it. You'll be able to judge where, and when (important in the back of a moving rig;-) to stick. Some good ideas: Only stick what you think you can get when starting out. Relax, it's not as bad as you think. Make sure you anchor the vein well so it doesn't roll on you. MAKE SURE YOU OCCLUDE THE VEIN!!! lol, I had alot of problems with this...lotsa bad looks at the hospital. Good luck in class!!

The region I operate within in NYS does not allow morphine as a standing order. The provider must request medical control clearance to administer morphine for pain. As it is, the DOH must approve all agencies to carry narcotics, and this then has to be approved by the Regional Medical director. At least this is to the best of my knowledge, I'm only an AEMT-I at the current moment, going for AEMT-CC.

In my volunteer agencies it is not required for anyone to drive, you simply do it if you wish. I never wanted to drive being a volunteer, but when I became paid, I had no choice. They put me behind the wheel, and basically just wished me good luck. I was a nervous wreck at first, hated driving...now I love driving, and want to get my driver training expedited for the volunteer sector. It's like a few have said, the more you drive, the more confident you become. Backing up the ambulance has given me trouble in the past, but it worked itself out.... Of course that was after i cracked a mirror....but i digress....

I like mixing up my PCR with a little "narrative/report". I like telling the "story" of the patient's present complaint, but also put in report type things. Ex: Subjective Assessment Upon arrival found pt. in X position c/o Y. Pt. stated etc etc. Objective Assessment Pt. has a patent airway (or non-patent). Pt. has += chest rise w/ clr. L.S. bilat. (or whatever you find) Pt. is not bleeding.(or whatever you find) I find this way works very well for me. I have yet to get a PCR back in my 1 1/2 years of doing this. As for radio reports, I usually just state the chief complaint, anything pertinent to the present injury/illness (i.e. wheezing if S.O.B.) Also vital signs, ETA, any interventions done by you or the patient, did the interventions help? Pain scale if any pain at all... I think that's pretty much it, hope it helps:)

Are Basics where you're from allowed to give Albuterol/Atrovent or Epinephrine? I know in NYS, in the REMAC system I'm in that is, a Basic can use Albuterol and Epi-Pens if they've had the REMAC class, or if their squad does an inserviec training with them. A campus first response team I'm on carries both Albuterol and Epi, and all are fully able to use them. The paid agency I work for however, seems to think that since we have fully staffed ALS rigs, Basics are somehow incapable of giving Albuterol or Epinephrine. There have been innumerable times where I have had to meet my ALS on scene, and he hasn't arrived yet. (We run a weird program here, ALS isn't required to stay in house if they live in town) I've beaten the ALS to the scene before, and had a patient that could have used Albuterol, but all I could do was stand there with my ass cheeks clenched. When is Epi and Albuterol better now or later eh? lol anyway, enough ranting, some thoughts?