Inf

So I've been thinking of dipping my toe back into this madness of a field and taking a CCEMTP course - is it even worth it?  Not trying to troll but I'm currently making 2x whatever the highest medic salary is, and its purely for the satisfaction of making a difference in someone's life that I would even bother attempting this. Is there such an agency that does inter-facility critical care transport on a regular basis whether its fixed-winged or rotary that does not feel like a regular 'grunt' ALS work of 911 EMS?

These are battle-tested and something I'm comfortable with:

1. Aspirin

2. Benadryl

3. Morphine

4. Lidocaine

5. Cipro

That is certainly the allure of a rural setting where you can almost be a part of the holistic healthcare that patients should get.  In the ideal world we would have medics provide most of the care that these patients receive in ERs, instead of hospitalizing these patients and charging their insurance thousands of dollars, subjecting them to undue stress of transport and potential risk associated with it.  Most paramedics should be able to insert GT tubes, perform debridement and other minor critical care procedures.   We should be pushing for more education and expanding the scope, as nurses are overwhelmed with the load and healthcare costs are prohibitively high.  EMS can certainly disrupt that market and provide high-quality just-in-time healthcare service that we all expect.  We need to start caring about people and society and stop putting profits as the highest priority.

And another thing.. why is AMA such a collection of scumbags?  Seriously.  Why?

Maybe its the urban setting, but I've never had that kind of downtime.  Also spending more than 20 minutes in NYC requires you to give you an update, as there have been potential times when EMTs done some bad things on scene involving patients.  You never want EMTs/medics to spend more than 30 minutes on scene of any emergency IMHO.

If you mean SAT exams like for college, no you don't have to. Most programs are either community college level or certificate programs. If done right the process should take you about 2 years from start to finish. This includes a 4-6 months EMT-Basic program, working as an EMT for 6 months before starting medic school and then another year for paramuppet studies. Good luck and if you have a choice, I'd go to Canada.

Alright so I did not read this thread, so I'll just ask - why would you want to work in the middle of Bumblefucktown, USA when you could be doing real work and actually learning something? If you are young, move to a big city and get an apartment, get a job as an EMT/medic/fireman/cop/whatever and pound the pavement for 5-10 years.  Really understand the salt of this Earth and what is 'real' - and then you can move back to Utah or Pennsylvania or whatever 1 person/sq mile area you were born in, and "settle in", and grow a gut and grow out your hair like a god damn hippy 

"I don't look to get paid for calls more of a just being a good citizen since I have more medical skills than 99% of the people here."

"I work with a bunch of old men who all think the world revolves around them individually"

Ok so I think, and please bear with me here, that you feel as though there is more to learn, and that there are surrounded by people who don't want to learn.

I refuse to believe that you are conceited and that you think you're better than everyone else, that is just an unsustainable state for a human being.

Instead, I believe you feel different because you have always felt different, perhaps there was an inflection point where you've really decoupled from society and went on your own way..

When I become an EMT, I thought I knew a lot, and I was eager to help people and to make a difference..

When I became a medic, I thought of how little I knew as an EMT, and how naive my thought patterns where..

When I got my first masters degree, I thought how little I knew as a medic, and how pointless all of it was..

When I got my second masters, I thought perhaps I could be humiliated even further and realize how little I knew or understood, and I needed to get a doctoral degree..

Needless to say, this progression does not change in life.  The more you know the more you realize how little you know.

I agree with you that there are some people who refuse to keep learning for various reasons, and honestly we cant be bothered with reacting to them or trying to change them.  There is no net benefit there.

Instead try to connect with people who 'get' you. Try to build on your ideas and improve the world.

Its a big ask and I'm glad there are people 10+ years younger than me who are willing to try.

Thing about burnout is.. its a smoldering fire yearning to become a flashover. You may not notice it until you are in it, and by then you are helpless to stop it. You should take a break and by break I mean do something else for 5-10 years, and if you still want to do this, it will still be there. It will always be there, waiting to take a bite out of you, taking everything you have and giving nothing back.

If you just starting out.. 3M Littmann Lightweight II S.E is a great scope, goes for 46-48 bucks on AMZN, looks like a U.  The more elite versions are the cardiology ones that look like a V, but I've personally found them to be less useful than classic.  The cardiology scopes look great but the sound is dull.

Hmm.. Having worked with some great and not-so-great medics, I have some ambivalence about this. Personally I've tubed over a 100 patients, from newborns to 90+ year olds. In my humble opinion if you haven't gotten the proper training under supervision of an ER doc or an anesthesiologist, you are more dangerous than beneficial to your patient. That being said, taking away this tool from someone with proper training and experience is not a good idea. The problem is that the wiser/smarter/more educated you are, the less likely you are to stay in this field.

The only thing I would recommend young EMTs just starting out is to hit the gym regularly. You may not need the physical conditioning 80% of the time on the job, but when you do, you will be glad you had the stamina and physical strength to raise to the challenge. Your partner will also be glad you can lift properly and not put their back and patient's safety in jeopardy. I've seen 6' guys that were dangerously out of shape, and 4'9" females that were better conditioned and capable, so you have to do your best, and don't take it personally.

I got out of the field 7 years ago and although I occasionally look back over my shoulder and miss parts of my former career, I can tell you this much.. get out as soon as you can.  The back doesn't heal back and is a constant reminder of the past.  After doubling and tripling my salary in the private sector doing office work in front of a computer, I can not believe the nerve that society has to pay so little to paramedics and EMTs.  Its a young man's job, not a career.  You will develop character, but don't push it past the point of no return - don't become a salty, cranky old man, or some angel of death alcoholic. Don't spend more than 5 years in EMS, its not worth it.

Now as for alternatives to this lifestyle.. look beyond the present, and to the future.  Look into synthetic biology, machine learning, biomedical engineering, and technology management.  There is a better way to live and to exist as a human being, and most people will never be lucky enough to experience it because they are stuck on an endless capitalist treadmill, unhealthy, depressed, and steadily getting dumber.  Break through the doubt, and believe in yourself as a human being.  You can do more, and be more, you just need to try.

I took a 3 year vacation from being a paramedic, best time ever. Doubled my salary, got a masters degree, lost extra pounds, and have a regular sleep cycle. I'll recommend it for anyone

Hey INF, how about trying this: After you have actually administered atropine to 10-15 patients, you can come in here and tell us all about it.

What does that even mean? I could walk before you were even a sperm in your drunk daddy's balls.

This statement is closed-minded, dogmatic, intentionally inflammatory, and wrong. It is not malpractice, and I don't know who convinced you of that. As illustrated in previous posts, there are clinical indications for atropine in heart block.

Are you being intentionally dense? First of all you keep talking about Atropine like it is used for any heartblock. I don't know what they teach you in the Caribbeans, but here in the states we prefer evidence-based medicine. Atropine in 3rd degree blocks is well documented to cause a cardiac arrest.

You do realise atropine also inhibits the action of acetylcholine on M2 muscarinic receptors? We also have M2 muscarinic receptors in the AV node. Inhibiting the parasympathetic nervous system here can increase conduction through the AV area of the heart and may actually work in some cases of complete heart block.

In addition, as Doczilla stated, there are many different types of pathology that can cause a high grade heart block and some of them may respond to atropine.

Again, I see no problem with a trial of atropine while we are setting our patient up for external pacing.

Take care,

chbare.

That is all fine, but its not our job to sit there and figure out the diagnosis. We manage symptoms, and most efficient way to manage the bradycardia is transcutaneous pacing. You can spend an entire hour there trying to figure out H's and T's and that is fine, but its a job best left for the clinical setting.

And sure, 0.5 - 1.0 mg of Atropine right before TCP is not going to hurt the patient, provided you restore the ventricular contractions right after you administer it by pacing

Ok, so then we should all be buried alive if we administer Adenosine because there have been cases of Adenosine induced Asystole in SVT and since that further endangers the health of the patient then we should not give it by your line of reasoning.

I've looked all over on reputable drug references and do not see any Absolute contraindications to Atropine administration in relation to heart blocks.

Just sayin

Lets stick to Atropine. Logically speaking, we all agree that for a complete heart block, i.e no signal transduction between SA or AV node and ventricles is occuring, Atropine will have no benefit. Further, we all can agree that by administering Atropine, you allowing sympathetic nervous system to accelerate the atrium, perhaps increasing the atrial kick, which I will agree is a beneficial thing.

However, in literature I've reviewed, the Atrial tachycardia actually decreased cardiac output and blood pressure, thus decreasing perfusion to the ventricles. It was in part due to the ventricular tachycardia that followed, thus decreasing the inotropic effectiveness. In the case of a 3rd degree block, you are not affecting the ventricles, but you are increasing an atrial kick, but considering you only increasing cardiac preload, do you really benefit the cardiac output? Simultaneously you have a drop in pO2 in the RCA and in conjunction with an ischemia and ectopic centers in the ventricles you will aggravate the situation.

Bottom line is, to me, transcutaneous pacing has always been the best treatment modality. You cause pain thus increase the sympathetic response causing vasoconstriction, inotropic, dromotropic, chronotropic effects on the pump, and most importantly restore the blood flow via ventricular stimulation.

Its like a symphony of the cadence of life. It just works. Atropine, on the other hand, is a very dangerous alternative therapy. Just my humble opinion. In truth, I like to be in control. By external pacing you are taking over the functions of the SA or AV node, thus establishing yourself to be in charge, and having the pads already on the patient will let you cardiovert should the need arise. In the cases of acute MI, which can cause the heart block in question, the biggest concern is deterioration into VF/VT. Having pads already on the patient will let you rectify that possibility, and free up your hands to draw up Amiodarone or Lidocaine. To me its never about just one condition, its anticipating what will follow next and being ready for it right now and not once the condition presents itself.

You should be buried alive if you administer Atropine for 3rd degree block. There are cases of Atropine induced VF in 3rd degree block, and if you think about it, Atropine will increase the atrial contraction rate, thus decreasing pO2 in RCA and decreasing available oxygen for the ventricles. If you administer Atropine for 3rd degree block you are in essence malpracticing medicine, as it offers no benefit whatsoever, and causes side effects associated with Atropine, and further endangers the health of the patient.

As I recall it, NREMT-P exam was the easiest I've ever taken and passed. The hardest exam I've ever taken was administered by North Shore LIJ hospital for their job interview. Cheer up, it will get a lot harder and humbling down the road, so pick yourself up now and try again.

Well if the heart block is due to an acute MI, then Atropine will worsen things by unopposed sympathetic stimulation, irritating the ventricles into SVT, VF, or VT, not to mention increased oxygen demand by the heart which could lead to further ischemia. For 3rd degree block the blockage is usually below the AV node, so Atropine will not be beneficial, not to mention the side effects that are associated with Atropine.

Personally, with "BP at 62/P, HR at 44, RR 10 with poor chest rise, PT is Altered LOC" I would have my partner assist ventilations with BVM and supplimental O2, start an IV, consider sedation with Etomidate and go straight for transcutaneous pacing.

On the other hand, if you have a patient with BP of 80-90, HR 40-50 and symptomatic 1st degree block or 2nd type I block, then 0.5 mg Atropine rapid IV bolus might be beneficial, again provided that there is no suspicion of MI after you've done a thorough clinical assessment and 12-lead EKG.

Slow heart rate and low blood pressure are not necessarily going to kill the patient. I've seen a patient with HR of 30 and BP of 40/20 who was well oxygenated and responsive to voice stimuli, with her eyes open

Well I came, I saw, I donated. Good luck.

Practical Joke Fail

http://www.nola.com/crime/index.ssf/2009/09/jpso_announces_arrest_in_broke.html

Part 1

Part 2

Part 3

Part 4

I thought it was funny in a sense of how stupid people are.

same way girls who are 5'3" deal with guys who are 6' tall.. they get on their knees!

Our local hospital doesn't have any key code on the ambulance entrance door. It's inside a bay, so you've got to have a garage door opener on the correct frequency to get to the door. There are cameras set there so the nurses can watch who comes and goes in that area.

The hospitals we do IFTs to have a variety of codes. I've seen the variation on 911 and just about everything else, I think.

Someone commented about the numbers being worn off on the key pads. I've seen the solution to that too. Some of the places we have for IFTs have gotten keypads that are lit from the inside with clear buttons. Everytime they're activated the numbers are in a different place. I just wish they'd put them higher than waste level. (Even with me only being 5'3", they are on the low side. I'd hate to see how the guys who are 6' deal with them.)

Just wash your hands after you use the keypad, before you touch the patient to take vitals, and after your touch the patient, and after you finish the ACR, and alcohol when you get in the bus :roll:

seems like common sense to me

BRAVO SPENAC!

Stand your ground. We in America are being de-sensitized and brain washed by the system. Leave us alone and allow us to raise our children. If the father and mother did (as the articles stated) the necessary means to evaluate the son and if then they felt he was fine- then leave him be. Let him go. Don’t try to twist arms and bully a family. As for the father refusing to sign the release form- Kudos to him. He didn’t call the EMS’ I wouldn’t sign it either! As a mother of 3 children, whom I have raised on my own (their father drove a truck the entire 12 years we where married) I will be the first to tell you if it was me in this situation, there would be HECK to pay for any one interfering. My children are MY blessing and they are intrusted to me to raise. So allow me to do it. They are MY flesh and blood, I will care for them. NO one will interfere or try to tell me what I can or can not do. This family in the article should be allowed the same stance. It was wrong for the Paramedics, Law Enforcment and Family Services to interfere.

I have been on the other hand of the Law where my children are concerned, I know how this father feels. I have a child with special needs. She has a behavioral disorder. Diagnosed by medical professionals at the age of 3, she has received treatment and counseling. I, as a parent, have taken classes to learn how to care for her; and received counseling of my own.

To the out side world, to the G.P. MY life and that of my childs is none of your business and when a nosey neighbor feels she should call family services because she doesn’t agree with my way of handling my child; IN her face when the Sheriffs department visited her and outlined the fact that I could press charges for harassment should she call on me again. (after family services and law enforcment did a through investigation it was clear for the 6 time nothing was amis at my house)

We have laws that protect our privacy and our rights as parents and the public should honor that. In the end we as parents will win if we stand our ground but all that is going to happen is much like these articles. It gets ugly, messy, names get drug through the mud and the press goes crazy. People debate, throw their weight around and think they know what is best. In the end, bottom line, WHO is the parent and was that childs welfare at risk? OR did we waste valuable TAX DOLLARS—YES YOUR HARD EARNED MONEY, on government resources to pacify a nosey busy body neighbor who thinks they know what is best for a child who is not there own.

What happened to this family is a shame. A pure shame and is the result of a bully system.

As a child who lost her mother to domestic violence and was raised at the hands of a mentally abusive and emotionally neglecting step mother; I will stand strong and say the system is OVER BOARD to the wrong direction tying to make up for years of ignorance and oversight. It seems to me the children that truly need help are not getting it and the ones that are not in harm are the ones getting pursued.

I have my own opinions and views on that but lets save it for another day….my rant is long enough aleady!

incognito, go back to your trailer and stop spewing nonsense over the airways.

you as a parent give up a lot of rights once you decide to conceive a child. abortion is illegal during 3rd trimester, beating your kid is illegal, and condoms are free. the child doesn't have the mental aptitude to determine whether he needs medical attention and its parents with an attitude like yours that the laws were created against.

"Vietnam paramedic" doesn't mean anything. If social workers got the judge to get a warrant after seeing a 'huge hematoma and a blown pupil' then the raid was justified, and the media portraing this story as an '11 year old son kidnapped by swat team' is the real problem.