Kaisu

Seeing the big picture means you are a clinician and not a technician. It means gathering all the pieces (signs and symptoms) and coming up with a diagnosis. In Arizona, medics are forbidden to use the word diagnosis. The reasoning is that we are too under-educated to make diagnosis and instead must state the protocol we are utilizing. This is a requirement on the PCR. We state our Impression.

A medic trained in another system where the emphasis is on underlying pathophysiology and looks for the "big picture" is looked on with suspician, labeled a "hot dog", is not fit to precept others because he/she will lead the poor lambs astray, beyond the allmighty protocol into dangerous territory.

I have to laugh. It's preferable to crying.

This is the dialogue that needs to happen in this country.

http://anarchistsoccermom.blogspot.com/2012/12/thinking-unthinkable.html?m=1

It is not about gun control.

Great stories about the bad old days. A lot of those things are still current in some parts of this country. I know because I ran in one. I was completely shell shocked to run in a rig with no 12 lead capability, no CPAP, no RSI protocols, a cascade O2 system, bite sticks and MAST trousers on board, no cell phones, fill 'em up with fluid in trauma, etc. etc. I ran with colleagues that are still being taught to administer lidocaine for PVCs.

It made for some interesting soul searching and a big lesson in picking battles..

I ran into a similar situation with a bradycardic patient who's BP was so low the automatic cuff didn't register it. The first responders on scene were in a dither because they couldn't get a large bore IV, their intention being to support the BP with a shit ton of fluid. They looked at me non-plussed when I insisted a small cath, which I obtained in 3 minutes, was plenty large enough to administer meds.

Fix the rate first dummies... it ain't rocket science.

PS.. for those that are interested, the rate was 37 to 40 afib. Patient had a new prescription for a CA channel blocker after a previous day's admission to the ER for uncontrolled afib (afib RVR for medics here in the wild wild west). Slow push of calcium chloride fixed her right up.

Excellent to see you Bernhard. You have been missed. Welcome back.

maybe if we are a little less hardass with newbies and firemen, people wont be afraid to post.. (speaking as one of the worst offenders)

I got to agree with the Captain here. Sounds like the service you are riding with is not on the ball. When we have a student come in, we all recognize that at the beginning is where we all started. A kind word and a welcoming attitude goes a long way to helping a student begin their learning experience. On a busy shift, there is not a lot of extra that we need to do except keep an eye on the kid and make sure they don't get into trouble. There is time getting to the scene where we encourage the student to be pro-active by asking questions based on the tone out information about what they expect at the scene, what they should make sure gets taken in to the scene, etc. After the call, we go over what was really there and monday morning quarterback the call.

If there are few calls, then the student gets taken to the back of the rig to explore where everything is and what its used for. We have gone as far as scene playing where one of the medics is the patient and the student runs the call.

It is an honor to precept students. We are usually the only experience they are going to get and it behooves us to make sure that student gets the most out of the situation that they can.

I am sorry that a lot of students do not get this.

What has she ingested or been exposed to in the last 24 hours? Is she the smoker? (I am assuming she is based on her O2 sat)

Good shit....

PS.. I read your book and loved it. Did you REALLY blow dart your partner? Laughed till I peed

I am very happy for you medicgirl. You are far too young to be saddled with a chronic back problem and I am really glad the surgery went well.

Did this happen while you were reclining? I'm inclined to think regurgitation.... edit... sorry - meant reflux. Stop eating all that fatty crap before bed.

edit PS Glad you are OK. Would really miss you..

PPS - about a third of cardiac patients have no symptoms of cardiac until the MI - when 50% of them die. thus our concern

... and he calls me pigheaded. Get your fat ass to the doctor Dwayne, or I will storm down there and kick the farts out of you...

I echo island.. Good advice. Do it!

Like so much in EMS, there are no studies out there. Opinions, like assholes and everyone has one. It can be very frustrating, especially for those that want to move the profession forward.

I assume you've done the usual internet searches.

edited to remove a dumb question

Bonjour. Welcome to the site and thank you for an informative and interesting first post. I hope you stay and contribute. Bienvenue

"... Brooklyn volunteer firefighter ..." I've seen the way some of these "heros" respond to calls as my Wisconsin home has a school zone directly in front of it. I think the cops should just shoot them.

well darn.. missed out... next year I'll jump on it.

These dudes are in EMS medicgirl.. they don't have a bead to put in.....

You disgusting old pervs... leave that beautiful young thing alone... C'mere by me Patton - let me fill you in on these ijits

Is it both days? or just one day? which day are you going?

Uncontrolled for rates over 100, controlled for rates under 100. Don't know why this terminology, but it was in use in school, clinical sites and approved ride-along services. Maybe it's a regional thing, although I continued to use this terminology in a state 2000 miles away from where I went to school and had no-one (except medics) comment on it. By that I mean ER physicians and nurses all knew what I meant.

BEoP if you look at V4 V5 V6 you will see that the rate has slowed enough that the absence of P waves is quite clear. The irregularity is also obvious. Most call this Afib with RVR. I was taught to call it uncontrolled afib. It is helpful to print long rhythm strips in these cases as you will often catch a spot where the rate is slow enough to diagnose.

One of the reasons we sometimes administer adenosine is to slow the rate enough to determine what it is.

You must admit that a respiratory rate of 30 is indicative of an issue as opposed to a rate of say 16, as is a rate of say 6

Thank you for clarifying that. Forgive my paranoid and suspicious mind.