MSDeltaFlt

yes, what I was referring to is the paramedic who now signs his name as ruffems, CCEMT-P but up until their weekend journey into critical care paramedic program they signed their name as Ruffems, emt-p or ruffems, nremt-p

Not where I live and work. When I work in respiratory, I sign my name M. Hester, RRT on all the charts. The same goes with EMS. When I'm flying or on the truck, I sign my name M. Hester, NREMT-P. I cannot put both at the same time. When I'm clocked in as a respiratory therapist, I sign as a respiratory therapist. When I'm clocked in as a medic, I sign as a medic.

You are restricted to placing only the credentials you hold in the field you are working as it pertains to the job dcescription you are in as it is governed by your state and employer.

so in other words these two paramedics were using the ccemt-p out of context and when asked what their level of certification was and their reply was Critical Care Paramedic was WRONG!!!!!!!!!!!!

Yes and no. In a way they were correct, but then again, they weren't entirely correct either. Once you complete the UMBC course and pass the exam, you have an option of patches/pins to receive. One say Critical Care Transport. One says Critical Care Paramedic. Guess which ones the medics will order? Here's the link.

http://ehs.umbc.edu/ce/CCEMT-P/CCEMTPStore/cloacces.html

Yes, they are critical care paramedics. However, your state is like my state. It does not recognize it. You can call yourself that all day long. You can write that behind your name on just about anything and just about everything...except a pt's chart, or on any legal document. So long as your area does not recognize it. Once it does, you can. It's not unlike graduating a paramedic course. You are a paramedic. However, you're not a Nationally Registered Paramedic until you pass the National Registry.

Hope this helps.

Hey everyone,

So the question I pose: Have you ever hit a sign?

I'll be honest I have. I'm a new driver, I'm a "baby EMT" by my own admittance ... yeah I'm learning! So I clipped a sign and now I'm catching a whole bunch of sh*t ... you know ... normal EMS manner ... so I did what every smart @$$ does .... I asked my fellow crew members if THEY'VE ever hit a sign. Of course they all said that they've never hit a sign ... :roll: .. so ... clip any curbs and get a sign to boot?

I did. And to be honest, I backed into a huge roll-off dumpster; I didn't hurt anyone and they were minimal scratches ... if any ... on the truck ... so if people want to get all uppidy about stupid bs like that .. I should just take the new truck instead of the oldest truck next week ...

Am I alone in the world of EMS driving? I don't really think I am but I figured I'd ask ... ever hit a sign?

*edited for vague terminology* In terms of "hitting" a sign, I mean clipping it with the end of the truck. I was backing down a road and hit a sign that was on a telephone pole. Well, I backed down the road without hitting the sign, when I left I didn't take the turn wide enough and scraped the back end of the truck on the sign; I forgot it was there but I was mos definitely not the first person to hit it ... but that doesn't really matter. So ... have you ever clipped a sign?

I can respect that. Although I have never hit any signs or anything of the like, I have been riding shotgun half asleep when a very large owl flew into the box of my ambulance just above the cab on my side. A good 3-4 ft wing span. Scared the living sh*t out of me.

In the dept I was recently hired on with ive noticed one thing that is consistant at most of our stations.

And that is, everyone wants the initial B/P taken manually, and that it should never be taken over a sleeved arm. I have been on units in several of my surrounding counties due to paramedic school ride time, and no one pushes like my dept as far as b/p taking goes.

How do you all feel about it and what is your personal practice.

Second, I have noticed from all the way back to emt school, no teo people like their leads put in the same spots. Some like them next to the clavicles, some like the arms, some like the wrists.

And along with that, some like the upper thigh region, the thighs themselves, the ankles, the top of the ankles the sides as well.

Where do you prefer their placement and why.

I know this is simple stuff, but im always curious as to the habits of different medics. I know many of them have come from, "Thats the way they were shown" and it just stuck with them.

As far as BP goes: I like manuals on bare skin. They are more accurate. Yes, one layer of thin cloth won't make any difference, but keeping good habits greatly decrease your risk of compromise when your pt cannot afford for you to compromise.

As far lead placement goes: It depends. If you want to just monitor, then it doesn't really matter where you place the leads - clavicles, arms, wrists. All you're looking for is the HR.

If you're looking to assess, then lead placement is key. RA stands for Right Arm. Put it on the right arm. The further down the arm the better, but it must be on the arm. The same thing goes for LL. "Left Leg", not "Left Lower" abdomen. If the leads are not in the correct place for assessment, then the readings will be "skewed" and, therefore, completely wrong.

Albuterol in CHF?!? I believe this horse is dead. NASA called. They said they can see the boot prints from orbit.

I don't mind any music at all as long as everyone is on the same page. I have just one stipulation. Absolutely no static. It drives me nuts. If there is a lot of static, I tell my partner there are two options: 1. get off the channel with the static (change channel or go to CD), or 2. turn the radio off.

I can only hope that people aren't waiting to see the trachea deviate before they decide to do something.

I certainly hope they don't either. That would just be wrong on so many levels.

If you see the late sign of tracheal deviation, it's amazing how fast it will straighten up after you do it.

Buff?!?!?!?

... I'm sorry. Probably shouldn't get on these forums after and while enjoying over a bottle of wine on my day off. I took it as a sexual statement. I was starting to get concerned.

Where I come from, we call it both "jumping calls" and "skud running" (in the aeromedical industry). We don't do that. We may listen on the scanner, but we won't jump calls. That's just rude.

Typing's a little tough. Damn, this sauvignon blanc is good.

There are several cliche's going on here.

1. One bad apple spoils the bunch.

2. A person is smart. People are stupid

3. Too many chefs spoil the broth

The list just goes on.

A small portion of medics (or just one) who, for one reason or another, misinterpreted a 12 Lead, got the ball rolling at 2 am, getting the cath lab out uncecessarily too many times... this tends to get doctors pissed. When they get pissed, heads roll; and we are cannon fodder. And I will bet you money that just one physician was made upset and voiced a complaint. That's usually all it takes.

The best thing to do is go ahead and transmit all the 12 leads, and get with ALL of the bigwigs to set up inservices to the cardiologists' liking, making it mandatory so the medics can get paid, and start up a QA/QI with a 100% review to see how well you guys are progressing.

Once you prove all of this to those doctors, they'll let you guys get back to calling them in the field. As they are giving you their blessings with a pat on the back and a handshake telling you, "Good job", you can smile, shake their hand all the while thinking to yourselves, "****** ******, we've been doing this good the whole time. Your rectocerebral inversion syndrome just prevented you from seeing it".

That last paragraph was just a rant, but you get my drift... with or without the insinuated profanity.

Good luck.

Are they on antihypoglycemic meds? There's one in my area (on the tip of my tongue and can't remember it) that is long acting. If the pt takes too much, then their sugar drops low and stays low. D50 won't keep it up. They need admition and put on a D10 drip with frequent Accu checks until they get it out of their system and then modify the dosing regimen or change meds all together.

There's another point to this story. When we call trauma alerts, depending on the level called, that starts dominoes rolling that some may not be aware. The on call MD's have certain time limits to be at the bedside, depending on the area. My area, a level I means that the on call has 30 mins to be at the bedside. A level II just needs to be scanned within 30min.

Now when a physician gets called out for a level I on an actual level II or III at 2 am enough times, they will get pissed off enough to complain to the state. MD/DO opinions carry a bit more weight than ours. And the state ends up having to do as they are told. It's a big political "broo-ha-ha".

Should they be thrown away completely? No. It just means that EVERBODY, MD's/DO's included for their imput, need more education and training.

This sounds like a stretch because there is not enough information here. Is he completely deaf or hearing impaired? If he can hear enough to work in EMS on a 911 truck, then there are amplified stethescopes out there that should help out fine. I have a Littmann that can also record breath sounds. I use it to record breath sounds for RT/EMS/nursing students that have a hard time learning different breath sounds. I also use it to auscultate difficult BP's at altitude. It gets pretty loud. I like it.

Here's the deal. My pt had better prove to me that they DON'T need something done. They called me for a reason.

I've used Epi drip when Dopamine was maxed out.

Because a probe "fits" does not mean it is the correct technology, as in transmittance or reflective, for that particular site. A lack of understanding how the technology works has burned more than one professional in court.

For some manufacturers, the neonatal probe, which is designed to be placed on the infant's foot may be used on an adult finger. Almost all manufacturers discourage the use of finger probes on the ear lobe or forehead.

Nellcor and Masimo went to great lengths to explain the discreptancies between the different probes when used in ways they were not intended. The ear probe was not invented just for the company to make another sale.

So do your patients a favor and read your manual and/or consult that specific equipment's clinical representative to learn the probe's intended application. Just because you have seen "everyone" do something, does not always mean they received the correct training but rather went with the "it fits" mentality.

I agree whole heartedly. If the pulse ox is not going to read, then it's not going to read. Treat clinically using oral mucosa, conjunctiva, LOC, RR rate/quality, breath sounds, and the like.

But this reminds me of back in my resp days...

ICU nurse went to check her pt. Vitals were all reading within normal range. Even the pulse ox showed a beautiful saw tooth waveform. She looked at the monitor (including the pleth), and noticed the pt's hands had no pulse ox probe on any of his fingers. So, she followed the pulse ox wire from the monitor searching where the probe was and found out that the pt, in his altered stated, had placed the probe on another appendage of approximate size. I heard her shout, "Mr So and So! It doesn't go there!"

I laughed so hard I shot coffee out of my nose.

"Tight" breath sounds is not official. Basically what it is bilateral wheeze with decreased air exchange up to and including not being able to hear any wheeze at all. If you hear no wheeze, minimal air exchange (sometimes none), and see gross assessory muscle use with tracheal tugging, tripoding, nasal flaring, and apprehension, I'd say that pt is "tight".

It could be argued that the pt is still wheezing, but there is such little air exchange that there is not enough air to make the wheeze audible, or they are wheezing but at such a high pitch that it is beyond our auditory range that we just can't hear it.

Just my thoughts.

If I am working in the ED, I love to hear the Thumper coming in if I don't want to start up a ventilator for the ICU. I have not seen many success stories come out of its use over the past 20+ years. I have seen it thump a lot of different parts of the body besides the sternum.

The Autopulse is just hitting our area so I can not say much about it from personal experience.

That's funny.

"Where'd this pt get his black eye from?"

"Beats the hell out of me doc, but you oughta see this new contraption. It's cool."

But in all serirousness, at the service I work part time, we've had a few issues with some medics and pronouncing cariac arrests. Therefore, our protocol has been changed to work a fresh code for 20 min on scene, then call Med Control, and they will advise. Sometimes you'll be transporting that dead person 30 miles all the way to the hospital. Usually you won't, but sometimes you will.

It's times like that when the service needs a contract with Gatorade to have some waiting for the crew after the call. Damn, that's exhausting.

That must have been hilarious (unless you happen to be one of the nurses).

All over the nurses, patient, code chart... the TV on the far wall. Yeah, it was bad.

lol@subject! Were you a cop dispatcher in a previous life?

First thing we have to teach cop dispatchers about dispatching EMS: Our patients are not "subjects", our callers are not "complainants", and don't preface every statement with "be advised".

But the most memorable "duh" moment that comes to mind was from back in my EMT days. Went to pick up some school girl at a suburban ER and transfer her to a larger hospital. Her diagnosis was meningitis. Thinking I would impress the ER doc with my vast knowledge of hospital medicine, I asked him if he'd done an LP on the patient. He just shot me an annoyed look and said, "No, I just used my tricorder". :oops:

Back during my respiratory days:

Did you know that a bottle of Tincter of Benzoin does NOT need to shaken well before use? ...especially while the flip top is still open? Boy, those nurses were pissed.

Here's the way I take it. Firefighter with 6 mos exp = "greener 'n' goose sh*t in August". The paramedics and other experienced crew members on scene helped him. Basically they were letting the new kid get his share of the spot light. Way to go. He did a good job.

When it comes to OB's giving birth, it's natural. This is what happens when you lay in bed all day screaming "Oh, God! Oh, God! Oh, God!" without protection. I believe everybody here are living manifestations of that very same situation. I know I am.

This is also a testament to the EMS crew. The article also reads to the stability of the scene, which probably led to the seasoned crew letting the new guy gain some vital experience. My hat off to the seasoned crew.

Just my thoughts.

Where do the "objective" observations from your physical exam go in this system, or do they?

One helpful hint about charting your exam results is to simply picture the body in your mind, from head to toe, and work your way down. That keeps everything in a logical order and helps you avoid leaving things out. Too many people start writing down the observations that are most prominent to the condition, and then either forget or draw a blank on charting the rest of the exam results. If you start at the head, charting pupils, ears, mouth, neck, etc..., and then work your way all the way down, you are much less likely to leave out key findings.

Dust is right. I would only add that not only should you chart the pertinent positives, but also the pertinent negatives. What do you find and what do you NOT find? The whole picture must be painted on your physical exam.

Also, the EtCO2 waveform is one of the two field confirmations of ETT placement. The other one being direct visualization. This is all mute if your monitor cannot print off the waveform. It cannot be confirmed if you cannot prove it with documentation.

Page 17 of the "Riding The Wave" link above shows pretty much what the proper waveform looks like. To me that is more important than just the number itself.

EtCO2 has about a +/- 5 torr margin of error to ABG's PaCO2; usually minus, but not every time. It is also dependent on cardiac output. If they're dead, they're not going to have that much of a cardiac output if any at all. You need to keep that in mind when looking at the waveform.

I'll let Vent work her magic from here.

Not enough information. Need VS, breath sounds (Rales? Rhonchi?), and quality of respirations. Tracheal tugging? Other assessory muscle use?

I use the DCHART method going by body systems on "A" covering Head, Neck, Chest, Abd, Pelvis, Back, Ext in that order on each and every pt stating pertinent positives AND pertinent negatives. Even the refusals.