Thunderchild145

Rookie syndrome. lol. (Not a bad thing. Happens to everyone.) at this point all I have in my EMT pants is a pen, and another pen in case I lose that pen.

Going straight to medic school from EMT school?

Yea. Don't buy a Littman till you know you are going to be doing this for a long time. I didn't get a stethoscope more expensive than $20 until I was enrolled in paramedic school.

I just started medic school 4 weeks ago. It's difficult, but I'd be lieing if I said I didn't expect that. Thanks for all the advice.

I have to admit, I appreciate calls where nothing is really wrong with the patient. Even when we do transfers I like to do a quick assessment of the patient. V/S, Lung sounds, that sort. It's like Dust, and coincedentally enough, my medic instructor said "If you know what normal is, it makes abnormal easier to recognise."

If you want to talk about confusing: The ambulance is referred to as a truck, IE "Get in the truck." On the radio, the ambulance is referred to as a Unit, IE "Unit 11, respond to blah blah blah". When referring to a specific ambulance, they are trucks, IE "Truck 1 is going to be Unit 11 today." On the radio, a truck refers to the captain/lieutenant's vehicle IE, "Truck 11 is responding with Unit 11 to 311 North Hills." I still call the ambulance a truck, though cause I assume what you ment is what we call the ambulance is a casual sense. (The first example)

Eh. I was wrong. It's not actually contraindicated but because it tends to increase myocardial oxygen demand it is not recommended in the protocols. (Class IIb) After rereading it it doesnt say "contraindicated". Just says "with caution"

Our protocols here say dopamine is contraindicated with AMI, So I would try atropine, 0.5mg every 3-5 up to a max dose of 3, try to get up her heart rate and improve BP. I would try to not give too much though cause I would not want to increase the myocardial damage.

Eh. After looking at it a bit more, I still think A-fib but the "ectopic beats" I talked about earlier could very well be Ashman's or even just artifact. As far as lidocaine, thats definatly a no, but amiodarone would be fine if you believe those are PVCs as amiodarone is sometimes useful in slowing the ventricular rate associated with rapid atrial dysrhythmias (like A-fib or SVT). Furthermore I don't think adenosine would hurt, if nothing else then to slow down the rate and let you see what is going on. Again, being mindful of contraindications. And lastly, I was a monitor tech for 3 years before I started medic school. You may get lucky with these types of rhythms every once and a while, and you may get good at reading them, but it never hurts to ask someone else what they think it is. Every person reads strips differently, so if someone says it might be SVT and I think it's A-fib, I look for both. I'm still interested to hear what you think it is, but like everyone else said, unless you happen to be an MD, don't tell me I'm "wrong"

part

I've never seen SVT be the cause of cardiac arrest. SVT being the cause of significant perfusion problems? Yea. PEA? No. So, my recommendations are fluid bolus and then escalating cardioversion (up to 360). If Sync-ing at 360 doesn't fix this, then you might want to consider something else. (Like Transport)

Actually, it's a seperate certification. EMT-Basic in Arkansas is your run of the mill NREMT-B. EMT-A has a longer program. More education, more clinicals, more testing. Much harder than EMT-B. (I know, that isn't saying much)

Arkansas has CFRs (Certified First Responders). EMT-P in Arkansas is licenced and an AAS version is offered, but not required. EMT-I I know is typicall the NREMT-I/85. I havn't seen I/99 around here and I don't know if they have a license or a certification.

Again, maybe I have no place in speaking seeing as how my "EMT-Basic" course was actually a "EMT-Ambulance" course and my certification actually says "Paramedic Assistant". Thought I do understand that that is because of more education. (EMT-A is about 2-2.5 times longer than EMT-B in AR, at least up here in my corner of the state.)

Eh. Well I do know of cases where combitubes are used by basics in some states. They're not used by basics here. IMO, let's let basics do BLS skills, medics do ALS skills, let bygones be bygones and stop bickering. ;-) After all, a good basic is more of a paramedic assistant than anything. Also, don't generalize. "Basics" aren't stupid, nor lacking in education. Well, lacking in education to perform ALS skills, but not to perform BLS or even assist with ALS. (IE, I know my partner has a ruetine. Shock, Tube, IV. As such, while he's shocking I get the laryngescope and tubes out. I also know he likes to use a Mac #3 and an 8 ETT. When he moves to tube, I set up his IV equipment. That's what I see my job as. Yes, I want to perform ALS skills, and (here it comes) THAT'S WHY I'M ENROLLED IN PARAMEDIC SCHOOL!) As an EMT-B, there are only so many things you can do, and so many more that you can't do. It's just the SoP. Get used to it. Lastly, in response to the original post, ETT versus combitube, the ruling is ETT by miles.

Accuracy is really only important to me in a couple of places. IE, if the pt needs adenosine and they get amiodarone, just because it starts with "a" doesn't make it "close enough". This isn't an exact referance, either. Just something that will bug (not anger, merely 3 seconds of slight agitation) me. The "This isn't a career, this is a hobby." quote does bother me. As a career EMT/Medic being told my career (yea, I said it again. I'm working on getting the word career into this sentence as possible.) is nothing but somebody else's idea of a "no big deal, nothing to write home about" thing DOES bother me. Now take the fact that one person holds that belief, and multiply that by the fact that that belief is about to be aired on television and my annoyance only grows. I won't pass overall judgement yay or nay until I see the show, but right now I have a foreboding feeling that this is only another show emphasizing how crummy our job is.

Yes, they can pick and chose, but it's like medik8 said, c-collar and LSB go together. Our protocols do say we should immobilize all patients with a significant mechanism. Most people know that if you need to be strapped down, you need to be strapped down and I'm not just telling you you need to be strapped down cause I feel like practicing LSB today. Yes, they can still choose to refuse immobilization, and yes, we still will take them to the hospital, after they sign a form that says they refused that treatment. I get uncomfortable in these situations because it brings about a whole strew of crap from people in the ER who then will X-ray this pt, find a fracture, and criticize me to high hell for not having the patient backboarded. But oh well. The patient always knows what's best for them I guess. :dontknow:

Yea. I'm in the middle too and we use LP12. I like them though. They are a bit heavy and at times confusing (as far as layout) but overall I can't say I prefer the mover another. I've used a Zoll and I didn't like it. I've never used one of the Phillips though. I've ehard great things about them. AED Pro also sounds like a good investment for BLS only units.

No, I'm saying if they want treatment, they'll get it. LSB is "treatment" in my book. As far as no choice, what I ment is before I move you into the ambulance, you're going on a board if you have spinal compromise. If they don't want I board I'm more than happy to do what I can on scene but I'm not moving a pt like that who isn't on a board unless, like you said, they sign that they refused said treatment. As I've found, there are some who aren't willing to sign papers, and I really don't want them shuffleing around to try and see it and sign it if they might have that cervical injury, but who knows. Maybe that pain in their neck is something else. I know that I can't tell without an X-ray. :dontknow:

Preciesly =) If he had no pain, I can understand this one. However, if they have a significant mechanism of injury and they say "My necy/back/head hurts." they are going on the board. It's not thier choice any more.

Sounds to me like maybe they had a good number of pts and so they C-spined some but didn't have a board for everybody

Finally, someone who agrees with me. =D

I'm just glad I got mine done, and managed to get some every day. One person in my EMT class went 2 weeks without a single call. They loved for him to come in, lol.

Not true, actually. At least not here. I went through 240 hours of classroom time alone, add to that EMT basic clinicals (64 hours in the ER and 12 ambulance transports (which doesn't sounds like much but the criteria of a transport is just that. They have to get in and go to the hospital). I know my transports took me 60 hours. (4 days, 15 hours a day.). Thats 364 hours. A pretty far cry from "below 200". Is it a paramedic? no. Is it anywhere close? Still, no. Is it better than nothing? Yes. FYI, standard contact time FR time here is between 48-80 hours. No required clinicals.

No. Not only is it not a good idea, it's illegal here in Arkansas. There are certain levels of certification that services can have, ALS (rig must carry at LEAST 1 Paramedic and 1 EMT-Ambulance), ILS: again, at LEAST an Intermediate and an -Ambulance, BLS: Must carry 2 EMT-Ambulance. There's no rooms for CFRs in here, except as maybe a third rider, and I don't think they should actually be a part of the ambulance crew. If, for instance, there is a CFR on scene and we could use an extra set of hands in the back, sure. Hop on in. But no, CFRs arent and shouldn't be part of a 911 ambulance or even a non-emergency transport crew. Notice I said transport. I think that CFRs can start up thier own squads and get thier own apparatus and uniforms and such and be dispatched alongside an ambulance. (That's what we do here, since we cover a large area.) CFRs get on scene, do what they can, and wait for an ambulance in the previous 3 catgories to arrive.