Jeepluv77

Hey, crotchity, don't include me there! I've never run on an ambulance yet as I'm going straight through the program, but my absolute favorite proctor is a black man. He's not only incredibly smart but he's real with students. I've heard him tell more than one student that they weren't going to make it unless the toughened up, studied more, prayed, etc. He's also fun to hang out with on breaks and you can ask him anything without worrying about him taking it out of context. However, I don't know of any black supervisors around here, and I really think this guy should be up for the next spot open. Not because he's black, but because of all the medics I've met, he's got the best supervisory skills. I have a feeling though that the reason he doesn't have the spot is that he's only been a medic for three years. The real question is how do you get more black students interested in the field? In the past three semesters we've had a total of four black men and no black women in my classes. Out of well over 100 students.

For whatever reason(I suspect a student messed up big time) Intermediate students are no longer allowed in the OR to get our intubations. We have to wait till 3rd or 4th semester now. Which means we generally either hope and pray we get one in our field clinicals or challenge the difficult airway stations(5 of them).

Thanks for the links! I'm hoping to start the last two semesters for paramedic next fall so I'll definately be taking those pharm classes!

Eccymosis from a seat belt may not be visible for awhile. I'm curious as to whether any developed and, if so, where. Is it possible that he had the lap belt on, either properly or improperly, but had placed the shoulder belt behind him as people often do? This could cause spinal damage lower than if he'd had on the shoulder belt.

I just found out Monday that our wing at the school actually has it's own collection of medical reference books that we can borrow. When I go to class tonight I'll see which one they recommend. I don't want one that's going to be over my head but if it's too simplified it'll be a waste of time to read. A few of the proctors have offered extra help with skills stations but since I've got those down pat I'm going to see if someone may come in and help me learn the drugs. It'll be hard though because we are in the last month of class and several of my classmates are still struggling in static and dynamic cardiology. I've got the algorhythms but on the last practical day we did I missed a static scenario because I gave atropine instead of amiodarone. Ami is one I struggle most with, probably because of it's complexity and the fact that we've learned zero about how it works. Just like I only remember lido because it's the same as epi. Also, during ACLS they only taught us the drugs we carry. So I missed a question on my written(still passed though but it sucked) and I'm going to be ill prepared for NREMT-I test. Now we've all got to play catch-up because we are teaching ourselves all the other drugs.

I was a little concerned about our respiratory pt because her readings were shifting all over the place. For example, she was at 130/60, 158/60 7 mins later, 163/63 5 mins later, 138/46 10 mins later. At this point her pulse pressure stayed very wide and she had started having frequent PVCs. At one point she had 11 in less than a minute even though her heart rate was 74. The nurses seemed very unconcerned about this and when I asked about why it was happening her answer was "I'm not sure". That was it. Even when the doctor came in to consult on the pnuemonia he seemed unconcerned. Is this normal post-op? Could it have just been the meds?

BTW, thanks for helping me understand all this. I kept careful notes and have been researching to try to better follow it all. You've been a huge help!

We recently had a big uproar when it appeared that the test for our city's police academy was discriminatory against minorities. Yeah, you read that right. I don't understand how a standardized test can be discriminatory, but that's what they said. Anyway, they "dumbed it down" which caused another uproar. The plain and simple is that the test wasn't the problem. The problem was the education these men and women recieved beforehand. By the time you reach the age to enroll in the police academy, you should be able to do basic math. That's the portion that was failing people. If not, take a remedial course and be angry with all teachers you had growing up that didn't bother to make sure you got it. Don't sue the city for making sure it's officers can do at least a minimal amount of math. We aren't talking calculus here. We are talking at most basic algebra, geometry, and statistics/probability. These are skills that can be essential in prefoming the job. Now we have a bunch of officers-to-be that won't be able to figure out distance or speed or anything else requiring any math skills. Not to mention the fact that they weren't willing to work for it in the first place by studying. I think maybe the time has come to put regulations on affirmative action. There are, unfortunately, still situations where it may be warranted. But when the public safety is at risk, no. Sorry, you should be held to the same standards as everyone else, which is still woefully inadequate at times.

It does! Thank you! I'm still learning how to study as I never had to do it in high school. I'm getting a little better with it, but it's still hard. I made up flash cards, but can't find anyone to quiz me with them. So I just read the front and try to recall what's on the back. I have trouble with rote memory so I'm also trying to learn more about what each particular drug does on a cellular level. If I know what exactly it does, why, and how it's particular theraputic index works it's easier for me. At that point the dosage becomes more logical instead of just another number. Unfortunately, you don't learn that as an intermediate student(at least here) so I'm having to try to do it on my own. I'm thinking of buying the text for advanced pharmacology, which I've been told doesn't actually add drugs but rather expands on how they work.

Don't worry, cosgrojo and admin. I had to ask about it, too. You have to admit, it's a good one! I hope she's got that on her license plates. Yeah, I'm one of those that will stare at a bumper for 15 minutes trying to figure out a vanity plate. I do try not to do it while actually driving though...

I'm glad your grandfather is doing well. It must have really been an awesome experience to meet the crew. This makes me wonder why we don't have a survivor's day around here.

This is just disgusting that these guys(including the thief mentioned at the bottom) betray the trust of the public like this. Hopefully, they'll be wrong about the fires, but I doubt this would be public if they didn't have some good evidence. I wonder if it ever crossed their minds that even though the places were "vacant" there may have been homeless people taking advantage of the shelter inside. Especially after the number of homeless has risen so sharply with the economic crisis of late. They could easily have killed someone and be up on those charges, too. They should consider themselves lucky. Too bad they can't be charged with dereliction of duty and gross betrayal of the public's trust as well.

VentMedic, as usual, you're right. I plan on working as a full time medic till it starts to really take a toll on my body. At that point, I'll choose my specialty and cut back to running rescue once a week. The asthma isn't the only major medical issue I've dealt with in my family. My alcoholic father survived bilateral subdural hematomas(twice), my oldest son had repeated bouts of status epilepticus(he's "outgrown" it and we never found a cause), my second son was born at 33 weeks after placenta abrutio, and my third son(with "asthma") was born at 32 after PROM at 22 weeks(I spent 9 of the 11 weeks in t-burg). Hence the difficulty choosing a specialty. I'm leaning towards the PICU because the number of parents that never even bothered to show up for their kids was heartbreaking. I figure maybe I can comfort them and more importantly help mom and/or dad get more involved. Some just don't seem to understand their importance in their child's recovery. One even told me she just couldn't take it and wasn't coming back till he was discharged. When you become a parent, you lose the right to run and find a way to "take it".

Thank you sooo much for the link. I'm trying to learn anything I can. I worry about the long term effects of so much medicine being pumped into such a young child. Or anyone for that matter. Not to mention that even though it's easy for me to manage his meds it's very confusing for dad and I worry about it while I'm at school or on shift and he's in a flare up. I always right down exactly what medication and what dose he gets at the exact time, but I still worry I'll get that call that he was overdosed or underdosed. Also, the doctor doesn't want me to use the Atrovent(it was prescribed by the ER doc, but without it we make multiple trips to the ER to have him stabilized and sent home. Seems stupid to me that I can give it to my patients but not my son. We finally compromised and I can give him one dose every 4 hours, but if he needs more than that in we go. They are also starting him on Singular and Zyrtec after his ear tubes are placed. Which is a whole other dimension of this because he never had infections till about 6 months ago.

As to the actual shift, I have decided if I get surgery it won't be there. Not once did any of the nurses manually check vitals. In eight hours, twelve patients, not one set of vitals taken manually. They just glanced up at the monitor. And that was only on occasion. I took most of mine manually not only for the practice(we do them all manually on our trucks) but also to check for discrepencies. The bp was normally accurate, but the pulses were all over the place. They should have at least gotten their baselines manually, IMHO.

Also consider giving thiamine with the d50. Does he show any signs of being an alcoholic? If he has identification, maybe ask the police to see if he has priors that could yeild clues(dui, possession, etc.) Also, nearby hospitals may have info on him. I saw were there was an NPA inserted, but not how we are delivering o2 for him. With the rate that high he may need to be bagged down. Also, with that hip I'd use the scoop not board. You stated he had diminished lungs sounds. Do we hear any adventitious sounds or is it more likely due to the shallow volume?

I was wondering, we were told not to give d50 with a possible intracranial bleed which is one of the things I'm considering right now. Apparently it can cause necrosis in the cranial vault because of the bleed. Is there truth in this, and if so is it just a judgement call?

All great examples, cosgrojo. Don't forget paramedicmike, VentMedic, FL Medic, Ridryder, and others that will undoubtedly come to me shortly after I post this. And you're right, chbare is extremely knowledgeable. Great to learn from. Celticcare is great with cardiology.

I'm hoping someone can give me some advice on learning my meds. I'm sailing through everything else, and I had the adult meds down pat. Then we hit PALS. I've retained everything else I've learned but now the adult dosages for meds are a big jumble. I'm not sure why, but seeing as I plan to test NREMT-I in August I kinda need to fix this. Not to mention I'd prefer not to kill any patients. I'm sure if I can just find the right memory system or study guides I'll get them all straight.

For the record, I wasn't comparing the two. He developes aspiration pneumonia occasionally with his asthma. The doctor says it's probably because he's working so hard to breath that he's probably not clearing his throat adequately. We aren't talking has an asthma attack, gets a hit of albuterol, is all better. We are talking gets a cold and his airways nearly shut down. Then he starts Albuterol, Atrovent, Orapred, Pulmicort, and they usually have me give him benedryl and delsym and an antibiotic for the PNA, too and he still ends up in the hospital every few months. I really think they've missed something and that he needs to see a pulmonologist, but they insist it's not necessary. I don't think a 2 year old should be a walking pharmacy(at least not without a full work up) but they seem to think that's normal. I'm looking into finding another pediatrician. He's been allergy tested and they found nothing but that's about it.

As to the shift problems, believe me, it's not a lack of interest in medicine. I've dreamt of working in medicine since I was a kid, just took me awhile to figure out where. I talked to another student and she had the same problem with that nurse. We've reported it to the school so they, hopefully, will not schedule any more students with her. Great nurse, terrible precepter.

Ak is brilliant. I'll give you that. But please don't discredit the others on here that are always willing to give great answers. I can go into names if you want. There are a few in particular that I'm always stoked to see answer one of my threads because I know I don't need to second guess their answers. Granted, in the time I've been here I've seen some people that shouldn't be allowed to hold a license, but for the most part everyone here is great. I'm still a student and I love that fact that rather than belittling me for my lack of knowledge, they seem to enjoy helping me to learn more and understand what I'm learning rather than just learning it by rote. We still need more scenarios, though!

This is somewhat deviated off topic, but still kind of there. In class the other day my instructor said to try to have the same person get the bp's throughout the call for consistency. Is this a good practice? It seems to me that if you are taking a reading properly it shouldn't matter who's doing it. Btw, we are talking all manual here.

Little know fact: he was a Marine pilot in WW2 and Korea. He was awarded 6 Air Medals in WW2 and had something like 85 combat missions in Korea. He retired a Colonel and was then a Brigadier General in the CANG.

He's in a different category from the others.

'zilla

Really!? That's cool as hell! Kinda makes me mad that people mocked him so much in his last years of life after he lost his money.

Heehee. I wonder if I'm the first person to go all the way through that thing...

I have "IT". I tried to fight "IT" for a long time because I didn't think I was strong enough mentally for what I know I'm going to see in this profession, but I kept getting pulled back to emergency medicine. I don't know yet if pre-hospital is my place or in the ER. Personally, I'm hoping both. But I have a naturally ability to understand what I'm learning in school(for the most part. of course i need clarification every now and again) and I need a fast paced, high stress environment to keep from getting bored. I do think, however, that no matter how much "IT" you have, hard work and commitment is still necessary. You owe it to your pts to be the best provider you can be. Not to just be good enough to pass with minimal effort. I'm so sick of hearing people say "As long as we pass that's all that matters." It terrifies me that one day I might have a mediocre medic working on me because they just needed to pass, not excel. These are the ones that no matter how much "IT" they have, they need to find a new line of work.

I will ask to go back. To a different hospital though. I think it was just the nurse. She was really nice, but she seemed to get overwhelmed easily. She was managing two patients and kept telling me she didn't have time to explain this or that even though both pts were pretty stable. Before we got the patients in she did go over the spirometry and how it helps to reopen the alveoli but that was about it. I asked as many questions as I could, but didn't get many satisfactory answers. For example, she never did really explain why our pt with aspiration pneumonia did worse after racemic epi(it was given before we knew she had aspirated). I noticed the sputum was pink tinged and asked if it was possible the pt had undiagnosed chf and the only answer I got was no. Never did get an answer as to why it was pink or to how they could definitively say it was not chf without further testing. The pt was 73 incidentally. I also saw her give some meds that I thought were unwarranted given the situation, like diphenhydramine, decadron, and the racemic epi. Especially the racemic epi, because I was taught it was for upper airway swelling and it was clear on auscultation that the wheezing was from the lower airway.

On Wednesday(June 24) I had my PACU rotation. That was the most pointless, boring 8 hours of my life. Even my "unstable" patient presented nothing of any value to my training. She had an aspiration pnuemonia(I've got a son with asthma. Been there done that.) Am I the only one that has had this experience with PACU? Was there a point to this shift that I'm missing here? The only good part was that I had the idea to put her on humidified o2 and she stopped dropping her sats.

We were "taught" how to do it in class, but I would probably never try it because we never practiced it or were taught how much strength to put behind it. Plus, last thing I'd want to do is miss and put someone's xyphoid process through their heart or lung. I think I'll stick with good ol' cpr and high flow diesel.

You're right. That is very interesting. The only part I disagree with is that all free men have the right to bear arms. All non-dangerous free men should have that right. But I'm all for violent felons not being allowed to carry weapons. It would be nice if we had the means to just keep them off the streets but that isn't always possible. Somehow they still have rights even though they've stripped the public of the right to feel safe as they go about their lives. Even though I'm not a big fan of guns and do not/will not own one myself, I feel alot better knowing that there is at least a chance that someone properly trained in their use may be on scene when I'm in a parking lot about to get robbed or worse. Just a thought.