Bieber

Sleep as much as you can, because pretty soon you won't be sleeping hardly at all. Just kidding, but you probably will find yourself sleeping a little less than you have been once you start. I'm in my last semester of paramedic school, so I'll give you what was probably the best advice that was given to me by my program director. In paramedic school, you'll find yourself struggling at first, and then you'll finally reach a point where you've gotten the hang of it and you plateau and you'll start to feel comfortable, and then you'll have to start climbing again. And then you'll reach another plateau, and you'll get comfortable, but it won't last for very long before you find yourself climbing yet again. Every time you reach that plateau and you get to where you feel like you've got the hang of it, you're going to find yourself having to climb and work a little bit more. That's how it has been for me throughout the entire program, anyway. It's a lot of fun, and if you really want it you're going to find yourself loving every minute of it--even when you're sick to death of it at the same time. It's worth every second, every bead of sweat, and every moment of thinking "I'm never going to get this." Another piece of advice, for the love of everything holy, have your social and family life in order, and definitely have your finances in order. Day one of field internship is not the time to realize that you aren't going to be able to keep a roof over your head unless you can keep working full time at your day job--and trust me, you won't have time for that in field internship.

Thanks for the warm welcome, everyone! I appreciate it and the all the kind words, it's nice to be in such an inviting environment. I look forward to enjoying more discussions with such professionals as yourselves. Dwayne, my hair may have been slightly Bieberish (though I admit to nothing), but I've since cut it. The nickname's stuck nonetheless.

Sorry about before, I thought you meant emetics like ipecac before. Excuse the brain fart. Yeah, anti-emetics probably would have been indicated. I get what you mean about the fluids for the dehydration secondary to vomiting and alcohol consumption; that time I was just wrapped up in the protocols I'm running under currently. They only allow fluid boluses for hypotension with tachycardia.

Hi, everyone, I've already posted a couple of replies to some existing threads here, so I thought I should go ahead and introduce myself to the forum. I'm Justin, I'm a paramedic student in the middle of field internship and set to graduate this December. My preceptors gave me the nickname Bieber (and made sure everyone in the hospitals know to address me as such), so feel free to continue the trend. I live in the midwest and got my EMT-B in 2007, my EMT-I in 2008, and entered paramedic school in 2009. After I finish, I plan to work part time at the service I'm doing my field internship through and possibly part time at one of the more rural services in the area while I continue my schooling and hopefully get into the PA program here. I originally went to college pursuing a Bachelor's in foreign language when I had a change of plans and decided I wanted to go to medical school instead. Someone suggested I go and get my EMT first to get my feet wet in medicine and it stuck. I went back and forth about whether or not I wanted to go through paramedic school for a while, but I eventually went for it and here I am. Anyway, that's me, feel free to ask me anything.

I'm just a paramedic student about halfway through my field internship, but if you don't mind I'll share my opinion. It sounds like the patient was able to maintain his own airway, and I'm assuming was also alert if intoxicated. You had good sats on the NC and he was maintaining his airway, and I'm assuming he wasn't in any respiratory distress so I think it was appropriate not to intubate him; it wasn't really indicated if he could manage his airway and wasn't in respiratory arrest. As far as I know, anti-emetics are no longer the recommended therapy for poisons, the preferred method is activated charcoal or the antidote for the poison, so I think you were right not to administer anything to him--especially if the patient and family are denying an OD. And I don't really think the NG tube was indicated unless you were thinking about giving him some charcoal anyway just to be on the safe side. Honestly, and this is just my humble student opinion, but I think your treatment was appropriate, and I don't think I would have done anything different. You kept the patient's airway patent, had him on the monitor and had IV access. Adderall's a stimulant so I think if he was having an OD you would have seen an elevated blood pressure, but you said it was fine. I think that hypertensive crisis and seizure would be the two biggest concerns with an OD of Adderall but you had IV access if he seized and his BP was stable. I don't know about him being so pale, so he definitely needed further eval at the hospital, but otherwise, like I said, I wouldn't have done anything different. The only question I have is why did you give him the fluid bolus? Did he appear dehydrated or what exactly was it that made you give him all the fluid?

I don't think it's inappropriate to visually inspect the genitalia. Outside of obstetrics I don't think there's much reason to manually palpate the genitalia, but I think it's acceptable and appropriate to visually assess when indicated.