PCP

I am gonna jump in with Dwayne on this one for a little while and do an virtual exploration of this lady's abdomen.

Here are some more questions

What does a hernia feel like under palpation?

What does a AAA feel like under palpation?

Is it possible for an AAA to bulge out the front of the abdomen?

If there were an AAA what vital signs would you expect?

What would possibly pertrude when abdominal pressure is increased by changing position?

What would be more urgent, the bulge or the BP?

DFIB I will answer those questions when I get back on Friday.

I am sure someone will answer the questions by then but I am looking forward to researching some of those questions as I don't have a clue what some of the answers would be!

Brian

Just a small question: have you checked peripheral pulses on the legs (dorsalis pedis, tibialis posterior) and radialis pulse?

Yes my partner checked the pedal pulses but did not mention to me what her findings where. I probably could have asked but I was busy getting information about medications and some more history from the care aid at the time.

No worries Dwayne,

I am done my last night shift at the mine site and now I am off for home to be a dad for four days. If I get time between diapers I will check back in and if not I will not be back on the site when I am back at work on Friday!

Have a great week everybody!

not to be critical or anything but my first thought was that someone needs to learn how to spell....the question was a good one though.

I will think more on this and then contribute an answer.

Yes I agree I am not the best speller and I do need to work on my spelling. I don't take your comment about spelling personal just as a reminder to double check my spelling before posting.

Thank you

Excellent question.

But instead of answering it straight away, let me ask you a couple of questions, ok? And researching them is fine if you need to.

When we talk about the possible solutions to this question, which I believe contains the answer, as you do, what two systems are we talking about?

If it is a AAA, what vessel are we talking about? Where does that vessel run? How is it attached in the body?

Why would I believe that 'my partner 'may' have felt a pulse in it' may be the answer to your question?

In no way am I trying to make you feel foolish with these questions, in fact, I love your question and believe it's really smart. But these are answers that you can find pretty easily (I checked) with Google, and I believe that you will look at future issues like this much differently if you choose to answer them.

I look forward to your thoughts man.....

Dwayne

Okay Dwayne here I go! I am going to take a shot at this first of all without using " google" .

question #1 The two systems I was talking about are the " Circulatory system" and the " Gastrointestinal system"

question #2 If it is a AAA we would be talking about the " decending Aorta".

The vessel runs from the " Left Ventricle down through the abdomen and at the groin area it splits into two and feeds the left and right leg.

question #3 I am not sure about this question? If I can remember right the Aorta is attached to the Left Ventricle and with each contraction the " Mitral valve " opens and allows the blood to enter the " Aorta" which then goes up into the " Aortic Arch" and into the " Decending Aorta".

Not sure if that was the answer you wanted?

No worries Dwayne I understand that you are not attempting to make me feel foolish but to make me think!

Brian

Why would you have a weakened pulse with a AAA?

Not 100% sure on this question but I will give it a shot!

Weakened femoral pulses is due to the AAA bursting and the patient having internal bleeding which will cause the body to shunt the blood to the vital organs making the pulses below where the AAA has occured weaker?

Kilo shifts are mostly in the remote stations and I believe the Kilo shifts started when most of the people that worked in the remote stations lived in town so they could carry the pager while at home or doing their regular business. Now any new hire usually starts in a remote station that requires them to travel. I agree and most of us in BCAS agree that we should be paid a regular wage while at the station as well as if you are carrying a pager it should be more than 2 bucks an hour!

Had a patient the other night that had mass located in the center of her abdomen and when she would sit up the mass would protrude outward but when lying down the mass would go away?

Vitals signs stable besides the BP which was 220/72 and clammy skin which I figured was due to the high BP.

No other complaints besides the mass in her abdomen. My parnter mentioned she thought she could possibly feel a pulsating mass on palpation but was not 100% sure.

My partner and I thought possible tripple AAA or Hurnia?

No 12 lead capability just BLS level

Any thoughts on what may have been causing the mass in the abdomen and high blood pressure?

We only have one car that is 2 bucks an hour while on pager and that is our transfer car which runs from 05:30 to 17:30 but of course you could always work longer depending on how transfers need to be done that day or after a transfer is done we can be used for any calls that may come into dispatch. The rest of the cars we have are full time cars or the Fox shift at just under 12 bucks an hour while at the station.

If you want to put your tent up in front of the condo building where I live and can get away with it sure. Maybe by the time you make it to the Island my condo will have sold and I have a house. Just put the condo up for sale a month ago due to my wife and I expecting child number 3 in December.

I am always up for fish and dungeoness if that is what you have to offer.

Good point Dwayne. How would we go about picking someone for student of the quarter, or semester?

By the number of posts and how strong the posts are?

Welcome to the City!

No need for a thrashing.

Hemothorax is the accumulation of blood in the pleural space due to internal hemorrhage which is associated with rib fractures as well as laceration of the intercostal arteries, pulmonary arteries, great vessels, or the internal mammary arteries.

A Pericardial Tamponade is when there is excess fluid that accumulates inside the pericardium. When this happens the excess fluid causes an increase in intrapericardial pressure that impairs diastolic filling and decreases the amount of blood the ventricles can expel with each contraction.

If anybody can explain it better please do so.

Brian

Well you are on your way as I see you have made 8 posts now! It takes time getting comfortable posting questions or comments due to not wanting to say something dumb! Well I am over that now as I do say dumb things at times or might not post the best question or post something about how my day went that may not be interesting to others.

I find it is very helpful after doing call that you are unsure of to post a brief discription on the site and read the comments to see if there was something you may have missed on your assessment or treatment. It helps me learn and hopefully make me a better Paramedic.

Don't be shy and jump in with both feet!

Welcome!

Welcome to the City Stephanie. You have joined the right forum if you are looking to make some friends. I am still working on making friends but hell I have been working on that now for 35 years!

All the forums on this site are good to post in it just depends on what question you have or what discussion you want to join. Browse the forum read the posts and Jump in to any discussion that you find interesting. Post a question and you will get an answer might not the answer you are looking for but you will get an answer from somebody!

Welcome!!

Brian

Welcome to the City!

It is a great place to ask questions, vent, or just talk with other medics about every day life!

Brian

tniuqs how would that work having an EMT Student of the Year award? I am all for it if we could figure out a way of making it work.

Paramedic but not ALS so I guess I would be considered an EMT-I in the United States? Sorry I know we have gone over this a million times but still not sure what level a EMT-B, EMT-I, can practice at. If I have it correct an:

EMT-B is equal to what we call a " Emergency Medical Responder " in British Columbia

EMT-I is equal to " Primary Care Paramedic " here in British Columbia

EMT-P is equal to " Advance Life Support " here in British Columbia

It sounds like now we are getting new jackets that insted of saying " Paramedic" on the back they are going to say " British Columbua Ambulance Service" on the back and on the front left corner of the coat is going to say "BCAS" Not sure why this is happening but I guess it doesn't matter too much as everybody from a driveronly to" ALS" paramedics all have the same jacket that says " Paramedic" on the back even if they are a driver only and just have their OFA level three. Which is very rare I just know of two people that work at a station that are driver's only but wear a jacket that say Paramedic on the back. I am pretty sure though that has or is going to change as Now to join the Ambulance service you have to be licensed as a "EMR"

I think they should maybe say what level you are on the back of the coat for example Mine would say " Primary Care Paramedic" others would say Emergency Medical Responder or Advance Life Support Paramedic" on the back. That way the public, first responders, and other paramedics in the service can identify what level of care you can give to the patient.

Just a thought

Well I did my second shift on my last days off from the mine site and it was a good shift. Had lots of calls along with a great partner. Ended up getting four seprates! We have different shift patterns and I was working a " fox " shift which means I get paid a different wage while being at the station on call waiting for a call to come in. Once I get paged I am on the clock and I get paid my full pay for a minimum of three hours. I can do one call in those three hours or three calls but still get paid my full wage for those three hours. Once those three hours are up I go back to my other wage until I get paged out again.

In that shift I got paid for 12 hours at my full wage and 4 hours at my on call wage. We did not do anything exciting for calls just mostly routine calls with one code 3 for an MVA which turned out to be nothing and we were cancelled by the police. Our thinking was the car had gone in the ditch during the night and someone in the morning drove by the car in the ditch and called 911.

I just wanted to say " Thank You " to all of you who for your positive comments and to let you all know that I had a great second shift and I am looking forward to working at my new station.

Stay safe everybody!

Brian

Being a Paramedic is more than just dealing with death on every shift. Yes there are times you are going to have someone die in your care. You learn to deal with it as many have said. People die and you have to be confident that you did everything that you could with your training to save this person and sometimes its not enough! Most will agree when I say " Being a Paramedic is a GREAT job with lots of ups and downs."

I am fairly new to EMS and have had a few bad calls but I have never not wanted to go back to work as I love my job and I know not everybody is going survive. You learn from each call you do and how to cope with each bad call that you do. For me just talking about it helps.

The best feeling is when your patient looks at you and says " Thank you " with a smile on their face. I don't need someone telling me how great of a job I did or a medal. If in a 13 hour shift if I get 1 smile and a thank you from a patient I am happy and I know I have done my job well. As Paramedics and most will agree with me when I say " We take pride in what we do and when someone says that they want to go to medic school so that they can become a firefighter we take it personal as it is like they are saying being a Paramedic is not good enough!. " I am not saying that is what you you where saying by your original post but that is how I feel when I hear comments like that.

The only way you are going to know if you handle seeing a dead body is when you see one!

I hope you enjoy your EMT-B calss and that you fall in love with being a medic and you stick with it. You can do what ever you want and I am sure you will do well at being a medic or firefighter.

All the best to you and please keep posting and asking questions. There are lots of GREAT medics on this site who will give you a straight answer to your questions.

Brian

In our email it stated pretty much the same thing paramedicmike. under scope of practice, job responsibilities and duties it states " we are to supervise observers on car and/ or related duties " Its just a sore subject with many of the employees as they feel that they should be paid extra to show an observer what goes on during a call or around the station while we sit and watch hockey waiting for that pager to tone!

I feel preceptors should get paid extra as they are putting themselves in a position to where they are responsible for this students safety and making sure the patient gets the best care.

Within in our EMS system our preceptors get paid a "little" extra on the days that they have a student. Now as a student you get one day where you go out and ride with a crew and in the past it has been with a crew that has a preceptor working on car that day so that they can show them the ropes and the preceptor would get paid extra that day. Now on the ride along that day the student does not touch a patient or even use the equipment they are only there to observe.

Within our system we just received a "memo" stating that a student can be placed with all paramdics preceptor or not for their observation day. I personally don't have a big problem with that because I look at it as if this person is a new employee and is getting an orientation to the job which they are inasense. I know I can show them how to use the equipment and fill out a PCR ( patient care report ) among other things. The discussion is that why as non preceptors should we teach this students how to do the job and how about pt. confidentiuality, scene safety, among other things.

My question is to those of you who are preceptors within your organization do you feel that you should get paid that extra money even though the student is riding as an observer only

also what are your thoughts on a student riding for their first time out on car with a crew where neither of them have taken the preceptor training or might be fairly new to the system?

Do you as a preceptor get paid extra within your EMS system on the days that you precept?

Hey Dwayne hope all is good in your world!

It might be tough at the beginning being the new guy but at least there are 5 of us new guy's starting at the station. I am excited to be working in my home town being able to help the people that live in my community. I am not going to judge anybody or the station just by doing 1 shift at the station as I know there are alot of good paramedics tht work out of the two stations in town. I am going to take this opportunity that I have to learn as much as I can from the ALS and vetran crews before I head off and start working full time in Vancouver in another year or two.

I will stay away from the negative energy and only give off good energy as I am not one to complain when things go bad or someone kicks me in the balls. I learn from everything that I do and try to always turn a negative into a positive.

I heard the comment " We eat our own " I believe we do that as paramedics but I like to think that those paramedics that give other paramedics a hard time are just burned out and trying to make themselves feel or look better. I know I am better than that and will not play into their little game!

Brian

Well I have to agree welcome to hell if your in Naniamo I am lucky as our station dosnt have the back stabbing that many BCAS stations do. It is suppose to be team work, if they are not talking to you go up and say My name is ______ its nice to meet you and put your hand out to shake. If they choose to not shake your hand its their issue not yours. I wouldnt last long in any of those stations because I dont tolerate back stabbing crap. When I did the precepting in PR they were having those types of issues, I came in and said to my partner and preceptor, If you have a problem with what I am doing or not doing then please make sure that I know what your thinking because that is how I am going to learn and that is why I am here. One of my partners saw me write down a BP of 190/130 and thought he had caught me in something, went to the hospital and they got the same. At the end of the call he said the above that he thought I did it wrong and it was great to know that. This guy is now a CCP and I still get to see him once in awhile which is nice. My preceptor was not very well liked in that station but she was awsome for me and most of all she informed me of what I did wrong and what I did right.

PCP there is always the "getting to know period" but dont let them walk all over you as it will just carry on. Enjoy your new posting and I hope you find great partners.

Thank you for your support Happiness. I do hope I work with great partners and I'm sure I will and I am sure I will work with not so great partners. Its their loss if they choose not to get to know me. I stay out of the political stuff and show up and have fun and do my job and thats the plan. I also plan on letting my partners know that I am fairly new and if they see something I am missing or have done wrong please tell me as I would rather hear from them then my Unit chief. I also feel that is a great way to learn is by vertran paramedics who are willing to take the time to teach us junior paramedics.

Cprted I have heard that saying before and not sure why they call it that, as I feel Surrey is alot worse than Nanaimo as I have lived in Nanaimo most of my life and we don't get many shootings if 1 a year. I will soon find out what I am made of and see how think my skin is!

Well my first shift at my new station did not go very well to say the least. It all started when I was at home with my 22 month old twins and my wife having a nice dinner when the phone rang at 18:15 and it was scheduling from Vancouver. They said I was suppose to be working that night at the downtown station on 20 fox and the shift started at 18:00. I was sure I was not suppose to be working that night as I had my schedule posted on my fridge but it turned out they had sent out a new schedule and called my house but the babysitter did not pass the message along.

Any ways I live ten minutes at the most from the station so I was there fairly quickly but course my car had broken down on my way home from the mine site a day earlier so I left in Campbell River along with my stethescope, scissors and pen light thinking I was not scheduled to work my first shift until the 15th of this month.

So at this point I was a little frustrated and nervous all at the same time due to being late for my first shift and starting a new station. My first page out came in at 19:15 for a abd. laceration and ALS and fire would be responding as well. I have never done a layered call before with ALS so course that gets me even more nervous since I don't know what they are going to expect from me when they arrive. Anyways, on arrival an RCMP member pulls up at the same time along with ALS right behind us and fire. When I walk in the house and find the patient young femal laying on the bathroom floor with a 3 inch laceration across her abdomen with minimal bleeding.

So I start my Primary assessment A,B,C, and D sure enough she said she had a syncope episode and hit her head. I was getting the hx while I was applying a abd pad to the wound to stop the bleeding. I feel do to being so nervous and working with a new partner and ALS I did not take C-Spine as quick as I should have so one of the fire guy's stepped in and asked if I wanted him to take C-Spine and I " Yes please ". To make a long story short I guess a certain fire guy or two where standing around making comments while I was doing my call and making eye contact suggesting that I was not doing a good job and a few other unnecessary comments.

I was not aware of this since I was focused on my patient but my partner over heared their comments and stepped in and spoke to their captain and told him that I was new and to ask his guy's to shut the f#@k up!

So we finished call and made our way to the hospital and handed the patient over to the ER staff. After words I maid the comment to my partner " So I guess you can tell I am new eh?" His reponse was " No Shit " That was when he told me about the comments that he over heard and told me not to worry about it, which I didn't as I don't care what some firefighter has to say or any other person for that matter as I am fairly new and have not had much exposure to the world of EMS.

The rest of the night went okay. I have had better shifts and I know once I get use to working in a busier station with different paramedics and ALS I will calm down. It's just hard to sit there at a station as the new guy and have people not talk to you and course you don't want to say something that might give the other paramedics a bad impression of you.

It is hard to explain as most of you have never been to Vancouver Island and no where I am talking about and the size of the town I am now working in but compared to the other towns I have worked in this is much larger with approx. 80-90 thousand people with two ambulance stations within the town. I have been told that some of the paramedics are going to give me a hard time since I am new but most of them are good and will help me learn which is what I am hoping to do.

Eyes and Ears Open and mouth shut along with being respectful and having the passion to learn will help me to be accepted into the station.

Next shift is on the 15th of this month so I am hoping things go better than my first shift did. Oh and alway remember to make sure the jump kit is closed before you pick it up cause if you don't everything falls out when you pick it up! OOPS LOL great way to end the shift.

As one paramedic said to me that night when he found out I was new to the station " Welcome to Hell " Should have guessed that was how my night was going to go!

Thanks for your comments fiznat and I after my night shift tonight at the mine site which usually is quiet I am scheduled for holidays which at this time I am going to see my Cardiologist and getting this taken care of. I have done some research on PSVT and the things you mentioned that causes tachycardia was also mentioned in the books I have read. Not saying that any of those reasons is why I expereienced those two episodes but I am working on changing my life style!

Thank you for taking the time to post your comments. I plan on taking it easy with my family over the next few weeks and I am looking forward to resolving this problem I experienced.

Jokes I was told by a friend who has been married for 40 years!

First joke

There are three rings in marriage and they are:

1# Engagemant Ring

2 # Wdding Ring and

3# Suffering

Second Joke

my wife said she would divorce me but didn't want to see me happy

Ha,Ha, sounds like the paramedic deserved to be puked on!

Yes being new sucks and that is coming from a fairly new paramedic myself as I have not been working in the EMS system long about 3 years and I still get nervous on calls. you are going to have good days and bad days when working in EMS. In my opinion I would not say anything to who ever is going to read the report unless if they ask you your side of the story but thats just me.

I have worked with other paramedics who are soft spoken and have had to ask them to repeat what they just asked for. Yes they get upset sometimes but I let it slide off my back as maybe they are just having a bad day or things at home are not going well and I continue on with my day and attempt to have fun with my partner even if they are grumpy and burned out!

Hopefully next time you have a better experience. Before your next shift make sure you take extra time going through the car and ask as many questions as possible about the gear you are going to be using and know where it is kept. Especially the equipment that you use on each call.

Good luck!