PCP

I will take a kick at the can. I am not a ALS paramedic so there is not going to be any 12 leads or tubes happening with me.

A flail chest is where three or more adjacent ribs fracture in two or more places. I was lucky enough during my precepting time to see a pt. that had a flail chest. His flail segmant was on his upper back which was caused by a fall and hitting a lawn chair. Any ways back to the questions.

I am going to assume this pt in this video was in a MVA, riding a motorcycle crashed and hit the handle bars or something that was stationary that would cause blunt force trauma like that.

Primary and short term concerns: course pneumo., tension pneumothorax, spinal concerns, hemothorax, paricardial Tamponade, myocardial contusion,Myocardial Aneurysm or Rupture, Traumatic Aneurysm or Rupture of the Aorta, breathing concerns for sure would need to bag this pt., want to look for any signs or symptoms of internal bleeding from a lacerated spleen or liver. By the look of that fellow there would and could be multiple things wrong with him and that could go wrong within minutes or hours.

Long term concern is a Pulmonary Embolism may occur, pneumonia, ummm cant really think of anything at this moment as it is three in the morning.

I would for sure be loading and going with treatment enroute, notifying the hospital what I am bringing in and my ETA. This is a trauma pt and the "Golden Hour" is very important for this fellow and he needs surgery. There is not much I can do for him other then what I will do for my treatment.

TX- first of all make sure he has a patent airway, check the breathing fix what I can in the breathing (BVM, splint the flail sagment with as many abdominal pads as I may need folded up covering the entire flail segmant and start taping it down. If the flail sagment is large and is going to take too much time to apply the pad and tape I would a pillow and have them hold it there for support or use a first responder to hold for the pt. If spinal immobilization was not required I would place my pt. on the side of the injury. while in tranport I would be starting an IV on the guy and depending if the BP is below 90mmHg I would run my line at TKVO or I would bolus him 500ml at a time and auscultate the bases of the lungs before and after every bolus checking for pulmonary edema. in between boluses if multiple boluses where needed, I would be running through my head to toe again looking for any other injuries that may have been missed while on scene.

Just by looking at the guy on the video I think I would be calling for a medivac for this guy, as our hospital where I work would only be able to stabilize him and he would be flowen to Vancouver, Nanaimo, or Victoria where they could do Surgery for him.

Hope I was not too far with my answers. I must say great post!

I am learning very fast that my first impression of a pt is usually not what I am thinking at all is wrong with them. Hopefully that will change as I get more experience.

The PCP scope of practice in BC would be roughly equivalent to EMT-I85 (Emergency Medical Technician Intermediate 85 standard). The scope of education would be roughly equivalent to EMT-I99. The easiest way to remember it is for EMT-B think EMR, EMT-I think PCP, EMT-P think ACP. Strictly in terms of scope of practice. In terms of education things can vary wildly from place to place.

I'm a mainlander from the southern interior myself. Currently I'm on an educational LOA doing my ACP training at SAIT in Calgary. My three year anniversary with BCAS will be the first of January. I started out working as an EMR in Lillooet (est. 700 calls a year) and lateralled to Merritt (est. 2700 calls a year) after 14 months and my PCP training.

You will find plenty of good knowledgeable people around here to bounce ideas off of. Quite a few Canadians included. For some reason many of the Canadian members are from Alberta, a few from BC, a few from Saskatchewan, and a few from Ontario. The other provinces are not that well represented. I don't think I've ever come across someone from Quebec.

I know a guy from the "Sooke" station who is doing his ACP training at SAIT right now as well. You may know him, his name is Marcus Mcpherson. I use to work with at the mine site that I work at as a first aid attendant. Actually my cross shift is there right now for the next two days with your class I am assuming as a observer. He is wanting to take the course starting next September.

Thanks for the post and the information. Good luck in you ACP training.

Thanks for the advice I will try that on my next patient. Another piece of advice I was told today was to use the bell end when auscultating the lungs. Has anybody had any success with using the bell end of the stethascope while auscultating lung sounds?

It's not a boring question at all. What causes the gastric distention and please if I am wrong anybody feel free to correct me, as I am fairly new medic. My understanding is gastric distention is caused by when someone is using the BVM and is pushing too fast and too hard and not letting the bag on the BVM to fill back up with oxygen before ventilating again . You want to be just giving enough air by pocket mask or BVM to make the chest rise, if you give too much air it will just go straight into the abd and start to cause the gastric distention. I am not sure how long it takes or how much air needs to be exposed to the abd. before this starts to happen.( Time to do some research tonight for myself) You are correct that gastric distention does increase the risk of aspiration and that is why the person at the head needs to be careful when ventilating a patien and watch for the signs of the distension.

I know in my OFA level course that I just had recert, they taught us to ventilate the pt. every 5 seconds while doing continous chest compresions, but in my paramedic program we did the 30/2 standard and that is what I use.

When a paramedic inserts a OPA that is keep the tongue from falling back into the throat and occluding the airway which then would deem as a patient not having a patent airway because the tongue is blocking the airway passage, but once the OPA is incerted and in place the patient is now deemed as having a patent airway. This is because the OPA is allowing as a device that as mentioned keeps the tongue from falling back and occluding the airway and allows for an air passage and for draining of any vomit which may occlude the airway deeming the airway not pantent do to the occluding vomit chunks or blood.

Hope I was able to answer you question for you and if I missed anything or made any mistakes in my answer anybody feel free to correct me as I do not want to be leading someone down the wrong path!

I have been struggling with taking a pt. BP for some time now, as I know Practice makes perfect but it it does not seem to be helping me very much! I have read the books on how to take a BP, but for some reason I seem to be having a hard time figuring out the exact location I should be placing my stethascope on the brachial artery. I have been told I may not being pushing hard enough to hear the BP or I am pushing too hard, as well as I am told different spots as to where I should be placing the diaphragm on the arm. Any tips would be great as I am tired of telling my partner that I need to retake the BP as I did not get anything and I am not about to LIE!!

Another problem I find is alot of time I am unable to hear the pt. breath sounds. I palpate the ribs and find the intercostal space so that I am not placing my diaphragm over the rib so I am not sure where I am going wrong? My guess is I am not placing the diaphragm in the correct area on the pt. or I should maybe be using the "Bell" end of the stethascope insted? I feel silly asking these questions, as I was kind of shown in class, but not much time was spent on teaching us the proper way of using a stethascope.

Any suggestions would be great as I dont want to be making any vital mistakes!

I am sorry, but I do not understand how and why you would not have the local ambulance transport a patient to the hospital unless if YOU feel that their life is in danger? NOt sure how your system is run, but ours is run that fire and ambulance respond to medical, trauma, mva calls and it is NOT up to the first repsonders to decide if the pt. needs to be tranported or not. Yes a pt. can decline to be transported, but we always do our best to talk them into going to seek further evaluation by a physician and if we can't then we "code X" them and have the police, fire, or family member sign as a witness. Waiting half an hour for a family member to transport them to the hospital to me is just looking for trouble.

PATIENT CARE IS NUMBER ONE and that includes TRANSPORTING!!

When I did my practicum I was lucky where my preceptors where willing to let me watch for a couple calls and then they let me attend the calls. One thing to remember is show respect when you are being precepted and ask lots of questions after a call, as well as ask for feedback good or bad. I have been told by a few preceptors that the worst thing a student can do is not show respect to them or to the other crew members working at the station.

For the most part I am sure you know your stuff, all you have to do is apply it now. The preceptors are there to help, which most cases they will let you do your thing, but if they feel that there should be more questions asked then they will ask them or suggest to you that you should be asking specific questions.

Good Luck!

I know myself or any of the partners I have worked with have never gone through a cell phone looking for "ICE" for the most part the hospital staff or the RCMP will contact the family incase of an emergency. When dealing with a pt. I feel looking for Incase of Emergency contact phone numbers is probably going to at the bottom of my list, just because if I am having to look for "ICE" that usually indicates that the pt. is unconscious, as if they are conscious they can call themselfs or ask us to call a family member.

Just my thoughts!!

Good evening everybody! Just wanted to introduce myself as I am new to emtcity. I live in Nanaimo British Columbia Canada and I have just recently received my Primary Care Paramedic license. Basically I can start IVs, give certain medications for a pt. experiencing SOB, drug overdose, Anaphylaxis response, chest pain, hypovolemia, and medications to a pt. experiencing a hypoglycemic emergency as well as we run a Not yet Diagnosed protocol which is a combination of checking for low blood sugar or if they have overdosed. I am not sure as to what level of care that would be considered down in the United States? I work for the British Columbia Ambulance service who currently employ about 3400 EMR, Primary Care Paramedics, Advance life support paramedics, ITT medics, and Critical Care Paramedics.

I have been with the service now for just over 2 and half years and loving it! As stated above I just received my PCP license and now I am able to transfer out of my remote station that had about 200 calls per year to a station that I am starting in December that gets about 5000 calls a year! We run three ambulances out of the station one is a full time car, one back up car, and the other one is mainly for transfers from one hospital to another which round trip depending on which hospital we are transfering to is any where from 1 and half to one way to 3 hours one way.

Any ways, I am looking forward to chatting with you all, and hopfully getting to learn some new things, as well as sharing some great stories!

Take care and be safe out there everybody!

Brian Strachan.