Medic2588

I think I said it before, but Critical Thinking begins with examining WHY we think the way we do. A good mentor will challenge the student to examine the thought process.

Devin

Per ACLS guidelines the patient is unstable. Regardless of underlying causes, his blood pressure sucks and therefore should be cardioverted. A stable BP I would go with Vagal Maneuvers and Adenosine, but the BP in this case is obviously low.

And I agree with Ruff. There's rarely a need to drive bloody fast to the hospital.

Devin

Education? Or is it good advertising? 8)

or perhaps I merely clicked the send button too many times :oops:

Devin

That's called experience!!! 8)

Click on my profile and you can get to the link (its the website listed).

Devin

That's called experience!!! 8)

Click on my profile and you can get to the link (its the website listed).

Devin

While I wouldn't agree the patients in need of critical thinking are "critical" patients, I do think more paramedics need to understand critical thinking. A great book to challenge the way you think is Morgan Jones' "The Thinker's Toolkit." It explains why we think the way we do and challenges the reader to look at many of the fallacies that we use in everyday decision making.

The patients most in need of critical thinking would be those patients that we automatically assume we know what the problem is. 1+1 doesn't always equal 2 in EMS. Ever been completely blindsided during a call? If you look back at the circumstances surrounding the call, you'll probably pick up on something you might have missed because you were lulled into thinking you knew exactly what the problem was. Usually this occurs with the patients who are complaining of the same routine complaints we always see and we've been prejudiced into thinking X complaints = Y diagnosis.

Interesting topic. I would definitely suggest picking up Jones' book! And since you're on Amazon anyway, click over and pick up my books too!

Devin

How big was this ant? Was it a genetically engineered super ant that was so big it was obstructing her airway? :shock:

I probably would have left it alone, encouraged her to cough, and let the ER worry about it.

Devin

I lost some good friends in 9/11, and even though I haven't checked out the game I'll still have to say, "What's the big deal?" Nate's right, officers being gunned down in the line of duty, firefighters caught in fires, EMTs rolling ambulances happen on a much more frequent basis than terror attacks. Their deaths should be no less noble than someone killed on 9/11. I think the issue that makes a 9/11 death more romantic or 'noble' is the fact that many of them knew this would be their deaths and still did it. The same was true for many Soviet firefighters during the Chernobyl mishap, fighting the fire while defecating on themselves from extreme radiation poisoning. But when it comes down to it, they died doing their job, as do many emergency services providers each year, and no one's sacrifice is any less important or less noble.

As for the game, it may be in poor taste, but like other forms of entertainment its up to you to decide what's good for you. I'm offended by country music, but be my guest if you like it

What irks me with the whole 9/11 experience is everyone who feels the need to be connected with it in some way. The survival stories of "if I hadn't quite my job 7 months prior and moved to California, I would have been there!" drive me insane. Similarly, sitting in a movie theater and seeing the preview for "WTC" I felt a rage at everyone who complained "They can't show that, it's too soon. I'm not ready to see that!" I can't stand people who have to make it about them.

And now that I just made it about myself, I'll bounce :roll:

Devin

In order to get me to watch this show you'd have to strap me in like "A Clockwork Orange."

Devin

Wasn't this an episode of "Emergency"? Didn't Johnny and Roy rescue someone who had an engine crush him in a car, and they boarded him prone, and tried to intubate and then the radio fell off the truck and they couldn't communicate with Rampart? Wow, I walk too much TV.

I agree, first off, board supine to better manage the airway. The fact that he can't breath supine alone is a sign that advanced airway manuevers are necessary, in my opinion anyway.

Devin

I'm not really sure how much detail the current EMT-B books go into, but the more detail the better. Yes, its true that you will try all respiratory distresses the same way - oxygen. However, understanding the pathophysiology of the diseases will give you a better understanding of how to expect the patient to present and how likely they might decompensate en route to the hospital. Maybe if 'flash' pulmonary edema is discussed in more depth I might start seeing more EMT-Bs covering CHF patients up when its cold outside.

This is the same case with other disorders. You really can't know too much.

Devin

I take blood sugars whenever I can. Hyperglycemia can be an indicator of a lot, including MI. So yes, I would take a BGL on both of them.

Devin

Thanks for the opportunity for a shameless plug! You can get great stupid comments in my books.

We had an old lady crying that she wished her daughter would be there at the hospital for her. I said "No to worry, I'm sure she'll be there waiting for you when we get there." She nearly had a heartattack and said "My daughter died four years ago."

Usually helps if I actually pay attention to what people are saying to me.

Devin

Rich, I took a bunch of grant management courses through FEMA and the NJ Department of Health. I'm familar with the Homeland Security Technical Assistance Grants and the Healthcare Resources and Service Administration Grants, but I wasn't sure about the cost sharing for the Firefighter Assistance grants.

Thanks to everyone for the info!

Devin

So do "EMS: The Job of Your Life" and "EMS2: The Life of Your Job"

8)

(Jersey City, Trenton, etc)

Devin

EMTCity Admin seems to be learning from the best! 8) Wonderful job with the self-promotion!

I like to think my books adequately represent life in EMS... lighthearted, politically incorrect, and honest.

But Dust is right, AFTER you buy MY BOOKS, then pick up some education books. You can never learn it all.

And as for Nate, I'm with you bro. I've never read another EMS related non-fiction book all the way through. I see enough of it in real life and on the screen of my laptop that I don't want to read it more of it. Plus what little I have read always seemed like the author was trying to point out how great they are. I like to point out what an a*s I am in my books.

So click on the link for my books on the EMTCity bookstore (I hope they're still there). If not, I have a link on my profile.

Devin

Thanks for the info. I'm doing the grant writing work for a couple of departments. I've been pushing the safety and training program, but you know how some people can be when they hear they might be able to get a vehicle.

Devin

Does anyone have any experience with the Firefighter Assistance Grants from FEMA, particularly the Vehicle Aquistion program? If awarded, does FEMA pay for the entire vehicle or just part and you have to match the rest?

Devin

My one concern is the vital signs on the 'load and go'

Is the BP 50 / 80 (which isn't possible) or 80 / 50?

Most crack OD's wouldn't present bradycardic and bradypneic unless they were circling down the drain, in which they probably wouldn't be able to communicate to you that they got ahold of bad crack.

Just my two cents,

Devin

By training hospital personnel in hazmat response I have heard time and time again "They will be decontaminated in the field." It seems like an idiotic statement yes, but hospitals are not hazmat experts. They assume hazmat teams are hazmat experts because hazmat teams should be hazmat experts. So the contamination spreading from the field to the ambulance to the hospital is a very likely scenario and one that happens time and time again. We have to be the ones to contain the problem to the field. We can't assume that everyone else will do things appropriately. Even if everyone else do things appropriately, the ambulance is still contaminated. The crew are contaminated and out of service, and hopefully not injured. The ambulance is out of service, and from the original post is sounds like an area that could not afford to temporarily lose an ambulance.

Devin

For the question of what does decon entail for meth labs....

Soap and water as always.

How you treat the patients depends on what chemicals were released in the production. (Ask me about upcoming Advanced Hazmat Life Support courses 8) )

Devin

Divinewind you just made the case against you even worse by your statement. At least in my opinion. If it was suspected to be a meth lab, which you sound like it was at the time, the patients are hazmats. You said you did what you did because hopefully they will live to see another day and change their lives around... but what about you? Honestly, I don't care what any of my patients will do in the future if it means placing myself at risk, let alone one suspected or confirmed of making drugs. And, before anyone asks, I've watched someone actively seize for over an hour and a half because we weren't allowed near them before they were decontaminated.

I've been in the same sort of situations, and know how adrenaline and emotions can get you pumped. But someone needs to step back and say Whoa. Too many of us are getting injured senselessly. You lucked out, but it really could have been A LOT worse. And every one we lose is another customer who can't buy my books, so I gotta keep you all around.

Armchair quarterbacking, I know. But you did good for you patient. Just learn from this and remember to do for you next time.

Devin

Easy enough for me to be an armchair quarterback, so I won't knock ya for what might have been. Just remember for the future, SAFETY! If its a suspected meth lab is a hazmat. There are some nasty chemicals that go into making meth, and even nastier chemicals that go into booby traps to protect the meth labs. And if you feel your hazmat team is a joke, you need to stop laughing and take charge and demand they decontaminate. If they disagree, call in another fire company. That usually gets them mad enough to listen. Just some pearls of wisdom for next time.

Devin

If it was suspected to be a meth lab, were they decontaminated first?

Devin

We use collapsible tents.

But remember, it's EMS Branch, not EMS Command under ICS 8)

Devin