P_Instructor

In Iowa they utilize the 1999 Intermediate curriculum that meet enough state standards to be classified as a Paramedic (only in Iowa). The current Paramedics in Iowa were then titled Paramedic Specialists as they were licensed at that level. This is all going by the wayside with the new Standards. They will only have the EMR, EMT, AEMT, and Paramedic levels. The 85I's will have to transistion to AEMT and test or fall back to EMT level. The 99I's will have to transistion to Paramedic or fall back to AEMT. In essence, the Paramedic Specialist is really a Paramedic on the national level.

That's the intent of presenting this to the class, to learn from it. I think there is a misconception I was on call. This was presented to me second hand to I tried to get as much information as possible. Just looking for other opinions with the post. Thanks.

The history is piss poor; did you ask for further information? This is the information that was given to me for review. No it's not, that is the bitches way out ... do you know that in South Africa, New Zealand, Australia and the UK there is no medical control?. What do you think we do? We use our brains I bow to your knowledge not taking into consideration how this post would be disseminated nationally. I was speaking about the US where that availability of on-line medical control can and is very beneficial in difficulty cases. That is why I mentioned the prior geography memo. The purpose of this review is to have the provider think about what is happening and what to or not to do. By utilizing medical control, if available, uses the adage of 'two brains can be better than one'. Don't use this as a crutch, but don't 'harm' the patient when there are resources available to assist in 'thinking it out'. Remind me again how adrenaline causes respiratory alkalosis? or how respiratory alkalosis causes cardiac symptoms? You are over analyzing the post. Adrenaline causing alkalosis? The point is that the patient was very anxious with signs of hyperventilation, where the EPI may have exacerbated the symptoms and potentially cause coronary spasm leading to the cardiac symptoms described. If you want to do no harm perhaps you need to seriously invest in a greatly expanded education of pathophysiology and pharmacology. This is what is being done with the review of this case in class, to discuss the differential diagnosis of presenting problems and how to properly assess and treat. Of all the drugs in the ambo bag of tricks adrenaline is one of the most dangerous but also the most life saving. You must use it wisely. . I do fully agree with you on this.

From what I obtained from the providers, ER EKG was suspicious with T-wave abnormalities suggestive of MI. I don't know the particulars of labs, etc....

Reference scenario. Case of trying to understand the problem at hand and assessing the patient. Limited classical signs/symptoms yet presents with potential laryngeal closure due to allergen per history. You may not have availability due to geography, but would be case to bounce off on-line medical control. There was some relief of symptoms with initial EPI as well as subsequent Benadryl. Combination of the respiratory alkalosis with EPI probably did cause the cardiac symptom. Sorry for the 'Levine sign' blurb. No, don't teach just do, but assess and analyze what you have (differetial diagnosis) and treat to do no harm.

Tiered in with EMT squad. Enroute information is female with complaint of throat swelling closed. Get on scene and enter their ambulance and see female sitting upright on cot, respiratory rate 40, accessory muscle use. Pt. awake, color pink, skin warm/dry. No adventagious sounds heard. Pt. on oxygen per NRB, sats 97%, BP 170/100, HR 120 per machine. Initial contact shows scared look from patient, 1-2 sentance wording. Best info from squad is possible allergic history to flowers where patient was helping setting up for funeral. Onset of slight symptoms 1 hr prior. Listen to breath sounds which are clear. Auscultate trachea, no stridor heard. With the lung sounds, no evidence of uticaria anywhere on torso, no evidence of swelling/edema. Only complaint is throat swelling. Oral cavity normal. Monitor placed sinus tach without ectopics. Patient very anxious and moving around on cot. Epi 0.3mg given IM. IV then established by partner. 25mg Diphenhydramine given IV. Pateint states a little better approximately 2 mins later. Reassessed lungs, etc. without change. Vitals BP 150/100, HR 110, RR 34, sats 99%. Pt. is exhibiting beginning s/s of hyperventilation. Pt. breathing pattern coaxed with some success. Calling in radio report and patient start again to become very scared as gestures throat again swelling up. 0.1mg Epi 1:10000 given IV. 10 seconds later patient begins screaming and shows Levine sign. No changes in monitor, ST. Episode lasts 10-15 seconds. Pucker factor is 15 on 1-10 scale. No time or conditions available for 12-Lead as patient very unsettled. Pt. verbally calmed for remainder of 2 minute transport. Arrive hospital and off load to ER. ER doc meets you at door, report given. Upon doc assessment, ativan given to calm pt. but then pt. again has throat swelling sensations and doc administers Epi with same screaming/Levine sign gesture. You leave to go back in service. Find out later pt. goes to cath lab with suspected MI. Later in evening, Cath reveals all vessels open. Hummmm....allergic reaction or atypical MI???? Thoughts.

News link on discrimination in my book.....If anyone can do the job in a professional and competent manner, let them do it. Carlsbad buried themselves in the cavern in my book. Waiting to see what else becomes of it. http://www.emsworld.com/news/10618324/woman-to-sue-city-of-carlsbad-over-firefighter-paramedic-position

Young and energetic......keep the emotion and look towards a great future. Welcome.

Probably the biggest hurdle to overcome is being prepared for everything. The trouble is that you usually will get calls that you never had enough training for. Having an understanding and being able to employ the cognitive and psychomotor aspect of pre-hospital emergency medical care will always be of best help to you. Never get in the 'tunnel vision' rut and always think outside the box. Use your gut instincts that develop with your experiences. If at least, identify, adapt, and overcome the best way you can. First and foremost, make sure you develop a sound patient rapport module. A caring voice, gentle touch, and calm demeanor may be the best medicine you can use.

Welcome back. I've got two nephews at U of Tulsa. If you are near there, keep them safe.

Another version of the original poster's formula can be used if you are having trouble figuring out weight in kilo's. Just ask the patient's weight. Using the same concentration of dopamine, and only for dose of 5mcgs/min, take the weight and then subtract 2 from the tens column. This will give you a very close drip rate for 5 mcgs. Example: Patient states weighs 240 pounds. With the 24, subtract 2 making it 22. This is what you set your drip rate (60gtt set) to, 22 gtts a minute.

His statement may be true to some, but what about all the first lady's? I would agree to Jackie, but I guess my next choice would be Ellen Lewis Herndon Arthur. Only my preference.

How I believe the system works is that there is a range that is considered as a competent level. Questions are asked initially in the middle of this range. If you answer the question right, the next question will be slightly more difficult. If you answer the question right, again more difficult for the next one. If you answer that question wrong, the next question will be slightly easier in difficulty. It is like a waveform when answering. Treat this like a patients pH range, 4.35-4.45. The middle is 4.0. If you continue to maintain in the range of 4.35-4.45 throughout the exam, you will be successful. If you are below the minimum, then you will be unsuccessful. The test could range anywhere from 70 to 150 questions dependant on where you maintain in that range. If you continually fall below the minimum of the range, the test could shut off at 70 questions and basically states that you do not know your stuff. On the other side, if you continually maintain in the upper or above range, the test may shut down because its like beating a dead horse, you know your stuff. The kicker is that you will not know either way until the results are in. If you continue to stay right in the middle of the range, the test may be the full compliment of questions, and you could still pass or fail. Lot of junk to take in, but this is how I think it works. PS: they also include questions that are not counted toward your grade but are possible future pool questions. However, you do not know which questions these are. Good luck.

All we offer is an associates degree.....sorry.

Apprehension is a good thing as this seems to prepare you for anything that may happen. The problem is that you can never predict what will happen next......so......use the apprehension and 'being somewhat scared' to your advantage. Wanting to get yourself involved, whether being scared or not only increases the likelihood that you are focused to what needs to be accomplished. I agree that your fellow student is a douche and needs to look for a different job. You, with your statement, shows a caring and compassionate emergency medical provider that is there not only for the patient, but for family members also. The aspect of the nurses talking about their weekend plans shows a stagnate persona of individuals that have been seeing way to much death in their job. I guarantee that if that was one of their family members, none of that talk would come into play. Your feelings are direct on, and you will do fine. Keep your morals and ethics on line and show the others how it is supposed to be done. Shucks.....you beat me to the 'punch'!

Great comeback Bushmaster. I agree with what you said, and also believe that todays young student need much more basic training before they even think of pursuing the 'professional' EMS career.

PMike, I agree with you but also state you may be a little to critical. I am one of those educators (Master Degree in Education) who instruct Paramedic classes. But there are also many non-educators that are very good in the education of students. All EMS educators, in my opinion, should go thru the NAEMSE Instructor course as a minimum. Another belief is that if you instruct, you should also work in the business also (me, still working part-time at least 36 hours a pay period while educating full time).

Crotchity - I think Bushy said it.......man, you keep coming up with this philosophy jargon and the hits will be down to zero Crotchity - I think Bushy said it.......man, you keep coming up with this philosophy jargon and the hits will be down to zero

The military service medics provide what is needed for that environment. There is always things that can be utilized from other training that can apply to any situation. Many milamedics can perform tasks that paramedics are not allowed, and that knowledge and skill is very useful. I do believe that the milameds can also take much experience from the public sector into the military and make it work. They, like us, always strive to 'be the best'. Sidebar: I have a former (recent) milamed (basic level) in my P class that really knows the base knowledge of EMS, and has the military drive and to be very successful as a street medic. He wants to learn, and has a vast amount of knowledge that the military training could be useful in the street sector. I think it is very interesting. Thanks for the link. P

Welcome to the city. I've been off for a while and when started to read your post, was very glad PMike had you clarify what you meant by knowledge statement. Take the knowledge in, and continually hone it as you will never know enough in this profession.

Ruff, I know what you are going thru. My paramedic class partner, working partner, and great friend also was killed in Lifenet helo crash in Norfolk, Nebraska back in June, 2002. The worst part of this was that day I was dispatching our Medic units and the local helo when I got a call from Lifenet to take a flight for them. I was dumbfounded as I knew they were already enroute to that location. With inquiry, they stated there helo went down. Unfortunately, I had the work schedule right in front of me as my friend also remained in a part time status for our service. We have quite a few of our medics working for Lifenet and when I found out my friend was on duty that day, my heart sunk. Hang in there partner.

What ever happened to the 'professionalism' of EMS. This was total unprofessional in an unappropriate place. I do believe in the 1st admendment, but what is that other term that is unlawful................defamation..................slander?