LegendaryPunk

I generally try to refrain from throwing the first stone and judging people...but those guys sound like a bunch of toolbags. Can't say I have a single drop of remorse for what they've brought upon themselves.

Not to get off topic, but as I understand things... One only (potentially) does jail time when found guilty in criminal court, for charges brought forward against you by the government. A civil case, such as being sued by a family, can only result in monetary fines; you can't be sent to jail. Semantics aside, being found guilty in either court very easily, as nyparamedic said, "cost you everything." I just wanted to clarify that there is a difference between the two courts.

Heh – that’s quite an open ended question, one which you could ask 100 different people and receive 100 different answers. The short answer: it’s tough. If you want to do the job well it’s REALLY tough. More so than any other job? That depends on the individual – you. Long awkward hours. Forever a student. Constant training. Have to always give 100% - can’t have a bad day and slack off. You’ll have to help people who you don’t think deserve to be helped. You’ll see people die; you might even kill somebody. You’ll constantly have to make difficult decisions (such as deciding what to have for dinner that night). Honestly, it’s a difficult question to answer over an Internet forum, especially an EMS forum where you’re likely to receive inflated answers from rookies such as myself, who want to raise the profession on a pedestal to boost our own egos. If you’re really interested in learning more, I suggest you: - Ask more specific questions. - Visit a local rescue squad / fire station to talk with some of the members. You’ll get a much better idea of the overall picture by engaging in a fluid discussion. And don’t be shy – we LOVE to talk about our profession. Hope this gives you some guidance.

Aside from patient safety and a potential diagnostic tool, there are other factors I consider as well. I had one patient with difficulty breathing who was arguing with me about needing to go to the hospital. Eventually, he came up with the excuse that he didn’t want to scare his wife and kids by having them see him being wheeled away in a stretcher. Ordinarily I don’t like to make people with difficulty breathing exert themselves, but it was a short walk, and it got him into the ambulance. Obviously this did nothing to improve his condition at the time, but it let him keep a bit of his dignity, and helped gain some patient rapport, making him more willing to work with me from that point forward. I’ve also walked patients who I probably should have put on a stretch because it meant less time spent on scene. Rather than working with a couple different contraptions and navigating a house with tight corners, I’ll have the patient walk so we can be en route to the hospital within five minutes instead of twenty. These were situations when I saw the patient and thought, “this guy is sick and needs to get to a hospital NOW.” If I have time to stay and play on scene I have no problem putting patient comfort higher on my list of priorities and giving them a full ride to the ambulance. This also does not apply to trauma calls. Generally though, it’s just based on my initial diagnosis of how sick they are. If the patient is borderline between sick / not sick, I will just ask them; if it isn’t a life or death decision, I’m perfectly happy to let the patient make their own (informed) decisions about optional treatments.

I just took my practical within the past week, so I'll share my experience with the exam. In my opinion, the most difficult stations, at least in relation to the other areas you'll be tested on, are the oral boards and cardiology. For the oral boards you just have to remember to verbalize everything that ordinaily second nature to you now. What type of structure is the residence? Pet toys in the yard? Stairs leading up to the door? Narrow hallways and sharp corners? In real life it might take you two seconds to think, "Looks like we'll need the stair-chair," or "gonna need the Reeves for this one," but for this exam you need to remember to verbalize those decisions, as well as your reasoning behind them. I terms of patient care, this is where previous field experience comes in handy. The scenarios are pretty basic - CVA, suspected MI, asthma, MVA etc. Don't expect to find compounded complaints either, e.g. difficulty breathing secondary heart failure. Very straight forward. Don't give them any extra rope to hang you with either. I've heard stories of students saying something like, "I'd also have my meds ready to RSI the patient and intubate," for a simple asthma call, then failing the test because they didn't know the RSI drugs / dosage / procedure. Cardiology can be tricky because you need to do a little bit of thinking, and also need to move quickly to beat the clock. Rhythm interpretation is generally straight forward, but don’t get worked up if you see one that makes you stop and think. The other tricky part is deciding if your patient is stable / unstable. Look for key words such as confused, diaphoretic, and decreased BP. After that it’s just a matter of regurgitating the algorithms. Also, there is usually one rhythm where you don’t have to do anything – just O2, vitals and monitor en route to the hospital. Good luck!

Since it’s been a few days since mikel’s last post, I’d like to take a stab at actually answering some of the questions he posted. I JUST completed my written and practical exams (as in <1 week ago!), which has made me feel more strongly than ever before that I should be spending time in the Students sub-forum. So please, feel free to rip my response to shreds if it will help me identify what I don’t know. First I’d like to make sure I have my terminology straight… - SA block: impulse in generated in the SA node, but doesn’t get any farther than the initial depolarizing cell – issue of conductivity - SA pause (or arrest): SA node fails to generate an impulse – issue of automaticity - AV block: impulse is generated in the SA node, depolarizes the atria, but has difficulty reaching the ventricles, if it makes it through at all - issue of conductivity - High grade AV block: different terminology for complete (3rd degree) AV block? SA block would be difficult to identify, as the ECG only allows us to see atrial depolarization (P wave). So, we see what happens AFTER the SA node fires and the appropriate cells respond, but we cannot detect the pacemaker cell itself firing. On the ECG, SA block could appear as a complete dropped beat, or as an escape beat. I seem to remember learning something about the timing of the P-P intervals being a clue as to the difference between SA block and SA arrest, but I don’t remember that off-hand, and I’m trying to not cheat and look anything up AV block would present with a normal P wave, followed by tracings indicative of whatever degree AV block is present (delayed, going going gone, sudden QRS drop, or complete dissociation). Treatment would be based both on how the patient presents, as well as the type of block encountered. - SA block / arrest followed by an atrial or junctional escape, with the patient sitting, smiling and going on about his grandkids? Let him be. - 2nd degree type II, 3rd degree or your patient appearing diaphoretic, pale and confused? Get ready to provide some Edison medicine because these blocks have a high chance of continuing to degrade, or your patient has already started decompensating. Bradycardia should also be treated w/ 0.5mg Atropine, unless you have 2nd or 3rd degree, in which case the drug will have no effect.

To clarify a little - I think the VA law says those with a DUI on their record may not operate a state EMS licensed vehicle for up to five years after the conviction date. They are still allowed to act as providers on such vehicles, and may still operate non-EMS apparatus (such as an engine tanker, brush jeep etc.) The only reason I'm somewhat familiar with this law is because a couple years ago I was cleaning up the files / records of our station members, and came across some paperwork for a member showing that he had received a DUI <5 years ago...but was still operating as a driver o_0. He was honest and had given us all the required paperwork, but the previous training officer had neglected to investigate the matter, and because of such the member was never informed that he could not drive; luckily he never had any incidents while within that 5 year window. Being able to drive EMS vehicles is typically a job requirement, which means most career options will most likely be off the table for the immediate future. If you just wanted patient contact though, you might still be able to function as a provider with a volunteer organization.

Some great advice in there for me to keep in mind as I continue through my paramedic class - thank you for sharing.

Memorizing is hard - but not impossible. What are your study habits like? Do you need to have somebody speaking to you? Flash cards? Rewriting the material over and over? Can you sit and cram for extended periods - or do you need a five minute break every half-hour? You said you have a difficult time visualizing cells as opposed to arms - this is completely understandable! You've known what an arm looks like for years. How many actual cells have you seen? I spend a lot of time searching through Google images and other image databanks, in addition to drawing lots of pictures in my notebook. A crash course in A&P can be very frustrating - it's a TON of new material. Don't be discouraged if you're not scoring 100% on all your tests - you'll be exposed to this material constantly throughout the program, and it will continue to build upon itself. That being said, the material and concepts you'll be exposed to later in the course will be MUCH more difficult if you don't have a strong grasp of at least the fundamentals.

Rhythm: Regularly irregular Rate: 80, using 6-second method P waves: Present, signifying atrial depolarization; premature P waves look similar, signfying that ectopic beats are originating from the same location in the atria PR Interval: 0.12-0.14 (a little difficult to count because so small) QRS: Present, narrow, follows every P wave, signifying depolarization from upper chambers of the heart My guess is bigeminal PACs. Not positive about this though as I can't really discern the P wave from the T wave.

What a great discussion! A lot responses by people who seem to be very passionate about what they do and have given a lot of thought to this matter - certainly has given me a lot to think about. Even though I'm only a rookie, as a current student in a paramedic program I'd like to throw my own two cents in as well... I can't imagine cramming everything I've learned so far (much less what remains) into a 12-week period. To parrot what somebody else already said: the 2 year program feels condensed as it is. Would it be possible to cover everything classroom wise within 12 weeks? Probably. Would it be possible to digest everything in that same time period? No way (not with my feeble little brain at least). Pharmacology, anatomy & physiology, pathophysiology, cardiology...so far all I've really learned about these subjects is that I don't know diddly about them. I honestly find it slightly terrifying to think about how "little" I'll have learned in medic class before being released into the world for precepting. My perspective of what it takes to become a medic has changed completely within the past year - from "two WHOLE years?" to "ONLY two years?!" As others have said, I think ultimately it comes down to asking yourself, "What type of medic do I want to be?"

Thanks for the help everyone - I appreciate the tips and suggestions! Looks like I'll be tracking down a $20 Sprague later this week. As for, "How could you let this happen?!" - I'm sorry to disappoint. It was an oversight on my part which has left me unprepared. I suffered for it during my first weekend of clinicals and am now correcting the issue.

Hello all, Currently in the second semester of my paramedic program and have recently started doing my clinicals. One vital piece of equipment that I quickly realized I am missing is a stethoscope! Yes, nurses will usually let me borrow theirs, but I feel like a moocher for asking, and I think it would just be easier to have my own. Is it possible to get something decent for ~$50? Ideally I just need something to last me for the rest of the year through clinicals, afterwhich I can upgrade to something high quality if necessary. Thanks!

Bookmarked - this is a great idea! We are just about to start cardiology in my paramedic class, and I've been told the only way to get proficient at reading ECG's is to go over them again, and again, and again... So I can't really contribute to this topic yet but hopefully in couple weeks that will change.