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BoCat9

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Posts posted by BoCat9


  1. I have a question about the first cardiac arrest I ran as a lone medic on the unit.

    The call came in as an anaphalactic reaction. We arrive on scene to find a 55 year old male siting in a chair, skin cool and clammy. The patients brother stated that he had walked to his house, came in complaining he had been stung by a wasp and then wouldn't respond any more. Initial assessment showed an overweight male sitting in a chair, unresponsive. Breathing slow and shallow, had a weak carotid pulse. Patient was placed on the stretcher and moved to the unit. On the way to the unit, I requested fire/rescue for assistance and a driver. For assistance, I got 2 teenagers, one of which knew CPR and the other did not. A couple minutes later, an older guy came up to drive.

    Before the older guy came up to drive, the patient was placed on the monitor, showing sinus bradycardia, HR 40, dropping. My partner was bagging the patient with an oral airway in place. One of the teenagers was holding cricoid pressure to reduce gastric distension. I also had been watching the monitor and CPR was initiated moments after he went into asystole. After a quick look to start an IV, I opted to start an IO due to lack of periphrial IV access. After I started that, I gave him one mg of epi and hung a bag of normal saline. At that point we were only about 5 minutes from the hospital and I had to call in a report. At that time, I moved to the head of the patient and directly after finishing report, tried to intubate. I wasn't able to visualize the chords, so we just continued bagging the patient. We were at the hospital about one minute after I tried to intubate.

    My partner and the 2 teenagers did everything they could do, no problem with them. I was just trying to find out if there was anything I could have done differently that would have possibly ended with a better outcome for this man. (The ER staff worked him for about 15 minutes before they pronounced him dead). Any input would be greatly appreciated.

    edited for grammatical error


  2. I have actually started working with a county service and I really enjoy it. I still work at the transport company part time, but I don't feel nearly as stressed as I did. I have also switched partners. It's not a permanent solution, I know, but it will work for the time being. Thanks for the advice, everyone.


  3. I went through my ER clinicals last year, and I know what you mean. What I started doing was when I walked in the door and got my assignment for my nurse preceptor, I would immediately go up to him/her and introduce myself (as long as they weren't in the middle of trying to get something done). The next thing I would do is ask them if were any duties they would like me to do on each patient during the day. Most of the time they would ask me if there were any skills I needed to work on. The main things I did during my clinicals were IV's, drawing blood and administering medications.

    The best piece of advice I can give to you is be proactive. If there is a procedure that you would like to observe or try, if it is in your list of approved skills, ask! The worst thing they can tell you is no. I asked if I could observe on quite a few things and after a few days, I was invited to observe or try things and the doctors on duty would take time to show me things.


  4. Sounds like a solid technique to me. I will palpate a BP as a back up- in case I'm not sure I heard the systolic number correctly. I know-not entirely accurate, but sometimes folks have really faint BP's, and confirming that top number is important to get a baseline.

    The only thing I will say is that often times, enroute to the ER, I will only palpate a BP, because it may simply be impossible to hear anything accurately- especially if the person has a weak pulse to begin with. If you are not moving, and it's just you, your partner, and the patient, you can control the noise level. If you are on scene, or with a bunch of folks, sometimes quiet is a relative term. LOL

    Oh yeah, I understand that. I guess I should have really worded that a little differently. I know people who don't even try to auscultate a BP. They either don't do one or they just use palpation.


  5. One way I learned in my basic class was to start out like you are going to palpate the BP. With your fingers on the radial pulse, pump the cuff up until you no longer feel a radial pulse, then pump about 10-15 mmHg higher, so you don't miss the first beat. Then put the bell of the stethoscope on the crook of the arm and release slowly. If you feel like you missed one of the beats, make sure you let the air out of the cuff before you pump it back up.

    Also, make sure it is quiet in the back of the unit when you are taking a blood pressure. Some types of patients have a BP that is very difficult to obtain, i.e. dialysis patients. Palpating a BP is acceptable, but should be used as a last resort.

    When auscultating lung sounds, I usually place the stethoscope right below the clavicle for the top lobes and right below the 5th or 6th ribs on the mid-axillary line for the bottom lobes, pretty much where I would listen to verify placement of an ET tube.


  6. I know a majority of 911 calls are going to be someone wanting a ride to the ER, but there will be some emergency situations. My main thing is the act that for the past 5 years, I haven't really used my skills. I take vital signs, do my assessment and then there is nothing else I can do. By the time I see them, any interventions have been done. I don't get the opportunity to see a trauma patient and do the splinting or put someone on the backboard. I still enjoy this line of work, I'm just bored with doing the same thing over and over again. Most of my day is taking someone from the hospital to rehab or to the nursing home. Biggest thing I do on a regular basis is put someone on O2. On long transports I go through "worst-case" scenarios with the person I am transporting and think of things I will do if something happens. I just want the opportunity to do different things.

    Quote

    2) Considering that I'll (hopefully) be a medic next month, which side is it better to work on starting out as a medic?

    Obviously the change will be good- new challenges, new responsibilities, etc. Not sure the "side" you are referring to here.

    IFT or 911


  7. I have been an EMT for almost 5 years, and I ave been doing transport work the whole time. I enjoyed it at first, getting to know the people and their families and enjoyed the work. I am really starting to get fed-up with it now though. I am starting to be irritable even before I get to work. I have started to snap at my co-workers :argue: and my partner and coworkers can tell I am tense. I've even started having nightmares and trouble sleeping, esp the night before my shift. I am afraid I am beginning to burn out. I am starting to look for 911 work and just have a few questions.

    1) How hard is it to get out of the "transport" state of mind and into the "911" state?

    2) Considering that I'll (hopefully) be a medic next month, which side is it better to work on starting out as a medic?

    3) Does anyone know of any services that do both 911 and transport in the USA? I am looking into moving at some point in the next year and a "dual" service may help to ease the transition.

    Thanks for you time.

    Bo

    Edited for a grammatical error.


  8. Ok, two quick questions about stabilization. Can a flail segment safely and effectively be stabilized using a KED? My partner said it could, but just wanted to get other input. Also, I was told in class not to use sandbags, IV bags or anything heavy due to the fact it will cause respiratory difficulty or make it worse. Are sandbags still an accepted practice, or is it best to use bulky dressings?

    Thanks for looking.

    Bo


  9. Two modules left in class, Operations and review. Then the alphabet classes. I feel good about it in the fact I think I'll pass the class and get my medic. Is it normal to get extremely nervous about what will happen after you get your medic? I am feeling that way right now, have been for a week. I keep thinking about what will happen when I get my first true ALS call. What if I forget something and the patient dies? What if I mess up? :confused:


  10. Ok, I'm sorry that I am not medic and cannot administer pain medications, but what I am trying to say is that instead of waiting on scene for 15 minutes or more for a medic who can take care of them to a higher level than I can, I will make them ans comfortable as I can and cut the time they have to wait. If the intercept is 15 minutes away and I meet them halfway, it will take 5 min or more the patient will have to deal with the pain. Sure it would have been better to have sent out a ALS unit out in the first place, but sometimes that is not possible or just not done. I do the best I can with my scope of practice.


  11. Meanwhile, nanna with the busted NOF is still waiting for someone to relieve her agonising pain...........

    They will be waiting just as long or longer if I stay on scene and wait for a medic.

    Call 911 for location purposes? Can they triangulate your position in that area? (I know some areas all they know if the cell tower used, but not your actual position) Or for directions? Is your area on the rural side? Do you work 911 calls?

    We have a number we can call to speak to the Dispatcher, buggered if I can remember it; 111 is much easier to memorise :D

    I work transport and in most cases neither me or my partner knows the area. I have the number to the areas we go to regularly, but I don't know the numbers to all the places we go to. It's not for direction, I will stop and ask for directions to a street before I tie up a 911 line. This is for an intercept if my patient goes downhill on me.


  12. I have had one call where I have asked for an ALS intercept, really didn't need one and then a couple where I needed one and didn't ask for it. I have also had times where my partner cancelled the ALS I had coming to me and then told me to ride the call, but I digress.

    I have started looking at the situations my patient has. If it is something that could benefit from ALS interventions I will look a the distance to the hospital that the patient is going to go to. In almost all cases I won't wait around on scene. If I can be at the hospital before the unit will be able to get to me, I will do what I can and not really even call for another unit. If I will have an extended transport, I will have the intercept meet me en route so it will cut the time to definitive treatment. I have also been told that if a patient I am transporting goes downhill and I ave absolutely no idea where I am that I should 911.

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