G2 PILOT

Thank you for the link, tniuqs; I read it and found this nugget:

For equivalent levels of CPP, cerebral perfusion is impaired more by reductions in blood pressure than by increases in ICP

And I understand that I can't forsee what my interventions are doing in the case of TBI; My instructors have been pushing us to maintain first, second, third line defenses.

So these are my take home points: Follow the curve; You can't get ahead of it. And in the event of falling BP, treat it. But not beforehand or else you have ischemia. Which makes vitals even more valuable since it can be tracked (please correct me if I'm wrong); Cushing's Triad of hypertension, irr. respirations, and bradycardia.

Most were encouragement and well wishes. I felt very welcomed. =)

So I'm trying to wrap my brain around this (see what I did there?). For a patient with confirmed TBI, you would want to increase CPP while managing ICP. It seems like a gigantic blind-folded juggle with only capnography (and patient reaction) as your guidance. But I've tried breaking down the equation into what I can and cannot influence:

ICP: Hyperventilation (low end of ETCO2; 30-35 mmHg); temporary relief, but the body will compensate and vasoconstriction leads to cerebral ischemia; Hypertonic solution -> reduces ICP through osmosis.

MAP: Hypertonic solution -> elevates MAP; mannitol: diuretic effect, decreases cerebral edema.

The delicate balance of ischemia versus herniation is confusing. Would it be better to err on the side of vasoconstriction (administration of vasopressor)? And am I missing anything from my theoretical treatment plan? Any thinking points would be welcome!

Edit: For the sake of argument, let's say only a TBI and no other injuries. And apologies for double posting! My laptop went slow and I was overzealous on the submit key.

Hi, I joined this site a few months ago, asking for help about my paramedic school interview. I have been in classes since September and the didactic portion is nearly over. It's been a crammed semester, but looking forward to the next term of a little less book work and a taste of clinical rotations.

I've been lurking on the site off and on. I realized I haven't properly introduced myself so here it is. I'll probably continue to lurk, but you may catch me posting in the students section. Thank you for your time.

Funny thing about the above is it's truly true.

But when our patient population bites us, they truly mean to bite us. Animals bite for a two reasons, protection or a response to fear or a noxious stimulus.

I've been bitten once and it was not fun for the other person, they ended up with a couple of teeth missing when I used my mag lite to get them off me by pressing it against their upper lip. I heard a couple snaps and when they let go, two of their teeth came out onto the floor.

very very bad situation all around.

Working with our community service patrol, I've seen this first hand. They're drunk, belligerent, and all-around nasty. They don't like us and we don't like them. Yet it's our job. Me, being fresh meat, still have my empathy for this demographic. Another EMT commented that I haven't lost my humanity, but it would eventually come around. The job can definitely wear on you.

I recently heard a story of an EMT being bitten by a drunk man. It was on the medial aspect of the forearm and hard enough to bruise, but not draw blood due to the meat of his limb. Needless to say, he reacted in a defensive manner and elbowed him hard in the back of the head. What's really funny about this story is the EMT is one of the most laid back, sleepy looking fellows I work with. You gotta do what you gotta do...

Hello! Just an update on my situation:

I was accepted into the program! I will be attending the OHSU-OIT Paramedic Program starting this September! I have much to do, namely gaining Oregon Reciprocity along with passing the National Certification for EMT-B.

To all those that responded with well wishes, I thank you immensely. I am excited and nervous to set upon this new adventure, especially since it will be the first time I've ever left my home state for longer than 3 weeks. It is a year long program with an internship in the final term. It will be intense and probably overwhelming. I do not deceive myself that this will be easy or a breeze. It will require hard work, dedication, and an openness to continually learn.

I've already contacted the Oregon EMS office for a reciprocity packet and am waiting for it in the mail...but in the meanwhile, would anyone care to enlighten me as to what they will expect? Also, I spoke with my EMT shift supervisor (who recently became an EMT-III) and his nugget of advice was to read up on the heart and cardiovascular system and how drugs will affect it. A solid foundation like this will slightly ease the sudden flood of information.

So my query to any that read this...do you have any more nuggets such as this? I have 2 months to pre-prepare, to study and get myself into mental shape. What should I focus on?

Thank you!

When a pt is in cardiac and respiratory arrest it is nice to notice the bleeding but it does not prevent you from starting effective CPR. Sounds like you did a very good job by telling the husband to call 911 and get an AED, this is the step most EMS providers forget when they are not on the job because they are used to being the ones responding. They eventually remember it when they go to hook the AED/cardiac monitor up and they are asked where they got it from.

When we interview prospective employees (in your case students) we have a written, skills and a face-to-face interview. This gives us the prospective employer a good understanding of their weaknesses and strengths. You don't have to score perfectly to get hired (or picked), we look for certain thins in a prospective employee to ensure they will be a good fit. Since we stopped hiring the "smart" ones we have had much less (< 10%) turnover, our one turnover in 5 years was due to a non-work injury. Before if you scored perfectly on both the written and skills you were hired, regardless of your personality. Now we hire people that will fit in with us and if they need a little help improving on their skills or knowledge then we help them out.

Sorry I got off of subject there. Just saying that you shouldn't of had to get a perfect, little mistakes are understandable, after all you want to learn more and become a paramedic. If your heart is in it and they could see that it is then you will most likely get selected.

I would like to see more Paramedic Programs require an interview before being selected for the program. In the Paramedic Program that I help with there are a lot of students taking it because "It's different" and they really have no desire to be in EMS. It seems like this should be a good program if they require an interview for it. Is there a lot of competition to get into this program?

Good luck and keep us posted.

Hi! Saw this question here: It is a competitive program. When I interviewed, I was in a room of 3 other applicants. If they had 4 candidates per session and 4 sessions per interview day, there were at least 48 candidates. But it was more likely that they interviewed 100 people (interviews ended up running over and notifications were mailed extremely late). There are only 22-24 spots available in the class. Thanks for your encouragement!

So had my interview; With the possibility that my interviewers peruse this site, I'd like to keep a lot of the information private (until the results have been given). But it was a standard interview, quick and efficient. I was given a scenario (tailored for an EMT-. The scenario went like this:

An elderly man and woman are in front of you while walking through the airport. There is no one else around. The woman suddenly faints and falls forward. She is unconscious and there is a pool of blood forming under her face. Upon inspection, it is discovered there is a possible fracture of the nose.

When I was answering this scenario, I carefully log-rolled the patient over (without assistance; looking back, I wish I had said I'd ask the husband to help me), I checked for pulse (none), for breath (none), and immediately initiated CPR while telling the husband to first call 911, then find an AED. My question is, should I have done something about the bleeding prior to performing CPR?

Thank you for the replies!

I have searched the forum for "interview" and got many hits back. It was one of my beginning sources of information. I have my girlfriend and another friend of mine who will run through the interview questions with me. I found quite an extensive list on google for med school applicants. I crossed out those that I didn't find pertinent to the field or don't expect the question to arise (e.g., if you were a cookie, what kind of cookie would you be?).

Going through my EMS textbook is a regular occurrence. The objectives and scenarios are very useful, but find myself constantly second guessing myself at the answer. I am hopeful that I am retaining the correct information.

Well, thanks for those that replied. I'm off to study now and will post back if there are any other questions. Also, anyone that would be interested in the 100 questions, let me know and I'll put up the link. Thanks guys!

Hello, I've been lurking on this forum for a few months, reading your anecdotes and learning from your experiences. I have tremendous respect for this field and my awe causes hesitation if I have the mental stamina to succeed as a paramedic. But this forum has helped me steady my insecurities so thank you for that!

I am slated for an interview at a paramedic school. My health care experience is broad and I don't know if it's "substantial" when compared to the rest of the interviewing field. I've obtained approximately 75 hours of radiology observation, worked for 3 months as a part-time Veterinarian assistant, logged approximately 50 hours as a community health fair volunteer, and have been employed as an on-call EMT for the community service patrol since November '10.

My interview is in 18 days. If I could find more experience, I would nab it! Any time in the field would be welcome. I asked an EMT-III what the interview would be like and he ran a few scenarios past me. It wasn't super daunting, but it is a different thought process (which I can handle). But please, I'm trying to gather as many resources as possible and not looking for easy "tips" but thoughts, scenarios, experiences that could help me better prepare for this interview would be helpful?

Thank you!

I'll keep you guys posted on how it turns out.