FireEMT2009

This might be a stupid medic student jumping into something he doesn't belong in but here is my thought on it. The patient was resuscitated without the use of an ET tube or meds. Since COPD is a bronchodilation/inflammation response why not use the BVM already in place to start a neb treatment to get her lungs back open while giving a corticosteroid such as decadron or solumedrol? The intubation giving versed, valium, or ativan would have given you the sedative properites needed to help the struggling on the tube and you could have used your BVM with a nebulizer and connected it to the tube and given a neb treatment with atrovent, albuterol, or combivent. It is hard to say what my response would have been to this call but I agree with you beiber a ET tube is a patent definate airway as long as it remains in place therefore if you knock out of her respiratory drive, what little she had via the note on your original post then that is what the tube is for. You can always breath for a patient if the drug knocks out the respiratory drive. You have an airway, breathing and circulation can be controlled by the EMT. Without an airway everything else is in vain. I think that if you had given her sedation and then intubated she would have probably done better. But this is a case of God knows what and opinions are flying. Either treatment, the ET tube or BVM is correct in my opinion as long as the proper stages of care are followed such as sedation assisted intubation or noninvasive intubation. Just a medic students input if worth anything. FireEMT2009

Firstresponder, First off welcome to the city. I understand that it seems that everyone is out to tan your hide by their comments but it truly is not what it seems. The reason they are being hard on you is because you practiced outside of your scope of practice and being in medic school I understand pharmacology and the human body and a mix of nitro and trauma is not a harmonious mix. I would like to point out that I have been a firefighter for 4 years and an EMT for 3. I understand that you want to go help and save the world attitude, hell we all have had it. That attitude will give you a great drive in your EMS career and EMT school and I truly believe with proper training you will be a decent EMT. Lawsuits, everyone is out for money, if this guy dies or has brain damage or something phyically or mentally wrong with him after this call due to your actions the family if not the patient will file a big lawsuit against you for doing something that is only done by trained personnel. And you will being paying them for the rest of your life. That being said, are you a certified first responder, or did you just place that as your credentials? I am not being sarcastic or smart ass just trying to figure out where your skill set starts from. I understand that reading your EMT book earlier is a great way to prep yourself for class, but you still need proper instruction and training everything from C-Spine, to operations, to medication administration. Everything is done via building blocks. If you decide one day to become a medic you will understand how much of it is built upon your skills as an EMT. In VA here you have to call medical control as a EMT-B to give any medication and you best know what it does, why you use it, what are the side effects, and what you can't use it with. Be careful with how aggressive you become, if you want to do some first responding, join a department and get some run time in with them as a observer and then work there through your EMT class ride time. It will help you become a better provider through the experience and street time that is ever so important. Overall, learning the right way the first time is the best way, I would suggest next time to just listen into the call because I promise you that you will have some of these calls yourself where they are filled with adreniline or you will have a good samaratain come up and drive you crazy by their actions, its a part of this life. Lastly, the people on this forum have 100s of years of experience combined and I trust their opinions and love to hear the inputs they have on my questions that I post, since I like you am still in school myself. Sit back and be able to let stuff roll of your back because somethings will be taken the wrong way by some people or it will not be meant like what it sounds like. Understand that the people here have more experience and knowledge than you do right now so they want to give you tough love so that when your an EMT you will fully understand why you shouldn't have done that. Its all for you and your patients best future. I wish you luck on all of your EMS ventures and I hope to see you post further with better reports, updates on class, and other questions that we can help you with. We all want the best for you. FireEMT2009

Well since he isnt seeming to be a psuedoseizure as of this point, I am now looking for possible factors that are treatable in the field. What ist he patient's temperature? If you have an I Stat what does his blood chemistry come back as, pH, electrolytes, etc. skin turgor, JVD, any other abnormal sign. Lets also get a 12 lead and get him exposed and see what we find. After that we will contenplate whether to load and go or stay and play for a little bit longer. I know we have 2 level I trauma centers within 20 minutes but what other resources do we have? Does he have a neurologist? If so can we get him on the line and get some better history of his epilepsy and contact our med control. Also while we are doing that go ahead and administer another 5mg of diazepam, seems like we are getting a little response in the severity and violence in the seizures with the administration. What do lung and heart sounds sound like? Trying to get all bases cleared here. And what did the doctors give him this morning to stop his seizure? How much?

PHTLS 7th edition textbook page 298 states: "Efforts to stabalize the flail segment with sandbags or other means that may further compromise chest wall motion and, thus, ventilation are contraindicated." We had to bring this to the attention of my program director because no one realized that update that went through the old PHTLS until we read the chapter on thoracic trauma. Thought I would share the information in case it hadn't been brought forward or in case ya'll didn't know. Thanks FireEMT2009

IOf this has been stated already I apologize, but i didn't have time to go through the 40 some replies. First off, great video! Second off, the stabalization of the wound with a liter bag, sandbag, or any other bag is a big no no now. PHTLS in its newest version states that no stabilzation should be used. Just BVM and ABCs. Thanks FireEMT2009

Thanks all I took lead on the externship I had the next day and it felt really good and I got remarked that I did well just need to slow down a bit. I actually am one of the top students in my class I just have very little EMS experience so I'm still gaining my footing but hey, baby steps. The patient I had was a load and go treat on the way.

Hello again all sorry I have been gone for a while. I was talkin to my program director today and he said that I needed to stop second guessing myself and get confidence in myself and my knowledge. He stated that I need to lead the calls now since I will be testing out in April. He stated that if I don't start picking up and treating as a paramedic would and stepping out of the student roll and as a paramedic in itself then I would start being marked down on leadership. My question is, how do i build that self confidence? I know my treatment plans but will easily second guess myself when questioned by my preceptor as a test in itself. It is hard for me because I walked into medic school two years ago with only being an EMT for 6 months and running as a medical transport EMT for 3 months. I joined a volly rescue squad around my college to gain that street knowledge needed that I was lacking. Any suggestions would be helpful.

The funny thing about my hometown fire and EMS departments is that they are 100% volunteer and in my town you cannot be a part of one and a member of the other you have to choose. And this is for all of you: Since you all have given me the idea that fire based EMS is the worse thing that anyone could have ever come up with for the profession I have a discussion topic myself. If fire based EMS services' leadership and management really stepped up and started encouraging more and more education, patient care, respect, and straight-forward professionalism from their employees do you think that it would change ya'lls opinion of fire/EMS systems? Or is that train too far gone to be be boarded again? FireEMT2009 (This is only as a firefighter/EMT trying to understand from more experienced providers)

I figured that was from the tradition where firefighters had to have horses pull the fire apparatus to and from the fires, thus earning the nickname horsemonkey. Ehh, I see the fire service as doing well with EMS involved. In my hometown the fire departments and EMS are completely separate entitities. Other towns surrounding mine can join both and 9 times out of 10 they do and truly give their all. Mine is old school so you have to choose between fire and EMS. I have been in the fire service 5 years come this November. I also run EMS when I am here for college and my college we do our Paramedic externships with the city Fire/EMS department. While I have been here I have been trained by very knowledgable people who love Fire and EMS respectively, not as the little orphan it adopted. They make you give rationale for treatment and will make you into a better medic by teaching you what they have come to know. Even the Intermediates in training still get into conversations with me about patient care, pharmacology, and ratioale for treatments of certain types of disease proccesses. I have not been treated as the new guy with too much information I have been treated as everyone else there. And I think the fire service has helped move and grow the EMS field forward not as much backwards. The "hero" aspect is not just on the fire side, it runs deep in the EMS side as well. There are great fire medics out there and there are lousy fire medics as well. I believe we have the choice to choose which one we will be. And I have choosen to be the best fire medic I can be. FireEMT2009

Since I would the a horsemonkey here, this is my opinion. In my public speaking class we had to right a persuasive speech and mine was on why Fire and EMS should be joined together and work together. I love firefighting and EMS and if I had to choose between the two I dunno what I would do. To me I feel that EMS is a welcome and needed change in the Fire service. To me I think that EMS should be treated as well as the fire service is treated and should be allowed to grow and become a true profession. FireEMT2009

Mike, What do you consider the difference between an educator and an instructor? To me an educator does not have to have a Ed.D or a Ph.D in Education. Anybody can be an instructor and tell someone how to do something, it takes and educator to teach them why they do something and the rationale behind it.

I wish to be a fire officer and possible administration, such as batalion cheif, deputy cheif, etc. I want to further my education in Fire and Emergency Services/Emergency Management. I plan on getting the Fire Officer certifications along with obtaining my Emergency Managers Certifcation. I want to have options in case something happens and I cannot do Fire/EMS for the rest of my career. I enjoy helping teach the new paramedic students that enter my program tips and things I have learned over time so they don't make the same mistake I have. I would like to become an educator and teach at the paramedic level but also teach Emergency Management, etc. I have thought about the education degrees and they are another thougght all together. Eastern Kentucky University is a brick and mortar school they just offer their masters online. I could attend it on campus but I plan to start working after I graduate with my B.S. And there are no schools in VA that offer Ph.Ds in the degree with the specialization that I am looking for. Oklahoma State has one, although I would have to move to Oklahoma to pursue it and that is out of the question and possibilities right now. This is more of an opinion post than a question post. Sorry for the miswording. Thanks for the comments. FireEMT2009

I know this technically isn't a true student EMS question but I think it fits; if not forgive me. I am going into my junior year of my Bachelors in science in Firefighter/Paramedic and I have been doing research for the last couple months about graduate schools. I have found that Eastern Kentucky University has two masters degrees in the same program (Safety, Security, and Emergency Management) the concentrations are Emergency Management and Fire and Emergency Services. The only difference in the two degrees are the 4 concentration classes in one and the 3 in the other. I figure that it would be far more resourceful to have the two masters with only that small class difference. I have also looked into Ph.D degrees and found one at Capella University in Emergency Management with a concentration in Fire Service Administration. I figure that this along with more experience in the Fire and EMS and leadership and officer certifications that I will be eligable to become a fire officer/administrator. I also would love to teach at the college level to teach the future EMS providers. I would just like to get some thoughts on these ideas. I am open to any and all comments and opinions. Thanks in advance. FireEMT2009 Edited to make it easier to read.

It doubled posted so this is the fix that I came up with.

We will have a spirited debate another day, guaranteed. Thanks. I understand venting, ranting, and raving happens. Though my vent, rant, and raving was taken way too far. But luckly the crew here in the City are very forgiving and understanding.

Dwayne, I completely agree that I was out of line which is why i recanted my previous posts and made a sincere apology. I do understand that this is my joke. I do realize I made myself into a giant ass. It was out of line and Happiness has accepted the apology. My apology was meant for everyone in the forum. I completely understand your rebuttal. Like I said I was in a horrible mood this morning and was looking for something to lighten my mood and this did the exact opposite. Like I stated in the apology EMT City first thing in the morning while in a bad mood is not the most greatest accomplishment I have ever acheived. So just to make it official, I APOLOGIZE TO EVERYONE FOR MY PREVIOUS POST!!!!

Definately a new spin to man vs. woman jokes. Made me laugh. Nice! Gonna share with some of my buddies!

Happiness, I will definately check it out, I am very much a redneck. I usually have a great sense of humor. Apparently EMT City first thing in the morning while annoyed is not the key. And thanks for accepting my apology! FireEMT2009

First off, I would like to apologize for my post earlier, I was not in the best of moods and wanted something to laugh at and found it tactless. I would like to say I judged and was too harsh in my approach and was just frustrated because I understand the muslim religion and have known some very well. I am also a big fan of religious freedom so it hit a wrong note with me. I apologize and officially recant my posts. Thanks and most truthful apologizes. FireEMT2009

Happiness, I understand that this was meant as a joke, but as you can see others did not see it as such. To me, it shows that you lack the needed tact to be in the medical field. I have arabic friends and they might laugh at this joke but all the same you are posting on a forum for EMS PROFESSIONALS. That means that all courtesy and professional tact should be used at all times no matter what the joke. If you were on a pure arabic forum would you be willing to post the same joke? If not then it does not need to be here. When you start to insult and take jabs at a race or religion you must allow them (and their supporters) to defend themselves and tell you whether or not this joke should have been said. This joke if made at a work place, no matter where, it could easily get you fired and make you undesirable in many areas. Just my opinon. FireEMT2009

Well I used Dr. Google and it came up with COPD for everything. So from what I can figure is that it is a synonym for COPD. Though I am not very positive on it. Like I said I have not heard of it and after I googled it I figured that it woud be best to ask experienced medics. FireEMT2009

I was talking to someone the other day and they said that their family member had small airway disease. What is this? Is it any relation to COPD? or a synonym for it? I have never heard of it and it was not covered in my respiratory class. Thanks in advance. FireEMT2009

Dwayne I think you just gave me the answer. The ear is the one of the center pieces for equillibrium and balance. The pop he could have heard was the popping of the ear that deals with equilibrium. That would cause the nausea and not feeling well and the near code look might also be from the problem. Jus in case that isn't the answer, has he been scuba diving in the last day or so? I'm thinking it might be the Bends.

You have it on and you are now 4 minutes away from the hospital. You already have an IV establised. Vitals are still the same as the above. Patient is still having shortness of breath but has gotten a "tad" better with the oxygen. Nothing else is making it better or worse. Thank you Dave. No recent history of illness just the mitral valve replacement and the diabetes. I have found your treatment plan interesting considering that it it is justi giving the basic V.O.M.I.T. acroynym to good use. You already have an IV established. Is MSK pain muscloskeletal pain? If so the pain cannot be reproduced on palpation over the chest. Sorry it took me so long to reply and give ya'll updates I have been busy the last couple of days and I apologize. FireEMT2009

Mr. Tniuqs, I didn't mean to insult you or offend you if i did. I was just trying to support my point.