FireEMT2009

Hey can you post the reference and their justification here? Truly curious, not busting your chops brother.

Dwayne

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.

Rationale, drugs etc are all very good an well bro, but any decent pe-hospital education program should have that anyway so its not exclusive to a fire department

Good, the way it should be. Unless your into taking over other service providers as well.... have you guys evert thought about doubling up as meter maids as well, you know, make some extra bucks from fining people for illegal parking, it might bolster your finances and youd still be free to respond

Dude, you are gravely mistaken. Spend 20 minutes searching the site and youll find some very honest opinions about the abortion that fire based EMS actually is, a minimum cost revenue raiser designed to keep fire fighters in work and screw the patient.

In the end dude, its not about there being great fire medics and poor fire medics, its about having a fulltime, dedicated ambulance provider, a specialist in its health care field, not half a dozen blokes on a pumper.

So, i fully recognise you think its awesome the way it is, because that all you know. Its warm and cosy and you can sit back at night and think that all is right with the world. The status quo would do. But if you spent 20 minutes on google, you will realise that what you you accept as normal most other 1st world countries would consider sub-standard. you point me out one other health profession that a skilled labourer could take over with a few weeks of training and ill eat my shirt.

FD's caught a boon from Eugene Nagel with his idea, pitty more of the US didn't pay attention to Zafar and Caroline instead. youd have a culture of highly educated health care professionals instead of some smokeys with an extra tool box.

This shit filters down you know, crappy systems create crappy data which MD's and administrators use to beat us up with, no wonder we dont place much stock in a lot of the studies coming out of the US, its not even performed by real Paramedics!

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)

So I had to see if there was such a word lmao

Horsemonkey from the Urban Dictionary

Etremely ugly woman/man with a very long angular face with Small deep sunken eyes. Is usually a stripper and has very bad pale skin.

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.

Do you not see a problem with that statement? If you want it to grow, leave it the hell out of fire fighting and leave it as a stand alone profession, not your adopted orphan.

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.

Edit. Before posting I only read, "Do you not see a problem with that statement." from Bushy's post..after reading the next sentence after posting I realize that my post is not only much less elegant, but now completely redundant. Sorry about that... :-)

I'm guessing that you don't work in the fire services at this time. Would that be accurate?

Your statement is true, EMS makes a great addition to the fire services. It adds money. The fire services on the other hand do nothing but retard EMS's ability to become an accepted profession as, in general, they have contempt for education. They have been lauded as heros for so long for simply applying C-collars and putting on O2 that they seem to have come to believe that that is all that is really necessary to be a medic.

To be a good medic you have to be supremely accountable and the fire services are famous for being unaccountable for their mistakes. Excuses instead of responsibility, ignorance instead of education, denial instead of positive change means that Fire Medic is nearly an oxymoron.

The reason that I believe that you haven't worked in the fire services yet is that when you do, you will find that your college education will be considered a weakness instead of a strength, generally speaking. It's common to hear comments in the forums from firemen saying, "You can spot the medic with a college education because he'll be running around terrified while I get all of the important shit done."

For more than a decade now there have been states trying to create AAS entry level requirements for medics, and in each case the fire services spend millions on ads saying something to the effect, "Your government wants your heros in a classroom instead of out on the streets saving lives!" With the mandatory picture of some shithead running out of a burning building carrying a baby of course...

I have met and been blessed to learn from a few really, really good fire medics. But in general, if you view your comments as a country, which we must, the cost/benefit is sloped so far away from EMS as to be laughable.

That is what Bushy meant about your thoughts being wrong. You implied that EMS can become it's own, respected profession by being absorbed by the one industry that despises it the most...Never going to happen brother. The fire services involvement in EMS has already pushed EMS back, maybe 20 years, and further involvement shows no signs of reversing that trend...

See what I mean?

Dwayne

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

So this thread really didnt start off the way I wanted it to but alas we are kind of off to the races. So by posting the non-joke it has been assumed the conversation should only involve race and religion. In reality we as a society tolerate many things on a daily basis. So I have 2 thoughts to make it go forward.

Hosemonkey's hummmm there's a nice term. They have been known in the city that they are knuckle dragging gorilla's that only has the purpose of carring my equiment at best. So what is it that has made this particular profession intorerant in the EMS world. So it's known I luv hosemonkey's. And to the hosemonkey's here please feel free to say why EMS is intolerable in your bubble.

Also as a 40ish white female it would be nice if people here of other ethnic or religious groups comment on how they are tolerant of our culture. If this thread is to have some sort of vality then it needs 2 sides.

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.

You may have edited your post to make it easier to read but you still didn't ask any questions. Just what kind of information are you looking for?

Based on what you've written I can see you're considering grad school. For what purpose? What do you have planned for whatever degree you could pursue? How do you think the degrees will help you? Why?

If you want to teach, why aren't you going for a degree in education? EMS has plenty of instructors. That's a shame because what we really need are educators. You think you want to get into education? Pursue graduate level education degrees.

And try to find a real brick and mortal school. Online and/or for profit universities aren't always your best option.

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.

Sorry brother. I made my post between patients and it took a while. Both you and Happiness replied while I still had it up on my screen so it reflects your pre apology comments only.

Though I WAS looking forward to a spirited debate... :-)

Dwayne

We will have a spirited debate another day, guaranteed.

Ok I disagree, I do not think you were out of line with your debate points they are typically accepted politically correct thing to do, on the personal directed comments to Happy, pfft well is happy now, it is her spirit, she gave you a peace offering to that end. Even if she watched too many Archie Bunker TV shows growing up she only had CBC (a canadian joke)

The FACT that that forwarded supposed joke is plagerised over and over on the internet, OMG I just realized I have no life !

Happy, well until Dwayne "that dumb ass" used the WOMAN WORD which is a proven thread locker.

One thing you should be aware that the old timers here don't hold grudges, (we are just too old for that shit) every topic is a new chapter, its understood that everyone has a bad day, some folks are actually here to vent and "not" take the frustrations we deal with daily basis, back to the job its a coping mechanism.

So get upset at an post and get it out through fingers instead of blowing a gasket in real life. That's the EMT City given, unless it becomes a habit and I just can't see that happening with you.

Remember that "sticks and stone will break your bones" but "words can never hurt you" unless you allow them too ... Ok my Mom messed with that, SHE always had to add extra stuff, you should here me sing our national anthem !

cheers

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.

Ok, great posts so far brother, but now your just going insane. You've diagnosed her as unfit to be a medical provider based on her comments, that, by the way, have triggered one of the more intelligent, tolerant threads in a long time, visited by some of the most intelligent providers at the City? Now that alone makes me questions your medical competence... (Irony, see? That was an attempt at a joke. Admittedly, not one of my strong suits.)

Yeah, fuck that.

That sounds good when in a professional environment where decorum is necessary, but this forum, the 'humor' forum, is meant specifically for no holds barred bullshit. It says so in big red letters before you even click on the link. I get where you're coming from my friend, and respect the spirit that drives it, but some of the most productive, most educational, most fruitful debates/discussions/arguments on this board have left me cussing and trying to bandage my massive wounds before they were done. "...all courtesy and professional tact should be used at all times no matter what..." is an awesome goal until it interferes with discussion, debate and learning, which is the ultimate goal of the City, along with all of the others of course.

Wouldn't you agree that though none of us is willing to admit to liking the joke, that it has in fact sparked intelligent input and debate? And can you imagine some other way that mainstream tolerance will ever be possible without illuminated discussion and debate? So then, hasn't Happiness actually done more in this thread to promote tolerance, regardless of her intentions, than most of us have done, say, in the last month or so? So the sum total is a positive, right? Just curious.

I completely disagree. This joke would not be appropriate on an Arabic forum. But we've given noone reason to believe that this forum is particularly sensitive to Arabic/Muslim sensibilities. I would not say 'fuck' on a Christian forum, though Christian ideals often make me want to use such language.

Disagree, I will give them the right to give their opinion on the joke, and express how telling such a joke may cause them to view me, but they have no right, in this environment, to decide what I can and cannot say. That is the domain of the Admin alone. You can try and chase me away, or choose not to participate, but in this private forum you have no right to dictate what I may or may not post.

Agreed. I assume that my employers, or future employers may/will read all of what I post here. Is this post the picture of tolerance and professional decorum? Of course not. But I believe that it shows a process of thought, and a clear, though perhaps brash example of written communication, as well as an effort to learn, as well as teach, instead of simply choosing to follow. All things that I think make an EMS environment stronger. (Yeah, probably bullshit, but I like to think that at least some of those things are in here somewhere.) Will all employers like that? Not likely, as EMS tends to like followers. But then again, I'll never have a happy career as a follower so I don't want to work for those folks anyway, nor would they be happy with me.

The politically correct world has gone crazy. But instead of opening things up and making people freer, it has clammed people up, suffocated dialog, made people afraid to have a contrary opinion, and that should be criminal. Blacks, Mexicans, women, Muslims...all the people that the masses tend to fear or be angered by have been locked into their little cages because now we are less able to understand each other as open debate has been deemed off limits unless speaking about the weather.

If in any way my rebuttal has cause you to believe that I have no respect for your opinions, please believe that you are mistaken. I look forward to your posts, as well as look forward to arguing them for many years to come. Thanks for having the balls to participate my friend.

Dwayne

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!

apology accepted if you want funny scroll down and watch red neck duck hunting, unless you are against those jokes lol jk

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.

Hm, I think you're right, Dwayne, I was a little hasty there. Let's reassess first, and increase that O2 to 15 LPM by NRB if we haven't already.

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.

Hello,

Nice scenario FireEMT2009.

Difficult to describe and define chest pain in a diabetic women with dyspnea. Stable VS currently.

Things to add:

1) Check BP in both arms and quality of pulses

2) Any history of illness in recent history?

Treatment:

1) Supportive care and transport as noted above.

My DDx list:

1) MI

2) Thorasic Anerysum

3) PE (small)

4) MSK pain

I am sure I could come up with a few more. But, I am blanking right now.

Cheers

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

I should have been more clear, in Alberta Canada the Alberta Health Services as removed Lydocaine has from protocols using Canadian Prehospital Evidence Based Protocols, some privately run operations still retain Lydocaine in their protocols.

Here is a link to a multitude of experts opinions and Canadian Prehospital Evidence Based Protocols.

http://emergency.med...otocols/toc.cfm

Mr. Tniuqs,

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

Imma go old school here but, here it goes.

Airway? is it patent?

Breathing?- RR, Lung sounds, depth and quality?

Circulation- Pulse, strength quality and regularity, major bleeds perfusion?

Place the patient on a nonrebreather 15 lpm

Reassess vitals

do full workup, pupils, skin tenting, grips, can i get a temperature in farinheit please? im not good in celsius, EKG followed by 12 lead, BGL, stroke test

also get a good look over of the vehicles, such as pill bottles, wallet with a file of life, medical id braclelets, any information that can lead you to any kind of conclusion.

Rapid transport with two IVs running on TKO for now just in case

What is the size of your patient (ie. weight, frail, thin, etc...) All things need to be looked at and everyone has good ideas. Any history of prior lung problems that may indicate a small spontaneous pneumo that cannot be detected with lung auscultation??? Just wondering...

Small geriatric female. I would not call her thin or frail. No previous respiratory problems just the mitral valve replacement, hypertension, and diabetes.

What would your treatment plan and DDx be?

Glucagon's a smooth muscle relaxant, though I think I'd probably try a couple other things before I went to it, considering it'll have beta agonist effects as well and in a patient complaining of chest pain. I agree with Dwayne on the ASA, and why don't we pop a nitro and see if that does anything? You said her lungs were clear, right? I'm gonna go down the cardiac route, get my line if I don't have it already, NS TKO, and do serial 12-leads at this point. I'm concerned right now that this could either be an atypical MI or possibly a PE.

Let's reassess!

I didn't know that, interesting. You have administered the nitro. Yes the lung sounds were clear and remain clear. You have a line in place.

Her BP is now 124/86

HR- 120

RR 24 still labored

SpO2- 98

serial 12 leads still show no ectopy.

I like your DDx.

Are you en route to the hospital yet?