JakeEMTP

With Bushy on this. I prefer to start IV's in the lower inside forearms if possible, especially on trauma pt.'s. My mrs., who is a circulating nurse in the OR, says most trauma surgeons prefer not to have IV's in the AC's because of the way pt.'s must sometimes be manipulated. Having an IV in a "fold" (for lack of a better term, hey, I just got up) can interfere with the flow of fluids sometimes due to the position some pt.'s must be placed. For me, I like to start them in the forearm because it doesn't hurt the pt. as much and it is easier for me to keep an eye on it. The vein's are usually pretty straight and will hold a 18/16 in most cases.

What if there were no FAA inspectors? Those douches in Washington wouldn't be able to fly anywhere. They might have to stay in Washington and do their freaking job!

No I wouldn't/couldn't. While helping out during a tough time is admirable, I don't think my creditors would be as understanding. But hey, if I hold a vote and raise my debt limit, I might be able to stand it for a little while. I think they actually have the Gov't by the balls. If they just said "fuck it" and didn't show up, the country would come to a stand still and they would have to be paid. It is not prudent to ask people to work for nothing, AND (Gasp!) charge their work related expenses to their own credit cards? I realize this isn't an unheard of practice, but where is the guarantee said expenses are going to be reimbursed and when? I mean, if they can't pay me, how are they going to reimburse me? It is a tangled web we weave.

Starbucks will give us a free regular coffee, but I always put $1 in the tip jar. The hosemonkeys are starting to abuse it though. Regular coffee is free, premium drinks you have to pay for. The knuckledraggers now will ask for a "shot" of this and a "shot" of that so it is almost a premium coffee. I can soon see this perk going away as I have been informed by a employee that the mgr. is getting a little miffed. Somebody always has to spoil it for others. There is a restaurant that only charges us $5.00 for the lunch buffet, which is about half price. Appreciated, but never asked for. This to is short lived because some members of the local fire suppression are starting to make it a family affair.

Just saw this on the NPR website. Turning juvenile delinquents into EMT's and then placing them with ambulance services. In a State where there are 25 EMT's (or better) for every position, who thought this was a good idea? I would hazard a guess that none will be placed with SFFD. The IAFF wouldn't allow this. Craziness. I would propose turning them into hosemonkeys and let them fight the wild fires instead of playing with people's lives. http://www.npr.org/2011/07/27/138761686/calif-county-tries-turning-juvenile-offenders-into-emts?sc=tw

I'm kinda going with Kiwi here. Pacing would work nicely with this pt. if Atropine didn't. I'd may have tried 0.5mg of Atropine first prior to pacing. Either way, a HR of 36 is not good and it would be considered bad form to show up @ the hospital with just a fluid bolus that didn't fix the problem. W/o a strip though I can't tell you exactly what I think it might be. Kudos for asking for opinions though!

I've been to the Cath lab several times since becoming a Paramedic. We always ask if we can stay and have never been refused. The last one they did was through the right wrist. That was a first for me. Part of my clinical rotations for Paramedic classes was some time in the Cath lab and found it to be an interesting experience.

Where they landed the second time, was a much superior LZ than the first. Question for you Mike, I personally have never witnessed a helo shut down @ an LZ. I don't know if that is common to BC or is common practice. Is that the way your crew is on scene? Help me out would ya?

Yeah, we have clean water to wash, clean clothes and drink as much as one can. I have washed cut of my own and my children with tap water w/o any ill effects. While not totally relevant to the current conversation, my favorite comedian Lewis Black has a few ideas about water.

I hope to find out and will let you know when their free sample gets here and I've had a chance to play with it.

http://hawaii.gov/dcca/pvl/faqs/medical_faq/pvl_faq_emtb_emtp.pdf http://www1.honolulu.gov/esd/ems/ http://amrhawaii.net/

Yeah Fiz, I should've added if the pt. is fortunate to regain ROSC, I have no problem inserting an ETT. I too like the bougie for tubes.

Agree with CHbare and Kiwi here. If I can ventilate the pt. well with a King, I won't pull it. Even the AHA says an airway is nice but chest compressions are paramount. As long as you have an airway, carry on with compressions please. The LMA was designed for and works beautifully in the OR. It has absolutely no place in an ambulance. Unless of course you have a dedicated LMA "puter back inner". Used one once and promptly through the other one in the trash.

We work 24 hour shifts. Accordingly, we are paid for the entire duration of the shift regardless if we are running calls or in bed. 24 hours worked = 24 hours paid.

I agree. I like the Midazolam idea. I have many times thought a Haldol-pen similar to the epi-pen is long overdue.

I disagree, somewhat. Yes EMT-B is an entry level position, but I still think a pre-test along the lines of the HOBET test should be administered prior to enrolling in class. It doesn't need to be as extensive, but you get the jest. As for the second comment, you will find many here that disagree with being a basic first and advocate acquiring at minimum an AAS degree. With 2 years of full time classes with clinical time, one should be able to master the skills of a Basic fairly easily. Anyway, it's all pt. care as in total pt. care, not BLS/ALS right?

I really have no idea about the DFW area. I think, Dallas is fire-based, but don't quote me. I just want to congratulate you on getting your degree and not taking the easiest route to the world of EMS. If I'm not mistaken, I think TX will have you licensed instead of certified for obtaining the degree! That in and of itself is something! Good job. Jim

Classic Kelly! I'm still laughing!

Most EMS systems in NC have their on Medical Director. Therefore, you have to get your local credential in each County. After all, if one is going to work under his/her license, shouldn't he/she have some say in who the provider is and if they are competent as a provider?

Way to go Metal! Congratulations! Now go directly to medic classes!

This one is not from my class, but from another college not to far away. Not to bad.

You did fine on the scenario. The fractured nose, which is extremely vascular and does have the ability to produce copious amounts of blood, was a distraction or curve ball if you will. As stated above by our esteemed colleagues, hemorrhage control doesn't mean squat when the pt. is a code. Good luck!

Once again I agree with Mike on this one. Based on your second post TC, I would not suspect CHF, rather the other option, "Dude was fat" Sometimes you just can't be politically correct! If you must, morbidly obese seems to work.

Or even a "thanks in advance". I work in NC but not for one of those agencies, although I do know a few that do. MEDIC seems to have a revolving door as they are SSM. The folks I know who work there though seem to enjoy it and have been there for some time. BUSY, BUSY, BUSY service. It is not unusual to have several calls pending when you check on at the beginning of your shift. WCEMS seems to be in a bit of a hiring freeze from what I understand. That being said, there is no harm in applying. Their fiscal year ends in June and that may create some opportunities. If your looking at NC, I suggest you look at www.NCEMS.org for employment openings. Forsyth County, Durham County, Orange County et al, are all good services.

We were dispatched to the waiting room for CP once. We were in the EMS workroom so it wasn't to far to go. Anyway, the folks around here know how to get a emergency response. It;s either CP or respiratory distress. However, we treat everyone the same. Turn out to be a STEMI and we wheeled the pt. right through triage and into the ED, stopped long enough for the Attending to confirm our findings and continued straight to the Cath lab. The pt. did have a positive outcome. So yeah, not all pt.'s who call from the ED waiting room are self centered and full of shit. Do your job and treat the pt. appropriately. That is what we are here for. One other time we explained to the pt. what the word "triage" meant. After doing our assessment we advised her that she would not be seen any sooner if we took her through the back door and would "loose her spot in line" if she left. However, we did not refuse to take her stating it was her choice to come with us or not, but also informed her that she was most likely going to be "triaged" back to the waiting room.