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portland medic

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  1. In my county we have quite liberal protocols, and while our MD in the past did not like to have us use adenosine as a diagnostic tool to see if we could see the a-fib when the heart rate slowed down he recently OK'd it (mainly because a lot of us were doing it anyway . For me it's fairly simple when I get a supraventricular tachydysrhythmia; if it's regular I give adenocard, if it's irregular I give a calcium channel blocker (our MD prefers diltiazem but sometimes its unavailable so we have a back-up protocol for verapamil). As to your particular patient, I know I've seen ED docs countless times give adenocard to not only see if it would help, but also as a diagnostic tool to see if it was a-fib or SVT, as it's much easier to tell when the rate slows down. I don't know off the top of my head what the AHA says but I'm pretty sure there's no evidence to suggest that giving adenosine as a diagnostic is harmful. In fact I think that adenosine is a preferred medication because of the extremely short half life. I know one of the reasons our MD changed the protocol was because they were finding that adenosine was converting some wide complex tachycardias. I know in thirteen years I've never once had an adverse event from adenosine administration. I guess my answer is that adenosine is probably safer to give to a-fib than it is to give a calcium channel blocker to SVT. Calcium channel blockers have some pretty significant side effects. I've had a few patients whos BP bottomed out after treating a-fib. Sorry for the long rant.
  2. My discs didn't herniate, but were bulging and required months off work to heal. That was 3 years ago. I have a few co-workers who herniated and underwent successful surgery, and came back to work. It can be done. Weight loss, and the swimming pool are your friends. Ice alot and beware of those damned painkillers that suck the life out of you and prevent you from taking a proper crap! Go to your physical therapy appointment and buy into them. Those PT's are amazing at what they do. Don't lose hope!!! You can do it!!!
  3. We've been using versed for years. I'm a big fan of it for several reasons; 1) It is very potent. When given IV, you will see it's effects VERY quickly, and see a marked change in the pt. 2) It has a half-life that is more conducive to EMS, ie short. We used to give ativan for seizures and it infuriated the docs and the RN's due to how long people were snowed for. (our main county ED is very busy and moving people out is a priority, for better or worse). 3) it can be given IM no problem, without the oily viscosity associated with many other benzos. When we used to give ativan, we had trouble drawing all of it up into the syringe it was so oily. Versed does not have that problem. 4) simple dosing regimen. 0.1mg/kg -.2mg/kg for kids IM/IV, 2.5 - 10mg for adults titrated. In general we start with 5mg IM, and 2.5mg IV for seizures and as a chemical restraint or for hyperadrenergic syndrome. 5) it is the single greatest and most effective med Ive ever given as a chemical restraint. It can be given IM, then you just wait a few minutes for the snoring to start. Beautiful. However, beware of giving versed with other CNS depressants, particularly opiate pain meds. My partner once made a pt stop breathing with 10mg of morphine and 2mg versed. The MS wasnt working on a pt with a severely painful fracture. he gave 2mg versed IV as an adjunct and bam, he was giving a kiss of narcan to wake him up. OOPS! Dont worry though. Its a great medication.
  4. Calichic, please DON'T process your emotions like many of our counterparts and I have done (and continue to struggle with) in the past, that is, with the bottle. That leads to dark places. Talk to someone about how you are feeling. It's too bad that you weren't invited to the CISD. Personally I think that's bullshit. I had a medic intern a few years ago that witnessed a warzone of an MVA with bodies everywhere and he was invited to the CISD. Students fall under the legal umbrella of the school they took the classes at when they are on the rig, so maybe if you feel you could use some formal support you could ask them. Talk to one of your EMT instructors also, as they usually are experienced and have felt similar feelings. Lastly, do not be ashamed that you expressed your emotions with tears. That is a HEALTHY reaction to tragedy. A human reaction. I have been on scenes where medics I respect greatly were crying alongside with family. The first time you witness tragedy involving children, it is difficult. You are emotional because you care, which is why you chose this field. We want compassionate people caring for our family members.
  5. In general I don't stop at incidents. I've been a medic long enough that I know that bystanders usually just end up getting in the way, prolonging scene time, and occasionally even hindering care. If I do happen to stumble upon something where a person is in obvious need of help, and no medical personnel have arrived, of course I'll help, but usually with very little results. I made sure an unconscious guy stayed still who got ran over by a semi in front of me once until the amblance arrived, helped a lady who vagaled down in a 747 bathroom on a flight, and not much else. In the era of cellphone saves, rescue is usually at the scene very quickly in my area. Also, when I am off duty, I have no kits, no lifepak, no airway kit, no meds, no IV's, and no PPE. If I do render help, it's just to try to do minimal scene management until the properly equipped professionals that are on duty arrive. When I'm off duty I am just unprepared like most people.
  6. Wow. Let me start off by thanking everyone who posted. It's nice to get some support, and this place seems like a great forum. People who don't work in EMS just don't understand what we go through, so I really appreciate all the responses in such a short time. Just to clear something up I don't have a coke problem, and haven't done it in almost a year. Probably shouldn't have even written that. Don't really like it, and don't plan on doing it anymore. It's not really the coke I was doing, it was a general lifestyle of binging with hard partying. The coke just happened to be there. It's just kind of a general binging on whatever is in front of me, TV, movies, food, beer, hell even nicotine gum! Haha! Lately it's been the bottle I turn to to calm me down after long days. That, and doing nothing. Last night when I posted this I was in a pretty dark place, and felt a little hopeless. I feel much better after a good nights sleep and reading all of your supporting comments. I do have a good support system around with a great girlfriend (soon to be fiance) and a great family. I'm gonna turn to them for support and a rigorous exercise regimen to start with. I think I may also seek some professional help with my stress ( and maybe mild PTSD ). Thanks again for all your kind and supportive words. You make me feel less alone.
  7. First post. Looking for a place to vent. Been a paramedic for 11 years in the Portland, Oregon area. Work for a very large national ambulance company who shall go unnamed but whose initials rhyme with lay-en-bar. I loved this job when I started, and loved it for many years. It was magical. Every person I helped, every diabetic woken up with D50, every SVT treated with adenocard, every severe respiratory pt treated with RSI, every CHFer treated with ntg / lasix, every trauma rushed straight to the OR, I glowed. Every time someone thanked me, or told me that they appreciated me, I was happy I chose this profession. It has been one wild ride. I wouldn't trade it for the world. But everyone knows this job has consequences. Several years ago, I responded to a co-worker who had passed away, and worked the code. I pronounced my friend, FTO, and co-worker dead at the scene. Whilst doing my best, I could not save one of my own. I don't think I have ever recovered from this trauma. That, coupled with holding dead babies, wading in human filth for 11 years, and seeing the general carnage, violence, waste, and human suffering that one witnesses while working as a medic, I think I am reaching the breaking point. I drink too much, am prone to eating binges, drinking binges, cocaine binges, and sloth binges. Generally, I want to do nothing. Sometimes I think there is nothing wrong with me. Sometimes I start crying for no reason, or start crying when I hear a sad song. Recently, I found myself crying (quite a lot) over the HBO miniseries "The Pacific", about the horrific WW2 campaign against Japan, and all the PTSD that one of the main characters had. I've been diagnosed by mental health people with PTSD before, but hadn't given it much thought, subscrbing to our professions' unfortunate "tough guy" syndrome. But tonight, sitting here remembering 11 years of pain and suffering, I realize that I have been carrying some serious emotional baggage. Tonight has been sort of a wake up call to me, and I am looking for some catharsis. Is there any one out there who is feeling the same way? Am i alone in feeling that this job is slowly eating away at my soul?
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