runswithneedles

couldn't happen to a nicer bunch of fishbait!

Question: What do you call 1000 lawyers at the bottom of the ocean??

Answer: A DAMN good start. :-}

Classic. Two thumbs up for that.

Amen. Thats why I turned down the full time job. I did my interview today. It went very well. I noticed that the supervisor who interviewed me handed me a copy of the protocols. However no one else received them? Can this be an indication of what be yet to come.

Sucks when your only 19. Not too many insurance companies will put you on the policy.

Looks like another 911 service has called me back. I have a job offer for a full time position with the old air ambulance company I used to work for back when I was in high school. They have acquired a 911 contract with a town in my area and they wanted me to consider the offer. And I still have the amarillo job I have to go up for. Im kind of nervous because ive never had a full time job before and I dont know how my instructor will react to it or even if I can get that to work out as far as coming to class since I would have to drive up to class three times a week when Im on duty.

Thanks island. Turns out I have a job offer from one 911 company already.

Good way to check for fire levels.

No problem sir. Ill moderate myself a little bit better.

I think NY medic was spot on though. The questions you need to ask yourself is this. Do I have the time necessary to devote on becoming a medic and not just passing the class and getting the patch? Do I have the drive to continue my education to improve, maintain old skills, and learn new skills? Do I want the responsibility of a humans life whatever be the outcome and be able to defend your actions in court and be able to have the ability to sleep at night knowing you provided the best patient care possible to a patient who might not have made it? I may not be a medic yet but from what ive already learned. Every seen you go on. The buck is going to stop at you. People will be looking at you to take the reins of a chaotic situation. You must be ready to make the tough calls no one else wants to make. And it could be the one that officially ends a code pronouncing someone dead and having to sit with the family and tell them.

But to answer your question. Is it hard to get your medic? To be a good one that doctors and nurses will respect as a health care profession, very hard.

We took another vent patient to lubbock. (Not only am I a certified shit magnet I get to be in the back with the most fucked up of the vent patients too ) Picked him up at CCU. Medic 17 (the truck we used for the last vent that went horribly wrong) had just come back into service. Got him loaded up into the truck. (of course with a medic who I trusted and had the experience to take vent patients.) The moment we switched him to our main 02 the problem arose yet again. But this time. With a different vent. It said we had too low of a 02 pressure and it refused to function. So my partner tells me to grab the BVM with 02 resevoir while he diagnoses the problem. After about 25 minutes of tinkering we found out it was the regulator on our truck that had failed. Thus explaining why our vent didnt work with our last patient. We took the truck back to the shop. Switched it out and it was running like a champ.

We took another vent patient to lubbock. (Not only am I a certified shit magnet I get to be in the back with the most fucked up of the vent patients too ) Picked him up at CCU. Medic 17 (the truck we used for the last vent that went horribly wrong) had just come back into service. Got him loaded up into the truck. (of course with a medic who I trusted and had the experience to take vent patients.) The moment we switched him to our main 02 the problem arose yet again. But this time. With a different vent. It said we had too low of a 02 pressure and it refused to function. So my partner tells me to grab the BVM with 02 resevoir while he diagnoses the problem. After about 25 minutes of tinkering we found out it was the regulator on our truck that had failed. Thus explaining why our vent didnt work with our last patient. We took the truck back to the shop. Switched it out and it was running like a champ.

I shall. Thank you everyone for your support.

It also sounds like you need to find a new company before it bites you in the ass.

see post in personal side forum. :-D

After feverishly applying in 6 different departments. One has returned requesting an interview and will accept me on their insurance if I get hired. Wish me luck everyone. I go to Amarillo for it this friday.

I wish you best of luck. And I hope I will see you around on the forum. My condolences go to you.

Peace be with you

this is easy:

Mike is a newbie working for a crappy transport company doing the granny shuffle and is terrified by every stiff he hauls.

I am not afraid of any damn stiff. I shit myself because IT wasn't my damn patient and I let this guy spin down the drain quietly instead of doing what I should've done.....Pulling out a BVM and bagging his ass and when my medic got into an up roar I shouldve told him to fly a kite. Hell I could've deep suctioned him, did a chest decompression if needed, or re-intubated BUT I didn't have the damn patch to do it. Because of his lack of action it makes me look like an incompetent fuck.And yes I am concerned what people think about me. Wouldn't you if you were "some kid". People judge me because of my date of birth. Not my ability to care. And I feel like if I can acquire the knowledge and ability to care they will overlook my age. Am I off key to think this way?

Im not afraid to act. Im scared of the consequences of due to my LACK of action.

Also on a different note. I came to the ICU a few days ago. He was no longer there. He died. So I am wondering if Ill be appearing in court a few months from now because my partner and myself let this guys brain fry due to hypoxia?

And im not doing no damn granny shuffle. Just last weekend we took a critical pedi. We are a ITFT that is under trained and underequipped. whatever drugs we need but dont have. we get the docs to write the orders (our protocols are the generic J-RAC and even than we dont carry all the drugs we are supposed to. so whatever we need we have get from the transferring doc) Hell the company is so damn cheap they are training all basics to give EPI IM instead of buying the damn EPI-pens.

Thank you very much. For some reason I had a thought that it could. But after systemets explanation I now understand how a pacer works.

And how do you re edit a post? I cant find it. Island pointed out something and its going to bother me if I cant correct it.

Dang im just on a roll this week with decent cases. Kudos for me. More to review with the fine folks of this forum.

Anyways we took a patient from ICU to hospice tonight. He was going for end of life care s/p caridac arrest and revival. In short EMS brought the body back but mind was a veggie.

Anyways after learning he had an implanted internal defibrillator which was disabled via magnet I was looking through his H&P. It indicated upon EMS arrival that he was in PEA. Can a implanted dfib cause a rythm like that should it get stuck in pacer mode or malfunction or in any way shape at all?

If you guys need any additional info feel free to ask. I actually have a decent H&P this time :-)

Mike;

The way this usually works, is you tell us what you think so we can lead your thinking path the right way through the forest. A Q&A session will warrent you nothing.

Let me ask: What are potential side effects, both good & bad, of giving low dose benzo's to an anaphylaxis patient?

perhaps I shouldve started another post at that time

Welcome to the club. Now enjoy getting your state. :-P

But yeah paramedicmike is right. The real learning process starts................*runs to clock out* NOW!!! :-D

sounds like a joke....an aussie, a kiwi, a yank and a sud affrican were in a bar drinking...............can only have a good outcome

A call dispatching us at the butt ass crack of night to pick up the belligerent idiot that cops want us to take so they can cover their ass.

I'm going to take a different approach to this just a little. I agree with the comments that have been presented so far. What bugs me, however, is that your response to this has been, at least as far as your written word goes, that you missed your opportunity to "shine and make yourself known in the company".

What kind of approach to PATIENT care is that? Are you doing this simply to be known to your boss? Or are you doing this for the recognition from your coworkers? Or are you genuinely interested in treating patients and maintaining, if not improving, their condition/status from when you met them?

Again. My poor choice of words has no bounds and gets a foot shoved in my mouth and breaks a few teeth. It was meant to come out as doctors and nurses would trust me with their patients and they would have piece of mind because I know how to handle a unstable patient. Take for example if My dad fell over from an MI in my home town and he had to go by ground to another facility. If I saw my medic from the run walk in to take my father I would tell that nurse to get another crew.THATS NOT THE MEDIC I WANT TO BE NOR WILL EVER LET MYSELF BE!!!

Heres another one. If a 4 year old child needs to go six hours to a pediatric hospital where mommy cant ride in the back. As a parent would you like to hear how the medic (who just so happens to be taking your daughter) Almost killed a vent patient who was perfectly fine and dandy in a short trip down the damn street. F***K NO!!!!! Or would you rather take the medic who nurses and docs alike know him for being a quality out of hospital care provider whom have brought them crappy patients from hundreds of miles and keep them in the same condition or better condition than when he picked him up.

I would go with option 2

In conclusion I wish to be a care provider who is good at what he does and perhaps maybe one day so good that he is known in his region for it. I want to be able to step into a ER where im from and the when the nurse sees me they are relieved and at ease their patient is in good hands. I was blessed to meet several of those And still have them in my life. With the exception of one who died in a medevac crash. And im further blessed I have one I work with regularly who has tought me so much and in the period of only 3 weekends working here the regions nurses were requesting him BY NAME to take their vent patients and their unstable ones and if he wasnt working they would send it somewhere else.

As for the glory jocky.

If I wanted to be that kind of emt. I would've purchased a penis extender, steroids, LED lights for my truck and joined the fire department in my area. (They pay more, work less, and have better benefits anyways)

Im now off my soap box. We will now continue with your regular broadcasting

This mostly isn't your fault either. Although you should, hopefully, have recognised the situation as being serious, and suggested the ER to your partner.

Save this experience, learn from it. Once you collect enough experiences like this, go to medic school.

I did. He Said nothing.

I am. Second semester out of 3. Already completed advanced airway managment COVERING VENTS!! Why the hell didnt I think it was the PEEP indicator!!! UGH whata bloddy brainfart from hell.

And 1+ (wouldve given you 5 but it wont let me ) for your post. Thank you very much for the in depth breakdown and your view on each section. Furthermore by adding the possible complications that mightve arisen. I did think of all of those but a mucus plug. Which couldve been easily fixed.

Than again. That BVM sure looked real shiny at that moment.

Thanks for having the cojone's to come forward and ask for opinions on this. It's tough to do here sometimes.

I should also be thanking the other users of this forum. The way you ladies and gentleman give advice and responding to posts make it alot easier for me to post cases such as these. If I would've said this within a the local fire department I would've gotten remarks like "You dumb fuck why didn't you do anything" "Yeap and that's why your a worthless transfer EMT and not a macho life saver like me" and "that's why I make you carry my shit and apply oxygen"

Im one of the worst contenders in admitting I screwed up. I'm also very young and still have alot to learn regarding professional conduct and knowing the whereabouts of legal boundaries in regards to liability. You guys allow this place to be a learning environment rather than a firehouse dick measuring contest or a house of elite paragods.

Had I have known I was just as legally liable for this patients well being as much as my medic I would've done something more or at least I would've actually spoke up.

With each time I replay that run in my head and reading the posts it sickens me that I actually stood by and let it happen. This was my moment to act and correct a quickly deteriorating situation. (Which I would like to add we as a company rarely receive cases like these.) And had I jumped on it would've demonstrated my ability to handle a less than perfect patient and perhaps had me recognized within the company. Now im open to liability as much as my medic if something should come up regarding this run. But most importantly I failed a personal goal which is to protect another human being from unreasonable harm which is why I came into this profession.

Maybe she was experiencing M.A.D. (Mexican Anxiety Disorder)

It seems very difficult to make a good clear field diagnosis with the patient is as anxious as she is. IF one should give this pt a small dose of benzo to reduce the anxiety what kind of detrimental side effects would I expect to encounter if I was wrong and this pt was in anaphylaxis?

Blasted typos. Gotta love having a netbook with tiny keys and be blessed with large fingers. Dwayne you nailed it directly on the head as to why I didnt intervene. If I had intervened I wouldve have opened myself up to liability if I was wrong and the pt continued to get worse and only being certified as a basic I cant re-intubate a trach patient My partner would've ripped my ass a new one as I was taking control of a patient that wasn't mine. I didnt want to point fingers to my partner in any way shape or form as I have learned from previous posts pointing fingers at fellow healthcare professionals only makes me look unprofessional and just a general know it all asshole. I tried very hard not to present my partner in a negative light in any way shape or form until I had a few comments from you guys because like previous posts their mightve been a reason of why he didnt just disconnect the vent and bagged him.

And to Chbare, I dont take it offensively in the slightest. I froze and fucked up when this couldve been my opportunity to shine. This was a call that couldve been probably uneventful had I said piss on covering my ass and took the reins. I firmly believe it was a displaced trach. But I knew my partner. I touched his patient or took the reins my ass would be grass and because of my certification and level of experience in comparison to him (EMT-B of 11 months vs EMT-P of 25 years).

I dont know maybe I just need to grow a pair.

*Back story to this post*

We were dispatched for a 0.2 mile Inter-facility transfer from one ICU to another because this pt had a type of pneumonia that couldnt be handled at his existing location. We arrive there and we have the following

approx 65 yo male who is sedated running 3 infusions controlled by a pump

norephinephrine

fentanyl

and a antibiotic which I cant think of at this moment

His vitals at the time of arrival

Pulse 77

BP: 105/58

Spo2: 98% via 100% O2 delivered by a vent

GCS: 3 (patient was sedated)

Weight: approx 250 lbs. or 113.6 kg

We have an

auto-vent 3000

Zoll M series cardiac monitor (ETCo2 not equipped)

Which was used on the pt. We get him hooked on to our cardiac monitor and vent with no problem whatsoever.

After we load him onto the truck we switch him to the on-board 02 system.

Heres where the fun begins

Short after switching it the medic and myself hear this high pitch squeak come from the vent (more specifically the part where it connects to the trach or ET tub) I see there's a clear window on top of that piece and every time it delivers a respiration the sound comes back and a little green piece inside the window goes red. (sorry I dont know my terminology of the equipment)

We checked the monitor and SP02 normal with the 3 lead showing a NSR.

About 2 minutes this bloody squeaking is still present and driving me and my partner nuts.

I start getting this gut feeling that something is really wrong and shit is about to hit the fan. So I start checking and re-checking that monitor and I begin to see a negative trend. His spo2 is falling rapidly and his heart rate is steadily increasing.

At this point I tell the medic somethings not right here. He looks at the monitor and yells up to the driver to go.

That moment I suggested a possible displacement of the trach. This guys vitals still deteriorating and Im thinking of pulling out my stethoscope to check but something kept me from doing it. My medic was quiet and said nothing he just was occupying himself with tasks and I didnt know what.

We had no further communication. The patient began to cough and gasp and appeared to struggle for air and at this point Im about to press the internal oh shit button cause im in the captain chair watching this guy spin down the drain before my eyes and im just sitting here. I didnt want to get in the way of my medic but at the same time I was frustrated because I keep feeling their must've been something I can do.

We arrived to the hospital and I was thinking we were going to hit the ER with the way things are going with this guy. But no, we head to the elevators and begin to take this guy up. My eyes were set on that monitor fearing he was going to code right in that elevator. By now his pulse was 140 spiking at 170 and his SPo2 leveled out at 80. His skin showing it too.

Once up to the ICU he was transferred over. And it was clear with the amount of staff in the room he didnt fair too well on the way over to their facility. After he was on their bed I removed myself from the room and went back to the truck. Hands trembling.

How do you ladies and gentlemen manage to maintain composure when a perfectly uneventful transfer spirals into a oh shit run.

And does it get less creepy to transfer sedated patients that have their eyes open after a while. its not a huge bother to me but it is kinda awkward to work around when hes spinning the drain in fast circles. Can I close them?