runswithneedles

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?

Wish I could jump on these posts faster. Seems like when I spot them they've already been busted wide open and not much more can be contributed without re-iterating another post. With the vitals and pts presentation would opiates or benzos considered to reduce the pts anxiety?

No sir. I'm from Texas and graduated highschool in Texas Two years ago. However I do have family in Midland, Michigan.

Put more emphasis with ER than ambulance. Depending on where you live your FD might have a low call volume. So you will either be sitting on your butt studying or you might be asked to assist in station duties. And also keep in mind EMS consists of 98% BS and 2% legitimate calls. Also talk to the medic students who where their in their basic or have been there for a while. They can tell you which stations have the highest call volumes shifts to stay away from and which shifts are recommended. And what kind of calls you could see with each station as one may have a highway in its district or several very dicey nursing homes where you might find some good medical runs. Also some stations and shifts hate students and will treat you like s***. Know your boundaries, offer to help whenever they are doing station duties, if they ask you to stand back just do it, if they offer to show you the box and where everything is say yes no matter how many times other stations have made you do it. You will find that some trucks may be outfitted differently or have equipment in different places or different bags. As I was saying with ER. Your more likely to find something interesting and you will have less down time.

I tried it on a buddy of mine coming back from a baseball game in high school. I don't recommend it.

I was flipping through the app store and I came across a possible gem for anyone who are either learning ACLS or just want to keep their skills up. http://itunes.apple....d430789636?mt=8 Not only does it cover ACLS but it also encompasses how to treat the underlying cause of the cardiac arrest. Which that includes trauma and medical scenarios. I purchased it a few days ago and noticed that not only is it helping me with learning ACLS algorithm but its also sharpening my skills as an EMT. It has three difficulties from trainee to expert and it covers treatments that are applied in both pre hospital in in hospital. If anyone else downloads this app please let me know what you think of it. And for 4 bucks where can you go wrong with it.

The packet I had received from them was not normal in camparison to others I had received. Every other I had taken did have a narrative of how they got here and why. This one was boxs to check and things to circle. Very simplistic and very lacking in anything useful for my narrative to medicare. And also the hospitals in my area have a record system that if they have had surgeries or other visits their it ould combine their medical histories and drug lists from their last visit I also didnt question the nurse. I was in my truck when I discovered her BP was the way it was. And the answers Im giving you are coming right off this patients paperwork or whatever I can manage to translate from chicken scratch to English. And for this Im very much sorry that I cant give you guys the best info. Good thing I just packaged and left. I wouldve served the passive agressive shit sandwich. Sorry it has taken me so long to respond. I have been on a 48 hour hiatus of running my ass off doing homework, studying, and working. (And bouncing off the walls from my monster binges on the side)

Sorry im so behind on the ball with this post. But in a situation like this one. The deputy made a valid point. He might try again to shoot himself after he is discharged. In the sake of your patients best interest in the long term.......................Wait a minute. Cant he be institutionalized for at least a psychological evaluation since he was considering to kill himself. Especially if you and the deputies have the paper trail to prove his intentions that night? Did you notify the attending physician of his suicidal ideations?

Im more worried about the eternal fire Im going to get from the big kahuna in the office when he gets an earful from the nurse when I "questioned her sound judgement". That is an awesome quote

According to her physicians necessity (gotta love medicare and their ring circus) She is bed bound, has dementia (which was not stated in her half assed version of a H&P.) Requires medical supervision (though it does not state why). She cannot sit or support herself in a wheelchair due to L sided weakness caused by a CVA (age of CVA not stated in H&P)

Welcome. What are the odds. Two paramedic students with the same name in the same state on the same forum.

I would like to point out. I did not call them idiotic assholes. I called them idiots. And as Dwayne pointed out it was my ignorance and lack of knowledge regarding hemo-dynamics and crystalloids that made me say they were idiots in the first place. And for that I take back what I said. Now to answer the questions I forgot. Workup: Besides the CT scan which was negative for a new CVA. Blood work up was done only finding glucose was 205 mg per deciliter and WBC of 3.9 She was prescribed vicodin PO upon discharge. I dont know the precise numbers in regards to ischemic strokes. I will take a stab in the dark and say a fair amount since it is by definition oxygen deprivation of the brain due to poor perfusion or lack of in a given part of the brain. And what do you mean by providing evidence? And to be truthful of the matter I didnt know I had much of a choice that I could return her to the ED after assuming care. I didnt know how to handle it when my boss rings my neck out for turning a run down. I didnt know how to explain to ED nurse Im not taking her back home after just wheeling her out the door. My gut wasnt screaming at me saying that this patient is unstable nor unfit to return home. But at the same time my mind told me their was the possibility of something happening. most of what im reading to you now Im reading for the first time of her ED record. (Boss gets pissed if I delay transfer so most of the time we load and go. Read paperwork while doing the report) Im trying my hardest to give you guys what you need. It sucks because the two page (or one page front and back) assessment I had beg to get has chicken scratch that easily steals my crown. And it has no narrative. Is that normal for ED's paperwork to not include a narrative

Thank you very much for the link. I believe most programs that further increases your specialty regardless of occupation should have a minimum level of experience in the field before being eligible. Its just like when I was fresh out of EMT (though I still believe im relatively fresh). You learn FAR more in the field than you do in class or your clinicals. And I quickly learned the endless hours in lecture and the ER was merely the bare bones. I can look back now and say im a far more confident EMT than some of the other paramedic students who have yet to take their own patient without someone to watch over them. Same should apply with their paramedic. Cardiology, pharmacology, and assessment based management comes to me so much easier since ive worked in the field.

Ooops. Here's additional info. Pt brought in via 911. Pain present at time of arrival to emergency department. Rated 10/10 originating from posterior region of the head. CT scan completed WNL. She has a daughter who checks up on the pt and her husband regularly. Stroke test revealed only her pre-existing left sided weakness. Nothing else remarkable. Patient did not appear to be in any type of distress on our arrival. Am I forgetting any other questions?

Thank you very much for all of your constructive criticism. I was figuring it would be worse. Since some of you ladies and gentleman have been users on this board for years and medics for decades. I seek to acquire as much of the collective knowledge I can whether it be medical knowledge or professionalism. In regards to my statement towards the ED I was very frustrated and irritated that I had my dispatcher barking up my ass asking where the f*** was I they are getting pissed and when I get there they don't have the paperwork I need ready. Im working on my temper but it's crap like that always gets my goat. >:-/

This is probably one of the worst places to admit a possible mistake. But I would like to hear your opinions on this one. Yesterday I was dispatched to take home a approx 75 yo female who had been admitted to the ED for a severe headache which lasted about 1.5 hrs. She has a hx of CVA resulting in L sided weakness and a-fib. She was on a blood thinner ( not coumadin or warfarin) I can't recall the name. Anyways ED assessed her and gave her a 1000 CC NS bolus and called us to take her back home. According to ED records her bp was around 160/108. Pulse 83 RR 18 no spo2. This lady was Spanish speaking only so assessment was very limited. Prior to departing the ER bay I took a set of vitals. BP 180/102 pulse 84 irregular RR 20 Spo2 89% RA. Her ED records (a joke to say the least) had no indications for HTN or medications. Her skin color was pink and warm. After the run I was starting to believe the headache she had was caused by Uncontrolled HTN. And the idiots in that ED mightve made it worse with that bolus. I feel now I should've pulled her out of my truck and taken her back in and said I will not take her. What are your thoughts to this?

I wouldn't be surprised if this topic has been covered in another post. But after cursing at my phone trying to find a search bar I finally admitted defeat and decided to start a new one. What are the differences between the two, what kind of doors does this open if I should get this credential, is their much of a pay difference, what kind of pre-requisites do I require before I can attend such a class, how long is the class, and what are the advantages to acquiring my Critical Care

So its the chemo receptors that are detecting a correction in ph that causes hypoxic drive? I did not know that Do forgive my complete brain fart. But what would the contraindications be for o2....Besides A good spo2 saturation

Thanks Dwayne. Glad to see your still here.

rope, my mind, good knife, hatchet, box of matches and a canteen maybe a tarp if space permits. I can make a good splint out of near by branches. and the tarp can be used for a makeshift tent or used pakcage the patient. also provides some insulation or the tarp can be turned into a kite to signal rescue

Sorry. I'm sure some of you guys wondered why I haven't posted my meet and greet. When I signed in a while back I forgot my username and password. (epic fail on both counts). When I found I could use my Facebook account I Figure it would be easier to use it here rather than making a new one. My old username I think was promedemt. Anyways so after a long period of silence between myself and the forum I would like to say hello to everyone again and thanking those who supported me through my EMT class. Cheers

X-D. They wont chase it if its not on fire, smoking hot, or edible.