runswithneedles

Ive recently received my rank as a texas certified EMT-I last week.

Dont forget about CCEMT-P program. Though its not an additional license it is the highest level of certification aside from the National registry

Thankfully I dont need to fret. Im off duty for an additional 36 hours :-D

thank you. Im soo excited and I go back for my paramedic im the falll

Ive been staying alive, staying alive, ah ah ah ah staying alive.

I got word yesterday. I passed my National. Im up for another 2 years. :-D

Stayin' Alive, Stayin' Alive, ah,ah,ah,ah stain' aliiiivvvveeee ..... where is that darn Lucas?!?

Another one bites the dun nuh dun dun dun another one bites the dust.

generally on scenes like those PD/SO/ state troopers will be there before the ambulance. First triage to determine what you have and direct SO/PD/ or state troopers as what is needed. If not than triage them on your own and provide minimal basic care until the ambulance arrives.

its good to be back

Sorry its been so long since I posted, Been incredibly busy last several months. I finally left private EMS and im doing my first 911 job in my home town. Looking at finishing up my paramedic probably next year. Couldnt finish because I was getting incredibly burn out from my old job. How has everyone been?

When I was in EMS the first time, back in the late '80s - early '90s, I was 18 and on fire. I thought I was "IT." I knew everything, I knew I was all grown up, I knew I was mature, etc. In other words, I had the typical thought process for a young adult. Now, with more than twenty years of life-experience, I have somewhat of a different view of things. I see now that I was not on fire like I thought. I wasn't the uber-mature, end-all, gift to paramedicine (or the world) that I thought I was.

Granted, in a lot of ways, paramedicine is a young person's sport. But is there some room to consider the idea of requiring paramedics to be at least 21? If you think about it, we have 19 year old medics who can push narcotics, but cannot purchase liquor!

I know the debate about degree medics is also raging, but should there be a requirement to work at a certain level for some time before advancing? That would build in a waiting and maturing period.

Its hard to say. Im twenty and got my EMT-B when I was 18. Ill be sitting for my paramedic licensure in less than a month and I know I have the mental capacity to handle the responsibilities I will be granted upon licensing. Some of my previous post may reflect otherwise but its because I came to this site and posted them I am beginning to understand the magnitude of what you (currently acting and retired paramedics) do, have done, can do, and ultimately what a outcome could be if a medic should make a error in judgement.

It truly depends on the student and how serious he takes this massive undertaking and if he is willing to take the time to do outside research and reach out to find mentors to help guide them.

The bug bite and reasonably rapid onset (20 minutes) are the huge clues that this is not an asthma attack.

unfortunately the bug bite was not pointed out until after the scenario. I totally fudged up on my complete physical assessment.

chbare covered the pharmacology which was the root of your question, but I am going to play devils advocate...just because I can.

Based on the formula for normal blood pressure of [(Age x 2) + 90 = 102], and hypotensive being [(Age x 2) + 70 = 82] I am going to argue that she is normotensive. She does not have any hives or angioedema. It sounds like her symptoms are localized to her bronchioles...making me lean away from anaphylaxis.

Her heart rate and her respirations are elevated which should be expected from her respiratory distress. She has a history of asthma but no history of allergies (other than seasonal -- does anyone know if there is a correlation between these and anaphylactoid reactions?)

You said that she had a "bug bite" which I take to mean something entirely different from a HYMENOPTERA STING. One of which is a leading cause of anaphylaxis, the other I don't believe carries such a risk.

In terms of the contrast in onset between asthma and anaphylaxis...well...I can't quite come up with an argument for that. But I think my case still stands.

So I'm going to say that your working diagnosis wasn't as wrong as your instructor may have suggested, even though he had the "answer" in his hands and had the advantage of building things around it. Now I ask you...so she was maxed out on albuterol, but what other medication could you have given that has a mechanism of action that is still pretty specific to the bronchioles?

Dexamethasone wouldve been another good one for this patient.

As far as the cookbook medic the idea seemed sound at the time. Looking at it now I couldve accomplished the same method of killing two birds with one stone by doing the epi IM. With respirations at 40+ i'm starting to think the nebulized epi wouldve been useless because the tidal volume (or is it inspiratory volume? I need to double check that) wouldve been insufficient.

Is it common for patients to not show hives during a allergic reaction? That was one of the key factors that made me rule out allergic reaction as a primary diagnosis. Because in this scenario she had not developed that nor was she experiencing the sensation at the time of her throat swelling or anything. It was only wheezing at the time. Sorry I didnt post that in the original.

.....crap

I was thinking the increased BP was from anxiety from the asthma attack and the increased heart rate from the albuterol combined with the anxiety. And the reason why I posted was for constructive criticism. So im not taking it as bagging at all.

And I'll be sure to begin breaking up large posts into paragraphs. Along with double spacing.

The little research ive done between the racemic epi and the epi IM was the dosing and I think the concentration (I cant remember specifically as this scenarion was done three weeks ago). But im curious as what kind of impact between the different route, dosing, and concentration would have for this patient.

Since both asthma and allergic reaction constrict the airway the racemic epi seemed like a way to knock out two birds with one stone.

But to be straight forward I think I got so tunnel visioned on the asthma I ignored anything else.

I have gotten better. And witnessing my first code on a fire rotation has helped me realize what he mightve meant when he said "private ambulance isnt box time". But having seen the fast pace of a true emergency versus the slower pace of a private it makes me nervous making the transition as a paramedic.

We did a pediatric scenario lab recently and one of which was a 6 y.o female which had a severe allergic reaction secondary to a bug bite. She had a Hx of asthma and seasonal allergies and NKDA. And last time she had anything to eat or drink was lunch several hours prior. Her signs and symptoms came on 20 minutes prior to EMS arrival. Had I did a full body exam I wouldve found the moulaged bug bite on her left shoulder and known it was a severe allergic reaction. (sorry if my spelling is off) Her pulse was 140 BP 100/75 Resp around 40 SPO2 98% RA. My primary diagnosis was severe asthma attack and my differential was a allergic reaction from a unknown etiology. My treatments were begin pt on racemic epi via nebulizer mask 8LPM, begin IV access at TKO for drug administration, and transport code 3 to nearest emergency facility. When my instructor told me I had the incorrect diagnosis and what needed to be done it made me wonder as to if the treatment I had rendered would have been detrimental or beneficial to the patient. My theory behind the racemic epi was she was nearly maxed out on her albuterol treatments and if was indeed a allergic reaction it might alleviate it or if it was a severe asthma attack it would open up her bronchioles. What are your thoughts on it

I gave you a negative for that. Why would you take the albeit slight risk of injecting a substance into a patient with no therapeutic benefit for the patient?

I think he was joking on that. Ive heard other medics make similiar jokes with NaChl.

arm drop test can rule these out.....

Then get everyone out of the room and tell 'em to get up and walk to the ambo!

Ive heard the arm drop test isnt all that effective. Especially if the patient is experienced with the test.

Are you referring to arm drop on the face or the crotch? Ive heard about both of these tests. (Having never seen either one done I dont know if its just a joke or if its an actual test)

my prayers go out to the families of those who are all involved. Another sad day in America.

Its pretty obvious im out of touch. And you guys have more experience and knowledge in this Ill just scrap that Idea. So Ill just do a pre professional (pre med) major to avoid taking the incorrect courses.

Welcome back.

Do you want to be a paramedic, a nurse or a physician? Why are you using nursing school to gear you up for medical school? Are you taking the scenic route on purpose?

If you want to go to medical school get enrolled in a pre-med program at an accredited degree awarding university. The prerequisites for nursing school are different from medical school. Med school requires some pretty heavy hitting science coursework that is not required of nursing school. A solid pre-med program will offer you the opportunities for you to complete the med school pre-reqs that you need. You won't get what you need from nursing school to prepare you for medical school.

And what Dwayne said about punctuation, grammar and spelling.

I'm still working on grammar and spelling. Its a slow tedious process but its getting better. And as far as why I'm doing it this way. Im using my paramedic to gain experience, a working knowledge of what I have learned, and financing my BSN along with my first car. Which to say the least not a junker. But a almost new Mazda RX-8. And yes you are correct the BSN does lack in several courses for a pre medical major however I will be taking the other courses in semesters where I have a low course load.Mostly the summers. Im acquiring my BSN because of the wage difference between medic and RN (which in west texas is relatively significant) and I will have some possibility of administrative positions in hospitals. But more importantly its a solid fall back in the event I should not succeed in getting into medical school.

As have been mentioned, I can't think of any reason to go this route. Does your pre-nursing include physics, organic chemistry, general chemistry, and general biology courses? Don't make the mistake a friend of mine made and think that anything other than "general chemistry" and "organic chemistry" fullfills those courses (i.e. don't take a "Chemistry for _____" course)? If you want to go to med school, then go to med school and jump into your pre-med courses head first.

The university I am attending does require those for the BSN

Along with micro-bio, genetics, and several others. I can bring a list back tomorrow since i'm consulting with them tomorrow.

most traditional stories regarding zombie bugs are viruses so I wonder why he has PCN in it. But aside the nit picking thats pretty funny. My medical protocols state 1.45 ACP round placed between eyes. Repeat until zombie no longer moving or trigger finger is satisfied.

Thats perfect. Someone forgot to take off the airbrake XD.

Hey guys. Last time I was on here 2 months ago I was in a downward spiral after a bad ending of a relationship and the stress of paramedic classes. Well good news is I have put back most of the pieces together and im ready to re enter to forum with productive posts. So Im back to stay. And in less than five weeks I will be sitting for my national registry at the paramedic level and be starting pre nursing for my BSN to gear me up for med school.