scott33

You have to upload it. Curious to know how it could be so long....

Second guess would be a bloody pacemaker of course

SVT with chemical / electrical conversion???

I have been sniffing around EMS and nursing forums for several years. Aside from the often addictive argumentative posts (whether contributing or not) which can be very amusing, there is an immesurable amount of relevant information to be gained from the likes of EMT City and others.

There can often be some confusion separating the wheat from the chaff with certain posts, but nothing that can't be sorted by going off and doing our own research.

As well as the clinical guidance which is handed out FOC from the more learned members, I have had my entire philosophy of EMS do a complete U-turn in recent years, and I am grateful to certain regular contrubuters for highlighting all the stuff that I didn't wish to acknowledge, when I first started out.

The ANSWER

This is a Sinus Rhythm with synchronous ventricular pacer.

Hmmm.

One has to wonder if, given the atypical pacemaker rate, and the atypical delay in conduction between the atria and venrticles, that there isn't a technical issue with the pacemaker itself.

May be time for the man with the magnet from Metronic, to interrogate the device

We only briefly touched on 12 lead, so I'm using lead 2 here. From what I can tell it's a sinus rhythm with st segment elevation indicating an ami.

The ST elevation in the lead II tracing would not be indicative of an MI, (no matter how high it was) as it there has to be elevation in contiguous leads (or groups). You may also notice that the gain was turned up on the single lead strip for clarity, which tends to exaggerate elevations and depressions.

What this strip was indicative of, was running a 12-lead for a closer look. As you can see, the results are more subtle, but can yield a lot more "other stuff", which should be taken into consideration along with the patient's chief complaint and other findings of the physical exam.

The only problem I have with "inf MI" is the lack of reciprocal changes, so I still wouldn't put money on it.

Maybe if we get the patient's S/S we may have a better idea.

We only briefly touched on 12 lead, so I'm using lead 2 here. From what I can tell it's a sinus rhythm with st segment elevation indicating an ami. I'm not sure where the mi is though. Or why the qrs deflection is negative.

Thank you for posting this, btw. I love learning more indepth than what we are doing in class.

Sinus rhythm with 1st degree AVB, RBBB (assuming QRS > 0.12s), and left axis deviation. Possible ST elevation in the inferior leads, though would need to see a larger scan so I could go "box counting".

please log in

Same here. Can you copy and paste please

That is it! I've had it! I refuse to EVER toilet another one of my patients. I'll just let them crap all over the cot. I have an EMT, they can clean it up. As for the patients that are covered in crap or vomit, tough. I'm going to have my EMT wrap them in a sheet and throw them on the stretcher for transport. Next time, don't crap on yourself.

Apparently I'm working too hard trying to do right by my patients and my team. I'm open to any more suggestions about what is NOT my job so I can go to work tomorrow and have the easiest day in my career.

Sad to say, but you Sir, are pompous. I bet everyone is just chomping at the bit to work with you.

And still the personal slurs keep coming. Always a sign of someone losing an argument though isn't it?

You and several others clearly have no idea of what I am getting at here. No idea whatsoever, and no idea of who's side I am really taking.

I think some people are now just arguing for arguments sake, I can only assume that raw nerves have been touched.

I am surprised that no one can see the obvious here. That is, given the sound bite that is clinical time for the EMT, there should be little or no dogsbody work. I haven't said none whatsoever, but it should be proportional to what you are there for. You are there to learn and practice certain key skills; chiefly history taking, and vital signs, and to a smaller (much smaller) degree, get an overview of how the ED functions after you have dropped off your patient.

I have tried to be subtle about it, but in many cases the EMT student is seen as a thorn in the side of many nurses, not that I share that opinion. Some of them will pounce on the opportunity to use the extra pair of hands in every aspect other than what they are supposed to. I know how clinical works, and I know the most important thing for many a student is the signature on the clinical form, anything else is gravy. So why should it matter what they do on their rotation? I get it!

I always thought things were a little backwards in NY EMS. Now I am grateful to have gone through 3 separate EMS programs, in which the staff made the clinical expectations crystal clear to both student, and healthcare facility.

I suppose there are also schools out there that have students lifting the patients too?

But that’s another argument

Sooo.... instead of having several interactions with a variety of patients each with thier own challenges (speech, hearing, language, etc) You want them to sit for hours and interview 1 or 2 people?? What skills does that teach? .... How to interview that one person

The "S" in my wording patients suggests that I was hinting at interviewing more than one.

Now you are just clutching at straws.

That is not a routine part of thier job. Bad example.... try again. No one is advocating for students to do things they are not going to do after practicum.

And I suppose handing out food trays, doing runs to the lab, and

Transports to the floors [end quote] are a routing part of the EMT's job.

One born every minute.

I think some of you are getting the completely wrong end of the stick, but I make no apologies for trying to encourage vectored learning.

Judging by some of the replies, there have obviously been a few people conned into doing much of the mundane tasks that they should not be anywhere near, and clearly that is where the overly-defensive tone of some of the replies are coming from. By some of your own admissions, one or two posters have spent way too much of their clinical time making beds and other tasks not related to the EMT curriculum. Whereas this is no big deal if it is kept to a minimum, it serves no purpose other than to relieve those who chose not to do it, of their obligations. On the typical 120 hour EMT course, in which only a fraction of that time is clinical exposure, bedmaking and piss-pot emptying should not be one of the main expectations of the student.

The EMT student is not part of the nursing or medical team, lets get that straight - they are an adjunctive component to the daily running of operations in the facility, not an integral one. Nursing staff who pair up with EMS students are usually hand picked (if they don’t volunteer) and should have an insight into the clinical expectations of the student. Many of them are in EMS themselves, so are ideal in bridging the gap between roles. Others are just very good tutors at any level, so can offer a lot of relevant information on the basics. Unfortunately though, some of them slip through the net, and there will always be those who will see the extra pair of hands as an excuse to have an easy shift, at the expense of the student’s learning experience. I have witnessed this several times.

No one likes it to be pointed out that they have been hoodwinked into doing something they really shouldn’t be doing, and perhaps this is why there seems to be a lack of objectivity in some of the replies. Learn from it and move on. Think about it though, would you rather have a clinical experience that concentrates on the key clinical skills as per your curriculum, and as per your classroom studies. Or would you rather be used as a runaround, hand-maiden, and dogsbody doing things which do not reflect the limited practice of EMS work? Sure, what student is really going to object to anything asked of them, as the ED is always an exciting place to be for outsiders. The problem is that it provides zero benefit to the student as an EMT. The "social networking" aspect can best be developed at the patient's bedside, not sucking up to nursing and ancillary staff, some of whom will happily take advantage of the student who just can't say no. This is my job, I hear the stories of gullible EMS / Nursing students all the time, who get used and abused as fetchers and carriers. It is wrong - end of.

And before anyone comes back to remind me (like I don't know) of all those jobs which need done in an ED, there is a little-known fact that the more "tasks", a non-staff member is detailed with, the slower the ED will run. The students are operating under someone else's license and with patients assigned under someone else's care. It stands to reason that the combination of the student’s inexperience and an extra pair of eyes upon them, will often make certain things run in "floor time"

Those few ED staff who haven't actually witnessed first-hand, the wrong-doings of the EMS students, who take it upon themselves to do their own thing, will have at least have heard the many horror stories. Hey, 5hit happens, but this is why many of the nursing staff flat out refuse to take anything to do with EMT students…it means a little extra work, and a lot of extra responsibility (read accountability) for them.

As for occupying time when it is quiet – if I were able, I could spend a whole shift interviewing my patients and developing basic history taking techniques if there was nothing exciting going on in the trauma room. I would much rather see the students even having idle chit-chat with the patient about their visit, than running about with commodes and handing out food trays. Just what "skills" does the latter help to develop, to help the EMT in their role... as an EMT? Some of the offers to assist in the running of the ED, are reminiscent of the overly enthusiastic family member who insists on speaking over her loved one –the patient, by answering all their questions. It just can't be seen from an experienced perspective here.

But, going way off topic, so I would suggest to the OP, as well as those who have already gone through clinical rotations, that they review their clinical policy and procedure for their school.

I cannot imagine being in a situation where I would need to ask an EMS student to do my dirty work for me if I am able to do it myself. I take the nurturing of the EMS students way more seriously than to do that. It is also something which could easily come back and haunt me if I did so, perhaps even relieving me of preceptor status. It is an abuse of power, counterproductive to the clinical experience, and not what the students are there for. If they are there to learn vitals and lung sounds, then they can usually spend an entire shift doing just that, by repetition, until it is second nature. That, is making the most of ones clinical experience.

I would love to see some official evidence of ANY EMT school endorsing or turning a blind eye to this practice - but we all know, none exists.

Question for the RTs, phlebotomists, rad techs, pharmacy techs, and medical students here…How many times a day are / were you asked to make beds, or assist with toileting the patients while on clinicals?

Thought so.

I've seen medics bring a patient in, 2 separate incidents, where they were infusing dopamine without a pump.

It is worrying but it does go on, and sadly quite legally.

Some medications should just always be on a pump, and Dopamine is a prime example. As for "titrating to effect", it is going to be quicker on a pump as you just plug in your new rate instead of messing about with a clamp or dial-a-flow. There is also the advantage of being able to document more accurate amounts of medication given, and over how long. You can set it to give the patient X amount of medication and no more, which takes care of arriving with an empty bag and red face.

What's next - Insulin drips without a pump?

Doesn’t sound like you ever did it in NY, otherwise you’d know that 911 medic’s don’t carry IV pumps of any kind…

(IV drip sets yes, pumps no)

It’s all titrate to effect (within dose limits mcg/k/min).

Although it is poor practice, there is little need for 911 to rely on pumps in NYC, given their proximity to the abundance of healthcare facilities which pebble the area. There are plenty of IFT medics who do use pumps in the NYC area however. Transcare, NSLIJ, and Lifestar are just three companies I know of who use them.

IVPB Mag and Amio, may not cause a huge issue with just "running it in" using the volume over time formula, but the potential will always be there to cause a bigger problem than you started with.

I would much rather see the likes of Dopa on a pump, but as already pointed out, that would involve education.

The one thing I don't necessarily agree with is going on transports to the floors unless it's a critical patient ie learning opportunity. Don't risk missing something in the ED because you're taking Grandma Drippy Drawers up to her Med/Surg bed for an overnight observation.

It just gets better. Transports to the floors

If making some beds gets him a better clinical experience, that's called initiative in my book.

In my book, it is called sucking up to the nurse to get a good report, or let go early. Seen it from both ends many times and is completely unnecessary.

And it won't get him a better clinical experience, it will get him better at making beds.

My, my, those lazy CNA's have punked me into making more beds than I can count. Just who do they think they are? It shouldn't matter that they have 8-16 patients that needs labs, ECG's, urines, blankets, and all that other crap that goes along with being sick. And those nurses, they have some nerve thinking I'm put on the earth to make their beds.

What a completely RIDICULOUS statement.

Thanks for the lecture. Now show me where in the EMT curriculum it has bed making as a psychomotor skill. Show me the clinical rotation sheet which has bed making, arse wiping and urine emptying as something which needs to be signed off on.

It is a complete waste of clinical time to be expected to make "more beds than you can count" on rotations, and if you had bothered to read your clinical itinerary, it may even have stated so.

As an RN whos real job is working in the ED of a level 1 trauma center, and who frequently assists EMT and Paramedic students - and as an ALS field preceptor who also has to sign the student off on ALS ambulance skills, I would never expect any EMT student to pick up my or my colleague's slack. Students are there to learn specific psychomotor skills consistent with what has been taught in class, not run around making beds etc. I don't see an issue with one or two bedpans etc if the student volunteers it, or if they are the nearest pair of hands - and volunteering to help with anything will always get the "enthusiastic student" on the rotation form. But take it from me, the hospital staff know that it is no more acceptable to ask these menial housekeeping tasks of EMT students ad nauseum, as it is a patient's family. It is nothing to do with being above making beds and emptying bedpans, it is a matter of getting the most out of ones clinical time as possible, and doing what is relevant to the role of the EMT. At the basic level, that means manual vital signs, lung sounds, patient history etc.

As I said, any decent EMT school will have explained to the student ahead of time, to politely refuse these tasks, and escalate if it becomes an issue. Obviously a lot of people have let hospital staff walk all over them in the past. More fool them.

Don't be shocked if they have you making a bed or something but they will remember the person looking for something to do over the one standing in a corner doing nothing.

Any good EMT school will have already advised the facility of clinical expectations of the students. This should not include "making beds" or anything similar. Clinical time is sparse enough in EMT school without making it less productive by being used as a skivvy for lazy arse CNAs.

I agree with tskstorm - take plenty of vitals, lung sounds etc.

Hi Scott

If you're who I think you are, yes we do "know" each other from another site based in the UK. (If it confirms who you think I am, I'm the guy with the red GoldWing on the other site!)

Thanks for the "basics", I will be in touch when I have sat down and sorted out the pro's and cons and logistics etc, mainly which will be the better option for all of us, ie, do I move to her or does she move to me, (Probably the former!)

All the best

Ian

Hi Just read this.

Yes it is the "you" I was thinking about. I am the same "Scott33" as on the Uk site and a few others.

Just PM me, here or on the other side of the pond and I will help all I can.

later...

you referring to mr Gift there scott ?

But of course

Can anyone intrepret?

Hello Kettle? This is Pot, confirm color, over!

Yes, there are many different colors of emergency lights, for those who are allowed to claim certain road privileges in emergency situations, and have received the appropriate training. I can't for the life of me remember the color of light used for "Obstetricians", otherwise this moron would have abided by the traffic laws like everyone else who have been given an instruction to pull over.

I assume there was major, major, complications with this birth - otherwise why would he be risking his life, and more importantly, other road users lives? I am sure there were other medical staff (of any status) around to cover while he was on his way in. Not that Doctors are really required at all births anyway.

Perhaps it is the cynic in me, but maybe the "emergency" was more to do with his concern about not getting paid, for a birth he was not present at.

Would be interesting to read more on this.

LOL! I love it!

Don't encourage him. He is *cough, cough* special.

My English friends agree

I am looking at moving to the Chicago area sometime in the next couple of years to be with my girlfriend, so accommodation etc is not a problem, however employment is.

More importantly is the issue of a visa. Without one you cannot enter the US with a view to commencing employment. If, and only if, you plan to settle down with your GF, i.e marry her, she may apply for a K-1 visa on your behalf which can lead to conditional permanent residency status for you. This may be adjusted to LPR (lawful permanent resident) after a couple of years, providing you have satisfied all the requirements of the USCIS (immigration), which includes staying put in the US for a predetermined length of time. While your adjustment of status is pending, and after you have been approved, you may receive a temporary work permit from the outset. This is restrictive and temporary, but it gets you out working, paying your taxes, building up a credit score etc.

Remember, it is your contact in the US who has to apply for a visa on your behalf, and she must prove that you will not be a financial burden to the state. She will have to submit a notarized affidavit of support showing that she earns enough to take care of both of you.

Your UK qualifications are not transferable, but that isn't a problem as there are so many medic mills out there, that starting from scratch is not going to be an issue.

It will take several years and several grand, for the application process to be completed. Here is where you start...

www.uscis.gov

If you need any more info, PM me. I am sure I know you from elsewhere

Want to back those words, or just speak from your anus? You use same repeated comment without any explanation leads one to believe you must have failed one of their tests.

NREMT has and still endorses formal education. Without their persistence we would not be heading for accredited programs. You can thank the NREMT for this or is this one of their "scams" you adress? Validity of tests per academia and again wanting programs to meet such standards.

Yeah, a whopping $10 a year scam.. poor baby. Apparently, you don't know the costs of most professional health care organizations and again I doubt you know or read the scientific research and the presentations they have performed within EMS.

So your asinine statement makes no sense, obtain your degree and NREMT demonstrating you have met the minimal national standards.

R/r 911

Rise above it. He is either trolling or, as you say, just a sore loser having sat it several times and failed. Three of his posts say the same thing about the NR with no rhyme nor reason.

He is obviously begging us to go after him, which is why I would just ignore him if he continues to post one-sentence antagonistic diatribe.

Thanks for sharing.

I have just landed back in the US only yesterday, having buried my Father last Thursday who succumbed to Colon Ca with liver mets.

I intend to get a colonoscopy in the near future even if I have to pay for it myself.

Also, if you consider atrial rates in AF, vs atrial rates in MAT - as well as other physiological differences such as cardiac output, you will see that AF and MAT are very different in many ways. AF often produces the "quivering atria" due to completely random impulses firing at such a rapid rate, from any and many foci within the atria, and of which only a fraction will result in conduction throught the AV node.

With MAT, the impulses are more organized and individually, are more likely to continue conduction through the AV node and beyond - hence the P-wave (or similar) before every QRS.

Sorry, completely different.

How about "D. Live Stud"

(Can anyone hear the Jeopardy tune in the background?)