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RSI

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RSI last won the day on April 11 2013

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    New England

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    Paramedic
  1. ASSESSMENT Pre-existing medical history: Aside from the spinal injury, does this patient have diabetes or anything significant? Has this ever happened before (the pain/numbness)? Current medications? Lower back pain relieved by meds? How much exercise does the patient get? PHYSICAL EXAM What does the skin on his affected leg look like? Intact pulses on his right foot? Palpation of his lower spine? Does right leg pain increase on movement or constant? DDX DVT or Claudication secondary to - Peripheral Artery Disease or Lumbar Spinal Stenosis? I believe his WBCs will be elevated due to his sickness and the inflammatory response may or may not be the cause of his symptoms (not good enough at pathophysiology to guess). I believe the signs/symptoms of his leg pain/history, associated back pain, and medical history may tell a lot before he gets the new CT scan. Thanks for doing this, mobey!
  2. RSI

    Dyspnea

    Just to recap the information provided: From the door Patient mentation: Altered/Unresponsive. Cyanotic around lips/peripherals Eyes open. RR - Shallow, labored, 35/min Pulse - Fast, weak. Obese Hx COPD/CHF "Okay" yesterday (HAHA, what does that even mean? Talking, conversing, aware? Or in the same exact unresponsive state sans SOB - I'm going to assume the former) Diagnostics EKG: Narrow Complex Tachycardia - 210 BPM; No P-Waves BP: 84/58 SPO2: 85% LS: Rales in all fields I think that's it? I'm coming late to the party but from what I've gathered, we're on the brink of cardioversion. And chbare brings up an excellent point. You don't have a lot of time. Interventions (~2-4 min with 2 ALS crew members?) O2 via NRB -> BVM IV - with blood glucose from the stylet; NS flowing @ < WO. Monitor - 4 Lead Cardioversion Prep Physical Assessment: Eyes PEARL? Smell of urine/feces? Sores on her body? Edema? Abdomen palpation - soft/hard? Assessment Questions (during interventions) What is she in rehab for? What is this patient's baseline mentation? Why is she not on oxygen? What has this patient's trends been in rehab? Improvement or deterioration? Increasing complaints of SOB during her stay or sudden onset in the last 6 hours? Any other complaints? Bed-ridden or active? Paperwork history: Recent infection, surgery? Pertinent meds - Antibiotics, Anti-Coagulants, Antiarrhythmics? Ddx Infection (sepsis), Stroke, Hypoglycemia, Hypovolemia (internal bleeding), Overdose, PE, CHF/COPD. While it's easy for me to say I'm shying away from immediate cardioversion, I'm sitting at my kitchen table nursing a caffeine headache in shorts and a t-shirt. On-scene would probably be a different story. I feel like an immediate cardioversion may convert her rhythm to NSR only to revert back to its narrow complex tachycardia (which I'm going to assume is SVT). So with my assessment questions in hand, I can cross off quite a bit of my differentials as I package. Assuming none of these questions are answered: TX Cardiovert; -> No response, package. (If there is a response, stop here). I feel like cardioversion is an appropriate, valid response. But I don't believe it will solve the problem (with the information available). Grab a nurse or a third responding crew member En route: BVM (followed by RSI), 12-LEAD. On-scene time: 10-15 minutes; Transport time: 10 minutes; Total elapsed time: 20-25 minutes. I'm a new, green medic. If this is inappropriate or VERY inappropriate, please tell me. I'm still in the midst of being trained. I'm working on my prioritizing my assessments so any feedback would be appreciated. And whoever thought of the auto-saving feature on this forum, you're awesome.
  3. Hello, Scrat! The unofficial results of the psychomotor exam was emailed to me later that evening. It was a service the proctoring facility did for test takers. Official results were posted ~3 business days later. Hold tough, the wait is almost as agonizing as testing! Also, I've been really lucky; I received my CBT results and passed. It seems to me that a portion of our verbal stations has to do with inflection and confidence in our voice. Hemming and hawing is going to cause the proctor to focus more intently on your words/"actions". I especially noticed this during my final, oral exam with instructors. I'm sure when the medical director tested you, you exuded this confidence! Great job on the scenario! I don't want to delve too much into my scenario, but in regards to my story of the fellow I had met: He paced a moderate-severe hypothermic patient (with related bradycardia, GCS 14).
  4. Hello, I took the psychomotor exam ~1 week ago and the cognitive exam this AM. I was definitely nervous for the psychomotor and thought I'd offer a few tips. The skills stations are pretty straightforward and the proctors may ask a question or two about the process. Be prepared for these. The questions aren't meant to trick you, but the proctor may test your knowledge a little bit for unacknowledged brownie points. These questions aren't found in a little obscure subtext box in your book, but rather concepts that should have been covered during class. These brownie points may overlook small infractions in your skill demonstration, but don't bet the farm on it. Memorizing critical fails is essential because at the end, they may give you the option to take or add anything from your performance. If you have the list in your head, you can add something you forgot, like pre-oxygenating the patient. If you forgot, it's better to own up at the end and correct it rather than hope to sneak it by the proctor's attention. They do notice. Oral stations: I was sweating bullets. At a bare minimum, know your common medical/trauma emergencies and their pathophysiology process and specific treatments. Protocols may help you, but remember: you can give the correct treatment for the wrong reasons. This is critical thinking so take your time, breathe, analyze the situation. Get as much diagnostic information as possible before enacting any interventions (the exception being oxygen, positioning, BLS). Reciting the bolus dose of Adenosine is not nearly as helpful as explaining the why and what. Also, don't "zone in" on the biggest, most "life-saving" intervention. At the end of the practical testing, I was walking out with a fellow who I had recently met and he was detailing the same scenario I had. His choice of intervention made me internally wince and his rationale was "I'm going to make sure this guy is going to f*'ing live!" I've heard horror stories of NREMT practicals being strict and regimented with proctors being stoic and unnerving. I can't vouch for that, but if fellow students/instructors mention this, it's probably more true than not. If there's a run down of equipment the night before the exam, sign up if your finances can afford it. The instructor will give you key tips that will help you pass. If you can't afford it, remember when you show up at a station and are faced with an unfamiliar piece of equipment, ask the proctor to show you how it works and transfer your knowledge of what you're familiar to this...new thing. Get sleep. You'll be better off in the AM. But study a little bit beforehand. =) And don't ever forget, 100% OXYGEN (my bane during lab). I took the CBT this AM. The best resources (aside from studying the entire book) is the FISDAP online study tools and practice tests that you find online. Don't think taking the tests with a passing grade means you'll do well. Use these practice tests to discover your biggest weakness and improve them. Rinse, repeat. I personally used an NREMT-clone testing app for the iPhone. It proved very helpful. Do what works for you. As to my personal performance, my test shut off after 80 questions in about 50 minutes. As to how I feel about it? It's 13:30 and I'm on my second rum and coke, about to strip down to boxers and start vacuuming. I celebrate weird, I know. The perils and enjoyment of unemployment! To quote a fellow classmate who texted me hours before my practical, "You know this shit. You've done it several times. Relax. And do it." Good luck!
  5. RSI

    Greetings

    Hello, just recently took my NREMT-P cognitive exam. I felt it appropriate to create an account after lurking around for so long. I hope to share many things and learn even more from this site. Thanks.
  6. RSI

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