MariB

Registered dietitian.

Apparently she has a masters degree in dietetics and nutrition

Actually, public education should be an important component of EMS. Injury prevention, public outreach, public health issues, disaster management and other areas are important and working in the "field" gives us unique perspective and can allow us to being said perspective to the public. If anything, public outreach is sorely lacking in the United States at least. This may be as simple as teaching CPR and first aide courses or complex as working with the public to develop a comprehensive community disaster plan.

YES!

I have a dietitian at work who I was talking with the other day. She had a display of heart healthy snacks out for the students and I had approached her and mentioned that maybe we could get together and have her with us while we did blood pressure screenings, Heart Health, Heart attack signs and Stroke sign Awareness some evening.

Now? I cant contain her!

Well my class is done minus the skills part to make up due to weather.

Our final was 100 questions written in national registry format taken from the test bank and I got a 94% .

Hoping I do well on the actual NR.

Yes I googled it and never would have guessed in a million years without STI and Swollen Joint. Those two got me my answer.

I think it would be hard to cone up with that king of field diagnosis with what you had though

MRI? I know when my Discs in neck acting up my fingers buzz and go numb.

Sciatic Nerve?

I had no idea so I did a search and so that makes me a loser. Interesting to say the least

http://www.littmann.com/wps/portal/3M/en_US/3M-Littmann/stethoscope/stethoscope-catalog/catalog/~/3M-Littmann-Master-Cardiology-Stethoscope-Burgundy-Tube-27-inch-2163?N=5932256+4294958428&rt=d

This is mine.

Actually, I work for a volly squad with a very small stipend lol. So no, you don't want to work here if you want to support a family, that is for sure.

Those EMTs who think having a high end stethoscope is cool won't think it is cool when they lose it or break it. I have to constantly check for it when I have it because I can't afford to just replace it. I was using the one from our second ambulance on test nights, but once sdwe went to breathsounds, I ccouldn't take it 2 to 3 evenings a week. I replaced it with mine which was OK but not that frequently.

Stethoscopes can run hundreds and hundreds of dollars. So a $50 one would be considered low end for some. Not for most EMTs though.

I bout a $75 littmann at first after using the tinker toy quality ones in class thinking a better one would help. I knew I had hearing issues since teen years and after a few tries at a bp, an instructor found his with a cuff on, pit it in my ears and said "Hear that loud thump? That's what you're looking for" I gritted my teeth, jammed the ear pieces as hard in my ears as I could and couldn't even make out a sound . He asked me if I ever had my hearing tested and I said I had and it wasn't the best, but I didn't feel it qualified for hearing aids since it didn't disrupt my day to day life. I for a fewminutes felt my EMT days would never happen

The lead instructor came over and knew I was having a hard time, he then inflated the cuff until the pulse was strong, put his stethoscope in my ears and asked if I could hear it. I did. I had thought I wasn't putting it on the right spot, or just wasn't getting it. Well he told me he was also hard of hearing and had a master cardiology stethoscope. I took several after that and was able to obtain a bp each time.

I looked around for a few days online and was let down. I couldn't pay for a stethoscope like that for a volly position.

Within days one came in the mail, from Santa

Sorry for the typos, on my phone and trying to correct them is causing a scroll issue

MAST isn't a station, nor an option for a random at NR skills stations, at least for paramedic.

I've proctored several of them, so I'm pretty confident about this...

good to know. We had to know them inside and out as a possible option . Of course we were told that with everything

Yeah, sorry, I worked a long shift, maybe someone else will have the brain power tonight

I was trained on MAST pants in 2005 in Maryland. They were taken out of protocol the next year I believe though.

State to state might be different, but as of 2012, they are being taught for National Registry Skills and written

I would have too but it's also a state that didn't allow basics to use a glucometer or combi-tube/king airway. Not sure what all has changed but it's not a progressive system. Colorado allows basics to do more than MD did.

Here is their 2013 protocols http://www.miemss.org/home/LinkClick.aspx?fileticket=Tz5wGQYZrKI%3d&tabid=106&mid=875 Page 144 breaks down skills by provider level and EMT's still don't have standing orders for glucometers, laryngeal airways, IV's/fluid, and a few others.

ohhhhhhhhh

I find the cheapo stethoscopes hard to hear with. However my Littmann which is the $50 model is a dream. It might just boil down to the Littmann fitting my ear better though. I have no need for a Cardiology stethoscope but a few of our EMT's have them. Personally I wouldn't waste my money on a $150 scope.

I don't like to palpate and I rarely do it. Only time I palpate is if patient condition warrants it or if I cannot auscultate. In the ambulance I just isolate the arm. We have Mercedes Sprinters though and even though they are diesel they are not noisy. I can still auscultate even in our old Ford type II's that we use for spares.

A $50 Stethoscope is considered a "Cheapo"

$30, $50, $75 or $300, use whatever works for you. However, it is not easy to press "lightly" while obtaining A bp. You usually have their arm tucked under yours, they are talking etc. Pressure is inevitable.

I do have a need for a Cardiology Stethoscope as I have a hearing deficiency . I couldn't hear breath sounds or obtain a BP with my $75 Littmann , I now have the Master Cardiology. No it is not a waste of money, and it was $210. I could not have continued in class without one.

I can hear their thoughts with it. lol

Why palpate when I can auscultate. We respond with the fire dept and fire usually "palpates" the BP on their initial assessment. However, I have come to find out that either the majority of the population has a bp of 120/p or quite a few of the Firefighters aren't accurately doing an assessment. I always redo an assessment when taking over patient care and usually prefer to auscultate.

That said I am not above palpating. I had a patient who was 2yo the other day. We don't carry a stethoscope that small so I palped the BP. If I am in a hurry due to patient needs I will palpated it as well.

So basically it is personal preference. I do compare the vitals I obtain with what we get at the hospital and I find that I am usually pretty accurate.

Very lucky, It is not easy to get a blood pressure cuff even near a 2year old.

"they" I put that in quotes because it has been said over and over and you hear it in class yadda yadda , that you are supposed to pull over to Auscultate , So I, with all my clinical work etc, choose to Palpate.

Observing and running with ALS units, they always Palpated also.. And it isnt common to get 120, most people being transported, are running 120. But whatever works for you, works, why not stick with it?

and Why dont you guys have a PEDs bag with a small stethoscope? Do you have special rigs you usually use for pediatrics?

Hmmm, medic intubates before the IV?

depends, I've seen it both ways, there has been a time when they couldn't get a seal on a bvm, pt had something wrong with mouth. And even with oral it did no good. ..

If the ambulance is there she can go straight for the IV. If not, airway. Our medics respond to scene first. All the IVs and meds are on board.

I haven't been on enough codes to see what they do first and why.

I've shown up in the ambulance, she had a bag, was actually out with someone else and was waiting for IV supplies, other time she was on board with us, she was putting in IV while others were intubating . We have a couple on and the will work together sometimes.

On ours whoever is there first starts, usually police, paramedic shows up in her vehicle and intubates by then an aed has been applied etc., ambulance right behind her. EMT takes over compressions while auto pulse is being brought in and then when ready we put the board under, and other EMT resumes to give first a break and first one takes over vent. Medic by then has a line in and we usually can analyze again if its been 2 minutes. Then the auto pulse is turned in and patient is loaded and medic works code in ambulance as she sees to.

If medic not around we don't have a line, we use king instead and then go for it after 3 shocks or no shocks.

Usually in er we continue autopulse and vents until doc decides what to do. Usually blood gases, epi, etc. We always continue CPR in er. It allows them to do what they need

I have only been on two codes but both were in a few minutes of hospital, we went ahead and transported both to hospital after analyzing.

Do you wear anything under it?

Yeah my skills test is april 29th or 30th I'm excited and nervous.

Im not really nervous, just not ready to be done, its like... I dont want it to end.

Ive been in this class for 9 months, I better pass it!!!

\

I have seen and worked with a lot of crews, just from transfers or assists.. and the only crews I've ever seen in a jump suit were the flight crew. And I have seen 25 to 30 different paid and unpaid services

Zoiks!

I can hear just as well in the back of the truck wit a $30 sprague as with my wife's master cardio II Littman.

It's an acquired skill thats takes time to learn.

When you start releasing the air from the cuff, palpate at the wrist and listen at the same time.

It may be a right brain skill that only lefties can do though:::

Dang Lefty Show off

I can hear fine in most situations, but you get a loud whaaaaaabulance, and a crying patient, squawking radio, taking emts , I just palpate.

layers of fat dampen sounds and make pretty much all procedure more difficult. Your optimum choice is to place the diaphragm just firmly enough to be able to hear the low resonance sounds. background noise such as from the diesel engine make it that much harder to pick up the rumble your trying to hear.

if they are in the ambulance, best to just palpate at that time.

Like I said, I have been firm with mine and light with mine, it hasn't made a difference with BP, only with breath sounds. If the bell is in the right place, the pressure isn't really going to matter for BP

Low, however the pressure frequency is great for breath sounds etc, I haven't noticed much when it came to blood pressures

.

Adding, but I have a totally different stethoscope. It is also a littmann

I need to know the rehab.

If she has a pace maker or defib, I mean, could she be withdrawing from drugs?

What's the rehab?

What a difference a few days makes!!!!

She ate today. A ham sandwich and chips.

She's doing fantastic. No pain. First time in months,!

The c diff is under control but medication isn't pleasant.

The histoplasmos is really what both specialties are certain of. Not too uncommon for area, rare but it happens. Especially since she is so outdoorsy.

They tested her for every autoimmune disease possible, hoping she didn't get it due to one, those were normal, so when she is strong enough to go home, I will take her home.

I'm nervous since we have had false recoveries before, but I have to have faith in this place.

Thanks for your thoughts and well wishes

I guess I never mentioned something didn't seem right after her bronch. Took her to er with chest pain. Wbc was 26000. Pulse 178. Doc excused it from invasion of scope. Pain killers, continue levaquin, sent home.

.

Few hours later I was jerked awake, was sleeping in loving room with her. Moaning, she was vomiting, severe diarrhea and I didn't feel right. At that point in time I had a choice. To take her to local er, or drive her 2 hours to one she is at. My concern was she wouldn't make it.

She was altered, feverish, and rating pain at a 9.

Bp was low, pulse high, clammy... she was getting shocky.

Went to er, the NP called MD back. NP wanted to transfer her before. He took blood again and her WBC was now 38000 with 5 bands in less than 8 hours. Pulse 170. Bp 80/60. Only verbal was moaning.

He called ambulance to transfer with ALS, however I was on as one of the staff, so had to make some calls to find another driver and they were off.

She has been here since Saturday lat night /Sunday morning.

What kind of rehab? Cardiac? Injury to limb? What's going on with that? Alcohol?

Thanks kat for updating, I've been too busy.

She's declined a bit. Switching meds for c diff as they are worried about her colon expanding. Making her drink hi protein shakes to get something in the colon. If she doesn't take them, going to tube feed.