MariB

OK adding more but it just keeps adding to post above.

After 10 days of antibiotic patient not improving, mother calls doctor demanding pulmonary specialist . Specialist is filled for 3 months. Strings are pulled, patient now able to get in within week. Mother wants her seen anyway due to pain and fever.

At office patient now has fever of 102,7. Wheezing and severe palpable pain to upper abdomen. Doctor concerned as abdomen is tender and patient guarding.

Severe right chest pain. Pulse 150, respirations 20 and shallow.

Patient admitted. Ct of abdomen reveals normal finding

Wbc 20s , glucose 60, 160 pulse bp 90/60

Positive d-dimer. Clot buster injected and tests for clots later negative

Transfer to higher level care hospital considered

Mothers and patients usual doctor visits, she's been booked and hears of issue. Asks if patient wants her to take over care. Patient unable to respond from morphine

Patient later says yes, mother finds doctor in nursing station with patients records open and studying them

More tests ordered. Ct with contrast this time as other one earlier of chest didnt. Cultures done.

Patient quarantined , ct shows fungus possible

Mycoplasma culture positive

Patient treated with antifungal. Zyosin, levoquin

Fungal culture also positive.

CBC shows glucose 60, Wbc 20s , anemia, low lymphocytes

Doctor consults with pulmonologist.

Patient improves after 5 days, released for appointment

Pulmonary specialist states he wants a bronchoscope done, under general anesthesia.

Large lymph node closing off bronchi and causing obstruction

Wants to do biopsy. Possible stint or removal of node to open airway

Irreversible lung damage, unknown to what degree.

Believes patient has suppressed immune system and may have had damage before, or visa versa. Wants to see.

Believes putting her under, even with pneumonia benefit outweighs risk at this point.

Patient still has extreme chest pain. Pulse 140s , shallow respirations

History of latex allergy, hives from sun exposure, premature lungs when born

This all started a few months ago. I had to go mama bear on them and take over and start demanding specialists and stuff. At first she went to appointments by herself, she's an adult and didn't want Mommy, but she realized something's wrong and I stepped in after her second pneumonia infection

Well, obstruction in the lung. Dang it, I am trained to keep the airway open. Hers is obstructed and I can't help her.

You will know a lot more than I. I am losing a lot of sleep over this, lack of answers is eating me up.

OK, patient scenerio? Very important, special patient.

18 year old girl presents with lump on neck. Not painful. Rubbery feeling but does move.

Doctor does CBC with differential and tests for mono, and cat scratch fever and looking for red flags of lymphoma.

Tests show anemia, and low lymphocytes, but otherwise normal. States daughter may just be fighting a bug.

A few weeks later daughter gets influenza despite flu shot.

Annoying hack lingers, repeat trip to doctor, doc tells her its viral and to rest.

Patient allergic to guifisen making congestion hard to clear

Daughter spikes fever and returns to doctor, cough dry and severe chest pain no wheezing or crackles.

Chest xray diagnoses pneumonia. Daughter put on antibiotics. No steroids given due to pulse being 160

Next morning I wake up to something wrong. Instinct? I hear grunting. Patient in severe distress. No cyanosis. However patient altered status.

I know from experience I can get her to hospital in less than three minutes.

Daughter spraying blood with cough.

In er nebulizer, codiene and zofran given. Pulse 150 bp 140/90. Pulse ox 98%, wbc upper 20s

Released with script for neb, codiene, rescue inhaler.

Follow up reveals Wbc in normal range, pulse 140 , severe chest pain now diagnosed as pluersy. No repeat chest xrays done.

Chest pain not subsiding, cough still continuing. Patient goes back to doctor. Xray shows pneumonia . Fever, severe pain. Script for stronger antibiotics. Blood shows wbc within normal limits, low blood glucose of 65 , anemia and low lymphocytes.

I do. But I would have to give up work. That's the hard part. The problem with financial aid is I will not pay for a degree to work for free if you know what I mean.

I haven't posted anything about this, but my daughter is ill. I don't know for sure how sick until the surgery tomorrow.

We have talked before off and on about it. I simply stated if my squad would pay, I would do it. Well my director does not feel the city would pay for it being we are within minutes of a hospital. Several years ago a grant was offered and a couple took it and we had nurses bridge over. That's how we got the ones we have now. However, one is moving away, another is in a different town now and only does short shifts leaving 2 available who work full time. I work in the education system. Summers less hours, nights, weekends and holidays off. Some extended holidays. Plus I can leave if I really have too.

I am holding a 95% this semester in a college level converted EMT program. I don't think I'm a bad candidate .

I'm still considering it in the back of my mind, but if I am to do it on my own, I'll need the help of financial aid. That would mean an associates. 2 years full time, giving up my job now, driving an hour to class every day and I will not remain on just this squad. I would then have to start commuting after to a paid service.

But I was joking around through email with the program director and told him that being that I'm his top student that maybe he should pull some strings and get me some free A&P classes .

He replied "How about free paramedic school?"

I was kind of taken back, he knows how bad I want to do that and how I can't pay out of pocket for a volunteer squad with a couple hundred dollar a year stipend.

Our college does not have a paramedic program. Is there scholarships available out there or was he joking around?

I just replied " I would love that, of course, but unfortunately we don't offer that here "

Our area is in EMS provider crisis . Some towns of 5000 having 3 EMTs and out of service several days a week so surrounding towns are all covering each other.

I had patient on side until I put KING in... and only did that cuz he said they intubated.

I can't do an ET tube obviously.

You would be hauling your butt to rendezvous with ALS.

And yes, yes I would use lights and sirens

You all impress me. I'm still Herr , venting through a king and waiting to rendezvous with ALS

OK, I would say screw it, if my medic wasn't with me I would load her and intercept for my paramedic assist.

I would put her on her side, hoping for vomit, preparing to remove the opa if she does with suction ready. Keep her covered with heat on in ambulance. Have hospital on alert with heli on standby (small hospital). 12 lead to send to ER and ready for my Paramedic..

Continue assisted ventilations with BVM with high concentration O2.

Have IV set up ready and paramedic bag out.

And lights and sirens.

This is why I do not want to end my education at the EMT level.

I don't have a farm

Suction, call back up. History of diabetes? Glucose check. Can she breathe on her own? Titrate 02, non rebreather, prepare to vent . What's her responsive to pain?

Edited to add, call for intercept. I don't like this feeling one bit. Is she clammy, sweaty? Has her BP tanked? Asthmatic?

Cold is in the title. What's her skin temp? What's the home temp? Known allergies? Heart trouble? Pertinent history.

I dont know how much some stipends are, but ours aren't enough to be considered paid.

Like the poster up a few, hourly is high, how is that volunteer? Ours stipends may cover gas and laundry.

West! West!

I totally ha a doc/patient fantasy lol

Love, lust, doesn't matter. Nothing wrong with anal probing .

You know a thread has come to an end when we start talking about anal probing.

Actually, the document was signed by the doctor on scene and the patients daughter. Not the patient.

So, was the patient terminally Ill where the daughter didn't want to accept it and signed the paper? Lots of unanswered questions here.

Advanced directive or not, if someone is decapitated , you don't start CPR. This man may have been dead hours. I wouldn't go against his own doctor.

Thank you for posting. So many times we never see the patient again to hear how they are doing.

Stick around, be nice to hear how you are.

Most places only require you to be 18 for EMT.

It is interesting to speak to different healthcare professionals and scientists about this. I have know both to have beliefs strongly both ways. Doctors who believe they get their knowledge and surgeons who believe God guides their hands while education guides their brain.

I think they will find ways to believe either way.

I believe in evolution, but who is to say our time line is the same as Gods? His day maybe our century. I don't know. I just choose to keep Science and religion separate.

Here is a link. A stipend or a nominal feed for expensees still keeps your volunteer status

http://www.dol.gov/whd/opinion/FLSA/2006/2006_08_07_28_FLSA.htm

We are what is called "volunteer call" we get paid a very small amount rounded to nearest hour. Volunteer call means while on call we do not get compensated for on call time etc. However we do get paid training, classes etc. The amount given during a run is supposed to help with gas expenses, wear on car, laundering and damage to clothing due to stains etc.

OK, I need your opinions and help.

I went back to the first hospital with ambulance service I went to and again had a great experience. There is one gentleman in particular , a paramedic who taught me things a classroom setting never could... his experience, faith in me and leadership, along with the way he treated me will stick with me forever.

I don't even know if he realizes how good he is as a teacher. I already told his director about him when I called and asked if I could finish my clinicals there and they made sure I was with him again.

I told my program director today, but this man has changed my life. How do you thank someone for this? He can't know how much it meant to me.

He seems to be quite humble.

Should I write a letter to human resources? Or what?

I was also invited back anytime, and even though I have my contacts done, I'm considering another shift just for more time with him.

Oral glucose in many states requires medical direction online, or offline orders. I'd check into that

OK, was just browsing another EMT site and a BEN52 Is asking this same kind of question today. A benasack was banned here. Is this coincidence?

I honestly doubt they go right into paramedic school without some form of minimum third-ride time on a BLS/ALS Rig or without at minimum EMT (unless it's a college degree program.)

Where I'm at here It's super hard for me to get a job as an EMT. All of the Fire Stations are full up and the only people running calls are the local Non-Profit Ambulance company. Their ALS Rigs run 911 and the BLS Rigs run Transfers all day. I do live in a fairly large City in Michigan. My goal was to Work as an EMT, get my feet wet and attend Paramedic classes but it appears that when the Ambulance company starts up Paramedic training in the fall I'll be attending that to have a much better shot at actually having any job.

We spent 48 hours on an Ambulance and 36 hours in the ER (Super busy) In that small time I saw enough to actually think: This is the job for me. So I'm pretty confident in going straight to Paramedic.

TLDR: I suggest getting your feet wet to make sure this is for you. And remember, at the end of the day don't forget your Basics!

It is fun isn't it? I am all finished with the medical part of the class. All we have left is a module on cleanind up the ambulance and sterilization etc. Then practical practice. In two weeks the fire Dept brings out a few cars for us to practice rapid extraction. Woot! Enjoy!