Eydawn

I know a paramedic who has nystagmus AND bowed limbs from a childhood meningitis infection. He's fantastic. As long as you know your own limitations and are aware of what you need as far as compensation (from your partner or company) you're good to go...

Wendy

CO EMT-B

RN-ADN

Score one for the guy who actually went to read his protocols and talk to his medical director!

All aside, that shows a LOT of potential for you, friend... major kudos. Let us know what the MD says, eh? I'm curious.

Wendy

CO EMT-B

RN-ADN

Breath sounds? Any chance she aspirated, here? (Or has some fluid overload issues, thereby negating wanting to drop lots of fluid into her right away?)

She's truly a GCS 3? Then she needs her airway secured and us to take over ventilation... I'd do that FIRST, even though I suspect some opioid issues here with the hx of chronic back pain. I really, really want to find the pill bottles and see what she's on... if she's got some of the hairier long acting stuff like Nucynta, XL Oxy or Opana, we may not have enough narcan to keep reversing her if she OD'd... I'd also like to know if there's some Metformin at play... (lactic acidosis, anyone?)

I'd also love to see the 12 lead and if we can get an SpO2 waveform. Also, do we have capnography by any chance?

Wendy

CO EMT-B

RN-ADN

With as much as you fly, you need to look at hooking up with a primary care doc of some flavor, getting some labs drawn, and getting set up with some anticoag therapy.

I feel you on not wanting to rack up medical bills... as mine are starting to come in from the bullshit I've got rolling... but you'd kick my ass three ways to Sunday if I wasn't following up appropriately.

God damn it, Dwayne. ~_~

Wendy

CO EMT-B

RN-ADN

So, this article ran in my local paper the other day, and I thought it was really interesting.

http://www.coloradoan.com/article/20130901/NEWS01/309010046/Patchwork-system-means-emergency-response-varies-across-Colorado

I thought it laid out the bare bones truth pretty well; EMS in Colorado is a county regulated affair, and there's a lot of discrepancy. I also like how it emphasized the difference between EMT-B training and the 1500 hours required for paramedic...

Thoughts?

Wendy

CO EMT-B

RN-ADN

I think the quality of program sometimes has nothing to do with cost... and the caliber of provider that comes out has a lot to do with that person, not necessarily with the type of class they take...

That being said, most folks looking for the "fastest, cheapest, easiest" option aren't necessarily setting themselves up for success unless there's some background experience or drive that would facilitate them doing well.

Wendy

CO EMT-B

RN-ADN

Condolences and prayers to family and friends... sorry to hear a good one has passed on.

Wendy

CO EMT-B

RN-ADN

Hey Cheeky, how's the recovery going? Where are you at in the rehab process? Major foot reconstructions like that are a *bitch* to deal with.

Chin up! You're a strong chickie (notice the punnage?) and you are gonna beat this. It's definitely a serious mental readjustment to be the patient... that I can speak to. Attitude is everything.

Have you gone to visit your work peeps? Sometimes a boost from your work family is a nice mental break from all the other stuff you're juggling...

Wendy

CO EMT-B

RN-ADN

Fastest you'll find in CO is any of the community colleges, one semester. Cheap? It'll run you $1k-$1700k depending on which community college you do it at. I'm curious- what paramedic program are you starting that requires EMT, but does not require a year of field time? Most programs in CO lean towards that 1 year requirement.

Wendy

CO EMT-B

RN-ADN

I wonder really at the rationale for using tranexamic acid in postoperative patients.... while concurrently starting them on coumadin, lovenox or xarelto. I wonder if the pharmacologic active life of tranexamic acid is really short enough to just be enough to help with surgical site bleeding, with subsequent anticoagulation to prevent DVT's or other issues... I s'pose I should go look it up. ;-)

Seems kind of counter-intuitive, though.

Wendy

CO EMT-B

RN-ADN

See, I've seen it used as a more continuous infusion for pain control, either for refractory post surgical pain or as the intended treatment for chronic regional pain syndrome. You're right- the environment isn't great, it's a busy post surgical floor. Lots of noise, lots of stimulation... and because they're on a continuous infusion, there's frequent vitals and assessments which causes more stimuli. They're fine once we stop the infusion and it wears off, it's during the infusion that we've seen problems. Oddly, I haven't seen one for a few months now, so maybe they decided my floor wasn't the best environment for ketamine infusions...

One can only hope, anyway! I think we need a lot more education on it before they use it again in our particular setting. Fortunately I was never directly responsible for a patient on it...

Wendy

CO EMT-B

RN-ADN

Uh huh. Suuuure... ;-)

Wendy

CO EMT-B

RN-ADN

Aw, Doc! Sad marriage. Lol!

(Ok. Maybe I should stop there. Yeah... no good way to add any more to the conversation...)

Wendy

CO EMT-B

RN-ADN

Gotta hate that.

Yes, it was an exposure. Duh. There's a reason I put band-aids with tegaderm overlay any open/cracked areas and/or wear gloves for all routine patient contact. On my floor, body fluid contact is always a possibility any time you go into the room... never know when someone decides the stool softener is working or you get surprised by the bandage leaking through...

If it's enough to bother you, it's enough for you to be worried about. And why forum hop? It's not like the providers telling you the answer you don't want to hear aren't gonna be on all the forums...

ERDoc, I gotta ask... why is BSI called marriage? (Cringes)

Wendy

CO EMT-B

RN-ADN

I could hear to about 17k, 18k was intermittent. Pretty interesting!

Wendy

CO EMT-B

RN-ADN

Excellent thread. Sorry I missed it earlier. Very good stuff!

Wendy

CO EMT-B

RN ADN

Doesn't it have to do with mobilization of K+ across the cell membrane post hypothermia with active warming? Something is tickling me about our hypothermic SAR patients and caution with rewarming without knowing labs... I also want to say profound hypoglycemia is a risk for some reason with associated seizures. Trying mightily not to google!

Wendy

CO EMT-B

RN ADN

Who are y'all referring to as traitor? Lol. Thread bump!

We usually have concurrent benzos. We do a continuous infusion with a PCA pump and I've seen folks hop off the deep end within 2-4 hours of starting the infusion.

Wendy

CO EMT-B

RN-ADN

Mr. Dunn- glad to see someone who works there posting!

I have a couple good friends who work there currently (and a couple friends who used to work there back in the hairy old days.)

Please don't take offense at this thread- one would hope that anyone seriously seeking info about an agency would pursue multiple avenues of research and treat an open forum thread like this one for exactly what it is.... scuttlebutt and second hand perspective. Valuable to some degree, but not an overall accurate picture of what it'd be like to be employed by that agency...

I don't think anyone was intentionally casting aspersions with regard to the PolyHeme study; it simply is known that the study failed after it showed so much promise, and Denver Health was the venue in which it failed. Unfortunate association, but I don't think anyone is saying DH is why it failed... it's like being the hospital where the patient caught fire from the chlorhexidine scrub and electrical implements being used. Craptastic, now that's what people associate with our place for a while...

The really good agencies to work for, both prehospital and in-hospital, are very hard to break into from the outside. While they may always be hiring, it takes persistence and sometimes sheer luck to break through that wall. It's definitely easier from the inside as a student. Hence why some people give up; they figure it's unattainable to work for XYZ hospital or EMS company... folks who are willing to repeatedly apply while working elsewhere to gain experience are who succeed. Colorado is this awesome niche for healthcare IMHO, and that makes it even more difficult (especially with a high saturation of educational programs along the Front Range) to crack that nut and get the gig you want.

Wendy

CO EMT-B

RN-ADN

This hit real close to home. Good friend of mine is from AZ and one of her friends is a hotshot... fortunately he was not on that crew, he was still on R and R from having been on a fireline out here in CO. Scary few minutes before we could figure out he was safe, though...

Incredibly tragic. Also makes my blood boil that folks are angry that the families are asking for the memorial and procession to be private... why don't some of the civilians get it? It puzzles me... it's such an invasion for people to insert themselves where they aren't wanted, let alone the goddamn media... I know some folks were anticipating the Westboro Baptist nutters showing up, and were going to barricade- why not block the media as much as possible, too?

Wendy

CO EMT-B

RN-ADN

Man, cardiac really isn't my thing just yet... if the half life is short and there's no reasons that you can find for contraindication, I might be getting ahold of whoever does your protocols to see WHY it's an absolute contra for you...

Don't have much to offer on the pharma/physio side of things for this one, sorry!

Wendy

CO EMT-B

RN-ADN

Boy, I'd be mad if someone was picking up on my patient being altered and didn't tell me... that changes my treatment dispo very quickly. I'd like to think that I'd figure out the person wasn't totally functional, but I'm human and make mistakes... if someone else is seeing what I can't see, why the hell wouldn't you speak up and say "no, look, this guy is altered because of XYZ and I really do think there's more than what we're seeing here..."

*Scratching brain* not sure why anyone WOULDN'T speak up... even with folks I don't work well with, clear and accurate communication is essential...

You can only nanny-state folks so much. At some point, individual competent autonomy has to have a say... like my patients with off-unit privileges who "go outside for a walk" and I know damn well they're going to smoke... I remind them it's a smoke free campus and tell 'em to take off their nicotine patches if they're hell bent on it... and let 'em be. Note, I will emphasize, COMPETENT autonomy...

Wendy

CO EMT-B

RN-ADN

This is fantastic. It'll be interesting to see what treatment avenues they pursue... the problem with diabetes (I or II) is that folks don't know they have it until they're really, really sick sometimes...

I wonder if the damage is reversible, or if it's permanent? And if they've found the pathway, I wonder if they can do routine testing for it and give pre-emptive therapy?

Wendy

CO EMT-B

RN-ADN

Stormdoc- are you able to take NREMT again? Did you fail practicals or the CBT?

Wendy

CO EMT-B

RN-ADN