Eydawn

My question is, do you trust your own judgment when you start to go wonky? I know my judgment tanks on me when my blood sugar gets low. Peanut butter packets are now my friend. I've made errors that could have been very serious providing patient care when I was coming off a shift on low sleep and low sugar. Do I think that I'm a danger to patients? No... because I know myself and now know how to mitigate the situation when it occurs (and recognize that it is happening much quicker.)

Do you know your warning signs? Do you have enough time that you could pull yourself out of a patient care situation?

Welcome to the club... like Arctikat said, most of us are nucking futs... in one way or another. As long as you aren't knowingly putting patients at risk by pursuing this career field, I say give it a shot. It may not work for you, or it may be the greatest environment for your brain EVER. You won't know till you try!

Wendy

CO RN-ADN Student

Speaking to my particular setting (Ortho/post surgical floor), when you're in orientation you work with a preceptor with experience. In my case, I worked on the floor with a few different CNAs who had worked on that floor for several years. The new hire RNs are assigned to a partner RN, and keep pretty much that same partner for most of their orientation. My orientation lasted for about a month; the RNs must go through a 4-6 month orientation period before they launch independently.

For both of the levels, there are certain competencies and in house educational programs that must be completed prior to being released from orientation. Including a wickedly dumb scavenger hunt. (You don't get to keep it, what's the point of writing all that stuff down?) But I digress. Once you have done a competency, you can independently perform that skill even while still on orientation (in my case, discontinuing foley catheters and IVs, putting someone in a continuous passive motion machine (CPM), vital signs, etc.) For the RNs, this includes all RN level skills once they're signed off- they can take progressively more patients independently and just check in with their partner (who shares the responsibility for those patients), and perform all necessary interventions. As they progress through orientation, they are expected to take on more and more of the load, until eventually they are responsible for all 4-5 patients with their "partner" just serving as a resource.

As far as pecking order goes, once you're cleared from orientation, you aren't viewed as any higher or lower than your peers really. Everyone is there to work. The charge RN is in charge, the RNs supervise the CNAs and the CNAs bust ass (at least, I do!) Yes, the newer nurses ask for help from the older nurses... but everyone helps each other to do skin checks and dual RN interventions. Nobody is "low man" as far as I've seen.

A lot of it has to do with our leadership. Our manager is very in tune with what's happening, what's working, what's not... he's a big fan of resolving issues as they arise and mediating conflicts quickly and efficiently. I love it.

Wendy

CO RN-ADN Student

Maybe the medic knows the firefighter. Maybe the firefighter was once a paramedic. Lots of unknowns here. He obviously knows how to bag the patient... at least, from the milisecond photo we got....

Wendy

CO RN-ADN Student

Thanks, Richard!

Sending in my paperwork today. We'll see if the EMS gods still like me!

Wendy

CO RN-ADN Student

Really, guys? It was a mid-movement photo. I know we don't always look perfect at every second and may have weird split second microexpressions on my SAR team... this crew looks fine to me. Looks like that FF who is bagging (totally appropriate) is also holding the tube as extra stabilization.

Looked better than half the stuff you'd see on "Paramedics" back in the day...

Wendy

CO RN-ADN Student

My husband's all excited for this one, me, not so much. I'm kind of over the alien horror/apocalyptica kind of genre right now...

I'd rather read another good scifi book, personally. Now, a movie I'm excited for? When they film Robopocalypse. That book was AMAZING.

Wendy

CO RN-ADN Student

It does not. For "new" certification, you must get your NREMT. If you expire past your grace period, you must get your NREMT again. I let the NREMT lapse, because it's a friggin' racket. I may have to get it again soon though... we'll see.

Good idea though, Richard!

Wendy

CO RN-ADN Student

http://www.9news.com/news/local/article/271976/346/Man-cited-for-prayer-ritual-to-stop-High-Park-Fire--

So, as many of you may know, my county is very solidly on fire. Last count, 41k+ acres and growing. Smoke blanketing Fort Collins. Our nearby recreational reservoir and water source, very solidly surrounded by flames. It's kind of crazy, really. Luckily the town I'm in hasn't been threatened directly yet... but people I know have lost homes and were forced to evacuate with flames chasing them.

So what does this lovely fellow from Boulder decide to do? Drop marbles in the Boulder Reservoir to pray for rain...

ONLY IN BOULDER YO! Them hippies be nuts (no offense to the Boulderites here on the forum... but really....)

Wendy

CO RN-ADN Student

Oh! Oh! I got a good one from this Memorial Day. Got floated to another floor, went to get a warm blanket for a patient, and hit myself in the forehead with the blanket warmer door.

Huge goose egg. Great icebreaker with patients! Not so great when you turn around (after putting ice on it and getting back to work) to see 6 nurses, including the house supervisor, staring at you and insisting they want to send you down to the ER to get checked. No, thank you! I'm fine. Just stupid. No really.

I will forever be known as "that CNA that floated to Cardiac on Memorial Day and hit herself in the face!"

~_~

That and anyone you work with having to treat you. My poor camp coworkers, and Venture Crew peeps... I've crashed more than once with asthma. I'm a lot better about that now. Live and learn...

Wendy

CO RN-ADN Student

See, that's the other thing, I could just take an online cert mill, test for the National Registry, and I'm back where I started...

Well, after all that, it looks like I have until the END of June before it's totally gone. And I am meeting with someone from my local service to see what counts out of my nursing school didactic towards CE's (A lot, according to a classmate who just did all this). So, I may actually remain a CO EMT-B after all...

I guess it will make it easier, in the long run, to pursue my paramedic (which I still fully intend to do). I plan to be an RN and a paramedic. Someday.

Wendy

CO RN-ADN Student

I find it odd that they didn't interview you, to be honest. Especially since you don't know the specific people you'll be working with. I would maybe contact the supervisor and let them know you have questions about the work environment you'll be going into... an email would be great for this IMHO. It shows that you're proactive about wanting to do well.

Other than that, what paramedicmike and Captain said. Don't be watching YouTube. You'll encounter your OWN situations, and you want a clear head.

Wendy

CO RN-ADN Student

The fellow I know who got bitten stepped on a juvenile that was sitting quietly in long grass. Heard it rattle AFTER it bit him... whoops!

If you're meeting halfway, that's different than just going all the way POV in my opinion... which is what I read as the recommendation. The team that was out with this fellow carried him out piggyback style (we're still really proud of them) and got on the radio with dispatch as they drove towards town. They had EMS intercept at a rendezvous point.

The important thing is to make sure you have the intercept coming... in case things go south as you're closing distance...

Wendy

CO EMT-B

Antivenin is not a prehospital intervention anywhere in my area. No, not all hospitals carry it. You will be transferred to appropriate care if they don't have it.

As far as severity of effects and time of onset, it depends on what bites you (juvenile vs adult), where it bites, and if it gets a major blood vessel instead of muscle tissue. One of my fellow SAR members was bitten on a training exercise and had systemic symptom onset in less than 30 minutes, as a juvenile snake popped right into a main vessel. He spent a good few days in the ICU and got about $36k worth of antivenin vials. He's a lucky fellow. If it hits a muscle, could just cause local necrosis. It's highly variable.

Only an idiot would go POV if the option of EMS was available. That's my stance on ANYTHING other than a simple fracture/sprain/minor burn/uncomplicated expected labor. Especially if you're talking a transport time of more than 30 minutes. What happens if you go into respiratory arrest in your parents' car? You get to die in their car! Whee!

@_@ Seriously... do like you would for any other serious injury/illness and call for the prehospital professionals who can provide support enroute, instead of just taxi service.

Do not cut, suck, nor spit anything. Do not apply tourniquets, nor ice. Remain calm to keep heart rate down, and keep the affected bite area below the level of the heart if possible.

Wendy

CO RN-ADN Student

Gloves, ANSI vest, cell phone. Paper towels. That's about all I need as a civvie, even if I do end up stopping for some reason (the ANSI vest is more for SAR roadside stuff where I'm parking in the dark up a canyon and don't want to get nailed).

Less really is more. Keeping a level head, getting transport crews to you ASAP and good information to them via dispatch seems to be the most useful IMHO.

Wendy

CO RN-ADN Student

I'm sure it is, rock- not disputing that. However, there is something to be said for letting people live their lives the way they've decided to live them. You're fighting an entire culture here that thinks cold wind is a problem... how far is it worth taking as far as cost-to-benefit potential? (I'm talking emotional/psychological cost here, too... not just $$).

I'm looking at it from a comparative cultures perspective, where we don't necessarily have to be "right" as the developed world medics ALL the time. Just food for thought.

Wendy

CO RN-ADN Student

I personally find TB and hepatitis much scarier. Especially TB that I start taking care of before we know it's TB. That was a fun day! "Wait, what do you mean you just moved them to the negative pressure room? Aw hell!"

Wendy

CO RN-ADN Student

Sometimes doing the right thing will get you in trouble with the system. Sounds like, to your judgment, it was worth it Ruff.

Wendy

CO RN-ADN Student

Try Western Ambulance, Denver Health Paramedics, Northglenn Ambulance... I'll see if I can find my old recent posting or PM where I consolidated links for this stuff.

Hang tight.

Wendy

CO RN-ADN Student

Western Ambulance (I know someone currently working there) http://www.westernambulance.net/

Northglenn Ambulance: http://northglennambulance.com/

Denver Health Paramedics: http://www.denverems.org/

Hope this helps... if you're willing to commute, there's Colorado Springs AMR, Thompson Valley EMS (Loveland), Pridemark (Boulder/Longmont), PVHS EMS (Fort Collins/Larimer County) or Weld County Paramedics. If you want my opinion on any of the above, PM me and I'll give you the lowdown.

Wendy

CO RN-ADN Student

And, there's the point I was trying to make all along! Ketamine, like other drugs, has pros and cons. I just figured it was a great setup to write it as a letter to Kiwi, because he's sung its praises incessantly and seems obsessed with it. ;-) It was too humorous and perfect to let that opportunity slip by...

Chris, I want to just sit down and pick your brain one of these days!

Wendy

CO EMT-B

I was about to say, wth mate I used the same links and everything! Lol...

Wendy

CO RN-ADN Student

See, I haven't been employed under that EMT cert for almost 3 years though and am currently working under CNA licensure at the jobs I hold now. That sucker doesn't expire until 2014. If the EMT were in any way related to my employment it wouldn't be allowed to lapse.

Dear Kiwi,

I know you have this great love of Ketamine used to facilitate RSI. You think it is, to put it bluntly, THE SHIT.

Please read the following blog entry, written by some nice Scandinavian anaesthesia registrars... I believe it says that their patient was given 300mg of Ketamine with NO EFFECT. (@_@)

http://www.scancrit....ketamine-match/

Therefore, "special K" is not in fact, always that special...

Lots of Love,

Wendy

On a serious note, HOLY HELL. Apparently, as far as the writer could figure out, lamotrigine (Lamictal) may block the effects of ketamine by blocking the action of glutamate on non NMDA glutaminergic receptors. Hence, how a 60kg psych patient could get 300 mg of IV Ketamine and still be fighting...

YIKES!

Wendy

CO RN-ADN Student

I don't doubt you for a second. You just seem to believe that everything needs to be disallowed by the government. I don't believe that we are mature enough as a nation or a world to accept that we can stand idly by, watch our friends and neighbors be victimized by douchebags and trust that somehow the government will make it all better.

*snip*

I'm not sure how to make the argument Brother that the government can't solve every ill. And that every man that chooses to stand up for himself or his family or his neighbors isn't simply a rabid dog because he's acting without proper government sanction.

*snip*

I'm truly grateful that we disagree on this. I think that your attitude is the future, and we need people that think of the future to bring it into being. But your attitude also has people behave as sheep unless backed by a police officer. It demands that you stand by at such moments and spectate pain in the name of 'progress.' I just don't have that in me...

These three segments here I think define the crux of what Dwayne is saying.

JPINFV, you know I respect you, and have defended you on multiple occasions. I will not argue that you are legally incorrect, nor that your position is not the more civil of many presented here. However, I will argue that these three snippets I dragged out above, especially the one I added emphasis to, are what resonate with many of the people who upvoted the fire hose/break the camera solutions.

For God's sake, we live in a world where everyone now sees themselves to be the paparazzi (and the actual paparazzi cause physical and psychological harm to those they photograph, all the while waving the "immunity" flag...) While I am not advocating assaulting someone just for being an asshole, I am saying that taking a public stand against this sort of crassness is a good idea, legalities of the situation aside. Do you need to break a camera? No.... but if you want to hose down the street and if they're not smart enough to get out of the way, then so be it, they were dumb and got wet.

I am all for the tarp/sheet block idea... and actually, if you have enough bystanders, you can recruit help. Many of you know my position on the media (I hate the bastards, no offense Pox, but I've had some really nasty sitch where they made a mess of my scene) and I love nothing more than making it difficult for the camerafolk to get a clear shot of someone who doesn't need to be photographed. Remember that kid in North Carolina who went missing a couple years back, and when they found him, they transported him out of the ranger's station surrounded by sheets? I literally cheered seeing that.

We have a duty to protect our patients' privacy. Ethically, and legally. Do your best, and try not to get into fisticuffs if you can help it. Also, if you have your own cameraphone handy, take a quick pic of the person filming in case pictures do get out where they don't belong, and leave that information with the patient so they can pursue their own desired legal avenue of justice once they're healthy enough to do so. No rules against photographing the photographer...

Wendy

CO EMT-B

If the fit has hit the shan, nekkid is the least of their worries. Strip, flip, thorough exam, then cover back up... if you've got nosy bystanders with cell phone cameras out, feel free to have the nearest free responder go over to tell them off and warn that their phones may be confiscated in the event of a criminal investigation surrounding the event...

Wendy

CO RN-ADN Student

I wondered when you said his name was Lincoln and he was tall and skinny...