The Hook

door

Got called the "Flashy light bus guy" by a drunk once. Been called all the classics! Had said to me "Are you the ambalance boy gonna take me to see the doc at thu doc at that big white hospital?" (some words pheonetically spelled) The names from the Narcan recipients seem to be slightly more harsh. Why is that?

Oh, definately talk to the crew. You never know, maybe this responsible individual chose to drink his beer BEFORE he came on the clock! I'd hate to accuse someone of consuming alcohol on duty, that would be irresponsible!

I own a Littman Master Cardiology and love it. First because it was a gift from my wife for graduating Paramedic school, secondly because I like the dual tone bell. Light pressure and you can detect the tiniest Sub-Q Emphysema, mild pressure and you can hear the heart tones of the person sitting next to your pt, and with heavy pressure you can hear GI noises from the pts shoulder! Ha! kidding a little, but still a great tool!

1. Why do the pt's that are begging for O2 asap when you walk in the door are speaking to you in 10 to 15 word spurts with elaborate and detailed descriptions of their breathing difficulty? They usually have 99% O2 sats and 1 second CRT's. :? 2. Why is it when walking into a Dr's office with a serious or critical pt they are surrounded by 1/2 dozen nurses and 2 doctors who all want to tell you what's wrong with the pt yet there is no IV, O2, ECG, face sheet, or enough room to get to the pt themselves? :shock: 3. Why is it when you get onto your ambulance at the begining of a shift and you've just made it on time you get a call the second you punch in and the unit is missing half the stuff you need and is completely out of PCR's? :x 4. Why is it when you are in a good mood you get great pt's and when you are in a bad mood you get jerks all day long?

Handing over the responsibility of these drugs is a much bigger deal than many may realize. I am sure it is exciting to say "hey I can do this and give that!". Though unfortunately without a paramedic level of training or higher seeing the big picture is very difficult. Cookie cutter medicine without understanding is like putting a gun in someones hand and saying go out and hunt bad guys. You've seen it on tv and have maybe read up on it a little but have no professional training and clinical experience with it's use and the expertise required to determine it's use. We recently had a paramedic student overstep his authority and placed a pt in danger. Not because he was wrong in his evaluation but because he had not yet had the training or practice with a seasoned paramedic to make that decision on his own. Everything turned out fine thank God. Though he made a crucial mistake in the process in handling the delivery of the drug. He did not take a BP before giving nitro in an almost unconscious pt. If it had been too low we all know he could have dropped the BP right out the the bottom. If it was a right heart MI the preload could have all but disappeared. Fact is these meds are (even in a simple setting with classic findings) too much to deal with only having an extra 1/4 in a college setting. The picture the instructor would have to paint would be limited due to time constraints. Dustdevil's passion for knowing your own education before attempting someone elses is going to prove prophetic with these EMT-J's. Be careful if you are a "J". The education itself may be setting you up for failure and disaster in the field. The Hook

Loved it! Definately going to use this one. Great advice for teenage guys thinking about sex! The Hook

Haven't seen it yet, thought it came out on the 12th of June. Is there a web site it is being held at or was there a screening of the first episode that I missed? The Hook :wink:

Greetings All! I have found and met several new friends and am grateful for this site! I am looking for any really good cardiology books that may improve my understanding on our (paramedic's) primary advanced skill. It has become obvious to me that EMT-Is are getting closer to us than we realize. Cardiology is the biggest subjectskill that sets us apart. I am looking to master my trade skill. Any downloads that can help would be great as well. Thanks again all! The Hook, Kevin firefighterkjhook@comcast.net

Back to business. The person below me (the one on this site you pervs) can't stand the color of his ambulance, his boss, or the expansion of his wasteline! The Hook

That is fantastic! I have actually printed it off at work. The Hook

One addition to my comments, the gash on his neck, how deep-long is it? Another concern would be Sub_Q Emphysema and the resuliting edema in the neck. It could potentially occlude the airway if left unchecked. The Hook, Kevin

I agree with the decompression. Check and recheck often vitals and mental status. Check the pupils and talk to any witnesses. The blood coming from his nose is there only blood? Have you done a Halo test to check for CSF? Question, how long was he trapped? How much of the body was trapped and to what degree? Is compartment syndrome a concern here and what would you do in that case? And personally I would go with NS opposed to LR for the drip. If compartment syndrome is a concern LR could throw his electrolytes off even more. Apply a C-Collar, confirm strapping to the backboard is complete and adequate. Pad the voids and check for additional broken bones. If pt can only be moved on stomach then a stokes basket would come in handy here. Stabilize the flail chest with a trauma dressing. I agree with notifying a helicopter and having them en route for transport (obviously as long as location of accident is further away than you could transport in the same time by ambulance). Start one IV at kvo rate and start one INT. Check the BP to see if the pt actually needs fluids. The kvo rate will not hurt if the BP is within safe limits. Automatically flooding the pt with fluids could cause it's own problems. Let me know what you all think! The Hook, Kevin

Not certain of the list of approved abbreviations. I will look. Thanks everyone for getting back to me. The help is appreciated. Kevin "The Hook"

Greetings! I am looking to drastically improve my PCR narrative writing skills. Is there a web site, download-able outline, advice, a book, or any other source of info floating around on the subject out there? Please let me know! Thanks to all! The Hook

To DustDevil, Didn't quite get the angle you were coming from. Still think you were a bit harsh/bitter. Constructive criticism is one thing though a swift kick in the arsh is another. Who knows, maybe she will react positively to your reply. She had the class the write you back with intelligence and guts. Maybe she does have what it takes? The Hook

I am a new Paramedic so please bear with me everyone. I am seeing a lot of A-Fibs with ectopy though I am not seeing the trashy baseline that was such a distinguishing factor in determining A-Fib. If we are seeing varrying shapes to the P wave then is it not simply multiple foci from the atria? Any advice or a quick tongue lashing would be appreciated! The Hook

Looks as though the rhythm goes into either a bigeminy of beat...pvc...beat...pvc. If not then perhaps electrical alternans. Was each qrs spike a perfusing beat? Was there an accompanying pulse? IV, O2, Transport, Nitro if BP is up. Is pt on Coumadin/Warfarin? If not then Aspirin. No pain indicated? No MS needed. How acute was the onset of SOB?

RidRyder, I agree completely. There is a pretty severe lack of concern for the pt. It has become a cookie cutter medical world and (not that we are falling behind medically as a nation) we are finding fewer and fewer people who are willing to go above and beyond to find that compassionate caregiver within them. A lack of concern for life and it "not being their emergency" has gotten to the point of being obscene in some areas. Locally I can tell you that many doctors have stopped reading the journals and stopped caring. They get together in groups so as to afford liability insurance and dish out antibiotics and pain killers like candy at holloween. Example: I took my kid to her pediatrician recently and without seeing an actual doctor an RN (no not a NP) walked in, asked what we thought, wrote a few notes, came back 5 minutes later with a prescription and a "thanks, pay your bill on the way out.". No actual evaluation, no direct contact with a doctor, not even a listen to the chest for breath sounds or to see if the smell on her breath was fruity (a contributing sign to strep throat). I think the heart of the current day health care provider is going numb. Unfortunately the numbing of society is accompanying this trend. As a whole our parenting skills, our involvement in our children's lives, and our concern for making the world around us a better place is degrading. We as Americans are losing our souls and our identity. We are allowing outside influences to govern our social decisions and that is weakening our character as a people, a nation, as parents, as caregivers; you get the point. I think it is our responsibility to in some small way improve the world around us. 1 little thing a day like setting an example by showing more compasion than the guy next to you will tell our peers that they are lacking. Let them throw the attititude. You are responsible for you first. Hold yourself and your children to a higher standard. By doing so both you and they will set the example for those we and they come into contact with. We in general have to hold ourselves to a higher standard than the rest of the public. We need to live up to that and try to go beyond. Food for though ladies and gentlemen. The Hook

Hey DustDevil, I have only been on EMTCity for about a month. I see your responses on most of the posts I have read here. I have never seen or heard you be so damn rude to anyone. I am disgusted. She was right, you should be ashamed of yourself. Tough love is one thing. Being outright rude and cruel is another. Being an EMTCity Master gives you a great deal of privilege here. With great power comes great responsibility. Ever hear of that one? It is, with your education and experience, your responsibility to hold yourself to a higher standard than the rest of us. I was surprised at your lack of class to say the least. I hope for better from you in the future. The Hook

Welcome to the wonderful world of EMS! No, you are not too old. I started at 30yrs, got my EMT-I, and now at 33 I just graduated Paramedic school. The lifting will come with some technique. An EMT-B does not pay all that well. I wish I could be nicer about it. The average paramedic starts out at around 38k down here in Atl, GA. If you need the money more a non emergency service will usually pay a little more as they know where more of their money is coming from and when. Have patience, and never stop learning. Now that paramedic school is done in a few years I will be headed to Nursing School! An RN starts out at a minimum of $25 hr. Once you have a specialty it jumps up between $5 & $10 hr. Now keep in mind I am talking about RN's not LPN's. An LPN can make average to good money if they find work in a nursing home. LPN's start out at about $13hr in the hospitals in my area. Most services will make room for you to continue your education. If they do not, find another service. Kevin

Agreed, look for the school that brags about those still working in the EMS field. A school that will state we not only have a respectable pass rate we turn out good EMT's is one you should pay more attention to. I attended schools for both my EMT-I and EMT-P and am having success in earning the respect of my peers. As for a Fire Dept that will throw fertilizer on a mistake I have a bit of resentment for the insinuation. I am a full time FF/PMDC/HazMat Tech/ training to be an Engineer. We take a great deal of pride in how much we train our people in EMS. We keep our skills current and are among the most respected Fire Depts in the region. Try not to group us all into the good ole' boy club with no accountability. We hold ourselves accountable. Anyway, the education you receive is the foundation upon which you will become a good or great EMT. Know that when you graduate and pass your tests you have been certified to the minimum basic standards that are required to operate as an EMT. You are not an expert or realistically proficient in the field yet. Be a bit humble when you enter the workforce and look for more than one mentor with some common sense. Even those with years of experience are still learning (if they are smart) and will hold different points of view on the same subjects. Good luck! Kevin

Everything I have read has covered the basics. Point of interest: my wife had a seizure as an allergic reaction to a drug called Ultram. I am not an expert on this drug though I believe it is a combo analgesic/anti-inflamatory. She had only the one and it was a classic grand mal seizure. We know that a seizure death is a hypoxic death. Concentrate on the airway and administer Benzo's as your protocol allows. Good luck! Kevin

I find this hard to say without sounding condescending. If you can't figure out how to use a Pulse Ox you may find yourself in the wrong field of work. There are only 2 numbers. As an EMT-B if you count out a pulse and match it up to one of the numbers; the other has to be the percentage of O2 the blood is carrying. These devices are usually fairly well marked. Here is GA we actually didn't have EMT-B's until the spring of 05'. Their scope of practice is so limited here they wind up, quite literally, as drivers and vital sign takers. Which is a shame, though since we have had I's and P's for so long taking a step down was almost an awkward moment. For all who do not know how to use these devices feel free to read the manual or ask someone who knows. You will find it a useful tool in assisting your diagnosis of a hypoxic patient. Again, please treat the PT and not the machine. Kevin

Just to make all of you a little jealous I am finished! I got an 85% on my cumulative final exam for school (15 months) and an 82% on my National Registry! It was a pretty proud day I can tell you. Keep truckin' forward! Know that the rewards of the level of Paramedic go beyond the money and respect. Knowing you can more effectively help people is a wonderful experience. A little cheesy yes... I'll take it all day long! Kevin J Hook