Mateo_1387

I am curious. How many people were in the room working the code? Just from what I have read, I think the problem with the code is leadership. One person should be on top of everything. This person is the doctor. Being that the OP's area obviously carries all their codes to the hospital, the ER staff should be capable of working them smoothly. Codes are so ....."cookbook"........ So, it is my opinion that leadership would have been the problem. Even if the hospital may have expected more treatments, the commander should realize in the first thirty seconds what is done. When they first walk in they can visibly see if and IV is established, the person is intubated, the monitor is applied. When these things are not done then that is the time for the doctor to start dictating what is to be done. What I am saying is that instead of saying something like "I need and IV, epinephrine, Intubation" say " Terri, get an IV established, Josh, get the epinephrine ready...." and so on and so forth. This way everyone will know their job.

I remembered something else. My memory was triggered from another post. ALWAYS ALWAYS ALWAYS make sure to have copies of your clinical packet ! This is why...

Here are my tips for the paramedic field clinicals. Get to know your preceptor(s) if you ride with them for multiple shifts. First impressions are really important. You will want to be a team player as much as you can. Your goal is for them to view you as a partner rather than a student (although you will always be "the student"). To get to this point make sure you know what you are doing, and always work for improvement. I do not agree with the whole "ask so many questions" thing. If you just keep going and going and going they are going to think you are an idiot. I would ask questions when you have them, but I would not ask so many that they think you really are incompetent. They probably already think that just because you are a student. I suggest you talk to other classmates and previous people you may know who have had to work with the preceptors you will ride with. Also if you are not familiar with the station location then I would suggest that you locate it in advance, and possibly drive to it. Get things ready early so you are not waiting until the last minute when things can be frustrating. I suggest when you first get on shift make sure to introduce yourself to the crew you will be riding with, and try to have a positive attitude. Talk to them early about how things will work on the ambulance so that you are not figuring it out on a call. They will probably ask how comfortable you are with patients and etc. Be ready to make mistakes but be strong enough to work through them and improve. You may also write down some of your weaknesses so that you know what to work on. You can bring these up with your preceptors and they can advise you and hopefully you will have calls where you can work on them. Bring equipment (watch, stethoscope, clinical packet, extra set of clothes, or whatever is required of you). Depending on your area you may also want to bring some food. Become familiar with equipment in the ambulance so when it comes time to use it you will be capable of doing so. Same goes along with protocols because sometimes what is taught in class is a bit different than what "the cookbook" says, so make sure to be somewhat familiar with them so you are better able to be part of the team. I also suggest that you run as lead on as many calls as you can. The more you do the more confident you will become. I hope this helps you out. Most of it is common knowledge, but maybe it will help to hear it again. Good Luck !

I am curious how you are better able to predict potentially deteriorating conditions in Iraq. What do you do if you are caught on the other side of the compound/base/wherever you are without your vest and conditions deteriorate? Yea, I see your point, pretty weak argument on my part to use a vest on a shooting. Again, what makes you more capable of predicting when thing go wrong in Iraq than in the US? I would wager that it is more predictable here than in Iraq. If I go to an area that I know is laced with crime, assaults against police, fire, or EMS than I can predict the chances of getting shot are higher. But then again you are right that I cannot always predict the situation 100% of the time. Furthermore, Strokes kill over 150,000 per year, with approximately 32000 being hemorrhagic. Guns killing EMS personnel is "10 mostly from homicides" per the study cited by Anthony in a five year period. I still do not see the emphasis put on the vests when there is a greater chance of being hurt in an accident. If I was provided one, I would be apt to wear it, just because it is provided. Same goes with turnout gear, its for my protection. I will not be all that worried if I am not given a vest. Thanks! I am sure it would help. I am saying that it should not replace a proper restraint system. Like your post from 2005 where you said the vest protected you from a rubbernecker, I can see it working well. Being an MVA I would think turnoutgear would do that same thing.

Agreed ! My beef with this is that the patient has a right to be a danger to herself if she so well pleases, with of course the understanding she is capable of making her own decisions. I do not feel that a comparison to someone who can not oversleep is accurate. I would compare it to someone who is a risk taker simply because they do not care. But even that comparison is shaky. This is a patient (from what I am getting from the OP) who is probably ridden with medical problems, and has little chance of leaving the SNF unless she is dead. Again I think the root of her problem should be the focus of the doctor. To tell you the truth, I would be willing to wager that the patient would be a candidate for Physician Assisted Suicide, considering by not eating she is basically committing suicide. Yea, for real... There always remains that possibility.

If she is capable of making her own decisions then the doctor would have no right to "form" her. He is not in charge. For the scenario, if the patient is capable of making her own decisions then I think her wishes should be met. What needs to happen with the patient is find out why she has a failure the thrive. Just presuming here I would wager that the patient is severely depressed, or just wants to die, or more likely both. Of course if I were sick enough to be stuck in a SNF, with nothing to do but watch TV, look at four walls, and have pills shoved down my throat day in and day out, I would probably have a failure to thrive too.

This thread has really got me to thinking. I have had to leave it, think on it, and then return to it just to do the same process again. I am all for safety, I want to return home by the end of the day as healthy as when I went to work. So this is how I see it. The major issue we face as far as danger goes is an ambulance crash. Restraint systems are a must, as well as ambulance design with injury prevention in mind. I agree with wearing a seatbelt, but too many people in the profession do not wear a seat belt. I feel a bullet proof vest should not be used for injury prevention in an accident, a proper restraint system should. The money to buy bullet proof vests I think would be warranted for protection from on scene hazards such as gunshots. On the flip side, I think more emphasis should be placed on vehicle safety than risk of gunshots. But then again the information I am getting from the thread is on deaths from each category, It doesn't say how many paramedics are exposed to each category, or survive from something in the category. I personally would not want to wear a bullet proof vest unless it was warranted, such as going to a gun shot victim, serving in Iraq, or other such situations. We cannot be protected from everything, but why not if given the equipment use it for your own safety. We are issued gloves, turnout gear, have seat belts, and other resources (police) at our disposal. So I would say use what is given to use to keep safe. Edited once because I forgot to use the spellcheck

Around our area EVERYONE ( except two newly educated persons (riblett and myself)) call the class B uniform as Class A. If I am not mistaking, if we wear the uniform to a special event, such as a funeral, then we add a tie to it and look "professional."

Rhabdomyolysis Yay, I win...........jk But really, who is looking anyways? :wink:

I would say use valium. It is a great benzo that will cause muscle relaxation and some calming effects.

What I got from the OP was that "slammed" meant that the full dose was given in one push instead of titrating to the desired effect. I also think the OP felt like she learned a lesson from pushing the full dose and having to fight with a patient who was in pain. As for the stories Ruff that keep getting better and better, how else are we supposed to be entertained with other people's stories......

My story is actually a bit different. I had a patient, a cancer patient, who was unresponsive. We determined that the patient had overdosed on their narcotic meds. The patient had vital signs within normal limits. I took the call and decided not to give any meds because I would have to make the man experience the pain from his cancer all of a sudden. We left it in the hands of the hospital because they would be able to give him other pain meds that would ease his pain without using narcotic receptors.

I do not think that dual medic would have helped overall in this case. From the Original Poster's comments the medic appeared to be very nervous. On top of the he also does not appear to be on top of things. I think this is where a dual medic system can be a bad thing. It is easy to get reliant on another medic to pick up slack. As a single medic provider you are forced to be on top of the game and be proficient at skills.

From reading through this post for the first time this is what I see and think. For the first argument about intubations at 70 seconds taking too long I don't think it is a problem, that is only in cardiac arrest. The newest CPR standards, for lay persons, is to do continuous compressions without ventilations, if so desired by the lay person doing CPR. So provided we have effective CPR and extended time of 70 seconds to get a "golden airway" to me should not be a problem. For a patient not in cardiac arrest who is apneic or near apneic 70 seconds for intubation would not be acceptable (example. Pulmonary Edema, trauma, RSI). Check this link out http://emscapnography.blogspot.com/2006/08...hould-know.html On this link find the LP12 about half way down, and three strips below that is a strip showing the gas exchange with CPR alone. Here is my second thought. One skill I have seen incorrectly done on every call I have been to where it involved a patient being BVM'd, the skill was done improperly. This is a so called "basic" skill that is essential to master. Using a BVM is a fairly simple skill, just done improperly a majority of the time. Multiple instructors I have had, and anesthesiologist in the OR have told me that it is a skill done improperly most of the time. I am also sure everyone reading this post has been to numerous calls where a person using the BVM is doing the skill improperly. So now that we have it established that BVMing is mostly done improperly, why in the world do we want to give the KING to basics when what the patient needs first is proper BVMing and an ET tube? Same goes for medics, why would you want to use a King when you should have the skills down to do an ET tube. I think King would make a good backup device in a dire situations, but I think it should be a device that is rarely if never used.

I have thought about attending a convention, but just never got the strong urge to. Now with the information that I can get it all in the City I'll probably never make it ! :hiding:

LOL, Yea, that works too !

Yea, for real !

Sounds like me playing the game, except I curse with a lot more anger ! And then I get frustrated and quit. I would never last as long as he did. Favorite quotes "This s**t is f^%$#$g worse than Panic At The Disco, f**k" "I did the correct input there Mario, you f*&^ed up !" "This is worse than Ann Coulter!"

Whaaa :?: :shock: :arrow: You would follow the cookbook by doing the Chest Pain protocol even if you know that it is not indicated? Even if you feel like you must always follow the cookbook, why not call a doctor and explain to it your patient's condition? Come one guys, we have to be thinkers and do what is right for our patients, not CYA because of what the cookbook says. :arrow: on another note after the third sentence where you started to ramble about aspirin and medics and stemi centers and abcd's I lost you. Could you clear it up and explain what you were meaning?

Do you have a link to the story? I would be interested in what the charges are. Also makes me wonder how old the kids are.

I cannot find any information where an IO has caused damage to the epiphyseal growth plates in adolescents or younger. It is more likely for the person to have infection, fat emboli, and compartment syndrome versus damage to epiphyseal growth plates. The most common adverse effect seens with IO use is extravasation. It seems like a great tool when other means of vascular access are not available. My agency uses them all the time. We have not had any problems with placements that I am aware of. Our problem with them has been that some medics have put needs used to drill back in the case they came in instead of placing them in the sharps container.

There should be a poster with smokey and that quote on it !

That is GREAT !

I can see that epi for some body in hypovolemic arrest is not necessarily warranted. But I do not see that epi is bad for someone who goes into cardiac arrest due to a MI. Maybe I am way off, but if somebody is in cardiac arrest due to MI they obviously do not have enough oxygen to support the function of the heart. The heart does not have any beta stimulation at this point. Also the brain is not being perfused. So I can see that epi's strong alpha and beta effects will cause vasoconstriction, increased inotropic, chronotropic, and dopaminergic effects to the blood vessels and heart, exactly what the patient's heart currently lacks. We have to increase the oxygen demand of the heart in order to make it function. Even if we watched a patient code in front of us, did two minutes of cpr, shocked once, and got return of pulses there is a good chance you will have to hang a drug like dopamine because the patient will be unstable. Am I thinking way wrong? If so please explain.

Please elaborate how strong beta effects that epi exerts on the heart is not desirable for someone in cardiac arrest?