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mobey

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Posts posted by mobey

    What gear to own, I'm new.

    in Equiqment and Apparatus

    Posted

    My suggestions are:

    Buy a "quality" stethoscope. Not the $15 pair, not the $200 pair, something in between. A Littman master Cardiology is not nesessary. But a cheap Sprague will not last mkore than a few calls.

    Purchase German shears. They look like the $5 cheapies but actually cost like $15. They are autoclavable, or downright disposable. Say what you will about us germans, but we know what will cut a pair of jeans.

    I also carry my own safety glasses. But that is just because Oakley Flak look fukin awesome and make me a better Paramedic. I am sure they will supply dome dollar store knockoffs that will work just fine.

    Alberta Election

    in General EMS Discussion

    Posted

    I just wish Raj Sherman was part of Wild Rose party. I really don't support Wild roses "Turn control of healthcare back to the communities" standpoint. Municipalities and local boards SUCK at running healthcare in the rural population.

    Under Pressure

    in Education and Training

    Posted

    Dave, you are probably right, but I disagree with you about keeping this patient dry.

    Lactate clearance and VQ correction is going to be accomplished with fluids. Although this is an ARDS case, there is an underlying SEPSIS that needs to be treated aggressively in my opinion. This patient is acidotic to a critical level, and I think for transport purposes we need to bring that PH up to avoid a cardiac arrest.

    I like your vent settings, except that PEEP is a little out of my comfort zone for transport, I think I would dial down to 10.

    Whether blood is indicated for this patient or not is way above my pay grid.

    Under Pressure

    in Education and Training

    Posted · Edited by mobey

    This patient is severly acidotic, and for my transport that will be my focus.

    I have no problem with levaing the PEEP at 8, although a lung protective ventilatory strategy may be appropriate here. Lets go 6ml/kg of IDEAL bodyweight and keep an eye on that EtC02 and Sp02, not to mention skin colour and diaphoresis (oh ya! we have a patient to assess too lol).

    I would like to get that BP up though. Do we have a MAP calculation? Just want to correct the V/Q mismatch from the poor perfusion. With a high lactate like that, and a CXR looking like ARDS, it is pretty clear we are dealing with SIRS/SEPSIS..... something inflammitory and bad. He can have a crystalloid bolus of 20ml/kg to get us warmed up

    What do those lungs sound like anyway?

    Urine output in last 24hrs?

    Thx for the scenario

    Which antiemetic do you use? Which one would you like to use?

    in General EMS Discussion

    Posted

    If I want the patient to be sleepy, I use Gravol.

    If they are nauseated, but not actively vomiting OR on a backboard (whether nauseated or not) they get Zofran.

    I use Maxeran pre-intubation since it increases lower esophageal shincter tone (which paralytics do not affect btw). I also use it for the people who I do not want sedated, but are actively vomiting since zofran in these people seems to be like dragging a cat backwards. I use it with a litre of saline for migranes as well.

    • Popular Post
    • Popular Post

    Longevity in EMS

    in Burnout, Stress, & Health

    Posted

    Alot of threads have been headed in this direction lately, and I personally have been questioning my own career longevity lately. Since I don't blog, I decided to write out my strategies to prolong my mental health, and career, and identify the problems we face as time goes by on the forum.

    I feel really passionate about this topic, and hope for alot of productive responses.

    First to identify the challenges:

    Although the number of years I have been in EMS is hitting double digits, the first time I was truly affected by a call was only about a year and a half ago. I was driving to my farm after treating a post partum hemmorage on a young redhead girl, I recalled all my actions from starting large I.V.'s to performing bimanual massage (not technically in my scope, but try stop me!).

    Eventually the hemmorage was brought under control, and all ended well for her.

    As I drove down the highway, I felt like I entered another atmosphere. Suddenly the air got thicker.... I became short of breath, the temperature in the vehicle seemed to rapidly increase, and I got a huge feeling of impending doom, as if something out of my control was going to happen. I pulled over and grabbed some fresh air, and it passed quickly.

    I thought to myself "man, that was wierd.... I must be dehydrated".

    I went to work, seeding peas that evening. While driving our 4WD tractor pulling our seeding outfit I crested a hill and looked around my fields, with no neighbors for many miles I got a feeling of being too alone. Almost immediatly, my patient from earlier came screaming into the picture, I could see her freckled face clear as ever, the innocent look in her eyes as she gazed at her first born through tears and wincing in pain as I assaulted her uterus in an attempt to control the bleeding.

    Finally I had to shut down the outfit, and get out to regain my composure.

    That evening I went in for supper, and my father remarked that I seemed "distant". I told him I just had a tough call, and needed a day or two to get over it.

    I returned home a day later (I farm somewhere else), to my wife and kids. My wife proceded to tell me about some problem she was having... likely something about what her sister said on the phone, or how one of the kids smart-mouthed her. I quickly shut her down, telling her she should be so lucky as to have a family. She had no freaking idea what I was talking about, but could tell I was not in the mood for chit-chat.

    The reason I told that story was to point out 2 very important warning signs that something is going off in the ditch.

    Warning #1 - Panic attacks. Seem to come on unprovoked, can be anything from minor hyperventilation and anxious feeling, to an all out bawl-fest

    Warning #2 - Deprioritizing the needs of the ones whom count on us.

    The story goes on......

    Another week or two goes by and I have a dream: It is an older lady that I recognize, it is the first patient to ever go from living, to dead while in my care. We are in a crowded mess-hall, and I get that same choking anxious feeling. I immediatly get up out of my chair (in my dream still) and everyone is staring at me. The lady starts to bleed profusely from under her dress as she sits at her table, she looks oer at me and cries in a helpless crackling voice: "Marc.... I'm dying, you have to help me".

    I awaken from my dream with severe chest pain, I can feel my heart pounding, I am sweating profusely and can't catch my breath. I have to get up out of bed, and grab a drink to calm myself. I tell my wife about the dream, laughing as if it was no big deal.

    The next few nights are short, as I have difficulty falling asleep with images of the elderly lady, or the young redhead, or that stupid dream, flash through my mind everytime I close my eyes. As soon as I awaken while i am still laying in my bed a slideshow plays in my mind of faces of people I have treated, I keep seeing pictures of intercostal retractions on a tiny chest, blue lips, concaved chests from CPR, blood running down a cot mattress.... ugh... I gotta get up, no sleep in day for me!

    I attend some more rather critical calls, being the sole Paramedic for hundreds of miles around has it's perks, and it's challenges. 2 successful neonate resucitations, 1 shakin baby case with increased ICP, a few transfers to the city (3-4hrs away) for different reasons, couple intubated transfers and of course some routine lodge type calls.... all in all exactly what I am educated to do. Please don't let me fool you either, there are many days I don't even do a call. But as I have said before 3-4hr transports makes for some pretty long days too.

    I'll be honest with ya, I have alot of Paramedics dream jobs. Work from home, Salary nearing an RN, being the only Paramedic in this area the Dr's respect me, and the surrounding (BLS) services look up to me.

    But this brings great responsibility. like the responsibility I feel as I back up a crew with a pregnant trauma victim, and they look me in the eye and say "thank god you're here" as if I am going to ensure she will surive.... she didn't.

    Or the responsibility I feel when I get that Difficulty breathing call wondering if this will be the tube I miss, with backup many many miles away. But this is not exclusive to me. Yes I may be in an extreme setting, however those in air medical have similar resources. Even a overworked city ambulance may not have backup available.

    These are the regular stresses of the job. The problem is, if you do not deal with them, one day... they sneak up, and tear you down when you least expect it, just as they have done to me.

    So as I sit here now, on another night shift, with my heroic Paramedic eppaulettes, and my tactical looking narc pouch on my side, I feel totally unprepared for battle. I have lost the will to prepare or seak out a good healthy meal, I am not sleeping as much as I should, and I am pretty quick to snap at my family since thier problems are not "real", not like the problems of my patients, so i have no time for them.

    This brings me to Warning #3,4&5

    Warning #3 Failing to maintain a balanced diet & excersise

    Warning #4 Sleep disruption

    Warning #5 Flashbacks

    So just what do I intend to do?

    Well here is my plan of action to increase my longevity in EMS

    1. Find an arbitrary confidant. An EMS provider from outside this area I can bounce calls off, and discuss treatment without too much judgement. Someone without thier own agenda of always "1 upping" as we often do
    2. Make a conscious decision, starting today, that fast food is no longer a part of my life. It can and will be avoided. Fast food is a fast track to failure in this industry.
    3. Occasionally seek a professional: Periodically I will be making an appointment with a mental health professional. i go for physical checkups.... why not mental health checkups??
    4. Make sure holidays are not EMS related. This means no popping in to staff meetings during holidays, no wearing wacker gear, no scanner, no accepting cell phone calls from co-workers, nothing! Just family, and friends.
    5. Find an outlet: I loooove being alone, but with a family of 5, it is harder and harder to do. I need to find an outlet where I can be in my "happy place" and organize my thoughts and do some filing. I think I`ll buy a vintage car to tinker on. I always think of my life as a car, I am driving, but right now all the shit that should be in the trunk is cluttering up the dashboard and making it hard to see what is ahead, and for some reason I have a HUGE rearview mirror I can't stop staring into. It's ruining my driving experience, and I know I am headed for a crash.
    6. Define the line between work and home. This has gotten to be a grey mushy mess, I spend way too much time writing work emails and work related calls from home. That is not nesessary, when I walk into my house, the uniform shirt gets hung on a hook, and THAT is my mental signal - switch - You are a husband, father, son, and brother now.

    Thoughts?

    • Like 7

    Pain managment techniques within the EMT-B and paramedic scope of practice

    in Patient Care

    Posted

    That is exactly what I battled with for years, felt like I was cheating my patients out of proper care. So I went to Paramedic school, and changed provinces!

    Entonox will be the only choice for BLS in the U.S..

    Honestly though..... you may want to consider a change of scenery if your ALS providers do not even have analgesia. Change can and should be made, but it will take years, by that time you may be pretty burnt out of watching the suffering and deterioration of your patients.

    As a caviet: Bowel obstruction can be verry hard to manage painwise. I just did a 4hr transfer of one a few days ago, I used Ketamine augmented with 50mcg doses of Fentanyl, as well as Gravol and Zofran, just to try keep her comfortable. She still wasn't. It hurts to not poo...... and in that case Entonox is contraindicated anyway.

    Rural Scene Times

    in General EMS Discussion

    Posted

    Mobey, as I believe we've established, here, we are all using some varient of CUPS status to determine appropriate scene time. For those who don't know CUPS, that is Cardiac Arrest (or Critical), Unstable, Potentially Unstable, and Stable, which should be used to determine staying on scene to treat, or taking the show on the road, what I've been irreverently calling "Load and Go" versus "Stay and Play".

    Neat! I have never seen this before.

    Excluding trauma, I have 30min on scene times with almost all of these patients. But as this thread is reerring to, that is kind of a rural/remote thing, Stabilize prior to transport.

    Rural Scene Times

    in General EMS Discussion

    Posted

    I didn't re-read this whole thread, so I am not sure if this has been said before, but I treat my patients to the max of my protocol/knowledge even if it means extended scene times because I KNOW I proide the best Emergency care in this area. To race off to the rural/remote local clinic so the family medicine doctor can take my critical cardiac pulmonary edema patient into x-ray, then fill them full of lasix and "wait and see" is borderline negligence on my part.

    Arrogant or not, I do not apologize and I'll do the same for you when you are visiting. ;)

    • Like 1

    FDNY Ride Along...

    in General EMS Discussion

    Posted

    I have neither a clue what Hypotonic means, nor am I required to know what it means. It does not fall into the scheme of things, where by I would use it in the duties I am educated and/or trained to perform. I was trained to look at the IV bag, before opening it, and verify it's the correct fluid. However, I doubt it would show up in an ALS bag, unless there were to be a purchasing error. Otherwise, I have no idea what anything that you said means. None whatsoever.

    PLEASE tell me you do not have I.V. therapy in you're scope of practice?

    • Like 2

    Dead body smell

    in Archives

    Posted

    So I turned off the freezer and let it unthaw, and cleaned it out

    Sorry, dunno any tricks.

    I will however be quick to point out that to unthaw something, would actually be freezing it.

    EMS management training needed

    in General EMS Discussion

    Posted

    I'm looking for an EMS management course. We need to find a program that is 1 or 2 days long

    Facepalm

    Serious.... 1 or 2 days?

    What specific topic do you want covered? The way your post reads, you are looking for a "Manager course" inclusive 2 day deal.

    Here in Ab a EMS manger program is 2 years with a prerequisite of being a working prehospital provider for at least 2 years, plus a diploma.

    Click here o see a profanity and share in my frusteration

    in General EMS Discussion

    Posted

    Thanks all.

    Ya, I was as usual, more than an hour away from any hospital, and with a cardiac arrest post-head trauma, the writing is on the wall, even if she was alive when I got there and ran a near perfect ACLS code, the statistics are just not in some patients favor.

    I am dealing with it pretty good now, I was just trying to rationalize it the last few days eg: Gods plan/everything happends for a reason/etc etc

    The rationality I ended up with was "Sometimes bad things happen and due to my career of choice I have to be a part of that, therefore sometimes this job sucks".

    Works for me.

    Good news is, the very next patient I had was a pulmonary fibrosis with sepsis & pneumonia I had to RSI. I called the ICU this morning and they are taking her off the vent today, nice to get a win the day after a loss.

    • Like 2
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