BushyFromOz

I dig this word "crumping". Im gonna use that

As for the question at hand, my biggest issue is the fact that I think I sometimes articulate in a way that comes off as being overly pretentious and complicated. Sometimes that occurs here.

I would not say i have ever seen you being pretentious at all ch.

Thank you all for your honesty

Thanks dwayne

Agree with what your saying. My only question would be at what point do you stop trying for the gentle gentle time consuming approach?

How do you positively reinforce some that has overwhelming confidence in themself but no competence?

Ive been reinforcing the positive message for seven weeks with nil results and my crashing CVA patient didn't have time for me to be the nice guy. I know the tone in which i asked my partner to do something was wrong, but when i say "snapped" i conveniently leave out the other 2 times i asked for the same operation to be performed in a more friendly way

Im not saying i dont have a scope for personal improvement - clearly there and with the roles i am aiming for in the future i still need to rise above that urge to snap at the guy not doing what is needed to be done - its not professional no matter which way you look at it.

My mentor said to me "Its not cool bushy, but when your working with people who cant be told and have no insight into whats going on then sometimes it just happens, it doesn't mean you have a bad attitude, it just means your human"

The next bit of advice i got was " and stop internalising verything, it will drive you mad"

Touche!

good point defib i think your onto something there

Just as well im on 4 weeks leave in 3 days

Man, its a shame not everyone will get how damn funny that really is!

Well, i get conflicting advice from my colleagues

Basically its 50/50 "yea, probably not the best way talk to people but understandable, you should still apologise" the other on i am getting is "some people need to harden up a bit and justb see it for what it is - a single moment in a high pressure job"

As has been pointed out though by a couple of more astute people, not all paramedics are made equal.

It pisses me off to no end that the new guys are not treated the same way i was. they seem to get it fucken easy, this gen y shit where they get wrapped in cotton wool " dont hurt their feelings" kind of crap. Guys are the worst for it, they cant help but cut the girls some slack but if they were blokes the older guys would cut them a new one

It also pisses me off that it seems to be that myself and a couple of other guys are being held to a much higher standard than other guys of similar experience. The mediocre guys perform the bare minimum required and get by and people just expect it from them. The high achievers get a lot more pressure on them to be high achievers which is ultimately my point

I dont ask for anything that was never asked of me in terms of job performance, and when they cant perform i get a bit snappy.

Basically i have to lower my standards and expectations of other paramedics.. weird huh?

Thanks guys

It must be bugging me, i actually lost sleep on it last night.

Im gonna grab one of my mentors this afternoon for a chin wag a chat and get some more feedback.

You guys are mean and Im not playing in your sandbox anymore ;P

Good.

Im pretty sure that weird kid in the polar bear suit just peed in the sand anyway.....

Unfortunately, there is no best drug ever. .

It called beer mate!

So, read the thread title....

Im one of those ambo's where self condifence makes or breaks your ability as a medic. its taken me 5 years to build up to a point where i am what i feel is a "competent" level of service provision. I wont go into how awesome i am but i get a pretty darn good wrap when it comes to the clinical stuff (thats a joke by the way)

So anyway, the last week has seen me be the lead ambo for a couple of pretty crook patients and im not an IC guy so when i work with other regular ambo's i find i get frustrated with other ambo's who for whatever reason cant move as fast or be as organised as i am. I particularly get annoyed when they cant seem to perform basic tasks. Anyway, to cut a long story short on 2 occasions this week i have unknowingly "snapped" at one particular guy for reasons i wont go into, basically the problem with what i said was not so much the words i used but the tone i which they were said.

On both occasions it was pointed out to me afterwards that i had done these things and i dont recall saying either one, but clearly the person i said them to was offended afterwards.

When you a confidence guy your integrity is paramount to survival, becuase in my case if you dont have integrity and respect i dont have confidence in myself

So how do you guys change personal attributes? What do you guys do to change your unconscious behaviour?

Bushy, I am not sure how helpful an ICU book would be to a fledgling paramedic student. For example, how helpful will it be reading about early goal directed therapy when you don't even know what CVP is or have any detailed understanding of sepsis and septic shock.

I should learn to read better, i missed "future" in the thread title.

In all seriousness, these are the kind of texts we would reference in my education. Tortora and Grabowski for A&P, pathophys book i posted and i wish I had the ICU book for management. Those three with the huszaar ECG book and the pharm book i have somewhere could have been enough. Instead i spent upwards of a grand on texts i ended up flogging on ebay for a lot less than i paid for them

Mosby's paramedic book was a waste of a hundred and ten bucks. But i'm guessing those particular books are written to the DOT curriculum??

Buy the ICU book later mate and stick on the shelf, youll find yourself returning to it over and over again.

The pathophys book i posted is a must

No. We were discussing options before it gets to that point.

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Yeah, thats what i thought, i skimmed through using my galaxy phone but i could not find the post regarding CPAP again

This

http://www.amazon.com/Pathophysiology-Biologic-Disease-Adults-Children/dp/0323065848

Particularly this

http://www.amazon.com/Ohs-Intensive-Care-Manual-Consult/dp/0702030961

Oh's is an exceptional book, easy to read all, all facts and no fluff. I needed this book 7 years ago when i was doing my degree

Im so liberal with analgesia i could be considered a narcotic whore.

I have very litte limits as to what i can not give narcotics too, i am generaly free to administer 20mg of morph and/or 200mcg IV fentanyl and i can double those on cunsultation. I also have IN fent and the green whistle (which is handy, but i dont like it)

I can anlso consult toexceed those doses by as much again

Undiagnosed abdo pain is not a contra for me

Late second stage labor is a contra for me - apparently narcotised newborns is a no no

Sudden onset evere headache is a relative contra as they are worried about obtunding emerging CVA - but i can consult to get around this.

The IC guys can pretty much do whatever they want within sound clinical reasoning

CPAP in respiratory arrest?

Reality is by the time you get to this stage you are well and truly behind the 8 ball, especially if your last line of drugs isn't already drawn up. the IMI adrenaline is best to go in when you start to see a loss of B/P. If they do respiratory arrest before you get them and they still have a cardiac output still give the adrenaline and ventilate them with chest thrusts and alow for a prolonged expiratory phase.

Corticosteroids do not have the time of onset you are after when they are dropping their bundle and should be lower on your priorities.

Either way the patient will declare themselves and you will start to get some air movment or they will lose output completely

This is a 4 person job being attended to by 2 people (or one if you driving). So delegating the right jobs in the right order will gte you out of the poo.

The window for RSI/IFS is so small after they lose consciousness that by the time you have your drugs drawn up and your gear out it will be a full cardio/resp arrest anyway so a cold tube then paralysis if you get a RSOC is more likely than a tube while they have apnoea but with output

The real practical answer would be get the IM adrenaline or preferably IV salbumatomol in earlier when they are still conscious, and avoid the resp arrest

IV salbutamol is the gas!

Beware the pneumothorax

I'm red/ green colourblind.

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So am i, which is why this being printed on a shirt i own amuses the hell out of me!

Anyway, im told it says something about color blind people... but i cant read it

We're fortunate that prior to settlement Western Canada was surveyed and divided into 160 acre parcels of land which were considered a Quarter of a section of land. Each of these quarter sections measured 1/2 mile per side. A section of land is one square mile. There are 36 sections in a township, 6 miles by 6 miles. (not necessarily a town, just a descriptor). These townships are set into a grid, with the lateral lines (East/West) called the range lines and the vertical lines known as township lines. There are 24 townships in a Rural Municipality (County) 3 wide and 4 high. When we get dispatched to a rural location we are given the numerical address for that Quarter Section of land. An address might look like this, SW-23-36-10-W2. So, we start at the Right and move to the left to find the quarter section on a map. We're West of the 2nd Meridian (W2) Township line 10, Range line 36 narrows it down to a township (36 square miles) 23 represents which of the 36 sections of land we're looking for in that Township. SW indicates the Southwest quarter section of that section of land. At this point we've narrowed it to a 1/4 square mile area of land.

It's difficult to explain, but quite easy once you look up a couple of addresses.

Thats wicked kat... a level of organisation that our surveyers didn't have.

Our mail numbering system changd a few years ago, previously we had RMB numbers, or Royal Mailbox Numbers which were the umbers attached to the property by the surveyer general for that parcel of land. the problem is that later on when those lands were subdivided they were suffixed with an alphabetical letter. A big cattle station that was lot number 783 (RMB 783) that has been subdivided over several generations ends up with a heap of different numbers with a suffix, so RMB 783A all the way to RMB783Z if its been divided enough

Then some genious decided thats not good enough, so they re-numbered everything, ditched the RB numbers after more than a century and gave them a number based on the distance from the intersection of the nearest main road. Main roads were numbered from the nearest town. 142 is therefore 1.42km, 1420 is 14.2km etc from said intersection or town - which is really easy to work with

The only problem is that all these recalcitrant farmers love their RMB numbers (its been in my family for 5 generations, i aint changing it for no gubberment!) and a lot of them havn't put the new system on their properties, so now we get the new numbers in the despatch but have to then find out their old RMB number, its a pain in the ass

Fentanyl and midazolam and sux to induce then pancuronium afterwards with a morphine/midazolam infusion to maintain the sedation.

The fentanyl can be swapped out if the patient is likely or has recieved IV amiodarone or the morph/midaz infusion can be changed to fent/midaz if an allergy exists

Im told the fent/midaz pe-med will be ditched for ketamine soon

Currently RSI is for the post ROSC management and traumatic head injuries. Respiratory patients are tubed by sedation with fent/midaz and then paralysed, but im told this is under review and will be swapped for RSI protocol sooner or later.

We don't seem to have any issues with missed oesephegeal placements like is reported in the states, facilitiated untubation MUST have waveform capnography available.

The intubation algorithm here is backed by a comprehensive failed intubation drill which basically goes 1 attempt with or without bougie (based on grade view), missed tube, pre-oxygenated with OPA/NPA, attempt with bougie, miss, LMA, if unable to ventilated adequately, and cricothyrotomy at the end (its a bit more to it than that but its the general gist of it)

I understand RSI is contentious. Basically it was supported by in house data that said there was a significant reduction in the number of patients with severe neurological impairment at 6 months (i think) in the setting of traumatci head injury. Also, RSI enabled therapeutic cooling post ROSC which contributes to the 30% + survival to discharge for cardiac arrest we currently have.

now who do they call?

The police, because all the other fire trucks are on medical runs

Wow.

As a side not, anyone with the surname armstrong seems to be copping it this week

But in partial defense of the medic, he was part of a group that just killed a man so he had to play the role.

Generally i gree with that statement, but the 2 comments about thomas being cyanotic didn't exactly prompt a flurry of action from the ambo's

good god!

MEdics testimony will be interesting, doesn't seem to be a whole lot of airway support going on there, but the image is not good

Within reason, i dont actually have too much of a problem with it

Now, im off to find my tin ht and dig a slit trench... incoming!

Tintinalli is awesome, we have

I don't think this is exactly what you are looking for but I reference Tintinalli's Emergency Medicine: A Comprehensive Study Guide quite often.

it in the branch at work and its referred to as the "red bible"

Its so darn expensive though!

I have a pared down version called "emergency emdicine - just the facts" which is pretty good

how much are you paying for tintinalli over there?

Tintinalli is awesome, we have it in the branch at work and its referred to as the "red bible"

Its so darn expensive though!