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Pesky students...lol.

Great to see your back on duty was following this one ERDOC, your senarios are good fun. squint pushes rookie on car out of the way, I will take it frome here and suggests get his/her chariot needs checking out...just kidding. Ok back to busniess: - grips + reflexes.... any unusual findings? the history may be suggestive of cluster type HA. - beta blocked.... hmm.... is she compliant with meds? and when was this treatment initiated? - When was she DX HTN...any complaints of leg pains, drowsyiness, unusual dreams or dizzyness when she first awakens? - Has she taken any OTCs to relieve her pain, or any herbal remedies? - Since we got to the call, has the pain changed in any way and have her describe what she is feeling if any changes. - Pulse 66 you say, ECG done yet? NSR? or any blockes? - Chestsounds...any adventicia? any SOB? - Any problem with urine production? (just no way to make that sound good) cheers, as typical your senarious start out benign, then..........???

Two points here....one, most RNs are very good with the teaching portion in promoting education....these days in our neck of the continent in fact I can honestly say if It were not for the good ones my education would have been far more difficult, but I have been around pre "medicnorth" period. Point 2 I NEVER cower from an argument with an RN that is or has the potential of negatively affecting patient care, patient advocacy is the most top priority in my philosophy period....... besides I usually win because its hard to fight with a guy using a walker, it looks so bad. Point 2 (eh)...I don't ever get "chocolate" the connotation of Valentines or a Romantic inference could be miscommunicated........so how do you like your Tims.....double double? it is way safer! ps where do you practice as your comment : We have ACP's that are going to shake things up around here as they enter their hospital practicum. These would be "students" not registered Paramedics, I sure as hell hope they DONT shake things up, they should be walking on eggshells if the program is new to you...... I would hope....as one negative incident ant the rest get painted with the same brush.

Is crotchety a real word? :twisted: LMAO @ Pretty much anything in my pants could be used as a weapon.

Ok Ok I've got a good one.....What do ER RNs use for birth control.....that is right their attitudes! Now that I have that down on paper, and having worked in ER (not as an ER tech I add) the interactions can be complex traditionally with nursing there is a pecking order, the higher you go the more "tude" you may encounter but not a firm rule.. At the same time these folks can be under a tremendous amount of stress, so don't take a curt word or 2 to be a personal attack....! It is usually hopping crazy where I worked sometime politeness goes astray, water off a ducks back man. If one thinks this is a place to "hit on chicks" or have them "hit on you" then go back to the Bay your not in the Bar....ps I doest work for me there either....lol. The folks that are respected are the laid back dudes, one's that have a sense of humour and are helpful ie "Can I assist with Compressions" and "you don't need to ask to help changing a patients bed sheets" pushing a stretcher to xray or even (I am not suggesting you become a Suck Up) Stopping by "later" with a box of donuts....this is usually very appreciated, "friendly follow-up" brings the best educational experience from the MDs...... ERDOC is very right "teaching" is ingrained in the MDs, but thats when there not trying to empty beds, send patients to floors, writing on charts...or get to the donuts! When your on a "hit the wall on hold" situation with a non-emergent patient, have the junior member of the team go look to help out the staff, they WILL remember you, if you show your "wanting" to be part of the team it goes a long way. cheers

IDEAL BODY WEIGHT, HAMWI Method Female: First 5 ft (154cm) = 100 lbs (45.5 kg) Add 5 lbs per additional inch or add 0.9 kg per additional cm Male: First 5 ft (154cm) = 106 lbs (48.5 kg) Add 6 lbs per additional inch or add 1.1 kg per additional cm. So in a perfect world a 6 ft man should ideally wieght 172 lbs or 78.01 kgs. Now...stand away from the Big MACs yall.

Interesting topic.....will sit back and watch this one till to be sure, some serious "lack of" evidence based medical practice here. :twisted: LMAO @ PVC!

Green Dude: Nope VORTAN is "NOT' goof proof...no alarms, and best use an ETCO2 to monitor efficacy of ventilations, a bit of a different way of thinking when it comes to ventilation fer sure, (a Pressure Controller) but no worries about calculating ideal body weight...tee hee. http://www.floteco2.com/htm/Products/B-VOR...esuscitator.htm But never the less, one can ventilate a hamster to a moose, it is really light, and one can scab off darn near any source of O2 delivery system. They look pretty cheezy, but Dr. Birds ideas still live on...hey maybe we could find one in Camo for you :shock:

Dust: Just an idea here, if you have a need to ventilate patient and need to free up a spare hand, the VAR (pressure controller) Ventilator is a real work saver (Bird -in-a- Bag coined by RRTs.) it was a developed for SARs epidemic in T.O. if you want one pm me I will send one to you, they weigh about 4 ozs. and one can drive it with a 50 psi wall outlet, or use a regular flowmeter.. cheers

Michael: I can't see where anyone here has been too harse at all, I think that you may be a bit over sensitive to the comments provided. I think Holocene got exactly what he asked for..... education and in-sight, dare to ask hard questions dare to receive hard answers, in fact he apologized for asking because the realizing that this can be a very sensitive topic for some that in itself speaks volumes, I don't believe that he needs someone to defend him at all. A lot of these posts really spoke from their hearts and please don't think of it as easy but in fact it could be very therapeutic for some to get it out, put it on paper, and hit SEND. Just a premature conclusion by myself but the "gross" things persay are not really the most difficult situations for EMS providers. In fact its the humanity side of things that is the real trend here..... quite reveling....... hey EMS workers are actually humans too! WOW! Just to be crystal clear here: Quoting myself: I believe its blatant morbid curiosity, edit (its a human trait) but agreed totally it is annoying and quite rude to my way of thinking. edit (the point here) I have often been at a social gathering when someone asks the standard question. I think R/r and hammerpcp summed this up nicely. I too have had some nightmares "that wake me up in a cold sweat" that I (can't remember) when I do wake. How about 8 arrests in one shift and not one survived....hmm.....I was the last person to ever talk to those good folks........ How about 16 burned to death in a train wreck, then 96 more to give care too with some being the living relative's....don't think that haunts me? I rarely get into this type of topic because one just can't explain this to the lay person, or even an ex wife :roll: Then someone decide's to post their religious values or beliefs believing that their way is the only way, now that does frost me to be certian. ... so like I was saying back to the free shrimp and doubles.....cheers.

Hey that IS funny! hit the nail....on the head....lmfao. I believe its blatant morbid curiosity, but agreed totally it is annoying and quite rude to my way of thinking. I have often been at a social gathering when someone asks the standard question "hey whats the grossest thing you have ever seen.....my short answer is.......... a Surgeon making his first incision.....odd thing that this never is asked of an MD? That's the part that I go looking for more free shrimp, and order a double. cheers

Ok first off where did that Lithum hide :twisted: ....he started this synapse challenging thread. Secondly medic-ruth.......come to the DARK SIDE Personally would like to hear what other enlighghted folk have to say.....testing testing come in DUST, or AK... ++++++ You you out there? cheers

Ok North you have my "somewhat" undivided attention.....Just HOW does one go about this? Frequently the heads are too full on absolute gibberish some folks do get the global picture from the onset were as others get tottally snarled up in the sequenses and or details of a senario or in fact in real life this is quite common. I guess I mean is there a established theory in education to address this as the teacher must be already be a critical thinker themselves....dont take this personal at your old age but so many of the educators focus on the cirriculem content as opposed to the I quote R/r "INTENT". We see this so much in law, the interpretation of the law can become quite squewred with prescedent being set, I am beginning to believe that emergency medicine somewhat follows this concept sadly. :roll: Question is: What guidelines as a mentor can be used to teach critical thinking? I suspect the adage "when your up to your ass in alligators it is difficult to remember the the intent was to drain the swamp".

Correction;

I can't disagree but as you stated the "Grey" areas become very fuzzy at the best of times. Presently in "my hood" the scenario testing has come under serious scrutiny as well.... just how would you propose an evaluation of ones critical thinking skills? OMG....this would open up one serious can of worms, as we all do not think alike. (nor should we) I will disagree with the theorists that the level of intelligence one is born with can be seriously modified or even think in a different manner, granted "some modification" can be accomplished if there is the desire....as Carl Jung stated (loosely) "one is a product of one's enviroment" you can't easily change the spots on a career truck driver. I have worked with very competent First Aiders but asking them to do multiple triage at a disaster is just not possible..... given the weight of outcomes. I think that's just a fact of life, spending inordinate amounts of effort to do this is a may be lesson absolute futility for some. Question is: Just when is the end point in an evaluation do you fail someone as not all will pass? Personally through my experience it has been some folks are leaders some are not, is not so much a "tangable value" that can one can put a finger on. Besides the criteria and goals would be extremely difficult to conceive from the get go, I would like to be the fly on the wall in that regard in those meetings :shock: .......but I am open to new ideas. cheers

Another fine example in educating the ADULT......repetition.... EDIT and admitting misteakes right away.....lol.

Very interesting topic here Lithium: So here is my .0181 (USD) cents.....Critical Thinking can not be taught persay but protocol medical treatment can as this a matter of wrote memory skills and is sequential in nature compiled by..... Critical thinkers. The protocols are just guidelines and not a cook book recipe book but in saying so they are the foundation for the educational process(s). In fact in services that I work for it is essential to myself that a "deviation from protocol" is included in the guidelines, bit of irony? You say but protocols cannot ever include all of the variables that we observe in the field, we are applied sciences not TECHs. Don't get me going here..... At the present time it is the only means to train an individual, and the bar in which to judge as well. This is an attempt taking the good with the bad to teach with a common sense approach to emergency medical care. A perfect example would be life threating haemorrhage of lower extremity in a entrapped patient......a critical thinker may go straight to a tourniquet because if one applies direct pressure, the helper is in the damn way and delaying extrication (maybe not the best example but it is all I can think of before coffee is brewed) I have spent many a day or rotation with students EMTs, Paramedics, RRTs and Residents in clinical critical care settings and have come to the conclusion that "Common Sense" cannot be taught, one either HAS IT or DOES NOT.... seriously.....so in following those that do not possess common sense will never ever become Critical Thinkers. Common sense + education + experience + (good observational skills) + situational awareness + Prioritizing - ego = the Critical Thinker [hr:8781938448] A perfect example here is Medic2588 taking a prime opportunity to use a topic to blatantly sell his books LMFAO! Devin shoot me the link, you have spiked my interest..... EDITED Re Micheal-----good advice all.

Just an idea here but a set of "scrubs" made out of Protex or Nomex may be a good joke gift for your MD.... sometimes a reward from like minded professionals goes way further than a an award from a government official. If you need a lead to where to get some of this kind of "stuff" I have link (contact pm) my contact just shakes his head when I ask for "special requests" like this, and I love the look on his face when I ask for specialty items..... like 5 bars on eplilets....te he. You know MDs and RNs get a bad rep for attempting to assist at "outside" calls, I can honestly say that I have never had a negative interaction, in fact most cases the good samaritans walk away with an improved understanding of what it is like in the field.... Kudos Doc, and welcome to the "Glad to be Alive Crowd"

Your not a geek you just like stuff... Hey did you hear the one about the di-sulfide bond that walks into a bar? Yah you probably did. cheers

Interesting and terrific methodology here..... knock out perfusing ectopics to determine an underlying rhythum?.....just what heck was this ER MD thinking? Certianly looks as if the pacemaker needs a bit of maintnence now. I bet the Patients Cardiologist is suitably impressed. Question so just how did the arrest work out? I highly suspect that the next thing you observed is tombstone "T" waves.

:oops:

Again guessing and "not to treat the strip but the patient"...if the ICD is in a non operative mode and the history preceding may be a hint.. A question would be are these beats perfusing?...I suspect so if his LOC remains a GCS of 15?? If this fellow is paced previously, as I am seeing zip for spikes...perhaps off to cardiology to tweek up the rate a bit... perhaps check the implant leads as well, I am confused as to your statement the data was removed? A rate increase "may" reduce the break thru ectopics, the rational would be that hypoxia could be part of this? dunno. Your senario did not include Sao2? how come? If they did an ABG and stat electrolytes that would be helpful as well, mag and ionised calcium would be nice, you are in the ER? cheers an interesting strip.

Is it just me or is the speling cow not working AGAIN......la la la. :twisted: :twisted: :twisted: :twisted: :twisted:

Ok so Brokeback Mountian WAS filmed here....will we ever live it down? :oops:

Doc we just have to talk.....LMFAO..... do need some educational links? Kyle: Yes thats right... bellys, your way too young for THIS tread...lmao.