Advice From All You Medics
- Thread starter jh504
- Start date
SunTzuNephew
Explorer
Nice! Good times on a rig. Remember to tx. the pt. not the preceptor
Or the symptoms....
Great shift yesterday. It was mainly a sit back and observe day. About half way through the shift on our first real EMS call, I stepped up and jumped the IV. 5 medics, 2 EMTS standing over an elderly patient with small viens and white carpet....no pressure. Nailed it! Felt like getting a base hit at my rookie first at bat.
After 15 years of not running EMS calls I forgot how many are really not warranted. It made me sorta of appreciate a lilttle more my cop job.
It should be a fun two months. Im at a great station with good guys. They all want to teach.
Plus I learned that one of the captians used to drive in Camel Trophies.
After 15 years of not running EMS calls I forgot how many are really not warranted. It made me sorta of appreciate a lilttle more my cop job.
It should be a fun two months. Im at a great station with good guys. They all want to teach.
Plus I learned that one of the captians used to drive in Camel Trophies.
kellymoe
Expedition Leader
Good to hear you are at a good training house, it makes all the difference.
Many of the calls you will go on are not warranted as you mentioned but remember to keep a good attitude, it will take you a long way as I am sure you know.
On our first call this morning we were dispatched to a seizure. Pt. was combative and big. Turns out it was a diabetic problem and after a few attempts at an IV with a hostile pt. the medics ended up giving glucagon. All the while the pt's wife is MF'ing us and threatening to sue us. The wife was simply overwhelmed and we were the closest target. I kept reassuring her that we were doing everything we could for her husband, but could not get her to calm down. After her husband's sugar returned to normal she was apologetic to us and turned her rage at her husband for putting her in this situation. It was then that she realized she was wearing a purple thing and teddy combo the entire time. At least we got a good show. See, a good attitude pays off:sombrero:
Many of the calls you will go on are not warranted as you mentioned but remember to keep a good attitude, it will take you a long way as I am sure you know.
On our first call this morning we were dispatched to a seizure. Pt. was combative and big. Turns out it was a diabetic problem and after a few attempts at an IV with a hostile pt. the medics ended up giving glucagon. All the while the pt's wife is MF'ing us and threatening to sue us. The wife was simply overwhelmed and we were the closest target. I kept reassuring her that we were doing everything we could for her husband, but could not get her to calm down. After her husband's sugar returned to normal she was apologetic to us and turned her rage at her husband for putting her in this situation. It was then that she realized she was wearing a purple thing and teddy combo the entire time. At least we got a good show. See, a good attitude pays off:sombrero:
Kelly, at tape and chart this morning a guy shared a call where they had a combative diabetic with a sugar of 30 that was spitting at them till they could push some D50. When he came back he was very apologetic.
Saturday when I go back Im ready to jump in with both feet and try to start making treatment decessions. Lord help me....and my patients.
Saturday when I go back Im ready to jump in with both feet and try to start making treatment decessions. Lord help me....and my patients.
jeepmedic46
Expedition Leader
Had a 400lb pt the other with a bp in the 50s x 24 hrs s/p hemodialysis treatment. Facility gave him a 500 cc bolus. When I went to put the line in I thought he was going to pop with the amount of fluid that came out and it wasn't blood. Gotta love rehabs and Nh.
jh504
Explorer
We have a lot of diabetics around our district who dont take care of themselves. I kind of like going to them though because we usually know who the person is and what their background is like. It is one of the kinds of calls where you can go there, do your thing, and really see some results. Take a person from near brain damage to alert & oriented and ready to sign a refusal!
It is sad the kind of care that goes on in this extended care facilities. I cant believe some o fthe things I have seen people at these places do. We had a call a while back for a seizure. We get on scene and the guy is activily seizing and barely moving air. The nurse blocks us from entering the room and wants us to hold off while she talks to the guy's doctor on the phone. We are like "no you called us we are going to treat him, back off." This poor guy's sats were like in the 70s. The staff also couldnt tell us how long the seizures had been going on. They said thats how they found him, but anyway.
I cant believe we are this close to the end of paramedic. I have got 3 more months and its all over. This course has been a mental rollercoaster ride for me. At the beginning I was revved up and ready to hit it hard. I stayed motivated until after pathophysiology then I dropped back to idle for a little while. Then we got in cardiology and I found my second wind to hit it again. Got passed cardiology final and I have been coasting for a couple months. Now I have got to do 200 hours of hospital clinical time before the end of class and I am trying to get myself back up and running again. I guess I have enough left for one more go at it.
Aint gona lie.... Im counting down the weeks. 8 more. Will be nice to have my life back.
I had my first code last night. It was ciaotic as I remember from 15 years ago. I didnt "run the code" Like in ALS. I had two medics and two EMTs each just went to work. I took the tube. I was amazed that I didnt seem flustered with setting up the equipment. It was real world and I did by best to try and keep things sterile, but that just isnt reality. I wasn't able to get the tube, I could just see the bottom of the cords and tried with the Buggie (sp) but still couldnt get it. Either could the other two medics. The king AW didnt work either. Everything we tried filled the gut.
The IV got pulled out during the third round of EPI. One big cluster. Even the doc couldnt get the tube for a very long time. Hate to say it, but it was good practice.
I had my first code last night. It was ciaotic as I remember from 15 years ago. I didnt "run the code" Like in ALS. I had two medics and two EMTs each just went to work. I took the tube. I was amazed that I didnt seem flustered with setting up the equipment. It was real world and I did by best to try and keep things sterile, but that just isnt reality. I wasn't able to get the tube, I could just see the bottom of the cords and tried with the Buggie (sp) but still couldnt get it. Either could the other two medics. The king AW didnt work either. Everything we tried filled the gut.
The IV got pulled out during the third round of EPI. One big cluster. Even the doc couldnt get the tube for a very long time. Hate to say it, but it was good practice.
jh504
Explorer
I hear you, Im counting them down as well.
A chaotic code IS definitely great practice to see what not to do next time. I have been fortunate and have had a lot of codes at work and have been able to see what I want to do different when I am in control. Our class had Dr. Brent Myers of Wake County EMS come and do a lecture on Hypothermic Resuscitation and their code procedures. It was great. I dont want to sound like one of the run of the mill butt kissers, but he really does have an excellent system there in Raleigh. The thing that they stress is to have the lead paramedic standing back and running the code. Basically not doing anything but watching the monitor and directing the other team members. They also stress not stopping compressions for anything, not even a tube. Their general practice is to start compressions, drop a King, and drill the IO. Then work the code right there, and call the code right there. He gave us a statistic saying that just stopping compressions for 20 seconds cuts a patients survival in half. Their best chance is immediate, hard compressions at 100 beats a minute. Of course everyone tries to stress that but what is taught and what actually happens in real life are two different things.
That being said I had a code at work a couple weeks ago and it was the most chaotic thing ever. My medic told me to get the tube so I opened the woman up and she was full to the brim with pea soup and the suction was still in the truck. We loaded her up, out of view of the family, and had 4 paramedics and 2 basics in the ambulance. Talk about a scene. It was bad, and I decided right there how I will be doing things once my cert is in.
jh504
Explorer
Wake County is very progressive, sometimes maybe too progressive (Advanced Practice Paramedic, cough cough). I really learned a lot about improving cardiac arrest save rates though. I will be modeling my codes after their protocols.
That last code we had I watched our paramedics get so focused on getting the tube that compressions were stopped 5 or 6 times for indefinite periods. No one was in control, there were too many roosters. There is no point in wasting all of that time just to get a tube when you can drop a King in and have an airway. Also if the doctor wants a tube, you can insert it using the King. Some say the IO doesnt allow the meds to hit the heart like they should but there are no studies that show that. If you are concerned with it though then you could always drill them and then start an IV after your first round of meds.
If you ever have a chance to hear DR. Myers speak I would recommend it.
jh504
Explorer
I have never actually done it, but supposedly you insert a stylette into the airway part of the King down into the trachea. Then you remove the King while leaving the stylette (spelling?) in place. Now your stylette is in the trachea and you simply slide an ET tube down the stylette into the airway.
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