I once...

I once met a fellow in a hospital.

He was a patient transport tech. He was the guy that moved folks around the hospital.

He could tell the liters per minute setting on an oxygen tank by listening to the hiss it made.

White Cloud

Haven't posted in a while because nothing particularly exciting has been happening in these last few months...really.

I work in a fairly rural system, so going an entire shift without a call isn't unheard of.

I am considering applying for a part time job at another service. I have a few choices.

One service is somewhat familiar to mine, but with a Community Access Hospital as it's Medical Resource Hosptial.

One service is the most busy in the area by far, but in terms of protocols is fairly behind the times(calling Medical Control for benzos for a patient actively seizing).

One service is a Community Hospital Based 911/Intercept Service. The Paramedics work in the ED when they aren't on calls.

In terms of possibilities I guess things are pretty varied. I know folks who work at all three services, so I guess we will see what happens.

I've probably lost 30 pounds since finishing Paramedic School, finally able to do the things outside I like doing and not eating crap all the time probably has something to do with that.

Still haven't worked a code yet as a medic, but I'm sure there will be plenty of those.

 

A few months...

So it has been a few months since I last posted. It feels like things have calmed down since I started, I don't know if we get more calls in the Summer, but I have been sleeping through the night more on shift, which isn't bad.


I can already feel the effects of skills and knowledge decay(Flowers for Algernon anyone?). I was thinking about ways that I can keep this from happening. I intend to apply to work part time some where that has a little higher call volume, as well as in a place that there is teh opportunity for discourse about patient treatments at the Paramedic level.

Being the most knowledgeable provider all the time has it's ups and downs, and I have seen among other Paramedics that have worked longer that if you assume your knowledge is infallible, eventually you will be wrong, and no one will be around to speak up and tell you as such. So I operate under the conditions that I continue to look for signs that my treatment and diagnosis is wrong, as much as I look for signs that my treatment is right.

Is it V-Tach?

I never work on the same truck as another Paramedic, and rarely are there 2 on shift at once. I keep in mind that getting though the Paramedic School gauntlet only allowed me to begin this journey, by no means was it an end.

I underestimated how widespread the "Para-God Ego Asshole" attitude is among other Providers.

To be fair, from the stories I hear there were some truly terrible Paramedics that have come (and gone) before me, so I guess the attitude is justified. Sometimes I feel like the unvented frustration towards them are directed at me but whatever.

While working, I try to be fair to my co-workers, as well as doing what is best for our patients, but oftentimes it feels like I am going to get shit from somebody no matter what decision is made, but I guess that is my burden to bear, earning the extra $2 an hour and all.

I have yet to kill anybody (that I know of).


I have given plenty of Fentanyl.

I have had calls that what I did was all the patient needed(see above 12-leads).

I am researching Critical Care Education programs, they seem really interesting.

I have learned that sometimes the best treatment is Diesel Therapy. I know this because the treatment that the ED made once I was there was a bolus dose of waytanzee.

Just one thing...

Dispatched to 37 yo female who has fallen...

On scene, first responders are administering oxygen and getting information from the patient's family.

Allergic to Penecillin/Amoxicillin, took sulfamethoxazole 5 minutes before passing out in the bathroom.

And she is flushed...like really flushed, lobster red flushed...pressure soft, pulse tachy, lungs wheezing and unresponsive.

No urticaria but I guess you can't have everything. Her lower lip is swollen, but it is also bleeding, she probably knocked it on the way down.


0.3 mg IM epi 1:1000, Abuterol nebulizer in a mask, another epi shot. Her sp02 is high nineties with high flow 02.

On the board and on our way. She starts coming to, and her pressure/pulse improves. Once in the back of the ambulance, she has the old 'Eau de Etoh'.

She says she had 2 glasses of wine before going to bed. Her repeated questioning leads me to believe she is concussed. She doesn't remember anything, she said she had gone to bed(it was 6:00 pm in the afternoon).

Oh, she is on Lovenox and Warfarin as well, prone to clots apparently. Did I mention she had an -ostemy bag?

She was somewhat evasive and confrontation about how much she had to drink. She chased that with Flexiril and Oxycodone, she takes that to sleep.

Jeez, maybe the allergic reaction wasn't causing the altered mental status.


Her color improved, her vitals got better, we made it to the hospital.

I'll have to keep this one in my head for training purposes.

Fentanyl

So, we you are administering pain medication to a patient whom you are also administering fluid, especially through a large gauge catheter that flows really well. It doesn't really matter much how slowly your push your 1 ml of medication into the extension set. Because it probably won't get to the patient until you start running the fluid again.

That being said, don't open the roller clamp full bore right afterwards. It might end up in someone in the ambulance vomiting from getting pain meds too fast.

Not that this happened to me, I'm just saying.

First Chest Pain Call...Updated

So, thanks to a comment in this post from Christopher, I have been led on the path that the first patient I did a 12 lead on as a Paramedic may have had something called Ashman Phenomenon.

Ashman Phenomenon, by my understanding, is when a patient in Atrial Fibrillation has a long R to R interval followed by a relatively short R to R interval. During the long R to R, I guess the corresponding refractory period is also lengthened, to the point where it isn't quite finished by the next beat, causing aberrant conduction, typically mirroring a Right Bundle Branch Block, but sometimes other patterns too.

I originally stated that the patient had A.fib with occasional aberrant conduction, which appeared to be a Right Bundle Branch Block.

I dug up the 12 lead that I saved and I saw that it didn't appear to be a right bundle branch block, but in fact a left bundle branch block.

But enough talk, here are 2 of the EKGs I did....

Ignore the Wandering Baseline...

I guess Ashman phenomenon is occasionally mistook for a PVC, but seeing as how this patient had multiple perfusing abnormal beats in a row at a reasonable rate, it seemed more like a block.

Lead II in monitor mode wasn't very useful in showing the aberrant beats(they barely registered as squiggles), in retrospect I could've used MCL1, that might have shown the rhythm better, but I guess that will have to wait for next time.

It is interesting though, because what I read about Ashman Phenomena on the internet (the source of all credible information) it seems to usually just be a single beat. But if this patient's heart couldn't refract (Is a word, no?) fast enough, I guess it would make sense for multiple beats in a row to conduct abnormally.

Now my question for discussion would be, Did this patient prescription to Diltiazem increase her aberrant beats or not?

Any comments?

Finally there...or just started

I have been working as a Paramedic now for...approximately 3 weeks.

I have been thinking like a Paramedic for much longer.

For Paramedic Bag-of-Tricks, I have administered exactly 150 mcg of fentanyl.

My first 12 lead interpretation as a Paramedic consisted of a diabetic chest pain patient....

How is A. fib with inconsistent aberrancy sound?

Go figure that it couldn't be sinus, or STEMI, or ANYTHING straight forward. No, it has to be a pt. with some narrow QRS once and a while, then wide RBBB-like QRS for a little while.

It wasn't runs of V-Tach, because it stated in a rate of the 60-70 bpm.

Luckily, when we got to the ED, the Tech already had an old copy of the Patient's EKG, and it looked the exact same.

Update (8/24/1): More information(or guessing and conjecture!) on Chest Pain patient here