Advice for New Paramedics

I am always scanning the web for information for brandi-new and soon-to-be-brandi-new paramedics...

Rogue Medic posted a good piece about the differences between EMTs and Paramedics here


then again, if you are the kind of person (er...NERD!) that is searching out EMS blogs and whatnot...you probably have already been there.

A Clinical Episode...

So yesterday I was at the ED for clinical time...I am getting ready to start an IV on a patient. She was a woman in her 40s and her father was there. I introduced myself and set about finding a vein that was suitable. The patient father asks

"Are you ready for the hurricane?"

"Well, I bake my own bread and I don't drink milk, so I have no reason to rush out to the store..."

That was kind of a joke....I do bake bread and I don't drink milk, but it was suppose to be an observation of the absurdity of peoples actions when they hear of incoming natural disturbances...They all run out and buy milk and bread. But their response was somewhat suprising....

"You don't drink milk?" the patient said..

There was a harshness in her words that was unexpected for the mildly mannered folks they seemed to be. I told them that I do eat yogurt though. And they were immediately more at ease.

"Do you make your own yogurt?"

I told them I did, then the conversation moved on to using pasteurized milk vs. raw milk for yogurt. If I had ever tried Kefir and why do so many new aged crunchies have to buy cultures and starters through the mail and at Whole Foods that aren't really necessary. We also talked about how greek yogurt has gotten so popular and how it uses more milk.

I looked at them again. They were definitely rural folks, and realizing how dairy-centric the conversation had been, I went for a shot in the dark....

"Are you folks in the dairy business?"

Thank god I'm not lactose intolerant...Security may have to of been called.

A window opens so I close the door...

So....Today is my last day at ForProfit Medical Transfer Company. Yesterday I accepted a per diem position at a local non-profit 911 service. The company does a fair amount of transfers out of the local hospitals...but they also do 911 in a pretty rural area, and the supervisor rotates everyone through the 911 shifts...which will be nice...becoming a paramedic never having done 911 was starting to make me nervous.

I start Tuesday...look forward to more clinical case studies of things I see in the field. Part of what spurred me to look for other work was that I wasn't seeing much of anything other than the steering wheel of a wheelchair transport truck in the last few months. Mostly due to the stubborn refusal of management to hire any EMTs for my station.

Onward...

Success in Rhythm Recognition.....

The Key to Successful Rhythm Recognition is to have a rock solid understand about what all the little tracing represent in terms of  vectors of electrical conduction through the heart. Its not about the heart beating....


At least that's how I think of it...and its worked for me pretty well..

Success in Clinicals

People will have different attitudes regarding Paramedics wherever you go. The response I have gotten from the ED has been overwhelmingly positive. Or at least....beige.

So far,  my time in clinicals, I have met people who have been very glad to teach and give me opportunities. I have tried my hardest not to waste their time. I have met people that don't want anything to do with me...And I try my hardest to help them where I can, and show them that I am not there just to waste their time. I could be a snot or ignore those people, and re-enforce the attitudes that already exist. But I feel like I have found a really great site for clinicals, and I want to try my damnest that the paramedic students that come after me have at least as good an experience as I am, hopefully better. My educational experience doesn't exist in a vacuum, and my experience is colored by those that come before me, and my words and actions will affect those that come after me.

Why do I need an expensive stethoscope? Part II

So...If you didn't read my first opinion on expensive stethoscopes...read it here

Long story short, a few months ago...I thought I lost my scope...so I bought another...I bought a Littman Cardiology III, like clockwork, as soon as it arrived I found my old one.

A piece of advice that I try to live by is that one cannot possibly know the extend of one's ignorance. I didn't know how fine crackles can be...or how few places

"My scope is for blood pressures and lung sounds, and I don't have a problem hearing those things in the back of an ambulance with the cheap scope,..."


That was before I understood the difference between fine localized crackles, clear, and subtle wheezes....these things are harbingers of things to come...more importantly...they are harbingers of DIFFERENT things to come.

What a good paramedic hears for lung sounds will help her/him determine treatment. In which case I will do everything I possibly can to hear good lung sounds.

I still don't think EMT-Bs should be spending their money on expensive stethoscopes.

I'm not sure but.....

It looks like my IV skills are improving....

If dozens of hours in the ED has taught me anything...

We received a call to response to a possible stroke. On the way there, I called dispatch and asked if the nurse that called us told them when the patient began presenting with symptoms. She didn't know. I told my partner that "when the symptoms came on" was going to be the only question that the nurse had.


On scene we arrive, get a short history from the RN that called, after multiple attempts and finally establishing what the patient's baseline mental status was (See, I learned!). Symptoms started approx 3 minutes before. The patient had a GCS of 9, -1 eye, -3 verbal, -1 motor(is that how you are suppose to explain it?). But we were off to the ED. Once there, we transfer the patient who gets hooked up to all the monitors and whatnot...I give a history, my findings, and what the facility told me, then she asked...

"Do you know when the symptoms began?"

I thought I was the cat's pajamas until....


"Do you know the patient's code status?"

Damn, maybe next time. The patient didn't have the documentation we needed as EMTs to withhold resuscitation efforts, but that doesn't mean the patient is a full code either, and I didn't ask the nurse, because I was so certain that all that matter was when the symptoms came on, oh well....next time.


Other than the needle sticks, tubes, and drug pushes, my time in the ED has really taught me what the Nurses and Docs really want to know, and any way I can help facilitate that just makes their job easier and helps improve patient care. EMS gets tons of primary information about what is going on with the patient, we get to see what is happening where it is happening, and that makes for a much clearer clinical picture.

Don't touch anything Blue!!!

My instructor stated that the most stressful moment in your Paramedic Education is when you are called into to do your first tube in the Operating Room.


He was definitely right....


The RN firmly told me "Dont touch anything blue!" as I walked in.

The floor was blue, the patient was covered in blue sheets, everyone's scrubs were blue.

I quickly realized that she meant the person with the safety glasses and apron and sterile gloves, and the table covered in surgical instruments.

I didn't touch any of that stuff.
There was a MD anesthesiologist watching, but a CRNA was in charge of this patient. She asked if I had ever intubated anyone....I shook my head.

I wasn't sure if the patient was still awake...in retrospect, I am certain he was not.

She asked if I have intubated the mannikin. I nodded.

I opened the patient's mouth and was amazed at how little it looked at all like those plastic mannikins.

Eventually I found my bearings, and found my patient's larynx. I glanced up,  and saw his oxygen stat was still at 100%.

The seal was cracked. One down....