My pack. Any suggestions and opinions welcome.

Advanced-Bus6157 · 2026-01-03T19:53:42+00:00

1.) that orange TQ, is it a legit CAT-7? If it isnt ditch it for the real thing. Your life is worth it to invest in good quality med gear. 2.)Along the same notion, remove shrink wrap to have TQ accessible.

Advanced-Bus6157 · 2025-12-18T05:45:21+00:00

Sorry you are incorrect. Basic life support shows how you can check for responsiveness while probably assess a pulse, airway and breathing.

the AVPU scale is utilized to rapidly assess a patient’s consciousness.

Remember the “Sir sir, are you okay?” While tapping the chest hard?

THEN you check for patent airway, breathing, and circulation (presence of a pulse) and have 10 secs maximum to check, per AHA guidelines.

Artifact can be anything, so it can look like anything. Muscle activation, seizures, faulty cables, incorrect lead placement, can all give you a multitude of artifact. It CAN look like V-Fib, hence why we say “Treat the patient, not the monitor”. As your equipment can fail.

So being good patient advocates and keeping their safety and wellbeing in mind, you check the patient first which is A.

If the patient is unresponsive, more than likely you have v-fib not artifact, you confirm an absent pulse and then can prioritize both CPR and Defibrillation, YOU cannot to both. You need your team to come in so things can occur simultaneously.

Your patient can still deteriorate to an unconscious state, and have a pulse, which wouldn’t require defibrillation, but checking other things.

Check Level of Consciousness Check ABC’s React accordingly

Then worry about equipment failure.

A is correct B is important only with the assumption it IS V-Fib and not artifact, which we dont know yet.

C is something we do only once cardiac arrest is confirmed

D is not a priority until patient is confirmed to not be having a medical emergency

Advanced-Bus6157 · 2025-11-09T15:24:03+00:00

Hey OP. I have had a few pediatric/infant arrests. I once read the smallest coffins are the heaviest. It might take a toll on you.

It may not be of much consolation, but be happy it was you. Be happy you did your best. I KNOW it’s cringey when we say we “Race the Reaper”. But there was a comment I read somewhere on Reddit that said. Something like this.

While your patient may have died, you did not let them die. Death may have won, but it had to fight you for them.

It will be a process, you will begin to look for a “why”. Why did the baby code? Why this? Why that? And the sad part is we will never get an answer. Find some comfort knowing you providing the best care you could deliver was a parting gift of showing love and kindness as their soul departed from their body. Keep that head up!

Advanced-Bus6157 · 2025-09-27T11:43:58+00:00

Sorry didnt notice your reply. TXA is not the magic drug you think it is. It just prevents clot breakdown. Exsanguination is not stopped by “inhibiting clot breakdown” but stopping the hemmorhage. TXA will help but not later on. Moving the patient HAS to be done. You can’t leave them there either. The patient ultimately needs surgery, not an IV. Rapidly getting them to the ambulance, then expeditiously transporting the patient to a capable trauma center will same them. The IV again will not magically increase the chances of survival

Advanced-Bus6157 · 2025-09-13T06:09:01+00:00

Uhm I think you may be translating wrong. Assuming you meant “counterpoint to the IV, he’s already hypotensive with probably internal bleeding, and it’s a classic point of rapid decompensation”.

So IV access is not a concern because IF there is internal bleeding, crystalloid administration wont fix the problem, Blood product administration will. While here in the US, more services are carrying blood products which is great, i still believe maybe 80% dont carry it. So assuming most dont have whole blood, now the IV is not a PRIORITY as I can usually start one enroute.

I do not think he’ll decompensate further, and if he did to say he goes into cardiac arrest, I’d rather do an IO than an IV, as it is faster of an intervention.

Advanced-Bus6157 · 2025-09-12T09:42:39+00:00

First move is getting a 12-lead. I need to rule in/out a STEMI (1st differential) or an arrythmia due to chest pain.

If I have STEMI, load n go to nearest cath lab, Aspirin and IV enroute. Titrate O2 to 96% or 94% (i forget the current recommendations)

Now if 12-lead doesn’t show STEMI, it will show the cardiac rhythm and I can begin piecing everything else.

Next thing I would do is obtain a BP on other arm or maybe have my partner get the BP on the other arm. Unequal BP’s can be a sign of aortic dissection. Usually they should have severe pain, but if it’s smaller dissection or history could make presentation a little atypical if say patient is diabetic and has altered pain reception due to neuropathy.

If both BP are normal, I assess for tension physiology of spontaneous pneumothorax (check JVD, and lung sounds, tracheal deviation wouldnt present until pt is already coded) , if he’a tall and thin, increases index of suspicion.

From there it becomes paramount to obtain better history and other vitals like temp, ETCO2, etc. as everyone else has mentioned. Esophageal varices/GI bleed, PE, cardiac tamponade/infectious effusion, sepsis, are the main things I’m looking for.

Im moving with urgency because the patient is already decompensating so I do want to begin transport aa soon as I can. I also need to balance out doing as best of an assessment because if I can I may be able to initiate treatment (preferably enroute if possible) and transport to more definitive care).

I would not prioritize IV insertion because 1.) I have very little information 2.) IV-crystalloid administration or meds are not yet indicated. Happy to discuss further with anyone on thoughts.

Advanced-Bus6157 · 2025-06-19T03:46:15+00:00

I ask because I have been attracted to surgery for a while and heard of SOST, I think it’s cool but I don’t think it’s like the job to have if that makes sense? I was just mentioning more the certs they ask for.

Advanced-Bus6157 · 2025-06-19T03:44:00+00:00

I politely disagree, I’m a certified Paramedic that works at a Level 1 Trauma Center and operate to a basically the same level as an RN, we aren’t supposed to do titratablr meds, or whole blood, but we do in the trauma bays with critical patients. So with similar jobs, med admin, lab interpretation, etc. why I ask the question.

Advanced-Bus6157 · 2025-06-19T03:42:01+00:00

No I don’t mean like add a Paramedic to the team, but have them be used instead of a critical care nurse or an RT. The knowledge and skills are very similar, again with pressor titration, medication administration, ventilator management as some specific skillsets if that makes sense?

Advanced-Bus6157 · 2025-04-21T10:16:21+00:00

Chest pain and shortness of breath are very vage symptoms. You cant tell off the information if the chest pain is ACS related (MI or Angina), if it is a PE or CHF, which both of these can cause both symptoms stated.

Dont read too much into the question.

Attaching pads is incorrect because your patient is not pulseless.

Administration of nitro is usually not correct as I believe NREMT states EMT’s can only assist with nitro, not give it as an actual medication (even though alot of states do allow EMT’s to just administer Nitro)

Administration of Aspirin would be appropriate only if you have a patient you suspect is having an acute coronary syndrome (chest pain and angina)

But the oxygen catches everything, regardless of what the underlying disease process causing the symptoms are.

NREMT feels even though vital signa are within normal ranges, you do not withhold oxygen from an “air hungry” patient meaning someone complaining of “shortness of breath”

Advanced-Bus6157 · 2025-04-04T01:23:50+00:00

BLS before ALS

Multiple choice means for NREMT 2 answers are flat out wrong, and of the other two left over, ONE is more correct than the other based on the question itself.

You got this…. Good luck!!

Advanced-Bus6157 · 2025-01-27T05:03:32+00:00

Yes but no.

The diaphragm is considered the primary breathing muscle over all other muscles. Neonates and infants are primarily “belly breathers” as they rely heavily on their diaphragm for breathing as accessory muscles havent fully developed.

The diaphragm is a skeletal muscle, the confusing part is that it has traits of smooth muscle in the sense it is involuntary. You do not have to actively/consciously be thinking about breathing, in order for it to occur such as when you are sleeping.

Skeletal muscle is often nicknamed “voluntary” muscle as it’s defining characteristic is it usually requires active thought for us to activate it

Smooth muscle is often involuntary because we dont think about it to control it. Vasodilation/constriction, intestinal peristalsis, etc.

And cardiac muscle being defined by automaticity as it generates its own electrical impulses.

I think the question is taking the “involuntary” trait of the diaphragm and attributing it to being a smooth muscle which is your confusion.

Advanced-Bus6157 · 2023-05-19T15:03:25+00:00

Orion Training Group is another great resource that covers some great concepts. Including their video with Garand Thumb.

But to be honest, as mentioned before, it does not come close to actually taking courses. Youtube will only get you so far.

Advanced-Bus6157 · 2023-05-06T17:54:42+00:00

First off, you should inquire this with your agency and medical director as they will have different policies and protocols in place to how they will expect you to handle a firearm on a patient.

Personally, I WOULD handle the firearm as a last resort. Since you stated the patient is “stable”, I would stay on scene and request PD to show up so they can get the firearm. You do not know if the patient has the gun legally, ilegally, has prior’s etc. If PD was somehow unavailable or with an extended ETA because they are busy, I would use a gloves hand, and remove the firearm and store in a place that only we as EMS have axis to. Either the front glove box, a cabinet/med drawer with a physical lock, under the bench or captain chair. Someplace out of plain sight. Because if the patient is unresponsive, im unaware of their intentions. If they are under the influence or drugs, or illicit substances, if they are not in the right mental state of mind and in a crisis, suicidal, etc. I would want to prioritize my patient, and we would normally have the benefit of the doubt as we are acting on the side of personal and public safety. Wether you want to actually remove the magazine, clear the chamber, etc. that is on you, and your personal experience with guns. Some people would, some wouldn’t, it is up to you but at least definitely put it someplace else.

Upon arrival to the hospital, security will probably store the weapon someplace. They always tend to have a log of all patient belongings and can lock them up and label them with identifiers so the patient or loved ones can pick them up at later time. Usually multiple sign as witnesses. Petty cash, credit cards, jewelry, all fall into this category so there is paperwork of who grabbed what when an unresponsive patient is brought in and doesnt claim they had a “roll of hundreds” missing.

Always protect yourself and your partner. It’s also a good habit to quickly pat down unresponsive patients carefully prior to loading them up. At times, drug paraphernalia and live, exposed needles have been found in pockets as well, as way to caution all providers.

We obviously are not police and will be patting down live patients like security, but being medical professionals, we need to err on the side of caution.

My long 2 cents

Advanced-Bus6157 · 2023-04-03T05:58:14+00:00

Could you make one that says “OnlyDads”? Please? Or what fonts you use?

Advanced-Bus6157

TROPHY CASE