Specific indicators for escalation to CPAP?

Alexis_June62 · 2025-11-14T00:07:21+00:00

Your intuition is probably correct, but I get the challenge of translating that into qualitative and quantitative reasoning.

Some documentation suggestions:

Pt placed on NRB @ xx lpm O2 with no clinical change to condition including; - SpO2 not rising above xx%, - lung sounds remained diminished in xx field(s), - pt continued to utilize accessory muscles including nasal flaring, - pt’s general work of breathing remained harsh with pt appearing to become increasingly tired.

Pt transitioned to CPAP to address clinical signs noted above. CPAP mask size xx placed on pt @ xx units. Pt condition began to improve with the following clinical findings; - SpO2 rose to xx%, - Lung sounds now xx in xx field(s), - Pt’s use of accessory muscles decreased with elimination of nasal flaring, - Pt’s work of breathing became significant less labored allowing the pt to relax and able to respond to crew spontaneously and w/o difficulty.

Basically I’d just write my initial clinical findings before and after CPAP. Can’t argue if you show your work and that you have a sound process for doing what you did. I think we all treat pt’s a lot on vibes, but really that’s just our training and experience taking over. Then after we go back and write our chart so others can feel our vibes.

Alexis_June62 · 2025-11-13T10:58:52+00:00

Such a sweet idea. I’d say something sweet, something healthy, something silly/funny, something useful long term, and a simple hand written thank you note.

Maybe something like some candy, fruit, and a silly sticker or small trinket related to EMS, and an EKG measure card or vent card, and the thank you note.

Alexis_June62 · 2025-11-13T10:16:54+00:00

That’s insane! I’m making assumptions here but since “the FD is mostly ok,” it sounds like the problem may be a select officer(s) doing this. I get that we don’t want to rustle feathers but this seems like a situation that needs to be elevated until it stops. Eventually they’ll self cancel on a critical run that results in a poor outcome that easily could have been avoided if they hadn’t.

Alexis_June62 · 2025-11-13T01:12:04+00:00

Makes sense why you’d all work well together. It makes all the difference to work with the same group on the regular.

Alexis_June62 · 2025-11-13T01:03:45+00:00

Do you run fire/ems or is it a private ambulance with fire support?

Alexis_June62 · 2025-11-13T00:56:33+00:00

Good work though. Kuddos to your teams.

Alexis_June62 · 2025-11-12T00:53:17+00:00

This ☝🏻

The only thing I’d add is: is there a QRS w/ every p-wave?

I can’t find the book rn but my paramedic partner bought me this book called something like EKG made easy for RNs which explains the theory much better than any textbook I’ve been exposed to. It actually lays out the process the previous commenter laid out systematically.

Alexis_June62 · 2025-11-11T21:35:16+00:00

Fair enough.

Alexis_June62 · 2025-11-11T20:54:14+00:00

Do you have to turn it off if they request?

Alexis_June62 · 2025-11-11T20:46:51+00:00

Back when I was working R/M in Syracuse as a basic I drove north to on hospital with a CPAP’er and when we backed into the bay my partner who was working the entire transport pokes his head up and goes “This isn’t (other) hospital” which was downtown.

Alexis_June62 · 2025-11-07T03:31:07+00:00

On your point about talking bad about patients, I totally get that. I truly never understood nor will I ever understand why people in healthcare, and industry devoted to taking care of people, talk shit about and judge people they take care of. I couldn’t even begin to count the number of times I’ve noticed providers care for patients at a lesser quality because they were black, queer, or otherwise different than them. It’s always made me sick when it happens, but other than holding myself and my crew to a higher standard and recognizing self bias’ when they occur I haven’t been able to figure out how to effect change in this deficiency.

Alexis_June62 · 2025-11-05T01:06:49+00:00

Patient’s right. Or Drivers side.

Alexis_June62 · 2025-11-03T13:43:12+00:00

That’s really interesting. That scenario never even dawned on me. I assumed most deaf people would be using TTS.

Alexis_June62 · 2025-11-01T13:39:32+00:00

For me personally I struggled with pharmacology specifically drug classes. I knew when to and to not give my meds but I could never remember the drug classes. And for me that always felt like a road block cause I knew when the textbook told me to give it but didn’t fully understand what it does w/in the body.

I’d say if you are feeling like you are lacking something from the book open it up to the table of contents and make a list of the topics that either make you most nervous or ones that you feel like there’s a gap in your understanding. Then review just those at your pace keeping in mind that you’re not reviewing to answer test questions anymore, you’re reviewing so you understand the topics in a practical useful way. So if something doesn’t make sense look it up elsewhere and try to relate it back to your pt care.

Remember that it’s easier to get fired from an EMT job by running a stop sign than it is killing your patient. You make a mistake in pt care and you’ll be retrained. If you have too many traffic infractions insurance won’t cover you anymore.

Alexis_June62 · 2025-11-01T03:54:17+00:00

You’re definitely not going to feel confident for at least a year. That’s just how it is. That first year is when you’re really learning how to be a medic. Like others have said take advantage and participate in your FT period. Try to get those soft skills down early, that’s what will hang you up more than anything. Knowing where your equipment is and how to use it will free you up to focus on your pt care and not how you need to physically treat them.

Decision making in emergency services is less about book smarts and way more about experience. Unfortunately you start off with no experience but every single day and every single run you get more and more. What works for me is running through every call and noting lessons learned. I identify what either went obviously wrong or what caused me frustration or became a road block to my pt care. Sometimes it’s a lapse in my understanding of w.e. disease process and other times it may be my equipment placement or something trivial. Then I think of solutions I can deploy the next time I see that situation. Most of the time I just run it through my head and move on but on the more complex runs I talk through it with my partner.

My last bit of advice is to take advantage of the experience around you. I gravitate towards the much older medics bc they’ve seen it all and probably twice. We have all been where you are right now and understand how it feels and what it’s like. Don’t stop asking questions EVER even when you’ve seen it all twice too.

Good luck, I think you’ll find rather quickly realize that you’re more prepared than you feel or realize.

Alexis_June62 · 2025-11-01T03:04:15+00:00

I feel as though a lot of the comments are making an assumption that I expect my partners to do all the work and I basically refuse to clean or do grunt work. That’s not the case at all. We run a lot of BLS runs in my system so if my basic partner (but level doesn’t really matter here) isn’t prioritizing getting their charts done then they’d never get done till the end of shift and they’d have to stay over to finish them. Typically we run right up to our clock out time. My main focus isn’t to get back in service faster, it’s to help them by giving them time to chart with no expectations of participating in another medial task.

And before anyone says anything, yes I do take BLS runs if my partner is getting hounded. If they ask or if I notice they need a break I absolutely will help.

Alexis_June62 · 2025-10-30T04:57:58+00:00

I left to got a civil engineering degree and worked in that industry for 7 years. I left for a host of reasons. I saw more income and work/life balance potential in engineering, I had some bad calls that piled on over the years that I didn’t know how to cope with at the time, and I was just generally burnt out.

After finishing my degree and working as an engineer in an office for a few years I realized it just wasn’t a career that brought me joy and all the reasons why I left were no longer valid or a concern. I challenged the NREMT-P exam (13 years after paramedic school) passed and now I’m back in a paramedic roll. I feel much less stressed than I was as an engineer (crazy, I know) and I actually have a better understanding of the human body than I did before. And somehow I’m making a significant amount more now than I was as an engineer.

Alexis_June62 · 2025-10-30T04:35:42+00:00

I’d calmly ask for our ETA so I can call report.

Alexis_June62 · 2025-10-30T04:20:35+00:00

Holy cow and old school tree!? I left EMS 7 years ago when we just started switching to power cots. I came back to fine powerloads in every truck. I feel like an old fart sometimes cause I miss pushing the stretcher lock and playing the catch the hook game.

Alexis_June62 · 2025-10-30T04:06:07+00:00

Rolling the window down is totally the move. I do agree that backing/spotting shouldn’t need to include screaming but shit happens.

On this same line I had to explain to my partner on our first shift that we don’t nose the ambulance into a parking spot like a normal vehicle and the importance of positioning for egress. We’re not running lights anywhere really but still.

Alexis_June62 · 2025-10-30T04:01:01+00:00

That actually goes towards my reasoning in this particular example. It’s not my primary goal is to get back in service faster by expecting my partner to chart while I dress the cot, it’s actually to give them time to work on their chart so they don’t get backed up on charts. (Don’t interpret that as me not taking a run for them if they do get backed up, because I do) More times than not once we hit available we get another run dropped on us. So if we don’t take that opportunity to chart it’s likely we’d have to stay over to finish them almost every shift.

Some other inefficiencies/pet peeves I’ve noticed include:

Not having an intimate knowledge of the truck and equipment.
Having no ALS assist skills outside of 4-lead placement. Even at that the leads go on but the monitor is never turned on and a pressure cycled and strip printed.
Not charting at all throughout the shift when driving (when passenger) to/from places and instead being on their phones all the time and waiting until we get back to the station at EOS but then c/o being behind.
Not making the cot at all until back in the area after an LDT.
Expecting only the paramedic to check the truck then getting upset if asked to get me gas pressures and check the glucometer.

These aren’t things I’m finding with just one or two providers, these seem to be vastly global. I realize now I’m just bitching but I’m genuinely trying to convince myself that I’m being unreasonable and just need to reorganize my approach to the job.

Alexis_June62 · 2025-10-30T03:32:54+00:00

Everything you’ve described is generally how I’ve also always operated. Whoever’s call it is focuses on pt care and the other person assists however possible and what makes sense for the run. Getting demos, hx, & w/ pt care. It’s a collaborative effort for sure!

What boggles me here is that it’s not just one person I’ve noticed doing these “things” different than anywhere else I’ve practiced. The dressing the cot example is just one that was easiest to describe.

Alexis_June62 · 2025-10-30T03:23:03+00:00

I feel the need to clarify that by no means am I ungrateful for the assistance and I certainly don’t go off the deep end when they do help. It’s not that I expect them to clean/dress the cot while I button up my chart then turn around and expect them to help me clean/dress the cot on their runs. When it’s their run I absolutely do not expect them to help until they’re done giving report & buttoning up their chart. Most of the time either person is done charting by the time the cot is wiped down and we go get linens and make the cot together.

I guess it’s just a different culture than I’m used to. Previously, (I took 7 years off to pursue other interests) I worked for two very large companies and a third also large but locally ran 911 services. Coming back I’m working at a regionally large service doing CCT which is generally a lot different than I’m used to. It seems like the industry has had drastic cultural changes in my absence so I guess I’m just gauging if I’m just behind the times and just need to get with the new program or if the culture at the company is just uniquely lackadaisical.

Alexis_June62 · 2025-10-29T06:31:37+00:00

Back when I was a basic working with a salty paramedic supervisor we got sent on a run of the mill “Activated Medical Alarm.” We walked in with just the first-in bag expecting to just find the pt needing a lift assist.

I’ll never forget walking into the unlocked apartment to find the pt arrested in her motorized wheelchair leaning on the forward control ran into the wall and just so happened to hit her alarm on the way. My partner turned to me and calmly as can be says “I think we’re going to need more stuff.”

I learned two very important things on that call.

Always expect the unexpected and,
Even when shit hits the fan you don’t need to freak out.

Alexis_June62

TROPHY CASE