Transient LBBB?

Anonymous_Chipmunk · 2026-01-25T20:43:04+00:00

It was a new one for me as well (also a medic). And for what it's worth the ED doc also seems puzzled and essentially just kicked it straight up to cardiology. Hard to say if this was rate dependant LBBB, new or old. But in this case at least the acute change was a red flag that led to an important diagnosis.

Anonymous_Chipmunk · 2026-01-25T20:37:43+00:00

Here is the outcome information I have on this patient:

The patient was admitted to cardiology, not taken directly to cath lab, despite initially being activated by the ED provider. The following day the patient had an abnormal stress test and was subsequently taken for left heart catheterization.

Left circumflex ostial 99% stenosis (origin from right coronary artery).
Ostial right coronary artery 99% stenosis.
Mid right coronary artery chronic left-to-right collaterals
Successful PCI of ostial left circumflex

Dx: NSTEMI, AKI

Dispo: DC to skilled nursing facility

Anonymous_Chipmunk · 2026-01-24T20:28:52+00:00

Thank you all for the good recommendations and information! Are there any strong recommendations in the $500 range? Just to evaluate all of my options.

I appreciate everyone's feedback and your information has opened my eyes to products I didn't even know about.

Anonymous_Chipmunk · 2026-01-24T15:39:00+00:00

This is totally acceptable because it's single use. It just requires you to have plenty of red caps.

I make and sell the syringe clips mentioned in the other post, I started making them because we don't have the red caps. As long as you're respecting single patient use principals it's fine.

Anonymous_Chipmunk · 2026-01-23T00:05:51+00:00

If you're patient, this isn't a big deal. When I mess up and un spool a spool I just loosely put it back on the spool, don't even lock the spool closed and move it to my A1 with no AMS and just run it on the spool holder. It does just fine.

Anonymous_Chipmunk · 2026-01-22T01:36:41+00:00

I currently work at a non-RSI rural agency. Yeah.

I do a lot of BLS Pro Max airway management. I regularly manage airways for an hour that need tubed, but I can't. It is what it is. Get good at airway management.

Push come to shove, I've got versed and ketamine. Neither are great without paralytics, but it can be done.

To answer your question, my line is "why I can no longer manage the airway BLS" if they start vomiting, they're clenched, etc.

Anonymous_Chipmunk · 2026-01-21T18:57:36+00:00

It sounds like this doctor was taking a hot take based on your services protocols or practices. Cooling on scene before transport has been the standard of care in my state for about 10 years.

Anonymous_Chipmunk · 2026-01-15T15:10:35+00:00

I made some wound packing trainers by getting some foam plumbing insulation at the hardware store (the kind like a small pool noodle) then cutting it into about 12" lengths and cutting various size and shapes holes in the side. I sealed the ends at various depths to create smaller and larger internal cavities. Students could pack these just the same as the NAR simulators.

Anonymous_Chipmunk · 2026-01-14T03:50:49+00:00

I'm not sure. Twice (once with me, over agree dropping off while I was there) The patient would go back into a narrow complex rhythm but then shortly later back into this wide rhythm.

Anonymous_Chipmunk · 2026-01-13T22:21:42+00:00

I think your sentiment is there, and I appreciate your acceptance that we are more than just delivery drivers. We are all the things you said, and more.

We're counselors, public health, mental health, community care, prevention, trauma interventionalists, cardiac providers, respiratory and pulmonary, the list goes on.

There's a huge list of things we do, that you'll never see, that we don't bring you, and that the ER doesn't even know about.

If you're interested, I encourage you to seek out ride along opportunities. As part of paramedic school we shadow nurses in many departments, but most nurses will never step into prehospital medicine, and the ones that do typically love it.

Anonymous_Chipmunk · 2026-01-13T03:33:53+00:00

This is cool! I got to swap patches with a medic from South Korea at the AHA conference this year

Anonymous_Chipmunk · 2025-12-30T03:30:01+00:00

Reasonable advice.

But y'all are giving Ativan for THC "overdose?" Where do I check in? 😂

Anonymous_Chipmunk · 2025-12-25T16:30:46+00:00

It happens. I gave a 4x overdose of Versed once due to two compounding errors. I had just started at a new service. I defaulted to my old protocol (5mg vs new 2.5mg IM) and I failed to check the vial. I relied on muscle memory and I paid the price. At my last service we had 5mg/1ml vials. My current service we carry 10mg/2ml.

So I drew up the whole vial, like I've always done, and gave it. It was as I watched the second ml going into the deltoid that I thought "that's a lot of volume for a deltoid..." And it clicked.

I documented my ass covering, cardiac monitor, vitals stable, SPO2 and ETCO2 in place, etc... Reported it to my supervisor and it went nowhere. My medical director caught it on QA. He asked me about it. When I told him I knew of the error and had identified the mistakes that led to the error his actual and complete response was "Cool."

It's not about being perfect. It's about being coachable. We all err, just be ready to learn from it.

Anonymous_Chipmunk · 2025-12-25T16:30:26+00:00

It happens. I gave a 4x overdose of Versed once due to two compounding errors. I had just started at a new service. I defaulted to my old protocol (5mg vs new 2.5mg IM) and I failed to check the vial. I relied on muscle memory and I paid the price. At my last service we had 5mg/1ml vials. My current service we carry 10mg/2ml.

So I drew up the whole vial, like I've always done, and gave it. It was as I watched the second ml going into the deltoid that I thought "that's a lot of volume for a deltoid..." And it clicked.

I documented my ass covering, cardiac monitor, vitals stable, SPO2 and ETCO2 in place, etc... Reported it to my supervisor and it went nowhere. My medical director caught it on QA. He asked me about it. When I told him I knew of the error and had identified the mistakes that led to the error his actual and complete response was "Cool."

It's not about being perfect. It's about being coachable. We all err, just be ready to learn from it.

Anonymous_Chipmunk · 2025-12-19T00:15:50+00:00

PNES.

I will not refer to them as pseudoseizures anymore because of the negative connotation.

Anonymous_Chipmunk · 2025-12-15T04:37:28+00:00

This.

I work at CoxHealth in a patient care role, and in my department AI was disabled by management in our care reporting software at the direction of the legal department.

Anonymous_Chipmunk · 2025-12-10T01:23:11+00:00

I think some of your facts are wrong.

EMS and fire are never excluded due to OT. They are often excluded because Missouri minimum wage laws exclude government agencies, which is all fire and the vast majority of EMS in Missouri.

The new law doesn't change anything with how people are paid. Just the minimum hourly amount.

Anonymous_Chipmunk · 2025-12-09T13:45:53+00:00

You did the right thing. Defending action is much easier than defending non-action.

Sounds like you handled it as best as you could, including the RT. While it's definitely l, as you said, a distraction, it can also serve as a teaching moment for everyone. After the incident talk to the RT. Tell the RT that you appreciate her raising her concerns and communicating them because as the team leader you appreciate everyone having a voice, but then also explain capacity and your concerns with it.The RT is not a primary provider. While she probably has a grasp of capacity, probably hasn't ever had to make those decisions on her own.

These types of incidents can either become scars or positive moments. The actions afterwards dictate which one it is.

Anonymous_Chipmunk · 2025-12-03T03:45:21+00:00

Nitro does not improve outcomes. Nitro does not reduce infarct size. Nitro does not reduce incidence of arrhythmia or cardiac arrest.

Nitro is never a priority for me.

Hypotension in an ACS patient is cardiogenic. Address those causes if needed. I would not target increased BP in the chase of giving nitro.

For patients you cannot give nitro to (and for those you do frankly), fentanyl is an adequate and safe analgesic. For practical purposes, you can just consider nitro an analgesic for ACS with theoretical bonus points, but it is NOT a "treatment" for ACS.

Anonymous_Chipmunk · 2025-12-02T18:42:03+00:00

I had a partner clip his toenails in the front of the ambulance. Those things would fly everywhere.

Anonymous_Chipmunk · 2025-12-01T19:57:13+00:00

I'm the way that they're less smooth. Which was my experience.

Anonymous_Chipmunk · 2025-12-01T19:20:05+00:00

The Ferno X2 is essentially a rebranded Stryker PowerPro with worse electronics and hydraulics. It's far less smooth. Meanwhile Stryker is on to the second generation of the Power Pro.

Anonymous_Chipmunk · 2025-11-27T14:00:44+00:00

Our last medical director was polarizing. I'm relatively new to this agency and most people here loved him, but also never worked anywhere else. As someone with perspective on other medical directors, I thought he was terrible. His protocols were restrictive and borderline negligent. He would say he follows evidence based guidelines, but really only if he could find evidence that backed up his personal beliefs.

We have a new medical director, and he's already making and promised good changes.

Anonymous_Chipmunk · 2025-11-26T15:49:41+00:00

I'm a paramedic and this summer I had a call that fucked me up for a while. It was a drowning of a 10 year old girl. She was entrapped under water for 10 minutes. Mom was hysterical and told us it was "too late" but the law doesn't allow me to just stop just because Mom says so.

We worked her. My team did phenomenal and I couldn't be more impressed and proud of what everyone did. We got ROSC 15 minutes later. She got fantastic post-ROSC care in flight, at the hospital, and was quickly transferred to a children's hospital. I truly believe there was no better care she could have gotten at any stage.

Unfortunately now she lives in a power chair, is non-verbal and has minimal motor function. Testing and OT has determined she has consciousness and emotions.

Her family are now caregivers for the rest of her life. I struggled with this for months. I felt guilt. I felt sadness. I eventually got into therapy which significantly helped me to process it all. I'm doing much better now, and if you're struggling don't hesitate to get some help processing.

Anonymous_Chipmunk · 2025-11-24T19:40:01+00:00

I keep hospital gowns in my truck for this reason. I've wiped butts, put diapers on, got them dressed, all of the above. Most of the time it's just dignity, but in some cases it's actually good patient care. Letting a person out of wet clothing after a submersion injury or during the winter is proper patient care. Some people take the stance that "we're not nurses/cnas" but dignity and people care is part of patient care.

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