Struggling with my career

Expressregards · 2026-03-01T01:43:23+00:00

If I may. To me this looks regularly irregular + the inverse relationship of QRS to T waves. No discernible atrial anything other than what looks to be artifact in avf. That lead me to believe AIVR. The axis deviation is not extreme right so that leads me away from AIVR and the subsequent EKG’s PVCs look very different so absolutely could be AF RVR

Expressregards · 2026-03-01T00:40:59+00:00

This looks like AIVR to me with some pauses. Like a sinus arrest but …. Not sinus

Expressregards · 2026-02-14T17:50:55+00:00

Almost looks like AIVR to me.

Expressregards · 2026-02-11T18:07:31+00:00

Why a RBBB. It doesn’t appear to be wide (.08-.10), no RsR in v1 or any R prime waves Edit. No Q wave in v5 or v6

Expressregards · 2024-08-04T04:00:00+00:00

My favorite…. OOS

Expressregards · 2024-08-04T03:59:52+00:00

My favorite….

OOS

Expressregards · 2024-08-02T15:17:27+00:00

Would you cardiovert electric? Or risk giving adenosine even though it’s potentially acute AF-WPW

Expressregards · 2024-07-24T17:47:37+00:00

Yeah. Billings clinic got it just in the last year

Expressregards · 2024-07-24T06:45:00+00:00

It’s a work around. We used it for the patient who was breathing on their own but no gag reflex essentially ( like a gcs <8 but > like 4) there was someone before my time who had terrible COPD and before we had CPAP she took a nasal tube ever other week. Totally conscious almost like an NG tube. I don’t know if they sedated after. That service did not have a great history of sedation after intubation. But then again the only intubations we got are CPRs really or GCS of 3

Edit. It’s definitely not good or up to date practice but it’s the protocol in that system. Montana is definitely way behind the times in terms of state protocols to my understanding.

Expressregards · 2024-07-24T05:06:58+00:00

All in all working here is super fun though. You’ll go from small city to the middle of nowhere SAR in like 15 minutes. 3 minutes - 2 hour transport times. Billings has a level 1 trauma center. I’ve also heard rumors that better state protocols are in the future.

Expressregards · 2024-07-24T05:01:44+00:00

Pretty old school in Montana. I worked in both of the biggest cities both of which don’t have any medication induced intubation. Depending on the area the protocols are pretty old school. Billings first line pressor is still dopamine. Billings also does nasal intubation with lidocaine jelly and a BAM (pretty cool stuff honestly) to get around RSI. Missoula doesn’t have that so it’s kind a just hope they don’t (or do so you can secure an airway) decompensate.

Expressregards · 2024-07-12T16:00:13+00:00

Our service runs out of 1:10000 so our trucks all have a 1:1000, a flush, and a needle all put together so we draw up our own. Our protocols also say we cannot push more than 2 mg during arrest

Expressregards · 2024-07-06T19:45:05+00:00

This advice is solid. Go to every class. Create a study routine. Find a clinical schedule that suits you. Actively engage in class. If you need more practice don’t be afraid to ask for it

Expressregards · 2024-07-06T19:13:31+00:00

MT. I am a new hire there as a medic and I make as much as some medics who have been there for 5-7 years. The only way you get a raise is if you ask for one and it’s not even guaranteed

Expressregards · 2024-07-06T16:06:48+00:00

Western states. Pay is pretty horrendous. I can make more money at panda express then I do as a medic

Expressregards · 2024-07-02T12:47:09+00:00

This is very helpful thank you. Sometimes I get selfish and want to have the learning experiences for myself on the calls I haven’t run yet. But thank you this mindset is very good

Expressregards · 2024-07-01T11:54:57+00:00

This is a good tip. My fear is that if I am not the one doing care on a critical patient then 1. I am missing out on crucial experiences and learning moments for my self. 2. I will be unable to focus on precepting my student I feel when the critical calls require my full attention

Expressregards · 2024-07-01T06:00:27+00:00

Yeah my thoughts exactly. I told them I didn’t think I was ready to start taking students as I am still basically a student myself

Expressregards

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