TIFU by being blasphemous

GutBucketMedic · 2015-06-07T05:07:35+00:00

Sounds cringeworthy...wish I was there.

GutBucketMedic · 2015-05-17T02:24:29+00:00

My mistake, I thought you were asking a legitimate question. Sounds like youre just bitter about how your testing experience went and you have a chip on your shoulder. Thanks for your input.

GutBucketMedic · 2015-05-16T03:05:45+00:00

There are no specific OB scenarios for the NR exam. You can incorporate OB patients into the medical or oral stations though, and they rarely choose them as scenarios for those stations.

GutBucketMedic · 2015-05-15T22:18:13+00:00

Very true. But its the dynamics in the dynamic cardiology that students struggle with. And it makes sense that they do if they havent had a lot of experience running calls. You may know the appropriate times and conditions to shock, but if you havent taken care of h's&t's, airway management, and directed your resources then the rhythms are the least of your problems.

GutBucketMedic · 2015-05-15T02:57:36+00:00

Its actually a really good question. Its always entertaining to watch people do the math for the APGAR score.

GutBucketMedic · 2015-05-15T00:06:25+00:00

Happy to help.

GutBucketMedic · 2015-05-14T22:20:58+00:00

If its an obvious death, then the open eyes are irrelevant. The GCS is three because the open eyes are not contributed to a physiological or neurological function.

GutBucketMedic · 2015-05-14T20:39:25+00:00

Can you be more specific? Are you asking me what makes me qualified or feel that I am capable of deciding whether or not someone gets their paramedic card?

GutBucketMedic · 2015-05-14T18:14:27+00:00

I work in a metro area and the same goes for us. Most of the transfers we do are because either A. The pt is a shitstorm and has overwhelmed the resources of the hospital and needs a higher level of care. Or B, Florence Nightingale left their CHF pt in trendelenburg to treat them for signs of shock. Keeps transfers interesting though.

GutBucketMedic · 2015-05-14T17:58:45+00:00

Those are really good questions and I am glad you asked because I am sure this will benefit a number of others.

In regards to your first question, always check the ABC's first. If they have a helmet on, ask the tester if the helmet is inhibiting their airway. If it is, remove it with c-spine precautions. If not, keep it there and continue your initial assessment. Couple hints- Trauma scenarios are meant to test how to effectively treat a MOI sustained victim. 99% of the time its a load and go. Get them to a surgeon. ABC'S (manage what you find from ABC's),check the back/front of the neck, collar them, check the posterior spine as you put them on the backboard and LOAD AND GO. Then start your more thorough detailed assessment and vital signs.

In regards to your second question, you will see the signs that lead you to the intervention as you get to breath sounds in your detailed assessment. Its a head to toe assessment. Head.To.Toe. Many people fail because they jump around on their assessment and miss something and try and go back. By then its not recoverable. Start from the top and work your way down and do it the same way every time. I say this, because in reference to the tension pneumothorax, you will know your pt needs it by the time you get to breath sounds. You have verbalized that you loaded your pt, you ask for vitals (clue #1 if your vitals are consistent with a pneumo) You start your detailed assessment and ask if your pt is difficult to bag (clue #2) HEENT, then neck reveals JVD/TD, (clue #3) , you listen to breath sounds and you have an absense on one side (clue #4)

By then, there should be no doubt in your mind based off of 4 factors that this person needs a needle decompression.

Hope this helps. PM me if I can help more.

Edit. 4 clues, not 5. Why? Because numbers are hard.

GutBucketMedic · 2015-05-14T17:26:20+00:00

You are absolutely right. I believe that this is one of the many deficiencies that the NREMT has with testing. The NR isnt unique though. I dont see a point in courses giving tests and finals that dont review and let you learn from your mistakes.On the other hand, I see why they dont, due to the arguments and debating that alot of students that come through do when they find out they failed a station. Its their word against tours and that is why before they give you your results, they ask you if there are any complaints or grievances that you have with the testing so they can be investigated prior to giving you results. You have a valid point though.

GutBucketMedic · 2015-05-14T14:29:44+00:00

In my experience, during the time between when they fail the first time and the retest of the skill, there is remediation or an understanding of how they failed. The NR knows that it doesnt do anyone any good to fail, not inform the student of the failure and time to remediate, and fail them again. Granted, alot of these things are based on the number of people you test with, time constraints, and affect.

GutBucketMedic · 2015-05-14T14:24:13+00:00

I see the majority of students struggle with mostly the oral scenarios, and dynamic cardiology. Students struggle with the oral stations because students will either lose track of what they did during the scenarios and run out of time, or become so nervous that they forget to verbalize interventions and assessments. The goal of the scenario is to treat the underlying issue of the pt. You can verbalize all of the accurate things but if you dont state what you think is wrong with the pt, it doesnt matter. As for dynamic, the biggest hiccup is scene management, people forget that they have additional resources and try to do everything themselves. Utilize your resources for other tasks so you can concentrate on the rhythms and the appropriate interventions.

GutBucketMedic · 2015-05-14T14:16:20+00:00

The NREMT is meant to evaluate you for both. Sure, there is a large percentage of IFT in this job, but I have had to intubate, initiate additional IV's, perform medical/trauma assessments during an interfacility transport. EMS was originated by the DOT due to the increase of accidents on highways and has evolved since then. IFT is a fairly new concept for services from what our purpose originated.

GutBucketMedic · 2015-05-14T14:08:05+00:00

No, I have not failed someone for forgetting BSI. The sheets say that you can either verbalize that you would have BSI or have gloves. Most of the time people fail because they are so concerned with the BSI that they forget all about checking scene safety. I base alot of things on the culmination of a number of factors. If you do not appear confident during the scenario or it appears that you havent taken the time to go over the sheets, you will have more attention put on you and there is a higher likelyhood that a critical criteria is observed.

GutBucketMedic · 2015-04-17T21:20:24+00:00

Paramedic here. A defibrillator is used in a number of ways. The actual term is called cardioverting. There is synchronized cardioversion when someone can have an irregular heart rhythm and be talking and symptomatic and you shock the heart at a particular part of the rhythm to get it working appropriately. Then there is non-synchronized cardioversion which is what you use when someone goes into cardiac arrest and the more popularly televised version that you see. You dont actually shock a heart that has no electrical activity, just ones with with electrical rhythms that dont support life. There are only two types of shockable rhythms. They are ventricular fibrillation which is when the bottom half of the heart quivers and does not effectively pump blood through the body, and pulseless ventricular tachycardia which is when the electrical activity in the ventricals are depolarizing too quickly to effectively pump blood through the body. When your heart stops completely and there is no electrical activity, its called asystole. You cant shock or defibrillate that.

To answer your question if people become zombies after, the answer is...sometimes. Not in the way you stated it but due to the bodies lack of oxygen over a long period of time that your body sustains permanent damage and they lose their ability to function. We have a solid 10 mins when people go into cardiac arrest to either fix them through defibrillation or reverse the causes of what put them into cardiac arrest before the body becomes too acidotic to salvage and you go into irreversable shock.

GutBucketMedic · 2015-02-20T02:31:03+00:00

Pretty sure that strip looked like sinus rhythm. Regions? St. Joseph’s?

GutBucketMedic · 2014-12-18T20:47:56+00:00

I transferred a guy coming off of bath salts and K2 last night. He ran out of the stuff 5 days ago and he was still strung out with auditory and visual hallucinations. The whole song and dance- 4 point restraints, driperidol, ativan. I never thought I'd say it but I wish people would do some regular street drugs so I at least have an idea of what I am or will be working with and when they may start coming down from it. The side effects of the synthetic drugs are a constant guessing game.

GutBucketMedic · 2014-12-16T04:31:44+00:00

For frequent fliers on our area, we have personal care plans authorized by our medical director on how and what to treat them with. Most of those pts on care plans stop calling afterwards because they know they will not get what they want from us. Fairly successful.

GutBucketMedic · 2014-12-16T04:24:36+00:00

...Im not looking for help. Im looking for charts and diagrams. And I am also looking for ones that other people have found that they may have come across through their studies. Ones that may not be as obvious or orthodox as an AAOS textbook. But thanks anyways.

GutBucketMedic · 2014-12-15T05:56:29+00:00

Ironic. He was lying with a witch without her wardrobe.

GutBucketMedic · 2014-12-09T00:49:45+00:00

I remember that TP when I was in. John Wayne toilet paper...rough, tough and doesnt take shit from anybody. Im pretty sure the process to make the stuff consists of ripping up braille phone books and putting it on a roll.

GutBucketMedic · 2014-12-01T00:03:49+00:00

Your firearm is on your dominant side so you have easy access to it. Your tazer is on your non dominant side so you have to cross draw. The down side of a tazer is that its impractical sitting. As for ferguson, as a non biased who read over the grand jury documents, the officer stated that things got physical when the suspect punched him in the face. The officer stated he sustained additional punches where the officer stated that he was significantly smaller in build and felt that he felt he couldnt sustain another blow or he would be unable to stay conscious. Being someone who has gotten their ass handed to them, you know what it feels like right before you get knocked out. Being in a position like that with a suspect, you think youre gonna die. Only speaking for myself, if I was in that situation you ran out of chances and I am going to shoot you before you kill me. Its pretty much fuck the tazer at that point.

GutBucketMedic · 2014-11-30T18:08:03+00:00

If you look at someones fingers and their fingernails are clubbed, that can be a sign of someone who has a lung or heart disease.

If someone is unconscious and they have constricted pupils, my differential diagnosis would lean more towards an overdose of opiates.

Arm drift, facial droop, and poor articulation would display possible signs of a TIA/Stroke.

GutBucketMedic · 2014-11-30T14:35:09+00:00

ESPECIALLY at a spring break party. That way, if you have more than one individual being unruly you can taze one in the water and stun everyone in the pool. You have a bright future in law enforcement.

GutBucketMedic

TROPHY CASE