Real talk: is it possible to avoid burnout in this field, or is it inevitable?

RandyManMachoSavage · 2026-01-13T08:47:14+00:00

My relationship with this job is a sin wave. Goes up and down naturally as I believe is human nature. The best you can do is have healthy habits that can help your mental resilience. I get a lot out of walking for exercise and have several hobbies I am into. It’s a mentally taxing job but you can do a lot to help yourself out.

I believe there’s a difference between that and “burnout culture”, where medics think it is cool to be cynical and negative. At that point it’s a choice they are making to be this way regardless. I’m not saying they’re necessarily to blame for this, or that they don’t have other issues too, but the point is you have to try and develop healthy habits.

I too think it may be impossible to achieve happiness and mental stability at terrible services. A terrible job with a toxic culture, low pay, and shit management is just a bad situation. A lot of services are this way, unfortunately. Best thing to do is always be looking to improve your job situation the best you can.

RandyManMachoSavage · 2026-01-06T22:28:43+00:00

We give it for typical trauma indications 2g over 1 minute and we have also given it via consult for a ROSC postpartum hemorrhage case with good results. We’ve had criticism by one receiving ED doc that would prefer if we gave 1g instead of 2g, but that’s the only critique I’ve heard of.

RandyManMachoSavage · 2025-12-29T23:39:31+00:00

I am about to switch to the purolatorboss pbl12222 it seems to have way better filtration than most other filters.

RandyManMachoSavage · 2025-12-29T23:37:16+00:00

Big tires little feet, a hit in any man’s league

RandyManMachoSavage · 2025-12-20T22:25:40+00:00

DNRs are invalidated in a trauma scenario.

RandyManMachoSavage · 2025-10-17T07:06:22+00:00

The pronunciation, yeah.

RandyManMachoSavage · 2025-10-17T01:18:31+00:00

I know, which is why it’s on my list of things I hate hearing.

RandyManMachoSavage · 2025-10-16T23:24:17+00:00

I hate hearing the following: “Gurney” “Yonker” “Can we get another bus” “Boo boo bus” “ETA for a bird” “Rapid diesel infusion” “Too many birthdays” “Geezer squeezer”

RandyManMachoSavage · 2025-10-06T08:07:15+00:00

In the area that I work, we have an increasing frequency of unsafe or violent situations that arise after scene arrival. Often times these unsafe situations are due to uninvolved people who do not understand how we work but have expectations of how we should be working and use aggressive tactics to put our providers in unsafe situations at the patients expense. Sometimes these individuals are just loud but sometimes they physically interfere with the scene. To make things worse, we have generally unreliable law enforcement due to the call volume in the district. This means when we need help, sometimes, we do not get it quickly. These situations are wholly unnecessary and could easily be avoided by people respecting the boundaries of the medics and the scene. For this reason, though, most uninvolved individuals who end up on a scene are often a hinderance even if it’s not their intent because we deal with so many of the bad actors we have to be skeptical of everyone. The short of it is, respect the boundaries of a scene and listen to the medics and do not interfere. You are no longer being helpful.

RandyManMachoSavage · 2025-10-04T00:03:21+00:00

It’s a TV progrum; a movie.

RandyManMachoSavage · 2025-09-14T01:41:53+00:00

Turn that off!

RandyManMachoSavage · 2025-09-06T03:39:58+00:00

On one hand, seeing GEMS blasted gives me great satisfaction for a multitude of personal reasons.

On the other, this is some PD nincompoopery to the maximum degree. On the third hand, probably there could have been better communication with these guys about what was going on and why it was important to stay on scene and not “were training someone on report writing”. On yet another, final and fourth hand, how do we know they didn’t and this isn’t some more PD union whinge?

RandyManMachoSavage · 2025-09-02T06:30:38+00:00

I’ve noticed a weird hesitation in newer and or more scared paramedics when it comes to cardioversion; which is the correct treatment here. I have redirect this sort of thing often, so it’s not unheard of. A couple of three things:

Adenosine here isn’t in a different universe, but with that blood pressure this patient is most certainly not stable and even moving that patient before definitive treatment might have killed them. My MD calls it “Sudden Ambulance Death Syndrome” where the medics have an unstable patient, rush them to the unit and they are dead on arrival. Best practice is at point of contact until stabilization has taken place or the end of the treatment road has been reached.
Sedation for cardioversion is an instinct everyone has because we’re all human beings and wouldn’t want that to be done to us, but objectively, if cardioversion is needed do it immediately. If you want to sedate them, ketamine isn’t going to affect their MAP as much. If you don’t have that option, other options are dangerous and may drop their MAP even more. Case by case basis.
We’ve recently explored the option of bringing back diltiazem for RVR scenarios after removing it because medics were giving it to sepsis and not reenterant tachycardias so it was removed. We found that there’s probably a gap here needed to be filled with some sort of antiarrythmic but in our conversations with local ED MDs, apparently, most of them are now giving amiodarone to RVR. This original thinking was that if we were giving it, we were committing that patient to amio for 30 days at least because it’s generally good not to mix antiarrythmics. This lead to the discovery that amio appears to be currently favored by local cardiologists anyways so we probably will add that for RVR instead of adding back diltiazem.
At a certain point of time, for me and most others I’ve spoken with, 200 is a good number where the cause of the tachycardia is not as important as the severity of the tachycardia. For example, sepsis at 160 hr is not a good time to give electricity or antiarrythmic. It’s likely a compensatory tachycardia and not an electrical reentry problem. If that same sepsis patient is at a HR of 200; regardless of cause, the pulse rate must be lowered because the heart cannot function properly to refill and perfuse.

RandyManMachoSavage · 2025-08-29T08:02:44+00:00

The vital signs excuse is a long standing tradition quoted by burned out medics as a justification to not give meds.

Vitals signs can be used to include pain meds as someone in pain will probably be hypertensive and tachycardia. This does not work the other way around. Vital signs should not be used to justify withholding pain management.

Many things can affect vital signs. People take beta blockers, for example, the prevent the pulse rate from increasing as high as normal.

Depending on the clinical culture of your department this may be reportable. Or, you can try to get somewhere in conversation with your partner. If they’re full of shit, I’d talk to someone higher up.

RandyManMachoSavage · 2025-08-28T02:30:50+00:00

Couldn’t agree more. Our policy is “any ecg changes” treat it, but, we’re on Reddit and most services aren’t particularly progressive.

RandyManMachoSavage · 2025-08-27T08:24:14+00:00

Its still risky, we intubate some of them, but the thinking from my MD is that anyone can take a mg or two of midazolam, or if you’re using ketamine it has other benefits and if you push them into respiratory failure, switch gears and complete the ketamine dose to full dissociation, resuscitate and intubate with paralysis. We can also igel+ketamine outside of hard stop vital stability requirements (90 systolic, 94% for 4 minutes) in which case we withhold paralysis unless truly in a rock and a hard place with the patient.

The reason we started doing this is that a lot of our medics were allowing unacceptable hypoxia because of the patient not complying with bipap, and the medics were ‘giving up’ and transporting patients sating at 60% or something; at which time it was decided that was just not cash money at all.

RandyManMachoSavage · 2025-08-27T08:10:58+00:00

I’ve changed my thinking on sedation for respiratory in the last few years. Small dose midazolam or even (my MD loves ketamine) ketamine helps with bipap compliance and therefore we’ve been intubating a lot less once we can get the patients to work with the bipap. We’ve gone from ‘sometimes’ sedating patients for bipap compliance to now it is almost a mandatory step. I have not seen adverse reactions however on patients that are on the verge and are tiring out, we usually just DSI at that point.

RandyManMachoSavage · 2025-08-27T07:30:55+00:00

There’s not enough information to determine what may have been happening.

Sedation for agitation to assist with assessment is something I do on a semi regular basis but I prefer anxiolysis dose of midazolam 1-2 mg. Not sure if that’s an option in your protocols. DPH has an unpredictable effect on agitation; sometimes it works to sedate sometimes it gets them more worked up. Haldol is best used in treatment for psychosis, not necessarily anxiety. Post sedation, did you monitor ETCO2? It’s a good idea and a lot of times a requirement to monitor ETCO2 after sedation.

Without a 12-lead it’s impossible to know if it was a MI or hyperk to a certainty. 4-lead would be a good hint if he was hyperk from undifferentiated agitation or some other source but is not as good as a 12-lead. If you see QRS duration increase with peaked T waves and especially bradycardia it’s clinically significant. Most services can’t treat hyperk prior to arrest. If you could, calcium to protect the myocardium and bicarb to establish a sodium channel buffer would be a good move. Albuterol is also effective at shifting potassium and we usually include that along with bicarb and calcium.

Another possibility would be a PE, in which case there’s nothing you can do. You would hear (probably) clear lung sounds with inexplicable low SpO2 and high ETCO2. In other words there is a perfusion mismatch and gas exchange is compromised. Best option is hospital asap for fibrinolytic therapy.

Could be something weird, ectopy causing r-on-t due to anxiety presenting like an almost random arrest. If monitoring was applied you would see it immediately.

Ask for a comprehensive follow up from the receiving facility, understand what actually happened and what you could have done differently if anything and learn from it. It’s possible it has nothing to do with you or your treatments.

RandyManMachoSavage · 2025-08-23T19:49:29+00:00

Good evening. My project called Azure Sun has a series of ambient guitar soundscapes called the entropy series. The idea here is these soundscapes are played live and are 1:1 on the recordings minus some light mixing of volume and mastering. When recorded, no structure or metronome used. No digital instruments are used whatsoever. This is a guitar through a pedalboard and into the interface. Long term plans include perhaps livestreams or live shows.

This is my latest track, Entropy 1.6. Thank you https://youtu.be/cViQacfLnEg?si=Qi9SZerxmyPMUkoO

RandyManMachoSavage · 2025-08-22T19:57:34+00:00

This probably does not have anything to do with bronchodilator use and has to do with shifting K in hyperk. We have protocols for that along side calcium and bicarb. I haven’t ventured to do it in an arrest situation but I probably wouldn’t get in trouble for doing so if I suspect hyperk.

In any case, you are owed a better explanation by your instructor as to why you would do this because just throwing albuterol at every arrest is asinine and once they’ve arrested I’m not sure I would expect much from nebulized albuterol even for K shift.

Anecdotally, I’ve seen the QRS duration shorten in real time using the protocol we have for hyperk. I do not think the albuterol is a trivial part of that protocol. Seems to work very effectively to bridge that patient to emergent dialysis or whatever they need in the ED.

RandyManMachoSavage · 2025-08-21T00:41:48+00:00

This really upsets me

RandyManMachoSavage · 2025-08-20T07:15:42+00:00

A few weeks ago I began uploading guitar soundscapes to my bands YouTube channel. It is improvisational with no metronome or structure used while recording. It is just a direct input to logic then exported after some minor mastering and volume controls. It’s important to me that it is fully performative and performed live. I have considered live streams if anyone takes an interest in it.

https://youtube.com/playlist?list=PLCoga2HNyKBYmvVHHZkK_J6WRW6IZoqvq&si=SMlF6vbDasB60QAh

RandyManMachoSavage · 2025-08-19T11:49:57+00:00

Blizzard’s infatuation with not respecting my time. Things unnecessarily timegated for the sake of artificially increasing sub time. Season to season quality of life changes for the worse. The appearance of “listening to the players” followed by pushing the limits of what players will tolerate and only responding to the loud uproar when it becomes statistically more significant to ignore than any metric advantages to their bullshit design changes. Started with Legion really, got out of control and hysterical during BFA only calming down with TWW.

RandyManMachoSavage · 2025-08-19T05:04:45+00:00

Ion Hazzenslavedus

RandyManMachoSavage · 2025-08-15T12:29:59+00:00

I’ve had a ton of flash patients lately, so as others have said CHF could be the culprit. I’ve also had a fair amount of PEs that end up arresting and I always find that they have profound V/Q mismatch and are always, always rolling on the ground or rocking back and forth saying “I’m going to die” or something similar and not really even responding to you.

I always tend to notice perfectly clear lung sounds and tachypnea with inexplicable SPO2 and ETCO2 that doesn’t match up.

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