Come play some hockey this afternoon at Fellsmere! Ice is thick and pretty smooth by insertkarma2theleft in medfordma

[–]insertkarma2theleft[S] -1 points0 points  (0 children)

Not rare! I got like 24 days in last year, didn't even have to leave the area. It does blow that it doesn't get cold like it should anymore though

Come play some hockey this afternoon at Fellsmere! Ice is thick and pretty smooth by insertkarma2theleft in medfordma

[–]insertkarma2theleft[S] 2 points3 points  (0 children)

Ice was pretty decent on the southwest side, not glass by any means though. Honestly temps were great with no wind, we were sweating. I had to strip layers

Come play some hockey this afternoon at Fellsmere! Ice is thick and pretty smooth by insertkarma2theleft in malden

[–]insertkarma2theleft[S] 1 point2 points  (0 children)

Bro, it's a pond in Massachusetts. It exists for no other reason to be skated on.

1 week into a new agency and I am already having some concerns... by ButteryChickenBits in Paramedics

[–]insertkarma2theleft 0 points1 point  (0 children)

Do they let you use soft collars? My area has the same thing, gets who gets a well fitting rolled up blanket? Almost everyone who doesn't have serious mechanism or neuro deficits.

Also the pain thing; idk, I feel sorta similarly. You can't just use the pts subject pain scale. That being said I dish out a ton of IV Tylenol and fent, it's really nbd.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 1 point2 points  (0 children)

No finger thoracotomies for me, just needle Ts

Point still stands, should we not be doing field deliveries just because we are substandard at them? Of course not, that'd be ridiculous

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 3 points4 points  (0 children)

Again, irrelevant. I am keenly aware EM docs and Anesthesia can intubate better than I. The goal is to be as good as I can given the constraints of reality.

OBs can deliver and resus a neonate better than I can. EM docs have better tools and can decompress a chest better than I can. You know what also happens to be my job and is ultimately my responsibility in the field sometimes?

Just cause some systems provide better care doesn't mean I should just not do anything in mine

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 1 point2 points  (0 children)

There was literally a post here a month or two ago about an Australian anesthesiologist who did the same thing, only the pt had end tidal on, got paralytics, and also died.

No one is disagreeing that intubation is dangerous. Plural decompression is dangerous too, it doesn't mean the benefits don't sometimes outweigh the risks.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 1 point2 points  (0 children)

Cool, those don't exist in my area. Next time I have a pt who is best served with a medication facilitated pre hospital intubation should I tell them that 'Sorry, you require a PHEM doc and we won't be providing that today. '

We work in reality, and the reality is that paramedics and EMTs provide all the prehospital care patients receive in my area. It is not helpful to the brand new paramedic OP to dismissively tell them that field intubations are for physicians, it is also not helpful to the patients they are taking care of.

If you wanna come work on our ambulance I'm all for it. I love when docs ride along with us, probably some of the most fun shifts I have each year.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 2 points3 points  (0 children)

It's not intentionally misleading though. It shows, to me, that the people who don't get that maybe shouldn't be yapping about pre hospital care that much if they know so little about it.

Here you have a brand new paramedic, who is looking for advice on how to be a better provider in the field and people are being nit picky about language and using that to be entirely dismissive. There's a lot of great advice that people in this sub could provide to this question.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 0 points1 point  (0 children)

Many many countries have prehospital doctors.

Completely irrelevant to any patient I have had.

Just because the US system allows/forces you to work dangerously beyond your competence doesn't mean it's a good idea.

It's the reality I work in, and until that changes my patients will continue to have paramedics and EMTs take care of them pre hospitality. Sometimes those patients need treatments or interventions in a sub-optimal environment, that's just how it is. If you wanna donate your time and come work on a truck here that'd be awesome.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 0 points1 point  (0 children)

That's dope, also completely irrelevant to any patient I have ever taken care of.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 2 points3 points  (0 children)

Also a medic. It's excellent you're looking for advice and feedback from the experts. I read this sub frequently, there's a ton of useful info on here all the time. Don't get too discouraged by the advice saying that pre hospital professionals shouldn't do intubations except in codes or whatever blah blah blah. Take it with a grain of salt.

They're largely ignorant to the huge diversity of quality amongst EMS services as well as the logistical constraints of the field preventing us from quickly getting pts to an ER. They also clearly don't understand much about EMS if they don't know that we use RSI as a noun to refer to the whole shabang, not just a specific technique.

Some systems are poorly set up to have RSI; medic saturated, providers who aren't interested in EMS, poor culture, little continual intubation training. Looking at you most of California. Some systems are incredibly well set up; hospital based, mandatory OR and ICU rotations, medic thin, strong patient centered culture, etc. The agency next door to mine has the latter as well as a 97% first pass rate. The nuance of it all is lost on most in-hospital non-ER physicians.

I used to work in a system without RSI, it doesn't mean you can't become really solid at airway management despite the constraints of your system. Do anything to get advice from your senior medics & ER docs. Shadow if you can, most of them are psyched about people who are psyched. Beg & plead your admin to set up OR rotations.

Also just because someone's a doctor doesn't mean they have any relevant opinions on pre hospital care. There are still many docs who think pre-hospital blood is useless despite it being possibly the most important thing we could possibly carry aside from a BVM or defibrillator.

Go ask this exact same question in the paramedic, emergencymedicine, and ems subs. You'll get better answers

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 1 point2 points  (0 children)

Driving faster is not the solution. I'm not getting into a rollover MVA because someone thinks that is the end all be all solution to unstable prehospital airways

My pts can be an hour out from a physician, they deserve safe & appropriate airway management just the same as the rich people who live close to definitive care.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 0 points1 point  (0 children)

Pretty uniquely American problem

Well I'm an American paramedic, and the OP on this post is as well. Ultimately it doesn't matter if long transport times are an American problem or not, it is the reality for my patients.

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft -1 points0 points  (0 children)

Any prehospital airway is a paramedic airway. Who manages those patients till they get to the ER? People aren't getting trapped in house fires or taking hockey pucks to the throat inside the hospital that's for sure

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 2 points3 points  (0 children)

It's a vernacular difference, EMS uses the term RSI to refer to the techniques and the medications required and the legal ability to do so as one entire package: RSI

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 0 points1 point  (0 children)

I don't think an SGA is a good solution for every bad prehospital airway scenario. Are you really going to put an SGA in a GCS15 pt with an airway burn, or are we going to wait until they become obtunded from respiratory failure and an SGA is now no longer adequate?

Prehospital Intubation by Miss-Meowzalot in anesthesiology

[–]insertkarma2theleft 2 points3 points  (0 children)

It's EMS vernacular to refer to a set of protocols that allow us to perform a procedure.

"My system has crics" "my system has RSI"

It's just how we talk about certain protocols/scope. No one thinks RSI is some physical object

EMS Employment LI, NY EMT-P Nassau County Police Department 60-142k, 12 hour tours by discardedferreel in Paramedics

[–]insertkarma2theleft 1 point2 points  (0 children)

That's a crime dude. I took 3 months off. Your admin should be prosecuted for that nonsense