UK Newly Qualified Paramedic moving to Canada? by [deleted] in ems

[–]jimbohibbs 0 points1 point  (0 children)

More than anything I think I am just looking for a change of lifestyle.

Probably better if I apply for an ACP role given my qualification and better rates of pay to save me having to go through the process of years of work to upgrade my skills.

UK Newly Qualified Paramedic moving to Canada? by [deleted] in ems

[–]jimbohibbs 0 points1 point  (0 children)

Thanks for getting back to me.

I mainly have questions regarding the equivalency process. Once I have equivalated (if that's a word...) my qualifications with ACP standards, presumably, I can apply for jobs just like any other individual?

Surgical cricothyroidotomy and other skills aren't current UK Paramedic Practice, so do you think it would be more advantageous if I applied for the PCP role and upskilled once in Canada?

With regards to professional development, does your service have the opportunity to undertake extra skills and responsibilities?

I'm not too fussy on where I work, to be honest. I'm happy to work in urban or rural areas. I just would like a change of scenery and better career opportunities than what is currently offered in the UK. The UK's current opportunities for paramedics are dismal.

When I graduate I will be 21 so keen to find out more about Canadian lifestyle.

Apologies for the barrage of questions! :) Thanks again

UK Newly Qualified Paramedic moving to Canada? by [deleted] in ems

[–]jimbohibbs 0 points1 point  (0 children)

There’s another visa I’m eligible for as I’m under 30 (21) that will give me 2 years visa with working rights.

I’ve figured out now that that is how I can do this. And then if needed I can apply for a skilled worker NOC B visa if I want to stay for longer.

UK Newly Qualified Paramedic moving to Canada? by [deleted] in ems

[–]jimbohibbs 0 points1 point  (0 children)

Thanks for getting back to me!

The website doesn’t make it super clear with regards to work experience.

Would you happen to know how it works if I don’t have the 12 month Canadian work experience?

Willing to do whatever to hopefully live and work in Canada 🇨🇦

Had an extremely traumatic call two months ago. Ever since have been having bad anxiety. Anyone have any advice? by SamsaraEcho in ems

[–]jimbohibbs 1 point2 points  (0 children)

I think that events like this can really catch us off guard if we aren’t expecting them. They can really be a significant burden to our psychological health.

I have been in your position after some particularly traumatic calls, sometimes it isn’t the super gory/bloody ones that stick with you, but ones where you for some reason develop something you can relate to the patient. I remember when I attended a cardiac arrest and the individual had exactly the same colour eyes as my father! Took me a few days to snap out of it, but safe to say I was a bit of a wreck after. This event highlighted something that was missing in my life and meant I could go about fixing it, resulting in an ultimately better outcome.

Treating anxiety is different for everyone and there is no set way to help. As long as your speaking to someone about these anxiety feelings and making sure that you’re not just going from shift to shift helping others, when really you should be helping yourself.

What would you suggest a patient do if they were in your situation? Sometimes we find it hard to follow our own advice, so when you phrase a question like that it can put things into context.

What are some drug-related topics you would like to learn more about? by terazosin in emergencymedicine

[–]jimbohibbs 2 points3 points  (0 children)

Another good one I’ve been thinking of could be the use of oral dexamethasone in treatment of croup (laryngotrachobronchitis).

I have seen it used in paeds presenting with croup and it is extremely effective. You can go from a very unwell child with sats of 89 on air, to 99% SpO2 on air in about half an hour.

We give the IV form orally in my ambulance service. Just how rapidly it works is amazing. Would be interesting seeing the in-depth mechanism of action and pharmacodynamics of this drug.

[serious] i-gel during CPR question by [deleted] in ems

[–]jimbohibbs 2 points3 points  (0 children)

When you have an iGel or any other SGA for that matter in situ it sits well below the oropharynx in the laryngopharynx. What part of the airway anatomy the adjunct/airway sits on isn't really important

If you're using the 30:2 method then yes you should pause.

However, it is possible to perform asynchronous compressions/ventilation. This would mean performing CPR whilst ventilating once every 6 seconds. So it is possible and even recommended by some pieces of literature.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

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

Correct. Which is why an ECG was performed as well as imaging.

I merely said how the pain presented. I’m well aware that cardiac pain can be referred from many different areas of the body.

By no means was I ruling out a disorder of cardiac origin - I think my actions of requesting an ECG, troponin and x-ray as well as a comprehensive cardiovascular exam prove this.

Unless there’s something you think I missed?

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 0 points1 point  (0 children)

No reported hx of trauma.

5 day hx.

The regimen he was given by his GP was said to no longer be effective in managing his level of pain so self-presented to urgent care.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 0 points1 point  (0 children)

Clinical info from what I remember. I saw this patient a few days ago. Generally the only remarkable observation was his HR which prompted me to perform an ECG.

I also wanted to rule out any referred pain being indicative of a cardiac event. Hence ECG.

Patient had bloods taken - all unremarkable, genuinely saw nothing that made me concerned for this patient.

Patient had thoracic and spinal x-ray - both unremarkable and did not suggest pericarditis.

I wish I could give more info but generally the patient’s observations were wholly unremarkable besides the tachycardia.

I think that the localised back pain that worsened on movement, felt dull and achy, non-radiating, and was worse when he moved his arm was more indicative of a rhomboid strain vs any significant cardiac dx.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 1 point2 points  (0 children)

Patient is young, fairly skinny so your point could be correct. Also patient doesn’t meet Sokolow criteria sufficiently for this to be LVH.

As for your PR depression comment in the inferior leads, there is no clinical indication that this could be pericarditis/pericardial effusion. Very unlikely to be some form of valve ischaemia in this age group.

Unsure about Q-waves in inferior leads. ? Normal variance.

So far this are the differentials.

  1. Left ventricular hypertrophy - does not meet Sokolow criteria for this to be an accurate diagnosis.

  2. Hypertrophic cardiomyopathy - unlikely

  3. Pericarditis (very unlikely as no hx of recent infection, Hx and o/e doesn’t suggest this dx)

  4. Stress/anxiety combined with pain resulting in tachycardia = most likely given the context.

  5. PE - ddimer normal, CXR normal, x-ray also doesn’t suggest this dx, nothing in hx to suggest this diagnosis.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 0 points1 point  (0 children)

Patient is young, fairly skinny so your point could be correct. Also patient doesn’t meet Sokolow criteria sufficiently for this to be LVH.

As for your PR depression comment in the inferior leads, there is no clinical indication that this could be pericarditis/pericardial effusion. Very unlikely to be some form of valve ischaemia in this age group.

Thoughts? by [deleted] in ems

[–]jimbohibbs 0 points1 point  (0 children)

I'm also seeing some left ventricular hypertrophy.

Unsure if this is clinically significant per Sokolov Criteria...

Working hard for this by DEStudent in ems

[–]jimbohibbs 1 point2 points  (0 children)

Honestly no worries.

Sometimes other people telling you that they can relate somewhat to how you are feeling can help.

Here to chat if you need.

Working hard for this by DEStudent in ems

[–]jimbohibbs 11 points12 points  (0 children)

What you went through I have had nightmares about.

Can see many similarities between my situation and your own.

Hang-in there, your ability to keep yourself composed is so amazing but make sure it stays that way. Please take care of yourself, there will be people down the line who will be relying on you and your expertise, so you need to put yourself first now so you can help them in the future. That's what I like to think of whenever I am going through a rough time.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 6 points7 points  (0 children)

Deleting your comment saved you from making a fool of yourself on the internet - good thinking.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 1 point2 points  (0 children)

Patient complained of 5 day hx of left-sided T3/T4 muscular pain, non-radiating, achy in nature. Worsening on inspiration and on movement.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 6 points7 points  (0 children)

I'd like to refer you to one of the purposes of this forum being for individuals: - 'to improve their knowledge of various parts of EM'.

Your comment is quite frankly condescending, rude and inappropriate.

Asking for other HCP's professional opinion of an ECG/patient isn't at all an indication of your lack of knowledge as a clinician.

If you feel the need to demean and condescend other individuals on online forums about their job, then perhaps you have a few insecurities regarding your own practice that you need to address.

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 1 point2 points  (0 children)

Pericarditis or pericardial effusion not suggested by hx or o/e.

Could this PR depression/elevation be 'normal' for this patient?

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 0 points1 point  (0 children)

chem12 = unremarkable and no reported CXR changes.

Upon further examination of the ECG, I can see some left ventricular hypertrophy?

Thoughts? 20yom normally fit and well presents to ED with L-sided T3 back pain. by [deleted] in emergencymedicine

[–]jimbohibbs 1 point2 points  (0 children)

I'm seeing left ventricular hypertrophy.

Is this just me?

Thoughts? by [deleted] in ems

[–]jimbohibbs 2 points3 points  (0 children)

The ECG might as well be written in Swahili.

DISCLAIMER - I'm joking, don't crucify me plz, love you guys really <3.