Ep 24 – Crics and Foley Catheters

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[audio:24_CricAndFoley.mp3] (55:38) This week we talk about Folly catheters and how it is different on a real woman than the mannequin. Also about getting the smell out of your nose. Ron had a big extrication day where he learn all about cricotomy, alternative airways, digital intubation and blind nasaul intubation. In pharmacology we learned about HTN drugs.

For the first time one of my teachers told me the exact opposite of something Kelly said was airway fu last week. Listen to us discuss why each of them felt the way they do. And while we’re having disagreements the newbie ain’t so sure about other things Kelly said, or maybe it is the other way around.

Listener Questions

Kelly, I am having a real problem being able to hold manual c-spine on on a supine patient who is face down as we log roll the patient on to a long backboard. Try as I might, I can’t seem to hold on thru the whole rolling process without falling on my face or breaking c-spine. I have to stop the roll midway thru & have someone temporary take over c-spine while I get my hands reset, then I take over the c-spine & finish the roll on to the board. My instructors are getting fustrated with my not doing the roll without stopping. My other classmates have no trouble being able to do this. Now I realize that I’m alot older than 99% of my classmates (I’m 42) & I’m not as flexable as I use to be. Is it ok that I stop & reset my hands?? Is this going to be a issue when I do my national registry practicals?? I understand the concept & I believe that I have my hands in the correct positions, it’s just can’t seem to flex enough to continue the roll. I will keep trying to figure this out. It is very discouraging to me. – Kenneth

I’m wondering if you (Kelly) have any advice for someone about to start their paramedic internship. – Matt
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  • Kj_reed

    Ron & Kelly

    I just left a message on your phone. JIC you couldn’t hear me when I left my message.
    Kelly – Thanks for your advise. I have been working with one of my lab instructors on getting correct hand position. I will see how well I do in Lab tommorow night.

    Ron- I am offically no longer a white cloud. I just finished my last EMS ride along yesterday. We had 6 calls on our 12 hour shift. All I have left now is to do my 2 ER clinicals in December. FYI the uniform we are required to wear when we do any of our clinicals (EMS ride along or ER) is a light blue short sleeve shirt & dark blue or black action adventure pants.

  • Ken, did get you message.

    Where are you at? Its interesting they tend to pick those colors.

  • Kj_reed

    Ron

    I live in southern lower Michigan (actually,I live 5 miles from the Indiana border). I commute an hour north to the community college where I take my classes. There is a community college much closer (20 minutes) but they stopped offering EMT classes last fall. I think part of the reason for the college to choose those colors is the fact that the school colors are blue & silver. A short sleeve shirt isnt bad for the fall but with winter comming here really fast, it tends to get a bit on the cold side wearing it.

  • Sorry Ron…I’m STILL trying to catch up on the podcast from when I fell behind a while back, so I’m just listening to this episode now.

    VERY, very, very, very, interesting discussion about bystander versus practitioner Good Samaritans. I wonder if I may probe Kelly for some more explanation on it though? You brought up a lot of interesting points about why you shouldn’t pull out your “fancy tools” when trying to help someone when off-duty, but I feel like you failed to address what I think was Ron’s main point of frustration, or at least mine: WHY is it that the game somehow changes just because you’re a bystander versus when you’re on duty? I mean, taking Ron’s car accident example, really the only difference in the situation is that Ron happened to have been off-duty and witnessed the accident instead of being dispatched to it in an ambulance. One might think that this person is lucky to have had Ron, an EMT, witness his accident rather than a lay person because Ron is trained to deal with these situations. But you’re saying that because Ron is off-duty, even though he has special training and equipment handy, that he is just as powerless as any other “John Q Citizen” who may have witness this accident instead. WHY is it that Ron couldn’t pull out his OPA in order to open this person’s airway and potentially help them? It’s exactly what the EMTs who pull up in the ambulance are gonna do when they get there–why can’t Ron just do it sooner since it could potentially help? I understand what you were saying about how it MIGHT not help, and it fact might be harmful, but again, it’s exactly the same thing that the EMTs who show up are gonna do and exactly the same thing that Ron would do were he on duty, so I guess I just don’t get what the difference is.WHY does scope of practice suddenly change just because you’re off-duty? Are you only an EMT when you’re in uniform and on-duty then?……I’m sorry, I’m not trying to be difficult….but I’ve listened to that section of the podcast twice and I’m still confused. Any chance you can explain it even more and maybe give more examples?

    I remember reading something recently (I THINK it was an article in JEMS, but I can’t remember, sorry!!) about how some EMTs in some systems are not allowed to administer epi to a patient in clear anaphylaxis because the medical directors won’t allow it. The author of whatever I was reading was pointing out how stupid that is because the neighbor kid across the street can run over and jab an epi pen in the person’s thigh and save their life, while the BLS crew responding in the ambulance (the people who are supposed to be there to help) would just have to sit there and watch the person die. Isn’t this kind of the same thing? I guess I just share in Ron’s frustration as to why even get training as an EMT or First Responder if all you can do is what a lay person can do anyway? I remember very early on in the podcast that you said that you keep a few medical supplies in your personal vehicle….why do you do that if you w/c/shouldn’t use them? And then, what is the definition of a “fancy tool” that you should not use when helping someone as a bystander? What about a C-collar? What about my CPR pocket face mask that I carry around with me everywhere I go?

    Finally, I also heard you say somewhere in this episode that Ron, as an off-duty EMT, does NOT have a duty to act. (Please correct me if you didn’t say that.) Again, this completely flips my world upside down because it is completely opposite of what I understood from First Responder training. I thought we DO have a legal duty to act. I took this to mean that if I witness someone who’s hurt or ill and needs help, I have a legal responsibility to offer my help to them up until the limits of my scope of care. But what I understand you saying in this podcast is that even though I have some amount of medical training in order to help people at a slightly higher level, that I should practice only within the same scope that a bystander layperson would…..*confusion*

    Sorry for such a loaded comment!!!! (Not really—take it as a compliment–you talked about something that piqued my interest and now I want to know more!) =] I am sorry, however, for making you come back and revisit this issue over a month after you talked about it! I’ll be caught up by the end of the week, I promise! 😉 Anywho, I so look forward to hearing your responses!

    Katie B.

  • Katie:

    We’re going to have a Q&A episode in the near future and we’ll address
    these questions on it.

    Ron