79 Finished Paramedic School

Play

(46:21) For Ron paramedic school is over. Finished his clinicals including getting his vaginal birth, took his department’s oral board exam and 180 question final.

Ron and Kelly noticed today that this podcast has become a lot less newbie friendly because he now understands all those terms he didn’t earlier in his school time, so we make a special effort to explain things in a new student friendly kind of way.

What I Did This Week

Assessment Based Management

Orals
Final

Clinicals

Finished Clinicals
How often do you have to wait a significant amount of time with a patient at the ER? Do you have fentenyl wear off? Do you administer more while waiting?
Birth
DKA – Kussmauls

If you are a newbie and interested in being on the show, contact us. contact@emsnewbie.com.

Mentions:

HHNK
DKA
Zofran – contraindicated with wide QT interval
Phenergan – give with fluid
Quicktrach
EMS Pocket Guide
Vagus Nerve Stimulator

Listener Questions

Christopher asks
Have you used the quick-trach and if so what was your experience with it? I used it on a recent call and was shocked at how difficult it was to insert. I was pushing in hard with both arms before it went in. Placement/location probably wasn’t the issue (ER MD said placement was correct).
Matt asks:

First of all, I follow both of you on Twitter and saw that Ron passed his final, so congratulations!

I have three questions for y’all:

1) How do you tell the difference between Biot’s and Cheyne-Stokes respirations? All the definitions I’ve seen describe them as being very similar, other than the causes.

2) Do you know why Atropine when given in small doses or very slow can cause paradoxical bradycardia? I’ve asked my Paramedic instructor (who Kelly writes occasionally with for EMS World) and he didn’t know, but said he has seen it happen before. I’m fortunate enough to attend an University with a Medical School on campus and I went to their library to do some research but didn’t come up with much more information than I already knew.

The only think I could come up with, and this is purely a guess is that maybe with small dosages/slow administration of the Atropine there isn’t enough atropine (either in the total dose or concentrations of it in the blood) to fully inhibit the vagus nerve stimulation, thus lowering the HR. If y’all are interested I can send some PDF files of the studies that I read on the subject.