79 Finished Paramedic School

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(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.

78 Plug The Holes

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(35:31) Ron finally had that call he was so worried about when he started EMT Basic all those years ago. He’s almost done with paramedic school, finishing up clinicals and classes over the next couple of weeks.

What I Did This Week

Assessment Based Management

Learned from one of the instructors – stick by what you decided. Don’t doubt yourself.
The oral station on the paramedic skills test is D&D for paramedics.

Clinicals

Plugged a hole in the side of someone’s head so air wouldn’t come out.

One of my biggest fears was dealing with the super gross.

Getting good at identifying dead. Well maybe not so much.

Being comfortable. Getting aggressive.

53 calls. 265 hours.

Listener Questions

Ryan
Have you or kelly ever treated a patient with Fibrodysplasia Ossificans Progressiva (FOP)? How would you go about treating a patient?
Sam:
Hey Ron & Kelly, are any of you going to be at EMS Today in Baltimore, MD. Like to meet you both, I live in Baltimore and am A Volunteer EMT here
Rob asks:
“Ok I have a question then on documentation what do we mark a transgender patient as? If they look like a male but have female parts or vice versa ”

77 Breakdown

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(38:42) Ron has a bit of an emotional breakdown during a clinical this week and we talk about the effects of fatigue and how you handle not knowing what to do. Also how do you know when you are ready?

What I Did This Week

Assessment Based Management

More scenarios and I’m wondering a little how much it is helping.

Clinicals

You know you are in EMS when you have to stop asking your patients what day of the week it is because you don’t know the answer.
Both days my first call was run at 0558. Walk in the door and get toned out.
Tip to other newbies, be ready when you walk in the door. Have you stuff in your pockets.

Lost it after a call on Monday.
What do you do when you don’t know what to do?

One thing from scenarios, sometimes there isn’t anything you can really do, so you just support ABCs.

Mentions:

Listener Questions

[MedicTests.com spot]

Hey Ron and Kelly:

I am a very hot-natured person. In my current A-EMT Class we are required to wear uniforms that consist 5.11 pants, a t-shirt and a uniform shirt. We are to always have both shirts on. Is there a way I can stay cool in this uniform instead of sweating like a pig in the middle of a classroom and especially during my clinicals? I have heard that Under Armour keeps you cool but I have also heard it holds the heat in. Do you have any suggestions for a fat southern boy that sweats when its only 70 degrees here in Georgia?

Thanks

Tim “Future NR-AEMT”

Andrew
Question for Kelly,
I recently purchased your book and read the chapter “Crying Wolf”. Could you explain more about the “White Lead CPR” and any other quirks that you may know about when messing with the leads on the ECG? Thanks!

Ryan
Learned something new today, but wanted to hear your opinion on the matter.

Had a patient who was hyperventilating, and seeing as how we are unable to use the paper bag method, the medic decided to use a NRB on 4lpm. This method did help to slow the respiration rate from about 40bpm to around 28bpm.

Have you ever heard of doing this before, or do you have any other ideas on what one could do?