81 NREMT Skills Testing

(34:56) Ron passed his oral boards but didn’t pass all of his skills. This week we talk about pediatric airways and prepping for the written exam. Also mentioned, doing drug math, paramedic test prep books and CPR HD.



Listener Questions

Matt asks:

I will be graduating college this coming December with a bachelors degree in Political Science and French (yes, I know my major in strange for a person interested in medicine!) I’m also hoping to be done with my Paramedic program around that same time. I’m really interested in research, what kind of opportunities are out there for EMS research?

What are some of the major differences between a rual EMS system as opposed to one set up in a major city?
JP Asks:
My question is do you have to be great at math to be a medic. I really struggle in my algebra classes in high school. Through out my emt-b program I haven’t seen very much math, but will it come back to haunt me in my medic course? I appreciate any advice you guys give me and look forward to your answer.

80 Not So Done

(22:48) Well I thought I was done, but it turns out I was living an illusion.

What I Did This Week

I did not pass my orals, as a matter of fact I failed them miserably.
12 Lead and ECG interpretation
Drug Doses

Hit the stress wall and flamed out during PALS.
Failed PALS

Doses are my nemesis



Listener Questions

I wanted to find out more about becoming a paramedic or EMT. At what level do these positions stop being volunteer and start becoming paid positions? What training and experience is necessary to become a paid EMT or paramedic?
– Sacha
Really a listener answer.
Kelly and Ron,
As an avid listener of the show, I can’t help but comment on some of what was said on the last podcast.
Firstly, any automated reading algorithm is prone to incorrectly measure the QT interval when the t wave is low voltage or biphasic. It’s important to manually check if the T wave ends past the mid-point between R waves (for heart rates about 60-100 bpm). It’s usually at this point that the QT becomes clinically significant.
Secondly, the risk of torsades with prolonged QT is exaggerated. While all patient who go into torsades have a long QT, most patients with a long QT will not go into torsades. (see Severe QTc prolongation under mild hypothermia treatment and incidence of arrhythmias after cardiac arrest–a prospective study in 34 survivors with continuous Holter ECG.Storm C, Hasper D, Nee J, Joerres A, Schefold JC, Kaufmann J, Roser M.Resuscitation. 2011 Jul;82(7):859-62. Epub 2011 Mar 15. PMID: 21482009; and Droperidol, QT prolongation, and sudden death: what is the evidence? Kao LW, Kirk MA, Evers SJ, Rosenfeld SH. Ann Emerg Med. 2003 Apr;41(4):546-58. Review. PMID: 12658255)
Third, the function of a pacemaker magnet is to turn off any sensing functions and cause it to pace at a fixed rate. This used to be how the battery was checked (the pacing rate with magnet correlated to battery charge). If the patient has an underlying rhythm, this can be dangerous because it creates the potential for an r on t. The pacer magnet is most often used when attempting to diagnose a pacemaker mediated tachycardia in an atrial sensing pacer. When the magnet is placed on a device configured as ICD only, any anti-tachycardia pacing and cardioversion functions are disabled.
Pacemaker mediated tachycardia has two common causes. The first occurs in a pacemaker that is configured to trigger the ventricles when it senses an atrial beat. A ventricular paced beat has retrograde atrial capture, which is sensed by the pacemaker as an atrial beat, so it triggers a ventricular beat that causes another retrograde atrial beat, which is sensed by the pacemaker, etc etc etc. The second occurs when the device is set for rate modulation. Some devices are configured to increase the rate of pacing when an accelerometer senses movement (eg going up stairs). If the patient is shaking from anxiety or is having muscle spasms, it can trigger the pacer to fire too fast. This theory can be tested with a pacer magnet, and treated with your favourite benzo.

Mat Goebel, NREMT-P
ED-EKG Liaison
Intermountain Heart Institute EKG
Intermountain Medical Center

SP09 My Clinical Preceptor – Sarah Francis McClure

(58:06) In this episode Ron talks with Licensed Paramedic Sarah Francis McClure his paramedic clinical internship preceptor about the time they spent together.

Tell us a little about you and how you became a paramedic.
What are your memories of your own clinical internship? How do they effect how you interact with students?
You have a lot of students on your truck, what’s the biggest mistake they make? What do they do right? What advice would you give them in general?

What did you think when I asked you to be my preceptor? I’m your first right?
What do think was the biggest problem I had starting out?
What was the biggest change you saw in me?
What do I still need to work on?
What was the hardest part of being my preceptor?

What did you learn from being my preceptor? Would you do it again? What would you do differently?

Any questions for me?