DragonClaw
Emergency Medical Texan
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the 100% directionless thread
- Thread starter KEVD18
- Start date
CALEMT
The Other Guy/ Paramaybe?
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Did they not teach V-Tach and V-fib in EMT school? I recall learning those rhythms along with Asystole.
Medic school we used Basic Arrhythmias (8th edition) by Gail Walraven. You could probably just GTS this stuff and learn, or you can tap into the knowledge that exists on this forum whenever someone posts a mystery 12 lead, or you can tap into the knowledge of a paramedic at work and have them show you the basics.
NomadicMedic
I know a guy who knows a guy.
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There's lots of basic ECG interpretation stuff out there... just google... Uhhh... "Basic ECG interpretation". If you've gotta have a book, Dubin's "Basic Interpretation of EKGs, 6th Ed" is what you want.
Interestingly enough, AEMTs in PA, who can run a code with an iGel, IO and Epi are specifically NOT allowed to interpret rhythms and must use the monitor in Advisory mode. (This is ridiculous to me, but if you know anything about PA, it's not surprising)
Also, EMTs may use the cardiac monitor for SpO2 and NIBP but may NOT place leads on a patient for continuous ECG monitoring. That's a quick way to getting your cert pulled if you tick off the wrong doc. See: Cocky EMT brings in a patient from a nursing home on a monitor, (without a medic) and tell the doc he's wrong about the rhythm. (Just recently happened here)
If you have a medic with you, the monitor should NEVER be in advisory mode.
If it's a basic, it should ALWAYS be in advisory mode.
Of course, YMMV, and you should talk to your operations and/or QI people to determine what's appropriate behavior in your agency.
Interestingly enough, AEMTs in PA, who can run a code with an iGel, IO and Epi are specifically NOT allowed to interpret rhythms and must use the monitor in Advisory mode. (This is ridiculous to me, but if you know anything about PA, it's not surprising)
Also, EMTs may use the cardiac monitor for SpO2 and NIBP but may NOT place leads on a patient for continuous ECG monitoring. That's a quick way to getting your cert pulled if you tick off the wrong doc. See: Cocky EMT brings in a patient from a nursing home on a monitor, (without a medic) and tell the doc he's wrong about the rhythm. (Just recently happened here)
If you have a medic with you, the monitor should NEVER be in advisory mode.
If it's a basic, it should ALWAYS be in advisory mode.
Of course, YMMV, and you should talk to your operations and/or QI people to determine what's appropriate behavior in your agency.
I absolutely love having the McGrath on my truck now. I will still throw a Mac 3 on for DL from time to time, but most days I grab the McGrath and bougie.
Jim37F
Forum Deputy Chief
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When I was still an AO at Glendale Fire in So Cal, we carried Zoll monitors on the ambulance. We were to use their AED function if we were first on scene to a cardiac arrest. But the Medics ALWAYS changed it to manual mode when they got on scene.
We were encouraged, expected as BLS to have the pt on 4 lead, SpO2 basically across the board, do a 12 lead if a cardiac case before medics arrived (tho we wouldn't interpret, but have it printed out for the medics). NIBP was discouraged but not specifically disallowed.
I remember EMT school talked a little about V-afib and V-Tach including showing pictures of their rhythms, but never did anything to explain those squiggly pictures in any significant detail. Outside Glendale, I only ever had AEDs (sometimes not even that at my first couple LA based private ambo companies).
All rhythm interpretation was strictly, 100% ALS skill. Sure if you worked with a Medic they could show you the basics, and you could maybe ID a rhythm on their monitor, but it was always officially the Medic who interpreted and treated the rhythm, regardless of any extracurricular training.
If I HAD used the Zoll monitor in manual mode to shock what I interpreted as V-Fib or V-Tach without any Medics present, that would be a quick way to lose my CA cert for going beyond my Scope of Practice.
We were encouraged, expected as BLS to have the pt on 4 lead, SpO2 basically across the board, do a 12 lead if a cardiac case before medics arrived (tho we wouldn't interpret, but have it printed out for the medics). NIBP was discouraged but not specifically disallowed.
I remember EMT school talked a little about V-afib and V-Tach including showing pictures of their rhythms, but never did anything to explain those squiggly pictures in any significant detail. Outside Glendale, I only ever had AEDs (sometimes not even that at my first couple LA based private ambo companies).
All rhythm interpretation was strictly, 100% ALS skill. Sure if you worked with a Medic they could show you the basics, and you could maybe ID a rhythm on their monitor, but it was always officially the Medic who interpreted and treated the rhythm, regardless of any extracurricular training.
If I HAD used the Zoll monitor in manual mode to shock what I interpreted as V-Fib or V-Tach without any Medics present, that would be a quick way to lose my CA cert for going beyond my Scope of Practice.
Company guidelines say Mcgrath only on first attempt and if we take a second attempt there is more paperwork involved. We have the copilot rigid stylette which works well with a Mcgrath 3. I doubt I couldve gotten that airway with a bougie once the camera was soiled.
Seirende
Washed Up Paramedic/ EMT Dropout
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Just deleted Facebook. I now have no social media.
Dubin’s is probably the best book out there.
RocketMedic
Californian, Lost in Texas
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Bonus?
RocketMedic
Californian, Lost in Texas
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What what in the butt?
CCCSD
Forum Deputy Chief
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Some companies pay a Pt bonus after so many IFTs. Local pays after 8, it’s like $50. Then more after 10, 15, etc. If you work an across the street to the CAT, it can be a lucrative day, as EACH way is a run.
DragonClaw
Emergency Medical Texan
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Yep.
On the 5th pt loaded transport, we get 40$, and 40$ for every one after that .
If I'm on a longer shift, it's 6.
This doesn't count for canceled calls, lift assist, taking a flight team to a pt (not pt loaded), etc.
DragonClaw
Emergency Medical Texan
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My dogs prevention med (heartworm, flea, other worm), is 30$ a pill, once a month. But I love him so he gets the best stuff out there
DesertMedic66
Forum Troll
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Keep the 60mg one and cut the pills in half = 60 day supply for $80
Capsules
DragonClaw
Emergency Medical Texan
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Is a protein powder shake thing equivalent to a meal replacement?
Seirende
Washed Up Paramedic/ EMT Dropout
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Put in an application for truck school.
Pretty radical change of careers...
For a cardiac arrest, I don't personally think so. Like someone else said, you might be able to interpret quicker than the monitor. Usually I figure it out within a couple of seconds to see if it is asystole, pulseless electrical activity, ventricular fibrillation, or ventricular tachycardia. If you interpret too quickly, you might confuse a slow pulseless electrical activity as asytole, but the treatment is no different anyways. Less interruption in chest compression is better for the patient, but waiting seconds longer for the AED to interpret, I don't think it's going to make a significant difference. In all likelihood, most paramedics will probably assess rhythm more frequently than the AED would, and they would more likely take longer than the AED. We don't live in an ideal world. It's a problem I usually see in my area.