# 5 responsibilities of an EMT



## Sikiller15 (Oct 25, 2011)

May i know what you guys have?? And thanks

5 responsibilities of an EMT.. (not d star of life ok) thanks


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## fast65 (Oct 25, 2011)

Ummm, not exactly sure what you mean, I have a lot more than 5 responsibilities.


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## Sasha (Oct 25, 2011)

We are not going to do your homework!


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## akflightmedic (Oct 25, 2011)

I also do my own homework....open any chapter of your book 1-5 and the answers should LEAP out at ya....

Darn you Sasha!


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## usalsfyre (Oct 25, 2011)

This is probably a good indication your instructor wants you to read the book...


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## AlphaButch (Oct 25, 2011)

1. Carry my monitor.
2. Buy my coffee.
3. Make me look good in front of the MD.
4. Wash the truck.
5. Clean the stretcher.


/i keed. i keed. 


Is this a homework assignment?


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## CritterNurse (Oct 25, 2011)

From the AAOS Emergency Care and Transport of the Sick and Injured, Tenth Edition, table 1-6, they are: 





> Keep vehicles and equipment ready for an emergency
> Ensure the safety of yourself, your partner, the patient, and bystanders.
> Emergency vehicle operation.
> Be an on-scene leader.
> ...



Is that what you were looking for?

Edited to add:

But yes, I would suggest reading the text book. They didn't give you that big book to try to build upper body strength .


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## fast65 (Oct 25, 2011)

I will assist him with his English homework if he wants though...


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## akflightmedic (Oct 25, 2011)

Seriously Critter?

We do no student any favors by handing answers on a silver platter, we do right by them when we encourage critical thinking skills and self reliance/independence.

They have the tools at their disposal and they need to use them. Posting on a forum is not a tool to use for these types of questions.

Had the student stated he has searched his book and was considering xyz but wanted clarification or affirmation he/she is on the right track, then we steer them to definitive answers by walking them through a path of reason. This approach assures their retention of the knowledge and leads to a better educated provider (we hope) eventually.


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## Sasha (Oct 25, 2011)

akflightmedic said:


> Seriously Critter?
> 
> We do no student any favors by handing answers on a silver platter, we do right by them when we encourage critical thinking skills and self reliance/independence.
> 
> ...




Exactly. Welcome to the forum, but stop doing other people's homework for them. It's pretty much an unwritten policy on this forum.


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## CritterNurse (Oct 25, 2011)

As someone who has been a tutor in many classes for many years, sometimes you need to show them where to find the answers so they can learn to find them on their own. 

This is only his first question. Now if he had made habit of asking us questions like that, that would be another issue.

Edited to add:

Advice noted. I'll wait before jumping in next time.


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## Sasha (Oct 25, 2011)

CritterNurse said:


> As someone who has been a tutor in many classes for many years, sometimes you need to show them where to find the answers so they can learn to find them on their own.
> 
> This is only his first question. Now if he had made habit of asking us questions like that, that would be another issue.
> 
> ...



how is he going to learn where to find the information when it is spoon fed to him?


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## CritterNurse (Oct 25, 2011)

Forgive me, I was only trying to help another student. I thought that by also giving *where* the answer came from, it would encourage him to look it up and check there for answers to future questions. I didn't mean to overstep any unwritten boundaries (or if they were written, I apologize for not noticing them, and would appreciate someone pointing me in their direction.)


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## bw2529 (Oct 25, 2011)

Sasha said:


> how is he going to learn where to find the information when it is spoon fed to him?





CritterNurse said:


> Advice noted. I'll wait before jumping in next time.



Sounds like they get it.

/thread


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## fast65 (Oct 25, 2011)

CritterNurse said:


> Forgive me, I was only trying to help another student. I thought that by also giving *where* the answer came from, it would encourage him to look it up and check there for answers to future questions. I didn't mean to overstep any unwritten boundaries (or if they were written, I apologize for not noticing them, and would appreciate someone pointing me in their direction.)



I understand where you're coming from, but the fact that they came here to ask for the answer to such a easily found question shows that they don't care much about the content. So I imagine this answer will go directly onto their homework, and they'll forget that that chapter even exists. At least that's what I'm seeing.


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## Sasha (Oct 25, 2011)

fast65 said:


> I understand where you're coming from, but the fact that they came here to ask for the answer to such a easily found question shows that they don't care much about the content. So I imagine this answer will go directly onto their homework, and they'll forget that that chapter even exists. At least that's what I'm seeing.



Exactly.


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## JPINFV (Oct 25, 2011)

fast65 said:


> I understand where you're coming from, but the fact that they came here to ask for the answer to such a easily found question shows that they don't care much about the content. So I imagine this answer will go directly onto their homework, and they'll forget that that chapter even exists. At least that's what I'm seeing.




To be fair, it's a bit of a BS question. A BS question that should be extremely easy to answer if he decided to interpret the squiggly lines (a process we call "reading") printed inside the book, but a BS question to begin with. 

/Waiting for the 10 responsibilities of a physician homework question...


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## fast65 (Oct 25, 2011)

JPINFV said:


> To be fair, it's a bit of a BS question. A BS question that should be extremely easy to answer if he decided to interpret the squiggly lines (a process we call "reading") printed inside the book, but a BS question to begin with.
> 
> /Waiting for the 10 responsibilities of a physician homework question...



No argument here, however, the key part of your statement is that it requires reading...had the OP done his required reading, perhaps this question would not have been posted.


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## usalsfyre (Oct 25, 2011)

JPINFV said:


> . Waiting for the 10 responsibilities of a physician homework question...


According to the nursing lobby you have none, you pawn it all off in them .


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## abckidsmom (Oct 25, 2011)

I like this question.  5 responsibilities of an EMT:

wash the  truck
carry the bag
go back for the clipboard
carry the patient out with fire while I "get the truck ready"
restock at the end of shift

Oh, wait.  Those are delegated responsibilities, aren't they?


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## usalsfyre (Oct 25, 2011)

I seem to remember the New Jersey version of "ALS" thats been mentioned here...


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## Chief Complaint (Oct 25, 2011)

To be completely honest, an EMT does virtually nothing in terms of patient care here.  5 duties include:

Load the cot with the necessary equipment.
Drive.
Tear the tape for the IV.
Clean the truck.
Restock after each call.


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## JPINFV (Oct 25, 2011)

No "Empty My Trash" yet?

EMTLife...


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## traumaluv2011 (Oct 25, 2011)

5 responsibilities of a Probie:

-Don't do anything stupid
-Fill out PCR
-Run to ambulance to get supplies
-Assist with any and all lifting
-Compressions


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## Scott33 (Oct 25, 2011)

1. Run fast to every patient.

2. Everyone gets high flow O2 via non-rebreather.  

3. Never miss an opportunity to say _'Paramedics save lives but EMTs save paramedics'_, if a patient or family member asks the difference between the two.

4. Carry every patient to the ambulance regardless of presentation. 

5. When asked to slow your erratic driving down, mention the _'Golden Hour'_ but change the subject if prompted to explain it in detail. If you get stuck, refer to #3.


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## usalsfyre (Oct 25, 2011)

No one's mentioned "carry the entire contents of the jump bag on your belt so your medic is never without supplies" yet.


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## Anjel (Oct 25, 2011)

Excuse you!

I'm taking offense to this. I have my own truck, my own pts. 

I am not Every Medics Trained- B$:censored::censored::censored


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## JPINFV (Oct 25, 2011)

Anjel1030 said:


> Excuse you!
> 
> I'm taking offense to this. I have my own truck, my own pts.
> 
> I am not Every Medics Trained- B$:censored::censored::censored




1. Who are you mad at?

2. You do realize that everything after the "Do your own homework" was pure sarcasm?


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## abckidsmom (Oct 25, 2011)

Anjel1030 said:


> Excuse you!
> 
> I'm taking offense to this. I have my own truck, my own pts.
> 
> I am not Every Medics Trained- B$:censored::censored::censored



Anjel, I was totally joking.  Some dude in class comes on here wanting us to tell him what chapter 1 in the book says, I'm breaking out the sarcasm.

I mostly ride with an EMT-B partner, a different one every shift.  I respect my partner as just that, my partner.  In real life, I get out of the passenger side of the truck, so I carry the bag in almost every time.  Also in real life, I send my partner to set up the truck, if setting up needs to happen, so I can stay with the patient as we carry them out.

Don't take offense, I was just poking the non-homework doer.


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## Anjel (Oct 25, 2011)

I meant to quote cheif complaint in that reply. My phone didnt do it.


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## abckidsmom (Oct 25, 2011)

Anjel1030 said:


> I meant to quote cheif complaint in that reply. My phone didnt do it.



In his defense, he did specify *here*.

I see it.  In plenty of systems I've worked in, the EMT just drives, carries stuff, and does what the medic says.  It's just a fact of the all-ALS systems, and the crispy medics and crappy EMTs that work in them.  Not everybody, but a few bad apples ruin the whole lot.


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## Chief Complaint (Oct 25, 2011)

Chief Complaint said:


> To be completely honest, an EMT does virtually nothing in terms of patient care here.  5 duties include:
> 
> Load the cot with the necessary equipment.
> Drive.
> ...





Anjel1030 said:


> I meant to quote cheif complaint in that reply. My phone didnt do it.



I honestly wasn't trying to be sarcastic or put down EMTs at all, that's actually their role in our system.  There just isn't much for them to do in terms of patient care since we have medics on every call who prefer to take the lead.


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## CAOX3 (Oct 25, 2011)

I assist medics everyday with spelling, algebra, a boost on but mostly off their high horse, attitude adjustments, behavior modification...........and so on.

So see its a team sport, and I'm all about the team.


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## Sikiller15 (Oct 25, 2011)

Ummm no sir i just wanna know what to be an EMT...cause i just past my exam...i want a motivation...thank you very much...


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## adamjh3 (Oct 25, 2011)

CAOX3 said:


> I assist medics everyday with spelling...



I think one needs to have a decent grasp on that before helping others with it :rofl:

(Not a jab at you, CAOX3) 

Sent from my DROIDX using Tapatalk


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## Sasha (Oct 25, 2011)

Sikiller15 said:


> Ummm no sir i just wanna know what to be an EMT...cause i just past my exam...i want a motivation...thank you very much...



You passed your exam and don't know how to be an emt? Serious instructor failure.

Sent from LuLu using Tapatalk


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## fast65 (Oct 25, 2011)

Sikiller15 said:


> Ummm no sir i just wanna know what to be an EMT...cause i just past my exam...i want a motivation...thank you very much...



Next up, English exam...


Sent from my iPhone using Tapatalk


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## Underoath87 (Oct 25, 2011)

fast65 said:


> Next up, English exam...
> 
> 
> Sent from my iPhone using Tapatalk



Seriously...
that was just a disgraceful senstence.


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## Handsome Robb (Oct 25, 2011)

Why wont anyone do my homework for me!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!??!




Critter, helping them get to their answer is good tutoring, giving them the answer es no bueno. 

Reference a page in the text maybe but don't spell it out for them.

All these hw posts are making me realize why people don't give us the time of day as professionals. 

Before people start the whole "this generation wants everything handed to them" save it, I bust my *** in school, don't blanket statement


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## fast65 (Oct 25, 2011)

NVRob said:


> Why wont anyone do my homework for me!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!?!??!
> 
> 
> 
> ...



That's the problem with kids now days, always wanting everything handed to them. In my day, we walked uphill to school, both ways mind you, and chocolate was a nickel.


Sent from my iPhone using Tapatalk


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## Handsome Robb (Oct 25, 2011)

fast65 said:


> That's the problem with kids now days, always wanting everything handed to them. In my day, we walked uphill to school, both ways mind you, and chocolate was a nickel.
> 
> 
> Sent from my iPhone using Tapatalk



bahahaha


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## Sasha (Oct 25, 2011)

fast65 said:


> That's the problem with kids now days, always wanting everything handed to them. In my day, we walked uphill to school, both ways mind you, and chocolate was a nickel.
> 
> 
> Sent from my iPhone using Tapatalk



When was this? You're like 12.


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## mycrofft (Oct 25, 2011)

*Sure...*

1. Keep the ambulance upright and between the lines when driving.
2. Avoid blipping the siren outside the manager's office as often as possible.
3. Be sure a full set of Fallopian tubes (metric and English units) is on hand.
4. Liberally apply axle grease to the scissor strand under then ambulance litter so it won't squeak.
5. Leave a mint on the pillow of the litter after each run.


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## fast65 (Oct 25, 2011)

Sasha said:


> When was this? You're like 12.



When I was 5...


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## JPINFV (Oct 25, 2011)

mycrofft said:


> 2. Avoid blipping the siren outside the manager's office as often as possible.



Permission to buzz the tower?


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## Handsome Robb (Oct 25, 2011)

JPINFV said:


> Permission to buzz the tower?



Negative, the pattern is full ghostrider.


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## abckidsmom (Oct 25, 2011)

JPINFV said:


> Permission to buzz the tower?


^_^

Negative, ghostrider, the pattern is full.

What a terrific movie.


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## Handsome Robb (Oct 25, 2011)

Bah! abckidsmom nailed it and I whiffed it!


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## adamjh3 (Oct 26, 2011)

fast65 said:


> That's the problem with kids now days, always wanting everything handed to them. In my day, we walked to school uphill*, barefoot, and in the snow after plowing the fields*, both ways mind you, and chocolate was a nickel.
> 
> 
> Sent from my iPhone using Tapatalk



Fixed it for you.


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## ffemt8978 (Oct 26, 2011)

:deadhorse:


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## Anjel (Oct 26, 2011)

ffemt8978 said:


> :deadhorse:


I knew you would chime in since they are talking about the days of your childhood scooter. :rofl::rofl:


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## Tigger (Oct 26, 2011)

NVRob said:


> All these hw posts are making me realize why people don't give us the time of day as professionals.
> 
> Before people start the whole "this generation wants everything handed to them" save it, I bust my *** in school, don't blanket statement



In all fairness, there is a crowd that wants the answers handed to them in every profession. While no one asks for the answers quite as blatantly as the OP did, there are a few kids in my chem class right now who just sit back and wait for others to find the answer and then just copy it down. And they want to be doctors... 

It's just extra-unfortunate that this occurs in EMS because critical thinking skills are very important to what we do (or should be doing). Plus the basic textbook is not what one would describe as "high-level" reading.


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## Handsome Robb (Oct 26, 2011)

My paramedic textbook  isn't something you could describe as "high-level" reading either.


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## JPINFV (Oct 26, 2011)

NVRob said:


> My paramedic textbook  isn't something you could describe as "high-level" reading either.




To be fair, I found my EMT course workbook to be very useful...



.... as a monitor stand.


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## Sikiller15 (Oct 26, 2011)

My english!! Thats just insult just because im asian...well anyways EMT supposed to act professional not bunch of kids right...if you dont wanna help a fellow EMT then dont act a little selfish kid we all grown up already...


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## systemet (Oct 26, 2011)

Sikiller15 said:


> My english!! Thats just insult just because im asian...



The nice thing with the internet is no one knows what you look like, where you're from, who you are, or what your gender is, until you decide to tell them.

So I think it's unlikely anyone's singling you out because you're Asian-American, -Canadian - Australian, etc.

Now, if you're saying that you're actually from somewhere in Asia, and English isn't your first language, then I think people might be a little more understanding.  

Because a lot of the posters on this forum speak English as their first language, it's often assumed that other posters do as well, until they tell us otherwise.




> well anyways EMT supposed to act professional not bunch of kids right...



Well "supposed to", and "actually do" are, of course, very different things.  I'm not convinced yet that either EMTs or paramedics are professionals, as a group.  I've certainly met individuals I'd consider to be professionals, but it's hard to apply the label to the group as a whole.  

Some might suggest that your average lawyer, physician, university professor, clergyman, or architect are probably capable of capitalising words at the start of sentences, using punctuation or avoiding common spelling mistakes.  Perhaps if you want to be seen as a professional you could try imitating this?




> if you dont wanna help a fellow EMT then dont act a little selfish kid we all grown up already...



Look, you're upset because someone told you that your English isn't up to the standard most people would expect of an EMT in an English-speaking country.  If you're not working as an EMT in an English-speaking country, then I'm not sure it's really worth getting upset.  I'm sure most of us aren't fluent in a second language.


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## Sikiller15 (Oct 26, 2011)

Im not upset...i was just saying...haha...


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## Aidey (Oct 26, 2011)

Tigger said:


> In all fairness, there is a crowd that wants the answers handed to them in every profession. While no one asks for the answers quite as blatantly as the OP did, there are a few kids in my chem class right now who just sit back and wait for others to find the answer and then just copy it down. And they want to be doctors...
> 
> It's just extra-unfortunate that this occurs in EMS because critical thinking skills are very important to what we do (or should be doing). Plus the basic textbook is not what one would describe as "high-level" reading.




My very intelligent partner is like this. He abhors reading textbooks because they are a waste of his time. If it isn't presented to him in bullet points he doesn't want to bother with it. He thinks they are all poorly written and I think he honestly feels offended that someone would present the information in prose. When he has questions he wants me to answer them rather than doing any of the work himself. What makes it really silly is that he is a huge reader, he just doesn't like expending any energy on something he thinks is a waste of his time (even if he is being unreasonable).


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## mycrofft (Oct 26, 2011)

*The best CPR instructor I know is like that...*

..as were most of my classmates in nursing.  Much of what we write for students is gas. ("An EMT's five primary responsibilities"..what is that all about?). Some people like adages, some analogies, some like acronyms, some like war stories, some need to get their hands on it, and other like Powerpoints (last group needing brain scans). 
He cannot abide sitting there reading someone else's lesson plan or text, but hen gets it FAST when he skims then asks questions.


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## Aidey (Oct 26, 2011)

Well, it might be ok if he got it fast. Or got it at all. Well, he gets it, he just isn't convinced by any of it. It is a looooooooooooooooooooooong story, that ends with him being a _*very *_stressful partner.


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## fast65 (Oct 26, 2011)

Sikiller15 said:


> My english!! Thats just insult just because im asian...well anyways EMT supposed to act professional not bunch of kids right...if you dont wanna help a fellow EMT then dont act a little selfish kid we all grown up already...



If you're in Asia and English isn't your first language, then I apologize. However, if you're Asian-American and live in the US, then I stand by my previous statement. 

I'm not selfish...just incredibly awesome.


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## Anjel (Oct 26, 2011)

fast65 said:


> I'm not selfish...just incredibly awesome.



Lmao I <3 you


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## fast65 (Oct 26, 2011)

Anjel1030 said:


> Lmao I <3 you



At least someone does 


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## hoss42141 (Oct 26, 2011)

How many contradictions is there to epi, and nitro?


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## Sasha (Oct 26, 2011)

fast65 said:


> At least someone does
> 
> 
> Sent from my iPhone using Tapatalk



Aww come on honey bear I'm sure lots of people love you.

Sent from LuLu using Tapatalk


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## mycrofft (Oct 26, 2011)

*Hoss, you meant Contraindications, right?*

........


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## Handsome Robb (Oct 26, 2011)

hoss42141 said:


> How many contradictions is there to epi, and nitro?



Epi has 2 *relative* contraindications.

NTG has 4. Now your hw assignment is to go out, look them up, then report back with what they are.  The best part is you probably think I'm joking, I'm not, you'll never be a good provider if you don't put in the leg work. Frankly if you don't want to put in the work when you get a job let me know where so I can stay far away from there. No offense intended, thats just how I feel about it.


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## fast65 (Oct 26, 2011)

Sasha said:


> Aww come on honey bear I'm sure lots of people love you.
> 
> Sent from LuLu using Tapatalk



No, lies! I will now continue to mope around for the rest of my shift.


Sent from my iPhone using Tapatalk


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## crazycajun (Oct 26, 2011)

Chief Complaint said:


> I honestly wasn't trying to be sarcastic or put down EMTs at all, that's actually their role in our system.  There just isn't much for them to do in terms of patient care since we have medics on every call who prefer to take the lead.



CC we also have medics on every call. However we do let EMT's take the lead on many calls. How else will they ever gain experience? Even though I am an EMT-I, I do train a ton of EMT-B's as I have been in this field for over 20 years. Although some of the newbies have no reason to ever be in any type of PT care, there are some that will make great medics in the future. I want to make sure they can learn by doing and not just carrying equipment and watching.


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## Handsome Robb (Oct 26, 2011)

crazycajun said:


> CC we also have medics on every call. However we do let EMT's take the lead on many calls. How else will they ever gain experience? Even though I am an EMT-I, I do train a ton of EMT-B's as I have been in this field for over 20 years. Although some of the newbies have no reason to ever be in any type of PT care, there are some that will make great medics in the future. I want to make sure they can learn by doing and not just carrying equipment and watching.



The running joke here is "Medics don't run the truck, Intermediates do." We run I/P and a majority of our calls are ILS or lower. EMTs in my service work just as hard as the Medics. We have semi-progressive protocols that allow providers to do a lot of critical thinking.

I know the medic is ultimately responsible for what happens on the truck.


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## EMT11KDL (Oct 26, 2011)

For all the basics out there that are taking offence to the comments and jokes about basics.. i am honestly LMAO and I am a basic.. when all the Medics fancy airways and meds dont work, the all go back to there BLS skills..


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## Chief Complaint (Oct 27, 2011)

crazycajun said:


> CC we also have medics on every call. However we do let EMT's take the lead on many calls. How else will they ever gain experience? Even though I am an EMT-I, I do train a ton of EMT-B's as I have been in this field for over 20 years. Although some of the newbies have no reason to ever be in any type of PT care, there are some that will make great medics in the future. I want to make sure they can learn by doing and not just carrying equipment and watching.



I think it stems from the fact that usually both providers on the truck are medics, its very rare for a basic to even be out there.  When they are there, its just in a support role.  In most cases there will be several units responding, which means tons of medics, so an EMT won't get a chance to do much.  I'm not saying that its right, its just the way it is here.


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## BrushBunny91 (Oct 27, 2011)

NVRob said:


> Epi has 2 *relative* contraindications.
> 
> NTG has 4. Now your hw assignment is to go out, look them up, then report back with what they are.  The best part is you probably think I'm joking, I'm not, you'll never be a good provider if you don't put in the leg work. Frankly if you don't want to put in the work when you get a job let me know where so I can stay far away from there. No offense intended, thats just how I feel about it.


I'm gonna be that guy that answers when not called on.

Emergency care 12th edition says specifically epi has no contraindications when used in life threatening emergencies. The only things I can think of is the epi is not prescribed to patient and epi is not a clear liquid and expired.

Nitro, patient with history of asthma, bp systolic under 100... Bummer let me get the book out... Patient has taken a drug for erecile dysfunction, patient has head injury, patient is a child or infant, patient has already taken maximum dose.


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## JPINFV (Oct 27, 2011)

BrushBunny91 said:


> Patient has taken a drug for erecile dysfunction ... patient has already taken maximum dose.



1. So, a patient has a history of pulmonary hypertension and has been prescribed Revatio. Do you give nitro?

2. What's the maximum dose of nitro? Additionally, what is the purpose for that limit for the administration of nitro?


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## BrushBunny91 (Oct 27, 2011)

My apologies. Asthma is not a contraindication for nitro. It is for aspirin.


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## JPINFV (Oct 27, 2011)

Asthma is also a contraindication for beta blockers.


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## BrushBunny91 (Oct 27, 2011)

JPINFV said:


> 1. So, a patient has a history of pulmonary hypertension and has been prescribed Revatio. Do you give nitro?
> 
> 2. What's the maximum dose of nitro? Additionally, what is the purpose for that limit for the administration of nitro?



I'm afraid I do not know what revaltio is, But I would assume that as long as the systolic is not under 100 that I can assist with nitro.

The maximum number of doses is three and it is to... Prevent the vessels from dilating too much? I honestly do not know the answer.


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## usalsfyre (Oct 27, 2011)

EMT11KDL said:


> when all the Medics fancy airways and meds dont work, the all go back to there BLS skills..


OOORRR...we break out scalpels and electricity...


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## JPINFV (Oct 27, 2011)

BrushBunny91 said:


> I'm afraid I do not know what revaltio is, But I would assume that as long as the systolic is not under 100 that I can assist with nitro.


Revatio is another brand name of Sildenafil (Viagra), except marketed for pulmonary HTN. This (and I know it's not -your- fault) is the issue I have with teaching students to avoid "erectile dysfunction" drugs instead of PDE* 5 inhibitors. Now add to this the fact that there's a body of evidence that shows it could be useful for [enlarged] prostate hypertrophy, and I can see some poor patient being given nitro when they're on a non-erectile dysfunction PDE-5 inhibitor.  



> The maximum number of doses is three and it is to... Prevent the vessels from dilating too much? I honestly do not know the answer.


Look up "high dose nitroglycerin." The 3 dose maximum is for the patient to know when it isn't just angina, and time to get to the hospital ASAP.



*PDE = phosphodiesterase = enzyme that breaks down cGMP, which is the second messenger telling arteries to dilate. PDE-5 inhibitors with nitro is like cutting the breaks to a car and then slamming on the accelerator.


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## systemet (Oct 27, 2011)

BrushBunny91 said:


> My apologies. Asthma is not a contraindication for nitro. It is for aspirin.



Bear in mind that asthma is generally regarded as a relative contraindication for ASA.  While you have to follow local protocol, if you have someone with a STEMI, they're going to have to be actively wheezing or very poorly controlled to be able to justify withholding the ASA.


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## BrushBunny91 (Oct 27, 2011)

So the PDE inhibitors is what we must avoid and not always erectile drugs? I'm having a little bit of trouble following your explanation. I am intrigued.


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## BrushBunny91 (Oct 27, 2011)

As for the high dose of nitroglycerin. I read that the patients that were reviewed received two mg of nitro every three minutes for a total of ten doses.
But as an emt I am still restricted to three doses max correct?


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## systemet (Oct 27, 2011)

BrushBunny91 said:


> So the PDE inhibitors is what we must avoid and not always erectile drugs? I'm having a little bit of trouble following your explanation. I am intrigued.



This has to do with the physiology of smooth muscle contraction.

NTG, and similar medications like sodium nitroprusside, donate nitric oxide (NO).  This diffuses across endothelial cells, into vascular smooth muscle cells, where it activates an enzyme called guanylyl cylcase.  Once activated this produces another signalling molecule called cyclic GMP (cGMP). cGMP ultimately activates cGMP-dependent protein kinase (PKG), which affects calcium levels within the smooth muscle cell and the sensitivity of the contractile apparatus to calcium, causing relaxation and vasodilation.

So in EMT school, it's often taught NTG--> smooth muscle relaxation --> vasodilation, we can look at it in increasing levels of complexity, e.g.

NTG--> NO --> cGMP --> PKG --> decreased [Ca2+] and decreased Ca2+ sensitivity --> decreased activation -->relaxation --> vasodilation.

Now, to make things more confusing, we have an enzyme that breaks down cGMP (phosphodisesterase V --- well other enzymes do this as well, but we'll focus on this).  This makes sure that the signal is turned off eventually.  So giving NTG will increase cGMP, but phosphodiesterase will rapidly consume this cGMP, so that the effect of the NTG wears off over time.

There are also medications that inhibit this process, by "turning off" phosphodiesterase, and resulting in higher levels of cGMP.  These include Viagra and Cialis.  This also causes vasodilation in some vessel beds.

Viagra --> inhibition of phosphodiesterase --> increased cGMP --> --> --> vasodilation 

This means that patients taking these medications are especially sensitive to the effects of NTG.  So if we give them NTG, they have a rapid increase in cGMP, without much phosphodiesterase activity to limit the increase or bring it back down.  This can result in a large amount of vasodilation, and profound hypotension / death (the profoundest of hypotensions).


* And yes, these phosphodiesterase inhibitors aren't always used for erectile dysfunction.

This image gives an idea, albeit in the context of erectile dysfunction:


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## Handsome Robb (Oct 27, 2011)

BrushBunny9 said:
			
		

> 1So the PDE inhibitors is what we must avoid and not always erectile drugs? I'm having a little bit of trouble following your explanation. I am intrigued.



ED drugs are a contraindication to NTG if the ED drug was taken with a certain time. Depending on the ED drug it can be 24-36 hours. Viagra is 24hrs, Cialis is 36hrs.

PED-5 Inhibitors block PED-5 which is responsible for breaking down cGMP. cGMP is the "brake pedal" for vasodilation in the penis among other things.

Think Sympathetic(SNS)/Parasympathetic(PNS) nervous systems. The SNS is the "gas pedal" and the PNS is the "brake pedal". 

Nitro is the "gas pedal" for vasodilation. cGMP is the "brake pedal". By blocking cGMP there is nothing to control vasodilation so when you administer a drug that promotes vasodilation there is nothing to antagonize (or counteract) it. It allows for the vasodilating agent to have its way with the vasculature and puts the patient at risk for extreme hypotension which is the same reason we don't give patients who recently have take ED drugs nitro.

Does that make sense? Sorry, it's late and I'm burnt from hw so I might be babbling.

JP, or anyone else for that matter, feel free to rub my nose in my own poo if I'm completely wrong and sending BrushBunny down the wrong path.

Per NREMT the max dose for nitro is 1.2 mg or 3 sublingual sprays or tablets, 1 spray or tablet being 0.4 mg. When working for an agency it is going to be protocol dependent. Where I work we can administer NTG as needed provided the systolic BP stays above 100 mmHg. If we have a long transport time we usually use NitroPaste instead of the spray. Now where I work when I say long transport I mean like 20 minutes tops unless we are way out on the edge of the county, then your looking at more like 30-45 but thats super rare.

Another thing to consider about Nitro is that it doesn't stay good for very long when prescribed as a home med. You'll find that when assessing a patient that's prescribed it they may have taken much more than 3 tablets with no relief. The next thing you want to find out is how old their nitro is and where they store it. If its old or stored improperly those 6 tablets may not have even worked.

Alright I need to go to bed I feel like I'm just babbling.


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## BrushBunny91 (Oct 27, 2011)

Ahhhhhh(moment of enlightenment) Thank you systemet and NVROB. You cleared up the confusion I had about nitro ^_^


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## systemet (Oct 27, 2011)

NVRob said:


> Another thing to consider about Nitro is that it doesn't stay good for very long when prescribed as a home med. You'll find that when assessing a patient that's prescribed it they may have taken much more than 3 tablets with no relief. The next thing you want to find out is how old their nitro is and where they store it. If its old or stored improperly those 6 tablets may not have even worked.



Really good post.

We used to use a new nitrospray with every patient, because of the risk of deterioration over time.  However a few people got in trouble with the pharmacists union for giving the patient the nitrospray to keep.  It seemed counterintuitive to throw away a full bottle after 3 sprays.  But apparently this is dispensing, and illegal unless you're a pharmacist


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## Anjel (Oct 27, 2011)

JPINFV said:


> Asthma is also a contraindication for beta blockers.



Im finding out why that is right now. Cuz I have both. 

And why would you give nitro to someone with a head injury?


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## DV_EMT (Oct 27, 2011)

systemet said:


> Really good post.
> 
> We used to use a new nitrospray with every patient, because of the risk of deterioration over time.  However a few people got in trouble with the pharmacists union for giving the patient the nitrospray to keep.  It seemed counterintuitive to throw away a full bottle after 3 sprays.  But apparently this is dispensing, and illegal unless you're a pharmacist



correct.... says the Rx Tech


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## JPINFV (Oct 27, 2011)

NVRob said:


> Think Sympathetic(SNS)/Parasympathetic(PNS) nervous systems. The SNS is the "gas pedal" and the PNS is the "brake pedal".


This doesn't have anything to do with SNS vs PNS. Even if the patient was maxed out on atropine, PDE 5 would still be active since you need someway to remove the signal, or else the signal would always be present. 



> Nitro is the "gas pedal" for vasodilation. cGMP is the "brake pedal". By blocking cGMP there is nothing to control vasodilation so when you administer a drug that promotes vasodilation there is nothing to antagonize (or counteract) it. It allows for the vasodilating agent to have its way with the vasculature and puts the patient at risk for extreme hypotension which is the same reason we don't give patients who recently have take ED drugs nitro.


cGMP is also a part of the gas pedal. It's like a pulley system that magnifies the signal (which is one of the major functions of secondary messengers), and is one component in the chain leading to vasodilation. Remove cGMP, no dilation. 

I guess another way of looking like it is that PDE is the spring that pulls the gas pedal back and NO is the foot pressing on the gas pedal. If you remove NO, you need something to pull the gas pedal back, or else the car will continue to accelerate. Removing PDE 5 is removing that spring, thus making it so that the car won't slow down on it's own.


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## JPINFV (Oct 27, 2011)

NVRob said:


> ED drugs are a contraindication to NTG if the ED drug was taken with a certain time.



See below.



BrushBunny91 said:


> So the PDE inhibitors is what we must avoid and not always erectile drugs? I'm having a little bit of trouble following your explanation. I am intrigued.



Yes. The caveat to this is that the vast majority of times you're going to see a PDE 5 inhibitor is in ED drugs, but it's due to the mechanism of action of the class of drug, not what specifically the drug is used for.


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## mycrofft (Oct 29, 2011)

*Boy the weather has been nice lately*

Oh, this isn't the pointless thread?


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## sop (Oct 30, 2011)

My 5:

1. Come to work on-time.

2. Check the coffee.

3. Clean everything I see.

4. Make sure I have gloves to fit my hands.

5. Ask my co-worker what we need and try to obtain it.


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## usalsfyre (Oct 30, 2011)

Obviously your from a hosemonkey background...


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## firetender (Oct 31, 2011)

*Hijack back to the OP*



Sikiller15 said:


> May i know what you guys have?? And thanks
> 
> 5 responsibilities of an EMT.. (not d star of life ok) thanks


 
This was not a frivolous question. 

It was treated as if every book on EMT level care starts with "The Five Responsibilities of an EMT". They do not. He was treated as if he was trying to take something away from us rather than learn.

Once the OP id'd self as Asian, I wondered if he could be from a different system that actually DOES identify the five major responsibilities of an EMT. 

We'll never know, will we? All he asked was "What do you guys have?" and he was pounced on.

He easily could have been answered by some people who took the time to take the question seriously. Maybe we all could have learned from it, like.

1) Respond to emergencies safely and expeditiously
2) Scene management: establish scene safety, protect the patient, utilize available personnel/standers-by appropriately 
3) take immediate intervention if needed or determine next level of care
4) communicate with appropriate personnel
5) transport to approprite facility

Have at it because it's a simple question worth looking at.


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## Handsome Robb (Oct 31, 2011)

JPINFV said:


> This doesn't have anything to do with SNS vs PNS. Even if the patient was maxed out on atropine, PDE 5 would still be active since you need someway to remove the signal, or else the signal would always be present.



I was trying to relay an example, not a actual correlations, should have been more clearly worded.


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## Handsome Robb (Oct 31, 2011)

systemet said:


> We used to use a new nitrospray with every patient, because of the risk of deterioration over time.



That's an interesting practice. I see why it would be used but doesn't seem like the most economical way to go about it. 

If your rural and don't see a ton of ACS patients I can see how it would be favorable but in my system we are very busy and tend to use our nitrospray bottles relatively quickly + a monthly inspection of all the equipment on-board for expired or nearly expired meds and supplies.


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## firetender (Oct 31, 2011)

*Get back on track*

...or start a new thread please.

Thank you.


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## Handsome Robb (Oct 31, 2011)

firetender said:


> ...or start a new thread please.
> 
> Thank you.



Aye Aye, captain!

1. My safety.
2. My partner's safety.
3. My equipment.
4. Patient Care/Safety/Advocacy.
5. Safety of the public.


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## JPINFV (Oct 31, 2011)

firetender said:


> This was not a frivolous question.



It is a frivolous question. It's just not the OPs fault that his instructors are asking frivolous questions.


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## firetender (Oct 31, 2011)

It's only a frivolous question if you choose to treat it frivolously.

In this case, it wasn't about the question, it was about the poster. Were you to take the question seriously, what are the top five things an EMT is expected to do?


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## systemet (Nov 1, 2011)

NVRob said:


> That's an interesting practice. I see why it would be used but doesn't seem like the most economical way to go about it.
> 
> If your rural and don't see a ton of ACS patients I can see how it would be favorable but in my system we are very busy and tend to use our nitrospray bottles relatively quickly + a monthly inspection of all the equipment on-board for expired or nearly expired meds and supplies.



This system was urban, relatively high call volume.  We often threw out four or five bottles on a shift.  It seemed incredibly wasteful.


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