# New type of scenerio



## Chris EMT J (Apr 7, 2022)

So I have been doing these scenerios that help me learn from feedback and I attend to still do some of those scenerios Because I love the learning. But I am also going to give scenerios for other people to work up for fun learning. 

You are dispatched to a 60 year old chest pain 
BSI scene safe 1 patient confirmed
Now ask what you want to know and just follow thru until done.


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## CCCSD (Apr 7, 2022)

I do What I always do.

Are you trying to teach us EMS? You come across like a HS student doing homework.


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## Chris EMT J (Apr 7, 2022)

CCCSD said:


> I do What I always do.
> 
> Are you trying to teach us EMS? You come across like a HS student doing homework.


What? No this is a fun way to keep updated. Also a bit hurtful of a comment.


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## CCCSD (Apr 7, 2022)

ChrisEMTA said:


> What? No this is a fun way to keep updated. Also a bit hurtful of a comment.


You posting scenarios doesn’t update you, since you control the questions.
As to “hurtful” just read the level of your posts and your treatments and it makes me concerned that you are providing care. This stuff is so basic, you shouldn’t have questions.


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## Chris EMT J (Apr 7, 2022)

CCCSD said:


> You posting scenarios doesn’t update you, since you control the questions.
> As to “hurtful” just read the level of your posts and your treatments and it makes me concerned that you are providing care. This stuff is so basic, you shouldn’t have questions.


The other scenerios help me by feedback. These keep other providers up to date. I shouldn't have questions? I thought questions are a good thing because means even after completing training I get to learn and improve. I haven't done one thing that would hurt a patient and haven't given a scenerio of a critical patient. I work as a team player I understand and accept I am not the best and try to improve. And if you ever actually see I do really good on critical cases and am a very fast and efficient person. Which I do something not do everything perfect as a human may make mistakes but haven't made any critical mistakes and I wouldn't be concerned about a provider that owns up to mistakes and still is devoted to improving. If I was the patient I would love to have a provider as dedicated to being the best he can be. I am sorry that I asked questions trying to learn and improve. I do sincerely want to improve and would love feedback to help.


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## ffemt8978 (Apr 8, 2022)

ChrisEMTA said:


> The other scenerios help me by feedback. These keep other providers up to date. I shouldn't have questions? I thought questions are a good thing because means even after completing training I get to learn and improve. I haven't done one thing that would hurt a patient and haven't given a scenerio of a critical patient. I work as a team player I understand and accept I am not the best and try to improve. And if you ever actually see I do really good on critical cases and am a very fast and efficient person. Which I do something not do everything perfect as a human may make mistakes but haven't made any critical mistakes and I wouldn't be concerned about a provider that owns up to mistakes and still is devoted to improving. If I was the patient I would love to have a provider as dedicated to being the best he can be. I am sorry that I asked questions trying to learn and improve. I do sincerely want to improve and would love feedback to help.


Here's where my concern lies: you have given the impression that you're too eager to jump to the advance treatments and skills while skipping over the basic, primary and less invasive treatments (ie considering giving a patient albuterol to improve their sats without putting them on O2 first).  To me, this gives me the impression that you too easily lose sight of the big picture and instead are enamored with what advance treatments you can give.

Your responses in the other scenario threads show a willingness to learn from your mistakes, and I respect that.  However, a scenario like you posted in this thread won't really help you learn,  nor will it really help others.  For the most part, taking history and vitals is second nature to the members here so they should be provided in any scenario posted.


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## Chris EMT J (Apr 8, 2022)

ffemt8978 said:


> Here's where my concern lies: you have given the impression that you're too eager to jump to the advance treatments and skills while skipping over the basic, primary and less invasive treatments (ie considering giving a patient albuterol to improve their sats without putting them on O2 first).  To me, this gives me the impression that you too easily lose sight of the big picture and instead are enamored with what advance treatments you can give.
> 
> Your responses in the other scenario threads show a willingness to learn from your mistakes, and I respect that.  However, a scenario like you posted in this thread won't really help you learn,  nor will it really help others.  For the most part, taking history and vitals is second nature to the members here so they should be provided in any scenario posted.


Ok thank you for being clear with your feedback because I can process and learn from it


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> Ok thank you for being clear with your feedback because I can process and learn from it


Chirs, instead of you giving us scenarios, how about you try one:

Your patient is a middle-aged male complaining of intermittent, moderate, right-side abdominal pain, onset two hours ago at rest, an hour after a meal, no prior episodes. He denies N/V, recent illness, or changes in bowel or urinary habits. His PMH is Type I DM, migraine headaches, and asthma, for which he takes insulin, Imitrex, and albuterol. No allergies to meds. He's alert and oriented with an irregularly irregular pulse of 110, BP 160/100, RR 20 and unlabored, clear lungs, SpO2 94, afebrile, pupils and skin unremarkable. BSL=170. Your EKG shows Afib. You ask if that's normal for him. He's not sure. Your ETA to the closest ER is 10 minutes.

What do you want to do?


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## Chris EMT J (Apr 8, 2022)

mgr22 said:


> Chirs, instead of you giving us scenarios, how about you try one:
> 
> Your patient is a middle-aged male complaining of intermittent, moderate, right-side abdominal pain, onset two hours ago at rest, an hour after a meal, no prior episodes. He denies N/V, recent illness, or changes in bowel or urinary habits. His PMH is Type I DM, migraine headaches, and asthma, for which he takes insulin, Imitrex, and albuterol. No allergies to meds. He's alert and oriented with an irregularly irregular pulse of 110, BP 160/100, RR 20 and unlabored, clear lungs, SpO2 94, afebrile, pupils and skin unremarkable. BSL=170. Your EKG shows Afib. You ask if that's normal for him. He's not sure. Your ETA to the closest ER is 10 minutes.
> 
> What do you want to do?


I probably would start a IV,  ask if right upper or right lower, do a exam including a mc Burney's, start transport and if a medic is on our way to the hospital and doesn't delay transport allow a medic to do a eval en route or just transfer. Advice ED on patch that patient is in AFIB with RVR.


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## Chris EMT J (Apr 8, 2022)

ChrisEMTA said:


> I probably would start a IV,  ask if right upper or right lower, do a exam including a mc Burney's, start transport and if a medic is on our way to the hospital and doesn't delay transport allow a medic to do a eval en route or just transfer. Advice ED on patch that patient is in AFIB with RVR.


Also check A&O and ask pain scale 1/10


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> I probably would start a IV,  ask if right upper or right lower, do a exam including a mc Burney's, start transport and if a medic is on our way to the hospital and doesn't delay transport allow a medic to do a eval en route or just transfer. Advice ED on patch that patient is in AFIB with RVR.


A few things for you to consider:

1. I think you're over-reacting to the HR of 110. That's not really RVR. For further study: What is it about true RVR that prevents the ventricles from doing their job?

2. The presence of Afib is not necessarily an emergency. For further study: How can you tell that this patient is perfusing well?

3. In this scenario and the ones you presented, you seem to be fixated on IVs. It's not a terrible idea to establish a line, but it shouldn't delay transport. For further study: How do you think your IV would be used?

4. I don't see how you could arrange an intercept without delaying transport to some extent. For further study: What do you think a medic might do that would be important, given that you're minutes away from the hospital?


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> Also check A&O and ask pain scale 1/10


I mentioned the pn was moderate and the patient was A&O (i.e., not AMS).


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## Chris EMT J (Apr 8, 2022)

mgr22 said:


> I mentioned the pn was moderate and the patient was A&O (i.e., not AMS).


Oops didn't see that the first time I read it


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## Chris EMT J (Apr 8, 2022)

mgr22 said:


> A few things for you to consider:
> 
> 1. I think you're over-reacting to the HR of 110. That's not really RVR. For further study: What is it about true RVR that prevents the ventricles from doing their job?
> 
> ...


1. Ok maybe I did over exaggerate 

2. I see a high BP so not low so I know they have perfusion                    

3. I do IV's on most patients because I really see so much that could be usually in ED like labs or doctor ordered meds. I did in this scenario Incase heart rate climbs and BP drops I would already had a line or if in ED and patient becomes unstable they have a line.

4. I will admit I have a issue on when to get a paramedic intercept. I have always been told that I do a lot of unnecessary intercepts and I am trying to work on my end. I did it for this one Incase patient gets unstable I can get advice because medics are trained in cardiology and pharmacology then me. 

Thank you for the feedback so I can improve. I do actually appreciate it


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> 1. Ok maybe I did over exaggerate
> 
> 2. I see a high BP so not low so I know they have perfusion
> 
> ...


2. Good. Also mental status.

3. If you're good at IVs, the hospital wants you to do them routinely, and you don't delay short transports of unstable or potentially unstable patients, OK. For further study: How much would the HR have to increase for you to use that IV? How would you use it?

4. I think you should consider how little time you (and a medic) have en route to make a difference. In general, when you're only a few minutes from the ER, an intercept probably won't improve the outcome, and the delay could make it worse. For further study: What can a medic do in under three minutes that you can't do to save a life?


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## Chris EMT J (Apr 8, 2022)

mgr22 said:


> 2. Good. Also mental status.
> 
> 3. If you're good at IVs, the hospital wants you to do them routinely, and you don't delay short transports of unstable or potentially unstable patients, OK. For further study: How much would the HR have to increase for you to use that IV? How would you use it?
> 
> 4. I think you should consider how little time you (and a medic) have en route to make a difference. In general, when you're only a few minutes from the ER, an intercept probably won't improve the outcome, and the delay could make it worse. For further study: What can a medic do in under three minutes that you can't do to save a life?


2.  👍

3. Our EDs like IVs routinely and not sure all about the pharmacology but I assume a med can be given to treat AFib with RVR and heart rate probably around high 130s before meds just a guess not completely sure it's not in my scope of practice to treat AFib with RVR but would love to hear what to do for learning 

4. Thanks for the tip and i will try focusing on that more thanks


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> 3. Our EDs like IVs routinely and not sure all about the pharmacology but I assume a med can be given to treat AFib with RVR and heart rate probably around high 130s before meds just a guess not completely sure it's not in my scope of practice to treat AFib with RVR but would love to hear what to do for learning


Given an ETA of a few minutes, it's unlikely that a medic would treat Afib emergently with drugs. If the ventricular rate were, say, 160+ and the patient were unstable due to the tachycardia, cardioversion is a possibility, but I'd certainly be reluctant to take the risks with an ER around the corner.

Remember, your primary goal (and the medic's primary goal) isn't to do stuff; it's to not make the patient worse.


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## Chris EMT J (Apr 8, 2022)

mgr22 said:


> Given an ETA of a few minutes, it's unlikely that a medic would treat Afib emergently with drugs. If the ventricular rate were, say, 160+ and the patient were unstable due to the tachycardia, cardioversion is a possibility, but I'd certainly be reluctant to take the risks with an ER around the corner.
> 
> Remember, your primary goal (and the medic's primary goal) isn't to do stuff; it's to not make the patient worse.


Ok thanks for all the tips and feedback. So how well did I do on your scenerio?


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## mgr22 (Apr 8, 2022)

ChrisEMTA said:


> Ok thanks for all the tips and feedback. So how well did I do on your scenerio?


If you're learning, we're good.


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## DesertMedic66 (Apr 8, 2022)

mgr22 said:


> 1. I think you're over-reacting to the HR of 110. That's not really RVR.


While yes a heart rate of 110 is nothing that is super concerning it is still considered RVR.


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## mgr22 (Apr 9, 2022)

DesertMedic66 said:


> While yes a heart rate of 110 is nothing that is super concerning it is still considered RVR.


You're right. I was trying to make a point to the OP about not rushing to treat Afib at 110 as a rate-related problem, and should have added something like "while technically RVR."


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