# What skills make you nervous?



## DT4EMS (Jan 6, 2006)

I had a pretty in depth conversation with a couple of medic recently and we were discussing continuing education.

We talked about how a lot of "In-House" training covered topics they were already comfortable with but rarely covered things like medication review or surgical cric's.

I am now curious about other providers and basically.......... What skills or requirements really make you nervous?


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## CaptainPanic (Jan 6, 2006)

all of em' - coz I havne been able to use them yet in a life/death situation. :blink:


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## FFEMT1764 (Jan 6, 2006)

RSI and thrombolytics scare me...they are 2 sure fire ways to kill someone if you dont know exactly what you are doing!


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## Stevo (Jan 6, 2006)

i think kid calls in general are of a higher _'rectal pucker'_ order

other than that, driving in an icestorm cones to mind, due to my experiences TT driving i have never gotten over that inertia/breaking traction phobia...

~S~


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## coloradoemt (Jan 7, 2006)

I do not get nervous unless I am on a call, need ALS, know I need ALS, do not have ALS, ALS is not on the way, nor is meeting ALS enroute possible. Then if ya really wanna see me squirm, make it a kid call... h34r:


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## emtff376 (Jan 7, 2006)

neonatal calls.  Baby calls make me nervous.


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## TTLWHKR (Jan 7, 2006)

Tubing a premie!

Gotta be real gentle, can't use a cuff, they don't have anything to puke up so that's not the problem. And seeing the cords is not really hard, because any light in the room illuminates their entire body. But the bones of the spine, jaw and face are really brittle, elastic-like, but easy to bend and cause life time problems.

It's hard to explain

Their air passage is sooooo tiny! Get out an oxygen hose, cut it in half, paint it red, stick a simple mask adapter on it and paint that black... Now try to intubate it....

No, that hose isn't the et tube... It's the permie airway. :unsure:


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## FFEMT1764 (Jan 7, 2006)

Lets not even discuss pediatrics...that is a nightmare for everyone from the FD and PD 1st responders all the way up to the ER Doc's...No one likes a sick kid...its even worse when its a true emergency...the only thing working in everyone's favor is that children rebound very well to oxygen therapy...for all you medics out there remember the inverted triangle/pyramid.  Do the simple things first, and usually the baby we turn around and head in the right direction!


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## Flight-LP (Jan 16, 2006)

Peds doesn't bother me..................


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## Wingnut (Jan 16, 2006)

The Very first call I went on was a 6 y/o girl in a car accident. When I heard it I thought "Oh S**t, my first call would be a peds call.  Fortunatly she only had a busted lip, but it killed me to see her so scared when I have a son so close to her age. Eyes welled up for a few seconds, but the medic knew I had kids and had me calm her down so he could check her out. Thank God for that "switch" to work mode, I'd be a sniveling mess otherwise.

All the skills freak me out. s'why I need dat dere experiunce


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## DT4EMS (Jan 21, 2006)

TTLWHKR said:
			
		

> Tubing a premie!
> 
> Gotta be real gentle, can't use a cuff, they don't have anything to puke up so that's not the problem. And seeing the cords is not really hard, because any light in the room illuminates their entire body. But the bones of the spine, jaw and face are really brittle, elastic-like, but easy to bend and cause life time problems.
> 
> ...



Hey TTLWHKR, have you ever had NALS? I had it back in '92 and haven't had it since. I thought it was a great course. Neonates still make me nervous too. Other Ped calls don't stress me too bad thanks to a BRASLOW Tape.

What I was hoping to do with this thread was to get a feel for what medics and EMT's would like to got on a continual basis for CEU training. There are skills I would like to train on myself (Cric, Needle Decompression, Drug Refresher etc) because I don't do them every day.

If you worked for a service that provided training over and above the basics (ACLS, CPR, PALS, PHTLS etc) what would you liked covered?


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## Ridryder911 (Jan 21, 2006)

It is now called NRP ( Neonate Resucitation Program), I just retained my instructor for it last week. Had all the medics go through a modified course. The course is set for in hospital staff, however; it can be modified for the field with a little inguniety. It is sponsored by American Heart Asssociation & American Academy of Pediatrics. 

It is not a detailed course, like it use to be, or like the APLS (which is near impossible to find), but very good refresher and insight of neonate and delivery resucitation. It is an 8 hour course (approved for EMT CEU's), with workbook and CD ROM included in the book. ( I would suggest to await for new publications with new standards) 

I had all the Paramedics and Intermediate certifyin my service. We have a womens correctional center in our response area.. so we get a lot of deliveries and high risk neonate deliveries. 

You can check their web site for classes near you..

Be safe,
R/R 911


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## Ridryder911 (Jan 21, 2006)

For the original question... bad ped's. Thos with epiglottitis, .. high risk with RSV or those funky congential cardiac problems, status asthmaticus...kids with nuerological changes that have no primary diagnoses...  Knowing they have until the age of 18 to sue you as well. 

Funny, I thought in my early part of my career, it would be crich's .. darting chest .. etc..but, like any skill after a few, it's not that big of deal.  

Be safe,
R/R 911


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## TTLWHKR (Jan 22, 2006)

DT4EMS said:
			
		

> Hey TTLWHKR, have you ever had NALS? I had it back in '92 and haven't had it since. I thought it was a great course. Neonates still make me nervous too. Other Ped calls don't stress me too bad thanks to a BRASLOW Tape.
> 
> What I was hoping to do with this thread was to get a feel for what medics and EMT's would like to got on a continual basis for CEU training. There are skills I would like to train on myself (Cric, Needle Decompression, Drug Refresher etc) because I don't do them every day.
> 
> If you worked for a service that provided training over and above the basics (ACLS, CPR, PALS, PHTLS etc) what would you liked covered?


 
*I'd like to see PEPP mandatory for all BLS providers, at least in PA. I don't believe the current EMT course touches base on many necessary topics.* 

More than that, I'd like to see better resuscitator equipment be available to EMS providers. Disposable, none of that hella expensive stuff that >can< be sterilized.

All we carry is three BVM's. Standard sizes, Ambu Spur's. For neonate, we only have smaller masks, for the infant bag. They need to make a neonate BVM, and market it to EMS. The resp. guy in the ER always said "why don't you have one of these" pointing at his silicone neo BVM, much smaller, made for premies, and another for newborns. Not just a different size of mask. I asked where to get them, he didn't know, but he said they cost $280.00 each. My service said no-effing-way, even if I could get them, six units, each would need one of each of the 3 pc. set. that's over $840.00 per unit. We know that when they shuffle us out in the rcv'ing ER, we would never see them again b/c most ER's won't be equipped such as a peds hospital is. 


If they could make different premie and newborn BVM's, that the volume of air moved is equal to the assumed size of the lung of the premie, that would be great. But they have to be made so that they are disposable, and affordable. I'm all for spending cash to save a life, but I'm not hip on cold chemical sterilizing of resuscitators. In such a fragile child, where they are sensitive to illness, and need to be in an isolette, I don't agree on using a reusable resuscitator on them. So disposable, sterile is the way to go.


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## Ridryder911 (Jan 22, 2006)

We carry disposable BVM's (all sizes) neonate (round, ball shape), ped's, & adults.. I was thinking it was Laredal... but, I know we have them. Also know all of our suff is disposable, & boss would never pay that as well.. I'll have  to check & see. 

I agree PEPP is an okay course, when I teach it I include PALS so they can get cert's in both. However NRP is more on-depth on neonate.

Be safe,
R/R 911


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## DT4EMS (Jan 22, 2006)

So it seems I am not alone in the feeling neonates still make even experienced providers cringe........... I still stand by the fact I am no pro at Cric's or needle decompression either. Rid or TTL do you have any good training tips for any of these? I have done the slab of ribs and such and I liked that ........have you done anything different?

Thanks for the replies guys!!

Hey Rid, the NRP is NOT as in depth as NALS was? What do you add to make it better for prehospital?


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## Ridryder911 (Jan 22, 2006)

We have a decompressin mannequin, but I still prefer a slab of baby back ribs with an inner tube underneath it.. a little supper glue seals it each time after the decompression, 
NRP is really designed for O.B. nurses. and a lot wants you to understand "self infalting anethesia bags" and such.. but, I enforce the amount of pressure required to "open the alveoli" in the initial breathing phase.. also instead of warmers, we discussed how to maintian and increase warmth in the field, with additional birthing blankets and now we carry a cap for the infant as well.

The other portiions such as meconium aspiration and ET suctioning is discussed as well as umblical venous catheterization. The workbook appears to cover most, and with the CD-ROM it has cut down class time.

The good thing was it made the medics address potential problems and also made us "prepare" for potential problems. 

Be sfe,
R/R 911


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## DT4EMS (Jan 24, 2006)

That is cool.....I never thought (or heard) of using an inner tube under the ribs...... Did you use the super glue to patch the inner tube each time?


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