# EMT Tricks of the trade



## EMTelite

Hey guys I thought it would be cool to post on here some stuff that EMT's use in the field that are not exactly learned in the classroom setting but you have learned in the field that really helped you out

One thing I learned I think on my first ride out was when just adressing the simple EKG (4 lead)---- White on the right, Green right underneath, smoke over fire referring 

Another one is when assessing patients vitals write everything on your glove so that you can remember--- Age, Bp, C/c, Pulse, etc... 

Anyone got any good ones?


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## Shishkabob

EMTelite said:


> Another one is when assessing patients vitals write everything on your glove so that you can remember--- Age, Bp, C/c, Pulse, etc...



While everyone has done that at some point, it's not the best thing.  You'll get bodily fluids on your gloves and if the writing doesn't get covered or smeared, you'll eventually take them off anyhow.

Better thing is put a small strip of duct tape on your thigh.


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## CAOX3

People spend years in EMS discovering these secrets and you want us to just hand them two you.......Just kidding, welcome aboard.

You can use a ford ambulance key as a o2 wrench, to open the cylnder...Shh I dont just tell this stuff to anybody.


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## mycrofft

*I'll give you a list (my usual contribution, a list):*

1. Do not leave the O2 cylinder turned on, but the flow stopped at the regulator. Everyone at some point considers this, but it will eventually lead to your finding an empty cylinder, and can damage the regulator gauge since it is not designed to sit and resist that sort of pressure.
2. Learn to carry and use your handheld radio left handed. Someday you will need that right hand, it may be tied up doing something, and you will not be able to reach it or use it with your left hand. (Ammo on the right, Commo on the left).
3. If you let brains dry on your pants, you will probably have to wash them twice to get them clean.
4. The loudest patients might be those needing care least, but the quietest often need care more. Loud ones who get quiet are in the most need.


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## NRNCEMT

EMTelite said:


> Hey guys I thought it would be cool to post on here some stuff that EMT's use in the field that are not exactly learned in the classroom setting but you have learned in the field that really helped you out
> 
> One thing I learned I think on my first ride out was when just adressing the simple EKG (4 lead)---- White on the right, Green right underneath, smoke over fire referring
> 
> Another one is when assessing patients vitals write everything on your glove so that you can remember--- Age, Bp, C/c, Pulse, etc...
> 
> Anyone got any good ones?



Here are a few tips I've learned so far.

One way that I remember is "Sky over grass" = white over green & "Smoke over fire" = black over red.

You can get a O2 sat on a pedi pt. by putting 2-3 fingers in the pulse ox.

If you you have a CABG pt. and his/her staples bust open, you can perform CPR by squeezing the heart with a gloved hand.

I've found out that patients with tattoos on over their arms are easier to get a IV established in, you can use their art as a reference when sticking.

If you have a pt that is hyperventilating, you can put a NRB mask with NO O2 and ask "is that better" and it usually works without a hitch!

If your Medic "loses" or runs out of electrodes and you need to hook someone up to the monitor you can use defib pads to obtain a rhythm.

Your hand held spot light can be used to navigate heavy fog.


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## reaper

NRNCEMT said:


> Here are a few tips I've learned so far.
> 
> One way that I remember is "Sky over grass" = white over green & "Smoke over fire" = black over red.
> 
> You can get a O2 sat on a pedi pt. by putting 2-3 fingers in the pulse ox.
> 
> If you you have a CABG pt. and his/her staples bust open, you can perform CPR by squeezing the heart with a gloved hand.
> 
> I've found out that patients with tattoos on over their arms are easier to get a IV established in, you can use their art as a reference when sticking.
> 
> If you have a pt that is hyperventilating, you can put a NRB mask with NO O2 and ask "is that better" and it usually works without a hitch!
> 
> If your Medic "loses" or runs out of electrodes and you need to hook someone up to the monitor you can use defib pads to obtain a rhythm.
> 
> Your hand held spot light can be used to navigate heavy fog.



God I hope you are freaking kidding with these?


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## CAOX3

reaper said:


> God I hope you are freaking kidding with these?



Im hoping the same thing.  Squeezing the heart with a  gloved hand?


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## HotelCo

You mean you didn't learn that in your EMT-B class? Seems like a pretty basic skill...


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## akflightmedic

NRNCEMT said:


> Here are a few tips I've learned so far.
> 
> One way that I remember is "Sky over grass" = white over green & "Smoke over fire" = black over red.
> 
> You can get a O2 sat on a pedi pt. by putting 2-3 fingers in the pulse ox.
> 
> If you you have a CABG pt. and his/her staples bust open, you can perform CPR by squeezing the heart with a gloved hand.
> 
> I've found out that patients with tattoos on over their arms are easier to get a IV established in, you can use their art as a reference when sticking.
> 
> If you have a pt that is hyperventilating, you can put a NRB mask with NO O2 and ask "is that better" and it usually works without a hitch!
> 
> If your Medic "loses" or runs out of electrodes and you need to hook someone up to the monitor you can use defib pads to obtain a rhythm.
> 
> Your hand held spot light can be used to navigate heavy fog.



Best trick of the trade is to disregard about 98% of the post above.


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## reaper

akflightmedic said:


> Best trick of the trade is to disregard about 98% of the post above.



That's being nice! I was thinking 99%


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## Buzz

Always have tape on you. You never know when you'll need it. It's a decent notepad, handy for fixing things, good for holding a broken valve on an airsplint closed, among many other things.

If you have a patient too small/large, A towel can be used as a one-size fit all c-collar. 

Avoid writing on your glove. You will eventually throw them away with something written on there that you still needed. A strip of tape on your pants works well enough.


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## marineman

Most of these are great but don't do any good if you don't know how to get there. Get familiar with your area, there are several clues you can use to figure out where the scene is. For me even number addresses are on the north side of an east-west street and on the east side of a north south street. All avenues in my response area run east west. The 400 block of one street will be the same as the 400 block one block north. Most street signs have smaller print with the block number on it. Compare the two sides of the street and you'll know which direction you have to go. Once you find out the small differences in your areas street designations and such you will rarely need a map to find a place much less GPS.


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## medicdan

I try to leave a towel on the head and foot of the stretcher. The head towel is for when its raining, to put over the patient's head, the foot for for particularly tall or poorly positioned patients, to put over their shoes. It makes lifting easier (especially with a white shirt), because you arent wearing their shoes or arching your back...


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## akflightmedic

I just ask them to bend their knees...


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## BLSBoy

Most people fit best in a Pedi collar. Go ahead. Try it out. 
Me? I am a baby no neck.


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## EMTelite

*Thanks*

So far so good guys I like that one about the tape on the leg the seems to make more sense... And also about the Sky over grass thats pretty cool


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## reaper

The best trick of all? The lead lines are marked as to where they go! Is it really that hard?


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## DV_EMT

similar to the towel at the head or foot of the bed,

AMR has a technique for putting sheets on their stretchers. at the feet, be sure to fold the sheet up instead of tucking it in at the bottom. 

They refer to it as the "Lompoc foot-fold" because most the people in lompoc have nasty feet. just drape the sheet over their feet and presto.... no more dirty feet to look at!


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## WannaBeFlight

If you place the Thumbwheel all the way up to the bottom of the IV bag, you will get no air bubbles in the line.


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## EMTelite

reaper said:


> The best trick of all? The lead lines are marked as to where they go! Is it really that hard?




But they are colored some people recoginize colors before they can read the letters on it so it therefore makes it easier its just like remembering tricks for tests like things that ryhme with words and associating answers with things that might remind you of the answer on the test


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## ffemt8978

We keep a knitting hoop with a red biohazard bag in it on the cots...great for when the patient wants you to see what he ate for his last 3 meals.  They're cheap, disposable, and can hold a lot more than the standard basins we carry on the rigs.  Plus you can get to them in a real hurry.


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## HotelCo

Never set your shears down anywhere, even for a minute. They won't be there when you goto pick them up.

A Tegaderm works better than a bandaid, it won't peel off so easily.


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## mycrofft

*OK I'm liking this thread.*

If you have a pt on a raised ambulance litter (aka "cot"), ALWAYS have positive physical control of it. They can tip them over, believe me. I'm talking at least one hand if the other hand is free, or both hands.

Don't use Combine or other "highly absorbent" dressings (often found sold as abd's) to stop bleeding. Toss a plain old gauze 4X4 on, then if you want pile on other stuff so you can make a pressure dressing and cover the mess. A "Combine" dressing is like a Kotex napkin, the blood is sucked up into it and the clotting takes place in the bandage not the wound.

Search our old threads about what NOT to pack ot carry.

Sometimes you can get a drunk to start to quiet down by talking and lowering the volume of your voice as you do, so they shut up to hear you. Sometimes.

Any pickup off the street, quickly and lightly frisk them once in the unit.


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## BLSBoy

mycrofft said:


> Any pickup off the street, quickly and lightly frisk them once in the unit.



I know the safety sallies will fall over with that one. 

Make sure you get yourself a pair of "skell gloves" for that. Ask any LEO for a suggestion.


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## Buzz

HotelCo said:


> Never set your shears down anywhere, even for a minute. They won't be there when you goto pick them up.



I once had some scissors tucked into my belt after dealing with a trauma patient. We got to the ER and there was another guy about to get flown out. A nurse ran out of the room grabbed my scissors and as she was pulling was like "Mind if I borrow these?" Only problem is the belt is a good way of holding scissors like that. She ended up yanking me along with it. She stopped was like "Those are in there really good, eh?"


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## mycrofft

*I meant patdown. Don't dip into pockets or socks.*

Remember that if you go to court, you paperwork will hang or absolve you. Make it good, keep it to the point, and make sure all copies go where they are supposed to.


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## NRNCEMT

HotelCo said:


> You mean you didn't learn that in your EMT-B class? Seems like a pretty basic skill...



And just to tell you, I saw a medic do the heart squeeze on a pt. on a scene and I asked my medical director about it and he said that it was fine.  Sorry if you don't like the tips I posted, they are ones that I've witnessed myself.


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## HotelCo

A medic doing a heart squeeze... A bit of a stretch, but I'll bite. Considering that this "trick of the trade" was posted in the BLS section, I couldn't help but poke fun at it.


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## NRNCEMT

HotelCo said:


> A medic doing a heart squeeze... A bit of a stretch, but I'll bite. Considering that this "trick of the trade" was posted in the BLS section, I couldn't help but poke fun at it.



Well...I am BLS, I don't do much roaming in the ALS section.


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## nomofica

place a roll of med (or any other type of) tape around the body of your steth; they can make great tape dispensers.

One for the c-spine: "C-3, 4, 5 keeps the body alive!"


Well known CPR compression timing tip: hum to (should probably do this in your head...) "Stayin' Alive" or "Another One Bites the Dust"

If scene safety is compromised by an individual (say, an "attacker"), throw something at their face/chest, and a jump kit at their feet. Then get the hell out of there.


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## mycrofft

*"C 1 and two, not much to do"....that's not right!?*

OK OK, serious stuff....
If you get the luxury of making your own kit, after looking at the threads here about what not to carry etc., consider these:
1. A good quality padded camera case will probably cost less than an equivalent "EMS" case, have moveable dividers, and a better selection of colors, straps, zippers, etc. Get burly double zippers, heavy nylon, no mesh.
2. Soft kits have less wasted space than a hard kit, and you can use their padding and the arrangement of contents to protect stuff. They don't hurt your legs.
3. Think of what you wil use most, stock the most of it, and make it central. Think of what you might absolutely need to save a life, list them, then stock the smallest and easiest to maintain items..one or two (OP airways being one). Periodically go through it for familiarization, inventory, replacement.
4. The capped plastic aliqout tube used to transport serum or the capped tapering  plastic tubes used to spin down urine are great for carrying a few ammonia inhalants, or AA batteries, or flashlight bulbs, large bore hypo needles, etc. Plastic sotrage tubes for Epi-pens are larger but good also.

Keep it legal!


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## zzyzx

"If you you have a CABG pt. and his/her staples bust open, you can perform CPR by squeezing the heart with a gloved hand."

Better yet, you should tear out the heart as it will then beat independently of the body.


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## nomofica

Not sure if anyone here has done this, but:

To improvise a good eye-washing unit, grab an NC, lay the pt supine and place the NC so that the nose tubules are in the corners of the pt's eyes (one in each eye). Then grab a 60cc syringe, fill 'er up with saline or water and squirt into the eyes via the NC tubing. Alternatively, set up an IV saline and hook the IV tubing to the NC tubing.


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## HotelCo

nomofica said:


> Not sure if anyone here has done this, but:
> 
> To improvise a good eye-washing unit, grab an NC, lay the pt supine and place the NC so that the nose tubules are in the corners of the pt's eyes (one in each eye). Then grab a 60cc syringe, fill 'er up with saline or water and squirt into the eyes via the NC tubing. Alternatively, set up an IV saline and hook the IV tubing to the NC tubing.



The second way is much better. You don't want to push the Saline/water through with a ton of force, just let gravity do it.


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## nomofica

HotelCo said:


> The second way is much better. You don't want to push the Saline/water through with a ton of force, just let gravity do it.



That's true, but not everyone has IVs available. I don't see many personal jump bags with full IVs.


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## mycrofft

*I've had mixed news on the NC thing.*

Poorly or not tolerated when I tried it, but I've had people tell me it worked wonders. 
I douse 'em if I can, works fast, gets the crud off the face which can get back into the eyes, and enough liquid gets rid of your worries about contaminating the pt, it's diluted.

For uncomplicted post-foreign object irritation or a little schmutz like dust, a refrigerated drinking fountain is very soothing, well tolerated if the pt holds their own eye open. Follow with NS flush if possible, can't hurt.

For a small kit like I have, carry a handful of the 3ml sterile NS pillows for inhalation. Good for IMMEDIATE mini-lavage (until you can get a real rinse for chemicals), often will wash out a speck of dirt on the first try, and also good for "dry eyes", or with small wounds. Extremely quick, variable pressure with excellent directivity, but little volume. And a lot cheaper than the "eyewash" they sell you for dry eyes, or  first aid kits.


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## EMTelite

I learned this in class as I was going through my trauma assessment... A blanket can be used very nicely as a hip splint


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## HotelCo

nomofica said:


> That's true, but not everyone has IVs available. I don't see many personal jump bags with full IVs.



Why would you need a personal jump bag? How often is it used?


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## nomofica

HotelCo said:


> Why would you need a personal jump bag? How often is it used?



Volly first responders and even the EMS boys at the oil rigs usually have their own bags.

I, myself, use a personal jump bag because i do a bunch of vollying for events like the Weekend to End Breast Cancer and the Ride to Conquer Cancer.


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## mycrofft

*Good question Hotelco*

It is a luxury and the first step down the steep and slippery slope to Whackerdom.
I use one because the beancounters and pilferers at my work make it dubious that I can quickly and efficiently treat "mandowns". 
All the more embarassing because they "put me in charge" of managing the emergency kits and gear, then largely ignore me.:blush:
OK, let's say you stumble onto the dream situation....
Back to the thread!


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## ResTech

Wow... a "Medic doing a heart squeeze" in the field after chest staples bust open.... that sounds like a good script for the new NBC show called Trauma! that's kinda like a Paramedic doing a C-section in the field.

Seriously, most of that list from NRNCEMT is bogus (sorry dude). From my experience with kids (3 of my own) and pulse oximetry... its either one finger is too small and two are too big for an adult sensor.... best bet is to have your service invest in the adhesive pediatric sensors. 

A tip my airway instructor told us involves nebulizer treatments.... and that is to tape the flexible tube to the T-piece so that the mist blows back into the patients face to try and maximize medication inhalation. Anyone else do this?


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## drdique

nomofica said:


> That's true, but not everyone has IVs available. I don't see many personal jump bags with full IVs.



I think the post about using an IV set and an N/C was referring to on-car situations. As for personal jumpbags, ask your service for a recently expired 250ml NS bag and a dropset, as you're not using it for intravenous purposes, saline is fine when expired <1yr to be used for irrigation. Again, i wouldn't recommend using this while on the job as you should use non-expired meds only with pt's. The N/C does work very well in my experience for eye irrigations though.


Also a note for all newby's: get in the habit of folding over the end of the tape after you tear off a piece. This will save you on that call down the road when you're doing an IV and have blood on your fingers and feel inclined to use your teeth to get the tape started. Something so small can save so much frustration.


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## nibejeebies

drdique said:


> Also a note for all newby's: get in the habit of folding over the end of the tape after you tear off a piece. This will save you on that call down the road when you're doing an IV and have blood on your fingers and feel inclined to use your teeth to get the tape started. Something so small can save so much frustration.



The Joy of working with a service that keeps a complete stock of Tegaderms!!!!!


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## drdique

We rock the tegaderms too.


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## DR_KSIDE

Try this one:

I know several people who like to stick their pens in their mouths....don't.

If you touched the pt with your glove and now you put the pen in your mouth, it like you just licked your glove.....you might as well forget the PPE.


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## Shishkabob

DR_KSIDE said:


> Try this one:
> 
> I know several people who like to stick their pens in their mouths....don't.
> 
> If you touched the pt with your glove and now you put the pen in your mouth, it like you just licked your glove.....you might as well forget the PPE.





My gloves are banana flavored, ergo, so are my pens.


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## nibejeebies

Linuss said:


> My gloves are banana flavored, ergo, so are my pens.



Ergo making PPE useless. 

I sanitize my Pens when ever I reach Destination. 

Oh Germ-X what would I do with out you?


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## Sasha

DR_KSIDE said:


> Try this one:
> 
> I know several people who like to stick their pens in their mouths....don't.
> 
> If you touched the pt with your glove and now you put the pen in your mouth, it like you just licked your glove.....you might as well forget the PPE.



Unless you keep seperate pens and don't write your reports with your gloves on, which you shouldn't.

I'm a pathological pen chewer.


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## Shishkabob

Sasha said:


> I'm a pathological pen chewer.





In middle school a girl was chewing on her pen one day.

It broke.

Ink all throughout her mouth.




Lets take bets on when it happens to Sasha.


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## Afflixion

also whenever possible don't ever touch a chart/ paperwork with gloves on... and I try to keep 2 pens on me 1 for PTs to sign with and one that I use myself. Can't give much more advise on "tricks" as I have been tainted by working in a combat environment... teeth are your friends, gloves are great if you have time, etc.


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## EMTelite

*Welllllllll*

Yeah the thing is here in california all reports are really done by computer and there is only one pen which is the electronic pen that pt's sign with that pen is also the pen that you are expected to do your report with so...


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## Scout

not touching paperwork?

Is that not part of the process of dealing with a pt, i'd go throught a box of gloves a pt if i was to do a change over between writting and touching a Pt.


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## Afflixion

said whenever possible... especially at hospitals nurse don't tend to like it when your hands are all over the chart with gloves on...


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## Sapphyre

EMTelite said:


> Yeah the thing is here in california all reports are really done by computer and there is only one pen which is the electronic pen that pt's sign with that pen is also the pen that you are expected to do your report with so...



Sorry, elite, you're wrong.  In Riverside, and San Bernardino counties, sure, there's ePCR for 911.  For IFT only companies, last I looked they were still on paper, as is the vast majority of LA County.


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## HotelCo

EMTelite said:


> there is only one pen which is the electronic pen that pt's sign with that pen is also the pen that you are expected to do your report with so...



The computers around here can use any pen.


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## mycrofft

*How about the many uses of duct tape?*

Patient, biomedical and automotive treatments.


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## Jon

I will back one of NRNCEMT's tips.

You CAN see lead II through the "paddles/pads".
I had a monitor cable fail on an SVT patient a few months ago. After 2 minutes of troubleshooting my medic and I hit the "f-it" point and pulled out the pads. Worked fine, and so did 12 of Adenosine.


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## mycrofft

*Mentholatum Lip balm or Vick's Vaporub*

Apply liberally under your nose for really stinky ones. Add a couple stonr mints in your mouth and it helps a lot.
Also good for chapped lips.


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## EMTelite

Sapphyre said:


> Sorry, elite, you're wrong.  In Riverside, and San Bernardino counties, sure, there's ePCR for 911.  For IFT only companies, last I looked they were still on paper, as is the vast majority of LA County.




Well as far as I have seen because I am yet as of now not on a rig hopefully soon I will be but I have gone on rideouts and have not seen one person use paper in Riverside they have all done everything on the computer my medic never touched a piece of paper.

But yes I was refering to 911 companies maybe I should have been more specific in choosing my words. I am really not sure about IFT companies as for me I have been doing everything with AMR riverside running ALS calls.


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## EMTelite

HotelCo said:


> The computers around here can use any pen.




And as far as what my FTO said to me... the computers that we use can only be accessed by this one pen because if is electronically attached to this computer and acts as a button on the end of it.


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## exodus

Yeah, we do paper paperwork here


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## EMTelite

are you IFT or 911?


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## Sapphyre

EMTelite said:


> But yes I was refering to 911 companies maybe I should have been more specific in choosing my words. I am really not sure about IFT companies as for me I have been doing everything with AMR riverside running ALS calls.



Exactly, you have experience with one company.  My experience in Riverside is about a year old, but, AMR was computer; Mission was paper; Lynch, while based in OC worked Riverside, and they were paper.

As far as Los Angeles County, I think only Shaffer is on computer, I know AMR and Care are still on paper.


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## Durchii

It really does differ from County to County. In Colorado Springs, AMR operates via computer (Typically, a laptop is given to both the Basic and the Medic) and from speaking with some Medics in Denver that I know, they're running on computer as well. 

_However_, I was in Larkspur for The Rennaisance Festival last Summer and broke off from my crowd to chat with Fire and the Stand-by's they had out there (Good way to piss off a girlfriend, by the way.  ) and they were all still operating on paper. I mean, Larkspur isn't huge, but it isn't tiny either. 

My conclusion, if it's not a major city, it's kind of a crap shoot as to what they're running. Buuuuut, I've been wrong before.


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## JPINFV

Scout said:


> not touching paperwork?
> 
> Is that not part of the process of dealing with a pt, i'd go throught a box of gloves a pt if i was to do a change over between writting and touching a Pt.



...and if you don't change gloves then there's no point in wearing them due to the amount of cross contamination.


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## notmeofficer

*Pressure point during compression wrap*

Ok.. I like this one and it works well in the field...

ALRIGHT.. REVIEW
4 steps of bleeding control
(PPE/Scene safe of course)
1) Direct pressure
2) Elevation
3) Pressure point
4) Tourniquet

Obviously there are sub steps and treating for shock//

One trick I learned was during the compression wrap (4 x 4s// more 4 x 4s.. compression wrap)... after you make a wrap or two make a twist in your kerlex as you come over the top of the wound.. the twist acts as a pressure point over the affected area.. also a good way to tighten the dressing if it is too loose.. which as we know NEVER happens.. at 2 am in the morning on some country road in the snow.. ever,,,,


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## EMTelite

*brillian*



notmeofficer said:


> if it is too loose.. which as we know NEVER happens.. at 2 am in the morning on some country road in the snow.. ever,,,,



^^ ^^^^^^^^^ lol


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## mycrofft

*That's the drawback to Medirip or Coban*

In the wet they don't stick as well if at all, but still fast for applying tight and compressive dressings. Good on you for not going to those combine ABD pads.


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## NRNCEMT

Here's a blood pressure cuff tip for you guys, you can use a manual BP cuff as a tourniquet to slow a gush/steady stream to a trickle.


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## mycrofft

*Also BP cuff to pressurize an IV bag.*

Watch those flow rates, though!:unsure:


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## Shishkabob

NRNCEMT said:


> Here's a blood pressure cuff tip for you guys, you can use a manual BP cuff as a tourniquet to slow a gush/steady stream to a trickle.



Been noted a lot, but you should also know to keep an eye on it as it will not be a long term solution--- air will leak out.


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## EMTelite

*maybe Im seeing it in a wierd way*

Just a question, has anyone used the blow by technique alot? doesnt seem like it is very practical but then again i am not working in the field yet so I wouldnt know just want to see what you guys think


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## Afflixion

Well you've never had to give O2 to a small child then have you? it is not the most efficient way to give O2 to a Pt but about 80% of small children will not keep a non-rebreather or a nasal cannula on so it's best to give them control of it to the children or their parents/guardians  and tell the child to put it infront of his/her mouth so they can breathe better... It helps alot but no it is not very effective but some O2 is better then none.


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## MtJerry

EMTelite said:


> Just a question, has anyone used the blow by technique alot? doesnt seem like it is very practical but then again i am not working in the field yet so I wouldnt know just want to see what you guys think



I have used it a number of times ... the goal is to enrich (increase the oxygenation) of the air around the mouth and nose of the child.  Even if there is no NC or Ped NRB, just O2 tubing pointed at the child's face is an improvement.


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## EMTelite

Ok yeah that gives me a better understanding and like I said I have not been out on the field yet so I will learn that


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## mycrofft

*Hypeventilation?*

Once yo ahve made sure you are not seeing MI, PE, or other "terrible nevergetover", some measures to address this are readily at hand.
1. Get the pt talking. This causes a break in the inhalations. It can also help reassure the pt. Ask them questions.
2. Have the pt pull up their shirt or blouse a little, and breathe/rebreathe the air inside which is warm, moist and quickly oxygen depleted. (Use commonsense, this works poorly with swimwear except maybe in Iran).
3. Continue to monitor, and make darn sure they are not hypertventilating because they are having an MI and are worreid etc. Treat the pt not the label.


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## vquintessence

mycrofft said:


> Once yo ahve made sure you are not seeing MI, PE, or other "terrible nevergetover", some measures to address this are readily at hand.
> 1. Get the pt talking. This causes a break in the inhalations. It can also help reassure the pt. Ask them questions.
> *2. Have the pt pull up their shirt or blouse a little, and breathe/rebreathe the air inside which is warm, moist and quickly oxygen depleted. (Use commonsense, this works poorly with swimwear except maybe in Iran).*
> 3. Continue to monitor, and make darn sure they are not hypertventilating because they are having an MI and are worreid etc. Treat the pt not the label.



Too funny!


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## mycrofft

*Here's a tip: slivers.*

STEP ONE: drip on Betadine if they are not allergic. Makes slivers visible, and if you fail to remove all or part of it, the betadine tends to slide down along the foreign object and disinfect along the way.
STEP TWO: use SQUARE TIP forceps like eyebrow tweezers, not sharp tip ones named "splinter forceps". 
STEP THREE: If forceps can't do it, use a hypodermic needle, at least 18 gauge. Very sharp, will not bend like a # 11 blade, and unlike sewing needles it had two sharp edges as well as a tip. 
STEP FOUR: If you can't get it out, and it needs to be gotten out, dress with betadine (no ointments) and send in. REMEMBER TO ASK ABOUT TETANUS STATUS.


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## mycrofft

*About asking for tetanus status...*

Never say "Is your tetanus shot current?", nor "When was your last tetanus shot?".
Ask "Do you REMEMBER when you had your latest tetanus immunization?". They will waffle and then admit "No" if you tell them most adults can't really remember.
If they say "YES", ask when where and why.


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## A140160

*Blow by*

Do you guys use an NRB when doing blow by?  We've found these really cool things that work wonders for us.  They're these rubber teddy bear like toys about 4 inches large, with a perforated space in the stomach (Think a care-bear with a old fashioned telephone mouthpiece in the center).  Kids tend to hold onto it better, even try to eat it... (And MAN to they drool...)  O2 comes through the holes. Pretty sweet.


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## Proud2bffemt

mycrofft said:


> Patient, biomedical and automotive treatments.



Just Remember If you cant fix it with Duct Tape and Bailing Wire, It Ain't Worth Fixin !!!


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## Proud2bffemt

mycrofft said:


> Treat the pt not the label.



I have always been taught, AND Teach in my Classes, Treat the Pt NOT THE EQUIPMENT.

If you have a pt who is breathing well and no distress with no signs but the SpO2 (Pulse ox for the non geeks of the group) shows a low number.. LET IT GO. If that is the Pts Normal sats and they are comfortable with no symptoms, To hell with it move on. but continue to watch ur pt. If they begin to fall off, then move in.


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## mycrofft

*Proud2bffemt, I hear you.*

I want so badly to take all the automatic VS machines we have (Dinamap, Welch-Allyn) and throw them off the roof.


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## daedalus

Proud2bffemt said:


> I have always been taught, AND Teach in my Classes, Treat the Pt NOT THE EQUIPMENT.
> 
> If you have a pt who is breathing well and no distress with no signs but the SpO2 (Pulse ox for the non geeks of the group) shows a low number.. LET IT GO. If that is the Pts Normal sats and they are comfortable with no symptoms, To hell with it move on. but continue to watch ur pt. If they begin to fall off, then move in.



So a oncologist should ignore the bright spot on the CT Scan if the patient has no outward signs of a tumor? 

The Cardiologist should ignore the slight ST abnormalities on the EKG in a patient with brugada syndrome even though it causes NO symptoms until the patient just drops dead one day?

The Paramedic should ignore the ST elevation in a female patient with a mild case of upset tummy?

The mammogram should be ignored when there is a potential lesion but no somatic signs of disease? What about the PAP showing some dysplasia? The lab word showing signs of systemic disease?

The saying is wrong, and it always has been. It was made as a teaching tool to tell Basics that they should give high flow 02 even if the sp02 was normal. Even that concept is wrong in most cases. In fact, lets just do away with the monitor because we shouldn't treat it. Than we can be left with AEDs. If we do not have telemetry, we cannot have manuel defibrillators or cardiac drugs, so lets do away with the paramedics. This whole treat the patient not the monitor thing is a self serving idea perpetuated by those who do not want more education.


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## MGary

*Blow-By*

Anyone here ever used blow-by to give an albuterol treatment to an infant or ped?

I was at the hospital here when the on call EMTs (Not me) brought in a baby having an asthma attack. I happened to be hanging out with respiratory therapy and she decided to give it an albuterol treatment but flipped the nebulizer around and plugged off the mouthpiece so that she was just pointing the dishcharge end at the baby's face. Seemed to do the trick.


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## smokd u2

I've assisted a Paramedic administer blow-by Albuterol to a 10 month old female infant experiencing an allergic reaction when I was riding along for my EMT class. It really opened up her lungs, she went from coughing and crying hysterically to being calm and quieter.


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## Patrol42

mycrofft said:


> Apply liberally under your nose for really stinky ones. Add a couple stonr mints in your mouth and it helps a lot.
> Also good for chapped lips.


I know I can use this one really well! Thanks!


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## Sasha

daedalus said:


> So a oncologist should ignore the bright spot on the CT Scan if the patient has no outward signs of a tumor?
> 
> The Cardiologist should ignore the slight ST abnormalities on the EKG in a patient with brugada syndrome even though it causes NO symptoms until the patient just drops dead one day?
> 
> The Paramedic should ignore the ST elevation in a female patient with a mild case of upset tummy?
> 
> The mammogram should be ignored when there is a potential lesion but no somatic signs of disease? What about the PAP showing some dysplasia? The lab word showing signs of systemic disease?
> 
> The saying is wrong, and it always has been. It was made as a teaching tool to tell Basics that they should give high flow 02 even if the sp02 was normal. Even that concept is wrong in most cases. In fact, lets just do away with the monitor because we shouldn't treat it. Than we can be left with AEDs. If we do not have telemetry, we cannot have manuel defibrillators or cardiac drugs, so lets do away with the paramedics. This whole treat the patient not the monitor thing is a self serving idea perpetuated by those who do not want more education.




Someone's getting a little sarcastic.

So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?

Why or why not?


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## JPINFV

That's why you use your diagnostic tools to develop a more complete picture of the patient's condition instead of just throwing out diagnostic results that don't match the patient's outward appearance.


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## Ped101

Always keep an extra pen hidden somewhere safe. You'll eventually lose your pen or it will fail in the middle of a run and you'll have a spare one to go 

xD


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## medic417

MGary said:


> Anyone here ever used blow-by to give an albuterol treatment to an infant or ped?
> 
> I was at the hospital here when the on call EMTs (Not me) brought in a baby having an asthma attack. I happened to be hanging out with respiratory therapy and she decided to give it an albuterol treatment but flipped the nebulizer around and plugged off the mouthpiece so that she was just pointing the dishcharge end at the baby's face. Seemed to do the trick.



Yes that is how you do it.  You can use a neb mask but if they are alert enough they will fight it, so blow by is easier and works great if they still are moving air enough to take the meds in.


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## daedalus

Sasha said:


> Someone's getting a little sarcastic.
> 
> So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?
> 
> Why or why not?



No, I do not think you understood what I wrote. Sorry for the late reply I forgot about this thread. 

I was making a pass on lack of education really. In fact, if one has proper education at the advanced level, they would see that this patient would probably not need 15 L oxygen based on their understanding of the pathophysiology of the patient's underlying deceases. There are so many factors like shock, anemia, CO, etc that factor into pulse oximetry that you need a proper education to utilize it properly, but it should absolutely be used to help formulate your field diagnosis.


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## el Murpharino

Sasha said:


> Someone's getting a little sarcastic.
> 
> So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?
> 
> Why or why not?



Blanket statements like this, as you very well know, don't fit well in any patient treatment modality.  I have had patients in no distress showing SpO2 in the low 90's having a AMI with NSR in lead II....again, it all comes down to a combination of your assessment and your tools.  The diagnostic findings, as has been pointed out countless times in other threads, should only be a small piece in the big puzzle.


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## remote_medic

Another thing I learned in my paramedic practicum:

A BP cuff makes a great tool to break into a vehicle. One of the guys locked his keys in the car in the station parking lot. H was able to sneak a deflated BP cuff in the door seam at the B pillar. Pumped it enough to bend the frame back enough to sneak in with a coat hanger and manuver it to get the lock.


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## guardian528

remote_medic said:


> Another thing I learned in my paramedic practicum:
> 
> A BP cuff makes a great tool to break into a vehicle. One of the guys locked his keys in the car in the station parking lot. H was able to sneak a deflated BP cuff in the door seam at the B pillar. Pumped it enough to bend the frame back enough to sneak in with a coat hanger and manuver it to get the lock.



i'll believe that when i see it


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## BorderDog

guardian528 said:


> i'll believe that when i see it



Something like this is available commercially







Works petty slick


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## KB1MZR

My Five Essential Pieces of Equipment:

Duct Tape
4X4's
Towels
Cravats
Trauma Shears

Just remember - anything can be repaired with tape and medic shears.

My favorite splints - pillow splint to a backboard if you have to do C-Spine.

I know there's more, can't think right now...


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## ethorp

guardian528 said:


> i'll believe that when i see it



yup it works. i locked my keys in my car and the leo opened it that way


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## ClarkKent

ethorp said:


> yup it works. i locked my keys in my car and the leo opened it that way



I have a 52 pic slim jim set and a door weg (smaller version of a BD cuff) is in it.


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## guardian528

well i've seen it, and i now believe it


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## Second

guardian528 said:


> i'll believe that when i see it



yep I've seen a locksmith use one before when I locked myself out. I felt like a dummy


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## wyoskibum

Blow by is great for kids who will not tolerate a cannula or mask.  We carry a stuffed animal and I'll wrap the tubing around the stuffed animal so the kid can hold/hug the toy.


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## Durchii

wyoskibum said:


> Blow by is great for kids who will not tolerate a cannula or mask.  We carry a stuffed animal and I'll wrap the tubing around the stuffed animal so the kid can hold/hug the toy.


Blow-By is one of my favorite methods for administering O2 to any child under three (hell, even four or five, depending on the child) when they won't accept the Ped NRB. I've also found that children can often be more scared of the Cannula than a Mask, due to the fact that they believe the extensions that fit into the nostrils are actualy syringe-like and will hurt them in some way. 

I had a four year old some time ago on a Ride Along that said, word for word, "No, I don't want that. It will go into my lungs and hurt." Kids are smarter than we give them credit for. So I usually skip the Cannula and go right to Blow-By with the Oxygen Bear if they won't accept the NRB.

Funny story, though. I must have had a really keen interest in the Medical Field when I was younger, because I was taken to the hospital when I was five or six after having a piece of ice and a bit of rock stuck in the Sclera of my left (or right... I really can't remember which one) eye during a snowball fight. From what my Ma tells me, I was so excited to have the NRB Mask over my face that I wasn't even concerned about my eye the entire trip to the ER. I think she was tempted to take one from the room we were in so I could take it home. Really amazing.


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## Momof7

Hi there, I never thought to put 2 fingers in the pulse ox. you can olso put it on their big toe. Let of a chance for them to pull it off.


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## Durchii

Second said:


> yep I've seen a locksmith use one before when I locked myself out. I felt like a dummy


Yep. I've seen a very similar device used by AAA when I locked my keys in my car nearly a hundred miles away from home. The guy they sent just slipped the pad in between the door and the frame, inflated it, and stuck a long pole into the gap it creates to hit the Unlock button. 

I tried the same technique with an old Adult BP Cuff on my buddy's Crown Vic, but the material around most Sphygmo's has _no_ grip to it whatsoever, so when you inflate it, it just pops out of the door before creating any gap whatsoever. 

Here's a good tip for doors, though. If you have a wire coat hanger and the basic technique down for opening doors with them, back doors will open much easier than front driver or passenger doors. A little patience, and it will work every time. Not that time effective if you lock your keys in the flippin' Ambulance and your radio is going off the hook... but...


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## Momof7

Oxygen bear? Explain, this sound cool. We have very little on our rigs to accomadate little ones. This is to bad as we hall a good share of pedi. Any other ideas to make our rigs more kid friendly?


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## Durchii

Momof7 said:


> Oxygen bear? Explain, this sound cool. We have very little on our rigs to accomadate little ones. This is to bad as we hall a good share of pedi. Any other ideas to make our rigs more kid friendly?



Hehe, I'm not kidding! 

They have Oxygen Tubing going through the dorsal side of them (or the bottom), which provides Blow-By while the child plays with the Bear. They look very similar to this one, except the ones AMR had during my Ride Alongs were blue in color and had a much more discreet method of providing the O2, as opposed to the very obvious holes on the front of this bear.







If you can't get a hold of these for your Units, carry one with you that you can wrap O2 Tubing around (As mentioned above), which will provide adequate Blow-By when pointed in the right direction. I like to give the child the bear and say, "Here you go, I trust you. Just hold on to this for me until the ride ends, all right?" This doesn't work with older kids, but under two or three it's pretty effective.


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## Medic744

We have the pedi masks that look like dinosaurs.  They are really cute.


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## Durchii

Medic744 said:


> We have the pedi masks that look like dinosaurs.  They are really cute.



Seriously? I would love to see those.


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## exodus

guardian528 said:


> well i've seen it, and i now believe it



One time we used the Pedi cuff to open up someones car who locked their keys in it...


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## gam649

rock med is a great learning org
u can make a rubber band from a rubber glove
you can fill a rubber glove with ice to make a cold pack
a medic showed how a garbage bag poke hole place around neck becomes a huge puke bag


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## ffemt8978

Closed for 13 year bump.


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