# I need help so I can pass



## italk (Nov 2, 2011)

I need New Jersey Medical Protocols for glucose, Epi-pen,Nitro, atsma inhaler. I need different scenarios I can practice  using each one of these


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## NomadicMedic (Nov 2, 2011)

Seems like your instructor would be the best bet for this. Practice with someone in your class.


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## italk (Nov 2, 2011)

I do not see my instructor still next tuesday by that time it is to late I either passed or failed. so I am asking on the forums so I can practice some.


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## EMSrush (Nov 2, 2011)

Protocols vary widely from state to state, even from county to county- so be careful not to confuse yourself with different protocols that might be on Emtlife.com. Have you tried to see if what you are looking for is available on your state's DOH/EMS website?


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## italk (Nov 2, 2011)

I can not find anything for jersey like for scarnarios I want people to give some so I can give it to someone to test me on it.


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## Handsome Robb (Nov 2, 2011)

Didn't you do scenarios in class? Maybe use some of them? All the meds you listed are pretty basic in their indications and contraindications.


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## italk (Nov 2, 2011)

We did some in class but, most of were trauma based not medication based so I asking for scenarios so my mom can test me.


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## italk (Nov 2, 2011)

All I am asking is for example scenarios I can test myself with I can upload all of the protocols if that would help


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## Chief Complaint (Nov 2, 2011)

For your medical assessment station there are only a few options as to what is wrong with your patient.  Its either going to be an allergic reaction (Epi), asthma (Albuterol), chest pain (Nitro), or a diabetic (oral glucose).

The scenario will be pretty obvious as to which medication is indicated.

Doesnt sound like your instructor prepared you guys and gals for registry all that well.


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## italk (Nov 2, 2011)

My instructor all he did was yell. I am scared because if I do not make it I'm out. third 3 try. can I have example scenario so I practice better.


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## Chief Complaint (Nov 2, 2011)

italk said:


> My instructor all he did was yell. I am scared because if I do not make it I'm out. third 3 try. can I have example scenario so I practice better.



Alrighty.

You arrive on scene and find a 62 year old female who is confused, but still responds to you.  Bystanders state that she began mumbling obscenities and "acting funny" about 15 minutes before EMS was called.  Her skin is cool to the touch and vitals are as follows:

Pulse - 96 and thready
Resp. - 18
BP - 138/90
Lungs - present and equal bilaterally
Pupils - PEARL
BGL - 48

Go!


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## Handsome Robb (Nov 2, 2011)

I'll throw you a bone.

19 yo patient complaining of respiratory distress. Upon arrival you see a 19 yo female in the tripod position at a family BBQ. ABC assessment reveals facial and swelling of the tongue, lips and mouth. The patient has audible stridor, accessory muscle use and is breathing rapidly. The patient has hives on her chest. Pt is tachycardic, BP is 92/70. SAMPLE indicates allergies to bee stings and asthma. Only meds are an Epi-Pen and inhaler prescribed by her doctor. 

What do you do?

Dispatched to Behavioral emergency. U/A 45 year old male alert to verbal stimuli, A&Ox1, pt is agitated/combative but talking to you. The pulse is rapid, adequate respirations, BP 128/82, skin is cool, and diaphoretic. The patient's wife tells you he has a no history of psychiatric problems but has a history of Insulin dependent diabetes.

What do you do?

There's two, someone else can give you the other two.

Your welcome.


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## Chief Complaint (Nov 2, 2011)

Scenario 2:

You arrive on scene and find a 58 year old male complaining of crushing substernal chest pain that radiates to his abdomen, and shortness of breath.  The pain started about 20 minutes ago.  He has an extensive medical history which includes a bypass surgery 4 years ago, and is prescribed Nitro by his doctor.  

Go!


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## Handsome Robb (Nov 2, 2011)

Chief Complaint said:


> Alrighty.
> 
> You arrive on scene and find a 62 year old female who is confused, but still responds to you.  Bystanders state that she began mumbling obscenities and "acting funny" about 15 minutes before EMS was called.  Her skin is cool to the touch and vitals are as follows:
> 
> ...



Cheating! Unless basics can do BGL in NJ.


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## italk (Nov 2, 2011)

What is BGL? Is this situation call for glucose?


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## Handsome Robb (Nov 2, 2011)

Dispatched to 21 year old female complaining of respiratory distress.

U/A 21 yo Female sitting on the porch in tripod position. C/C of shortness of breath and tightness in her chest. She talks in 2 word sentences between breath. She is breathing 30 times a minute. She is blue around the mouth. She tells you "my boyfriend...gasp....just broke...gasp...up with...me". She has audible wheezing. She has a history of asthma and depression. When you ask about meds she hands you an inhaler.

What do you do?


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## Handsome Robb (Nov 2, 2011)

italk said:


> What is BGL? Is this situation call for glucose?



BGL = blood glucose level. 

You need to reference which scenario your talking about, there's more than one that was presented.

Don't as us what it's about, tell us what your thoughts are and how you would treat it.

I'm willing to bet that we have more medical knowledge than your mother, no offense.


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## italk (Nov 2, 2011)

In nj paramagic's can do BGL


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## Handsome Robb (Nov 2, 2011)

Seeing as your not a paramedic student that doesn't really matter now does it?


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## italk (Nov 2, 2011)

The one of glucose from Chief compliant I would first ask if he has not taken his insulin in day and make sure he can swallow but I would calls ALS.  I would use one tube of glucose in the tongue suppressor places between in the cheek and gum also, rapid transport


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## Chief Complaint (Nov 2, 2011)

NVRob said:


> Cheating! Unless basics can do BGL in NJ.



I know i know, i shouldnt have put that in there!



italk said:


> The one of glucose from Chief compliant I would first ask if he has not taken his insulin in day and make sure he can swallow but I would calls ALS.  I would use one tube of glucose in the tongue suppressor places between in the cheek and gum also, rapid transport



Well, you got some of it.  You are correct, this patient is a diabetic and oral glucose would be your treatment (pending verification of the 5 rights).  ALS should also be called (you should verbalize this for ANY medical scenario they give you).  Its not called a "suppressor", its a "depressor".

You arent planning on just walking up and giving the glucose are you?  There is an entire assessment to be done.  Do you have your skills sheets handy?  Sounds like you might want to look them over quite a bit.


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## fast65 (Nov 2, 2011)

NVRob said:


> Dispatched to 21 year old female complaining of respiratory distress.
> 
> U/A 21 yo Female sitting on the porch in tripod position. C/C of shortness of breath and tightness in her chest. She talks in 2 word sentences between breath. She is breathing 30 times a minute. She is blue around the mouth. She tells you "my boyfriend...gasp....just broke...gasp...up with...me". She has audible wheezing. She has a history of asthma and depression. When you ask about meds she hands you an inhaler.
> 
> What do you do?



I feel as though she may have carpopedal spasms as well h34r:


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## DV_EMT (Nov 2, 2011)

Called to a Park where a 23 y/o Male is complaining of Shortness of Breath. Patient Vital Signs 

HR: 140  
BP: 82/38 
Resp: 28 - Labored 
Skin: Cool & Diaphoretic  
Eyes: PERRL

Patient has known allergies to latex. Patient last ate 30 minutes prior to 911 call. Friends stated that they shared their lunch with him which included Trail Mix and a Banana. 

What do you do? ask any questions you may have if I forgot to mention them


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## Handsome Robb (Nov 2, 2011)

fast65 said:


> I feel as though she may have carpopedal spasms as well h34r:



Wheezes are not created by the patient? When questioned the pt states this feels like previous asthma attacks 

Put that in your pipe and smoke it!

italk, you didn't address any scenarios I presented...They aren't gimmes but they aren't overly complicated either.


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## Handsome Robb (Nov 2, 2011)

Chief Complaint said:


> I know i know, i shouldnt have put that in there!
> 
> 
> 
> Well, you got some of it.  You are correct, this patient is a diabetic and oral glucose would be your treatment (pending verification of the 5 rights).



6 rights  Drug, Dose, Route, Time, Patient, Documentation


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## Chief Complaint (Nov 2, 2011)

NVRob said:


> 6 rights  Drug, Dose, Route, Time, Patient, Documentation



Interesting, its taught as the 5 rights round these parts.  All of the above except documentation.


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## fast65 (Nov 2, 2011)

NVRob said:


> Wheezes are not created by the patient? When questioned the pt states this feels like previous asthma attacks
> 
> Put that in your pipe and smoke it!
> 
> italk, you didn't address any scenarios I presented...They aren't gimmes but they aren't overly complicated either.



I overlooked that fact...don't judge me


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## italk (Nov 3, 2011)

Chief Complaint said:


> Scenario 2:
> 
> You arrive on scene and find a 58 year old male complaining of crushing substernal chest pain that radiates to his abdomen, and shortness of breath.  The pain started about 20 minutes ago.  He has an extensive medical history which includes a bypass surgery 4 years ago, and is prescribed Nitro by his doctor.
> 
> Go!



Scene size up and primary acessment
give him o2 on non-rebreather at 15 liters per minute or nasal canula.
request als and monter response time 
place patient in posision of confort
obtain baseline vituals and obtain SAMPLE history
__________________________________________________

Chief compliant chest pain
Does he have his own nitro
is his systolic pressure great than 100HGmm
Has he taken the maxium dose prior to me coming
Ask if he had any Ed meds within 24 hours 
see if he has head injury 

_________________________________________________

I will check to see if his nitro is right patient,right dose, right route , right time and right documentation.
Also, it can not be exspired beyond the date it says on the bottle
if this all valid I will assessst him in his nitro 
I will do eithe one spray or 1 tablet under the tongue
Now I will wait 1 or 2 minutes 
Reassess his vituals if still complaing repeat process


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## italk (Nov 3, 2011)

NVRob said:


> I'll throw you a bone.
> 
> 19 yo patient complaining of respiratory distress. Upon arrival you see a 19 yo female in the tripod position at a family BBQ. ABC assessment reveals facial and swelling of the tongue, lips and mouth. The patient has audible stridor, accessory muscle use and is breathing rapidly. The patient has hives on her chest. Pt is tachycardic, BP is 92/70. SAMPLE indicates allergies to bee stings and asthma. Only meds are an Epi-Pen and inhaler prescribed by her doctor.
> 
> ...



Scene size up and primary assessment
administer o2 on non-rebreather device at 15 liter per minute or nasal canula at 6 liters per minute
place patirent in posistion of confort
call/request als and moniter response time
obtain base line vituals and Sample history
Conduct physical and focused assessment
no contra because this a 911 problem
_________________________________________________

Cheif compliant Anaplaxes
adminster epi
Make sure it is here epi 
Make sure it is not exspired
Check for color if yellow throw it out if not use it
stab epi pen in liatual thiegh  and hold for 10 seconds and after that rub for 10 seonconds
than put epi in the sharps
resasess vituals 
rapid transport


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## Imacho (Nov 3, 2011)

italk said:


> Scene size up and primary acessment
> give him o2 on non-rebreather at 15 liters per minute or nasal canula.
> request als and monter response time
> place patient in posision of confort
> ...



You WILL ALWAYS CHECK the 6 pt rights prior to ANY DRUG ADMINISTRATION. Regardless if it is their rx or not.


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## italk (Nov 3, 2011)

I ment to say will sorry


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## italk (Nov 3, 2011)

NVRob said:


> BGL = blood glucose level.
> 
> You need to reference which scenario your talking about, there's more than one that was presented.
> 
> ...



My mom is a nurse in plastic surgery


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## JPINFV (Nov 3, 2011)

italk said:


> The one of glucose from Chief compliant I would first ask if he has not taken his insulin in day and make sure he can swallow but I would calls ALS.  I would use one tube of glucose in the tongue suppressor places between in the cheek and gum also, rapid transport



Is insulin the only medication that can cause hypoglycemia in diabetic patients?


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## italk (Nov 3, 2011)

I do not know


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## fast65 (Nov 3, 2011)

italk said:


> I do not know




I think he was hoping that you would research it a little bit...


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## NomadicMedic (Nov 3, 2011)

fast65 said:


> I think he was hoping that you would research it a little bit...



That's kind of the way it works here. We won't spoonfeed you the answers, but we'll point you in a direction where you can learn.


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## Anjel (Nov 3, 2011)

My help to you...

Wait a couple years and retake the class. From what you have presented on the board you need to grow up a little.

Work on your spelling, punctuation, become independent of mom, and learn study and research skills.

Take an anatomy class, finish high school, enjoy your teens. 

In a few short weeks you are going to have your own real pts, real problems that are going to be other than asthma, heart attack, allergic reaction, and diabetes. The answer wont be high flow o2 and rapid transport. You have to think outside of the box at the big picture. 

This is the only help I can give you.


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## italk (Nov 3, 2011)

I  almost done with my class just 2 more mods left I think. I have been on call. If fail this scenario I might try first responder than go back to emt. I am going to be focused and I will pass.


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## italk (Nov 3, 2011)

JPINFV said:


> Is insulin the only medication that can cause hypoglycemia in diabetic patients?



I found out I ask a real diabetic in school today they told me soda and food. Also, stress


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## Handsome Robb (Nov 3, 2011)

Soda and food will cause *hyper*glycemia. More glucose with nothing to do with it.


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## italk (Nov 3, 2011)

Should I do nothing just wait for ALS and than meet up


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## Handsome Robb (Nov 3, 2011)

What are you talking about?

You should never delay transport in a critical patient. It all depends on transport time and ETA of the ALS unit.


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## JPINFV (Nov 3, 2011)

NVRob said:


> What are you talking about?
> 
> You should never delay transport in a critical patient. It all depends on transport time and ETA of the ALS unit.




"Never" and "always" are dirty words. In most cases, don't delay transport unless something system specific is in play. It could easily be argued that patients who may be triage to a specialty center based on paramedics (e.g. ruling out hypoglycemia in a potential CVA, diagnosing a STEMI, etc) should sit tight pending paramedics, especially when the specialty center and closest hospital are in opposite directions. It's better to delay transport a few minutes than deal with the time delay for setting up, and then transporting, a patient to a specialty center.

Also, I'd also argue if I was working today that paramedic ETA vs hospital ETA would be more beneficial if it was something along the lines of hospital ETA vs Paramedic ETA + 5 minutes. Even with conditions that can be stabilized by paramedics, there are going to be a few minutes between rendezvous (paramedic ETA) and initiation of treatment, be it moving gear to the patient or assessment.


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## BrushBunny91 (Nov 4, 2011)

Medications that can cause drug-induced hypoglycemia include:

Bactrim (an antibiotic)
Beta-blockers
Haloperidol
Insulin
MAO inhibitors
Metformin when used with sulfonylureas
Pentamidine
Quinidine
Quinine
Sulfonylureas

The site also lists that alcohol can induce hypoglycemia. Because of the sugar content of alcohol I would assume it would be more likely to cause hyperglycemia. Unless it somehow prevented the cells from absorbing the glucose properly or it stimulated urination so that it would expel the glucose?

http://www.drugs.com/enc/drug-induced-hypoglycemia.html


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## Chief Complaint (Nov 4, 2011)

All of this input is fantastic, but keep in mind the OP is aiming for his EMT-B.  No need to overcomplicate it.


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## BrushBunny91 (Nov 4, 2011)

It was my answer to a question asked earlier in the thread.


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## JPINFV (Nov 4, 2011)

Chief Complaint said:


> All of this input is fantastic, but keep in mind the OP is aiming for his EMT-B.  No need to overcomplicate it.




Memorizing which specific medications, including how to identify medications (e.g. beta blockers are -lol medications, like metopro*lol*)  would be over-complicating entry level EMT-B. Understanding that insulin isn't the only medication capable of causing hypoglycemia, however, is definitely important.


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## Handsome Robb (Nov 4, 2011)

JPINFV said:


> including how to identify medications (e.g. beta blockers are -lol medications, like metopro*lol*)  .



Why? it's not overly complicated and can tell you a lot about a patient's condition. Most just know take the blue and purple one with breakfast, the pink one with lunch and the red one at bed time.

I'm not saying all of them just the common ones. olols, prils, sartans, pam/lam.


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## BrushBunny91 (Nov 4, 2011)

I'll remember that "lol" is not funny when dealing with hypoglycemia... :rofl: 
Gosh I need to go to bed.


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## STXmedic (Nov 4, 2011)

I'm going to have to side with Anjel on this one. Take some time off to go to school and mature a bit, kid. You are obviously not ready to work independently as an EMT. If you're having this much trouble with the medical emergencies that the school drills into your head, it scares me to think what you'll do in the field when things aren't so black and white.


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## italk (Nov 4, 2011)

I will post video on of the scarnaros so you guys can see


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## italk (Nov 4, 2011)

I will post the video if it is allowed


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## Handsome Robb (Nov 4, 2011)

Lets see it.


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## fast65 (Nov 4, 2011)

NVRob said:


> Lets see it.



+1

Let's see you run through them 


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## Handsome Robb (Nov 4, 2011)

fast65 said:


> +1
> 
> *Let's see you run through them*
> 
> ...



Even better


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## italk (Nov 4, 2011)

i WILL RUN THROUGH EACH MEDICATION SCANARIO


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## fast65 (Nov 4, 2011)

NVRob said:


> Even better



Oh, I thought that was the plan the entire time 


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## STXmedic (Nov 4, 2011)

italk said:


> i WILL RUN THROUGH EACH MEDICATION SCANARIO



Sooo... How's it coming?


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## italk (Nov 4, 2011)

It's coming good but, my only problem is that I could not find a human so the only thing I could find was the dog.


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## STXmedic (Nov 4, 2011)

italk said:


> It's coming good but, my only problem is that I could not find a human so the only thing I could find was the dog.



Is he answering all your questions appropriately? If it's uncooperative, get a BGL.


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## DV_EMT (Nov 4, 2011)

PoeticInjustice said:


> Is he answering all your questions appropriately? If it's uncooperative, get a BGL.



I LOLed pretty hard at that.


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## mycrofft (Nov 4, 2011)

*Is it dark under that bridge? Goats bother you?*

................:rofl:


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## Handsome Robb (Nov 5, 2011)

PoeticInjustice said:


> Is he answering all your questions appropriately? If it's uncooperative, get a BGL.



:rofl: Win :rofl:


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## exodus (Nov 5, 2011)

italk said:


> It's coming good but, my only problem is that I could not find a human so the only thing I could find was the dog.



I just busted up laughing. XD

Use your mom. She's a RN. She can assist you with scenarios. Hand her the skills sheet and read it to her from your memory. Thats it.


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## NomadicMedic (Nov 5, 2011)

This thread is on the verge of ridiculous. Based on the posts its fairly obvious that the OP isn't at a point where he can pass testing scenarios, never mind manage an emergency scene as a provider. 

OP, wait a few years, get some maturity, spelling lessons and some perspective... Then try again.


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## fast65 (Nov 5, 2011)

I'm going to have to agree with n7lxi here, the OP just doesn't have what it takes to pass the practicals yet, as harsh as that sounds.

You need to focus on high school at this point in time, get a solid education of the core subjects and then focus on your EMT course after that. If you can take some A&P courses, some chemistry, and some writing classes in high school, then you'll be much more prepared for an EMT course in the future. Work on your primary education right now, then focus on your career goals after that.


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## Sasha (Nov 5, 2011)

I've had a hard time understanding so I've just stayed out of it (part of my effort to be nicer)

But I agree with n7lxi.

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## Sasha (Nov 5, 2011)

Wait I agree with anjelica. She said it first

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## NomadicMedic (Nov 5, 2011)

In that case, I default my position to whoever said it first… But I stand firm in my conviction that this thread has derailed to the point of ridiculous. 

If I were doing QI and had to read this guy's charts, I think I would shoot myself in the face with a flare gun.


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## fast65 (Nov 5, 2011)

Sasha said:


> Wait I agree with anjelica. She said it first
> 
> Sent from LuLu using Tapatalk



Then I agree with Anjelica...and n7lxi


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## STXmedic (Nov 5, 2011)

fast65 said:


> Then I agree with Anjelica...and n7lxi



Pfft. I agreed with her first.


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## fast65 (Nov 5, 2011)

PoeticInjustice said:


> Pfft. I agreed with her first.



Well we're besties, so I agreed with her by default ;P


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## STXmedic (Nov 5, 2011)

fast65 said:


> Well we're besties, so I agreed with her by default ;P
> 
> 
> Sent from my iPhone using Tapatalk



But... But... 

*sulks away grumbling*


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## Handsome Robb (Nov 5, 2011)

fast65 said:


> I agreed with her by default ;P



Would you like me to help you get your man-card back? :rofl:

I kid, I kid!


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## Sasha (Nov 5, 2011)

fast65 said:


> Well we're besties, so I agreed with her by default ;P
> 
> 
> Sent from my iPhone using Tapatalk



Uhm no. She's MY bestial. 

Duh.

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## fast65 (Nov 5, 2011)

NVRob said:


> Would you like me to help you get your man-card back? :rofl:
> 
> I kid, I kid!



That's ok, I lost it a long time ago 


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## Anjel (Nov 6, 2011)

Aww I feel loved.


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## Remeber343 (Nov 6, 2011)

I think you guys scared him off...


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## fast65 (Nov 6, 2011)

Remeber343 said:


> I think you guys scared him off...



Honesty has that effect on some people.


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## Remeber343 (Nov 6, 2011)

Very true.. he just needs time.. A lot of his answers were very vauge and generalized.. and we all know that 15 lpm o2 isnt always the answer


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