# Hardest part of paramedic school



## jgw1981 (Apr 19, 2010)

I'm a pretty new EMT-B (no street experience) and I'm starting Medic class in a couple of weeks.  I just would like some of you more experienced people who have gone through medic school to chyme in on what you found to be difficult part of Paramedic school.  I look forward to hearing what you all say!


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## Veneficus (Apr 19, 2010)

The last few weeks is the hardest.

After the marathon, and you are feeling confident from your achievements you see the end and start to slack off. 

It is a sprint to the finish, not a fade out.


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## 46Young (Apr 19, 2010)

A major pitfall that gets many is not finishing your clinicals in time. If it's up to you to schedule your clinicals, then I advise you figure out how many weeks you have to do them, how many hours you have, and divide the number of hours by the number of weeks. In my example, I had an average of 18 hours/wk. That means 16 hours a week and an extra rotation every four weeks. Ideally, you try to get ahead of schedule, but make sure, at all costs, that you don't fall behind your weekly average. 

In addition to falling behind by slacking, life issues may come up that prevent you from doing clinicals. You can get sick, or even worse, injured. How far will you fall behind with a 3-4 week back or shoulder injury, twisted ankle, etc. What about mandatory OT at work that conflicts with your clinical schedule? Stay ahead of the curve as much as you are allowed with respect to where you are in the program. You don't complete your hours, you can fail the class. Many don't extend time after the deadline to complete hours after the fact.


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## Shishkabob (Apr 19, 2010)

Depends on what you mean by 'hardest'.  Academics can be hard to some.  The amount of clinical time can be hard.  Internship can be hard.



Academically, people seem to have the most trouble with pharmacology and cardiology.  When it comes to pharmacology, as long as you have a decent understanding of the body, the drugs will make more sense (and buy a pharm book).  As for cardiology, get an EKG book, like Dubins, and study up on that.

Don't take a test then forget the material you were just tested on.  Even if material you learned was not on the test, it can be on a future test, the NR, or even save a patients life.


Don't just memorize the material, learn it.  Learn why a drug works the way it does.  Learn why you don't give a drug for something.  Learn how pacing works.    Strive to do more.  Too many students do the bare minimum and don't really care about learning more than they have to.

And when you finally schedule your clinicals, make sure you schedule atleast 1 day a week off from school and rotations where you can just relax, spend it with the family, and veg out.  You'll thank me (Coming from the person who pushed most of his clinicals in a 6 week period, taking only 1 full day off)


This is the career you chose, take it seriously.


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## Epi-do (Apr 19, 2010)

Linuss said:


> And when you finally schedule your clinicals, make sure you schedule atleast 1 day a week off from school and rotations where you can just relax, spend it with the family, and veg out.



This is probably some of the best advice you will get!  You will definitely need that time with friends and family to decompress a little.

As for what is the "hardest" part - like has already been mentioned, that will vary from person to person.  As far as the academic portion of class, the hardest part for me was pharm, but that was because it was pretty dry and we were expected to do a lot of memorization.  Understanding how/why the drugs worked certainly made it much easier to get through and retain that information.

Honestly, the hardest part for me was time management.   I just didn't feel like there were enough hours in the day between work, school, clinicals, field internships, my husband, my son, friends, family, and studying.  It was really tough sometimes to make any "me" time, and I didn't always make it a priority.  Try not to do the same thing.  It will greatly help with your level of stress if you realize that there are going to be times when you won't be able to do it all, that something has to give, and accept that it is ok.  Just don't neglect yourself in the process.


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## firetender (Apr 19, 2010)

The hardest part about paramedic school is the hardest thing about being a paramedic. Each person has, and is sure to find, an area in which they are weak, if not downright dangerous!


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## jgw1981 (Apr 21, 2010)

Thank you guys for the words of wisdom!  Pharm is what I think will be my biggest challenge, but it'll happen. Thanks for the advice on keeping ahead of the curve on clinicals, I'll be sure to do that!


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## EMTinNEPA (Apr 23, 2010)

Pediatrics and neurology, without a doubt, have been my biggest challenges.  Everybody says cardiology and pharmacology, but I've actually not had too much difficulty with those sections.

Pharmacology is mostly blunt memorization combined with a knowledge of how the body works, especially the sympathetic and parasympathetic nervous systems, alpha and beta adrenergic receptors, cellular metabolism, and the sodium-potassium pump.  Calculating drip rates, dopamine in particular because it's weight-based, gave me trouble until I found my own method for calculating... it will be the same for you.

IV access can be the most difficult skill to accomplish because think about it... you're trying to slide a little tube inside of another little tube.  Every other procedure we perform... intubation, needle decompression, etc.... there is some kind of anatomical landmark.

And definitely follow the advice of giving yourself one day a week to just go "blah..."... because thus far I have not, and I'm starting to burn out in a big way.

Just study your rear-end off and you should be ok.


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## Stephanie. (Apr 23, 2010)

I was wondering.. Is acid based balance really as hard as everyone says? I'm scared to even open up my book to that page, from all the horror stories.:wacko:


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## Veneficus (Apr 23, 2010)

If you passed General chemistry it is not bad at all. If you have no background in chemistry, you will be jumping into the middle of something big.

The best thing to do is get a copy of the PH and acid/base chapter of:

"Textbook of Medical Physiology" by Guyton. It is explained as if you have never taken chemistry. 

If you are really a glutton for punishment though, just get a general chemistry text and read the chapter on Bronsted-Lowry acid base.

It is not explained well in any Paramedic text. 

(as just a helpful piece of advice, the reason paramedic class is listed as a sophmore college credit in college is because it assumes understanding of freshmen level sciences aka biology for science majors, general chemistry, math, and physics)


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## 8jimi8 (Apr 23, 2010)

acid base is freaking simple.

Don't worry about it, don't try to memorize all the numbers at once, The most important numbers are 7.35 to 7.45, everything else can be arrived at by looking at the pH.

If you have been studying your airway chapters, then you have half of it figured out already.

Sorry, not trying to brag or show off, just don't let other people make you afraid of something that an 8th grader could learn.

I watched an interesting video in a psych class one time.  They had handraised monkeys and showed them a video of another monkey getting scared of a snake....

guess what happened to the handraised monkeys after they saw a snake...


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## rescue99 (Apr 23, 2010)

jgw1981 said:


> Thank you guys for the words of wisdom!  Pharm is what I think will be my biggest challenge, but it'll happen. Thanks for the advice on keeping ahead of the curve on clinicals, I'll be sure to do that!



Is it nosey to ask where you are taking the Medic class? I may be able to  help a bit with some study stuff if I know which school in the area.


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## Shishkabob (Apr 23, 2010)

EMTinNEPA said:


> Calculating drip rates, dopamine in particular because it's weight-based, gave me trouble until I found my own method for calculating... it will be the same for you.



Easy tip for Dopamine calculation for people, from a person who sucks at math himself--and this is for a 1600mcg solution

To get a 5mcg/kg/min drip rate, take the patients weight in pounds, take off the last digit, and subtract by either 2 or 3, depending on the originial weight.

If the pt weighed more than 209, you subtract 2.  If the patient was less then 209, you subtract 3.  

So if their weight was 210lbs, you take off the 0 getting 21, then subtract getting 19, and your answer is 19gtts/min for 5mcg/min.  Adjust accordingly for 10mcg/15/20mcg.


If weight was 190, take off the 0 to get 19, then subtract 3 to get 16gtts/min.




Disclaimer: But obviously, learn the real way to do this stuff first so you can always double check and be able to work with other drugs.


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## irish_handgrenade (Apr 23, 2010)

dealing with teachers whose teaching style is opposite yours... My medic teacher was one of those that read from the book the majority of the time, and would talk about these cool skills labs we were gonna do and they were always half assed or not done at all. I had trouble staying awake in the actual class.


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## EMTinNEPA (Apr 24, 2010)

Linuss said:


> Easy tip for Dopamine calculation for people, from a person who sucks at math himself--and this is for a 1600mcg solution
> 
> To get a 5mcg/kg/min drip rate, take the patients weight in pounds, take off the last digit, and subtract by either 2 or 3, depending on the originial weight.
> 
> ...



What I do is I put 400mg in 250cc and take the patient's weight in pounds divided by 10, subtract 2, then multiply by 2.  That will give me the gtts/min for 10mcg/kg/min and I titrate up or down.

For Lidocaine I use the clock method.

And for my epinephrine drip for symptomatic bradycardia I put 2.5cc of 1mg/cc 1:1000 into a 250 bag, which gives me 10mcg/cc and just set it at 60gtts/min.  Multiples of 10 are my big thing and if I can somehow get the driprate I want by multiplying, dividing, adding, or subtracting 10, I will do it that way.


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