# clinicals



## ironguy321 (Oct 4, 2007)

I have clinicals in a few weeks and I'm a little worried because I have no idea what to expect. Our instructor is also having us fill out patient forms as well to get the practice. Can anyone give me any hints/tips/insight to what I'll be seeing/doing?


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## rgnoon (Oct 4, 2007)

ironguy321 said:


> I have clinicals in a few weeks and I'm a little worried because I have no idea what to expect. Our instructor is also having us fill out patient forms as well to get the practice. Can anyone give me any hints/tips/insight to what I'll be seeing/doing?



It entirely depends on where you are doing your clinicals. I did mine split between one of the busiest Level I trauma centers east of the Mississippi and a tiny community hospital that coincidentally will be closing next month. I was lucky enough to be able to split my experience like this and saw a whole range of different types of patients. I can only share with you my experiences.

In the trauma center we saw pts from fatal MVAs and motorcycle wrecks (one with a grade 4 liver lac), a pt from a nearby corrections facility who had been severly injured in a riot, CHF'ers,  Asthmatics, PTs with renal failure, and a GSW to the chest. We were exceptionally lucky in that this trauma center was at a large teaching hospital. This translated to Attendings who threw us in with their residents and treated us with great respect. We were encouraged to assist with patients (under close supervision of course, and within our skill set) and ask as many questions as possible. We had medics en-route call the hospital and tell them to have us meet them at the door so that they could show us pts that they were bringing in.

At the community hospital we saw some allergic reactions, SOB, AMS, COPD'ers, and a car vs. pedestrian. We were encouraged to utilize our basic skills in helping nurses with vitals and patient assessment and were given patient histories so that we might better understand the events that brought the pt to the ED. 

Every clinical experience is going to be different, and I feel very lucky to have been able to do time in such different environments. It was during my clinicals that I knew this was the field for me. In the TC we were warned that should we feel weak or nauseous to simply sit against the wall and wait it off, as this was something they saw frequently. While assesing the pt from the motorcycle wreck (who's injuries were ultimately fatal) the attending looked up to see us eagerly peering over his shoulder and commented that it was clear he didn't have to worry about either of us passing out. 

I learned a great deal about emergency medicine and patient care during my clinicals, and feel that they were not only an invaluable experience, but one that I will never forget. I can only suggest that you go into your experience as open-minded as possible and try to observe closely. I realize that I've begun to ramble a bit, I only hope that some of it helped.


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## Gbro (Oct 4, 2007)

Depends on the size of the facility you do your clinical at.
I think the Anasteziologist could be a valuable treat. They "ARE" airway managment. Hopefully you will get a chance to watch them preform.


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## Asclepius (Oct 4, 2007)

It doesn't really matter where you do your clinicals. What is important is that you seize the opportunity. You'll only get as much out of your clinicals as you put into them. You'll have some preceptors that consider you a nuisance and others that will love the help and the opportunity to teach. 

Be proactive! Don't sit around the ER waiting for something to happen. Look at charts, ask to help, follow the doctors and nurses around. It's their job to teach you and they are getting paid for it.

In surgery ask for the intubation's. It can be scary, but that is the place to practice. In the controlled environment, I mean. 

If there is nothing going on in Labor and Delivery then try to do some labor assessments. Ask all the questions you would ask the patient in the field. Some patients will let you observe the birth, others will not...but almost all of them will let you ask questions. Practice figuring out the estimated date of confinement, measure the fundus, try to listen for fetal heart tones with your stethoscope, etc.

The key point in all your clinicals is to not blow them off. They could very well make the difference in your career. 

Good luck!


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## Hastings (Oct 4, 2007)

I don't know what you can expect to experience, because every location is different, every day is different.

What I can tell you however is that these people are there to help you learn. Don't just stand in the hall. Get involved in whatever you possibly can. The instructor will not let you make any fatal mistakes. Just do what you've been taught to do, and do it the best you can. As long as you are as involved as possible, you will see a lot of cool things, do a lot of cool things, and earn the respect of those around you.

You should be nervous, but those feelings will pass quickly. It'll simply be fun. Make sure that you get the most of it.


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## Ridryder911 (Oct 4, 2007)

Asclepius said:


> It doesn't really matter where you do your clinicals. *What is important is that you seize the opportunity. You'll only get as much out of your clinicals as you put into them. You'll have some preceptors that consider you a nuisance and others that will love the help and the opportunity to teach.
> 
> Be proactive! Don't sit around the ER waiting for something to happen. Look at charts, ask to help, follow the doctors and nurses around. It's their job to teach you and they are getting paid for it.
> 
> The key point in all your clinicals is to not blow them off. They could very well make the difference in your career. *



Nothing more can be added ! 

R/r 911


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## BossyCow (Oct 6, 2007)

Are the 'Patient Forms' the MIR or Medical Incident Report?  If so fill out one on every patient you see. Being able to write a good report is an important skill.  I tell my students that everything they do in their patient care should be supported by something in the report.  If they put a n/c on the pt, I want to see something in their report that justifies it.  If they didn't, I want to see something that tells me why.  If they did or didn't call for ALS support, same thing, why or why not.  

When we get new EMT's, I have them write their own version of the report on every call they ride along on.  Then I go over it with them, comparing it to the official one.


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## Easy (Oct 9, 2007)

THe best time I had in clinicals was at a small community hospital.  We had a STEMI patient come in and I got to see the treatment from start to finish.  Rig to ER to cath lab, watched the entire procedure, then I wheeled him to ICU myself.  Pretty cool how things get cooking when the heart ain't right.  Have Fun!


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## jakobsmommy2004 (Oct 9, 2007)

ironguy321 said:


> I have clinicals in a few weeks and I'm a little worried because I have no idea what to expect. Our instructor is also having us fill out patient forms as well to get the practice. Can anyone give me any hints/tips/insight to what I'll be seeing/doing?



They might ask you to help with a patient ( within you scope of practice).   jump from room to room. ask all the questions like you were in the ambulance. get the SAMPLE and the OPQRST. get the vitals. bring a note book and later write your patient forms. you might see stuff that we will never have to do as a basic. i seen them do spinal taps. and give a central line. (witch i felt a little woozy lol)  the nurse might tell you to retake the vitals on a certian patient. ask alot of question to the nurse because you are being graded and it shows you are willing to learn.  have a neat and clean appearence. do not stand around doing nothing. go and retake vitals on the patients. if you find something abnormal tell the nurse. remember to listen to lung sounds. hope this helps


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## DisasterMedTech (Oct 10, 2007)

I also found when I did my ER time, that I asked if I could float when not otherwise occupied and just talk to the different patients. They let me. It was a good way of hearing them talking about their CC, work on questioning skills....if they are their for a chest cold, ask if you can listen to their lungs. Just remember to always tell them you are a student. We had one girl say she was an EMT..needless to say she will never be one because she was charged with essentially impersonating EMS personnel.

Overall, have a good time. Its a great learning environment. And dont get insulted if you get told to get out of the way. This happens alot because a severe trauma may just not be the time for a teaching case.

Have fun and let us know how its going.


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## OreoThief (Oct 10, 2007)

*Communication....*

Clinical locations will vary on what they will and will not allow you to do. At my clinicals, the first thing I did was introduce myself, ask what was expected of me, and then let my preceptor know what I was or not comfortable doing. I took vitals, vitals, vitals, which was great practice, and spoke to nearly every patient I came into contact with. It's truly what you make of it..... Hope you enjoy.


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## ironguy321 (Nov 6, 2007)

had my first rotation today, it was only a 4hr triage but you have to start somewhere. I learned a lot and asked a ton of questions (mostly about triaging rather than what’s happens in the ED since I wasn’t back there much). VERY BUSY! I was literally busy the entire 4hr’s and I enjoyed it (nervous but expected). A pt commented and asked me if I was nervous. I said I was a student and she understood. How do I get rid of that nervousness? I’m still new so I don’t have a ton of confidence but I was just wondering what you guys did so that pt’s DON’T sense if your nervous or not? (I’m still practicing practicing practicing)


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## MMiz (Nov 6, 2007)

This will sound weird, but I'd suggest faking it.  Fake being more confident until you are more confident.  Attitude is everything, and if you don't quite have the confidence you want, fake it until you reach that point.


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## medicdan (Nov 7, 2007)

MMiz said:


> This will sound weird, but I'd suggest faking it.  Fake being more confident until you are more confident.  Attitude is everything, and if you don't quite have the confidence you want, fake it until you reach that point.



I would usually agree with that, but do you want new EMTs Faking vitals, faking understanding of a patient's condition, or because of their "Fake" confidence, overlooking patient symptoms that should be reported to nurses or doctors?


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## Ridryder911 (Nov 7, 2007)

Here is the jest of it. Basic EMT clinical are presumed to be observation type clinicals. Most realize that all this medical exposure is new to you. There are very little skills or interventions that you can perform, so relax, enjoy and learn as much as you can!  They will not allow you to harm anyone, as well they do not expect you to know or will demand much of you. 

Now, if you were in advanced levels, that is another story and another thread! 


R/r 911


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## BossyCow (Nov 7, 2007)

emt-student said:


> I would usually agree with that, but do you want new EMTs Faking vitals, faking understanding of a patient's condition, or because of their "Fake" confidence, overlooking patient symptoms that should be reported to nurses or doctors?



No one suggested that she 'fake' care, but that she attempt to appear more confident than she felt.  Very different kettle of fish indeed.


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## ironguy321 (Nov 9, 2007)

I understand what you’re trying to say Mmiz. It’s easy to go over this kind of stuff in class but when you see your first psych. Pt (never will forget that it) and open fx everything gets blurry. Some of my classmates started the 12hr rotations last night and had trouble with their assessments. Our instructor gave us some sheets to fill out on our pt’s that have basic name, age, sex, etc. kind of information followed by S(opqrst)AMPLE, vitals, head-toe assessments etc. My classmates said they had trouble finding people who would let them asses them. Do nurses have to ask and do all the information I just described above? I noticed all these questions were answered in triage but I’m not sure  if nurses generally ask them again in the back. Is there a way for me and my classmates to do our work without sounding like a student? One girl said “Hello there, I’m (name) and I have to perform  a full body assessment or else I fail my class) --- That really doesn’t sound good to me at all.


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## BossyCow (Nov 9, 2007)

Most of the patients in the ER are not familiar enough with the routine to know what is and isn't going to be asked of them.  I've found that telling the patient... "I need to get some information from you if you don't mind" works really well.


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## mcvey7218 (Nov 18, 2007)

I have been doing my EMT-I clinical rotations in Georgia.  Small rural hospital, with my rotations split between ER and EMS.  My preceptors are great to teach and lead, and they let me have my "own patients" who are not critical.  Go in with a positive attitude and with a readiness to learn and work.  Ask them what you can do.  Don't just stand around.  Let them know you are willing.  On my last rotation last wednesday, I had my "own" two patients-- one 81 year old female who had fallen and was complaining of abdominal pain... one 42 year old female who went unresponsive during dialysis.  I did the assessments, focused history and physical exam, and detailed exam in route.  The other patient was an MVA... 18-wheeler vs. S-10.  I was nothing more than an extra set of hands in the rig and in the ER, seeing as how this guy needed more care than was in my scope of  practice.  Let your preceptor know what your scope is and what you have checked off on...eg. airway adjuncts, combitube, iv's.  Your medics/preceptors will let you work, but rest assured that they will not let you do anything to harm your patient or yourself.  Jump in with both feet, learn, work, and have fun with it.


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## ironguy321 (Nov 20, 2007)

I finished my rotations yesterday and let me tell you, WHAT A BLAST IT WAS! I was nervous about doing the EKG's on the females and asking pt's more questions which they had already been asked but I did it and I feel great now. I saw a lot of things (pedi. 2nd degree burns, OD'S, MI's, etc) and learned a lot. Thanks for all the information guys, it was great to hear from people who had "been there, done that" and understand how I felt going into it. Next up, ambulence time!^_^


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