# There is nothing more irritating than incompetent nurses...



## NYMedic828 (Feb 23, 2012)

Had a call this morning in my volly area for a 94 year old female with acute on-set dsypnea at 8am. (im sure most people know what the problem is already)

Medic flycar is there before me, he takes vitals and puts her on O2. Tells me she hasn't been able to urinate x 2 days and has SOB with Rales bi-lat.

BP 164/82
HR 80 Irregular (a-fib)
RR - 18
SPo2 - 96 on room air.
ECG - A-fib stable.

Patient takes a cornucopia of meds but has Hx of CHF, A-fib and HTN.

She said this happens occasionally and she just needs IV lasix, which is available on standing orders here.

I gave her one nitro tablet 0.4mg SL.

After the nitro she said she felt worlds better, I asked her if she felt another would help and she said no she feels ok now. (Rales still present but improved)

Bp dropped to 144/62

Due to the stability of her condition, and being 5 minutes from the ER I opted not to bother starting a line to give Lasix. The Lasix didn't seem necessary pre-hospital. (the ER is just going to rip my line out to do their own anyway, and I didn't want this poor old lady to get poked for no real reason)

So I walk into the ER and this nurse asks what is going on. I told her

"Shortness of breath secondary to APE with bi-basilar rales"

She gives me a completely blank stare has no idea what im talking about. I put it into English for her and just said "Fluid in the lungs." 

I then told her I gave 0.4mg of nitro and she still has rales but feels better. She then gave me this attitude over the fact that I felt it was wise to give nitro without starting an IV.

Since people don't take their own nitro without an IV at home all the time or anything... Its not like I gave nitro to a hypotensive she was 160 systolic.


Sorry just had to get all that off my chest. Nothing irks me more than nurses thinking they are better than us just because they have a higher title.


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## Veneficus (Feb 23, 2012)

I don't know, I find the paramilitary cookbook medics to be much more disturbing.

The nurse may not know. These medics do not care.


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## R99 (Feb 23, 2012)

How can you possibly "know what the problem is already" without having laid eyes on the patient nor preformed an examination?

Why did you give her GTN? Did any clinical signs of myocardial ischaemia present themselves? Did your ECG show any signs of myocardial ischaemia? Did you even do a 12 lead ECG or did you just do a single lead rhythm strip? 

The old "GTN before IV" debate died here a decade ago so I'll give you that

Also remember that for a patient who is hypertensive usually their 160 systolic might actually be like Joe Moron's 120; you drop their BP down 20 or 30 points from a very high number that does not mean its "safer" but could be comparable to dropping an average person from 120 down to 90.  There is an old saying here that the "good old more is better ambo trick is not always true" and this is one of those situations.

You do know that there are many more causes of "rales" than just cardiogenic pulmonary edema? How do you know she did not have pneumonia or something? It's up to you as the clinican to establish an adequte differential diagnosis of exclsion regardless of what the patient tells you "usually happens".  The very limited information you give makes this sound condusive to a mild exercabation of left ventricular failure but if the information you present here is the only examination that you performed then that ain't too flash mate.

Also, "rales" is a term which was pointed out for historical interest only when I last heard it used, which was during the Advanced Ambulance Aid course ... that was in FEBRUARY OF 1994!

I am not surprised that nurse looked at you the way she did honestly if you said "bi-basalar rales" to me I'd quietly discredit you as a moron to myself because nobody in the entire history of medicine probably EVER said "bi-basalar rales" ... hang on, hey Semmelweis, did anybody ever say "bi-basalar rales" back there in the 1800s? Nope, didn't think so.

I'm siding with the nurse on this one mostly, except on that GTN before IV thing.


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## Veneficus (Feb 23, 2012)

Wow.

Ummm. I still use the term "rales."  

and "EKG"

Never said "bi-basilar rales though." 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2262205/pdf/tacca200043-0215.pdf


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## Aidey (Feb 23, 2012)

Ummmm....Okie dokie then. 

Nitro is frequently used here for pulmonary edema secondary to CHF, both in and out of hospital. Rales is still in common use here. Very very rarely I'll hear it called crackles, but rales is what everyone calls it (at least in my region, and the other regions I've worked).

And last time I checked rales and rhonchi sounded different, and thus made it possible to differentiate between pulmonary edema and pneumonia. The pts history also helps with that.


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## NYMedic828 (Feb 23, 2012)

R99 said:


> How can you possibly "know what the problem is already" without having laid eyes on the patient nor preformed an examination?
> 
> Why did you give her GTN? Did any clinical signs of myocardial ischaemia present themselves? Did your ECG show any signs of myocardial ischaemia? Did you even do a 12 lead ECG or did you just do a single lead rhythm strip?
> 
> ...



Sorry wasn't aware it was dbag day on the forum. 

Bibasilar rales is a commonly used term around here. It is entirely possible to only have fluid present in one lung and not both. The term is obviously used to distinguish between the two possibilities. Sorry they don't use such terminology out by you. Feel free to google it, it is an actual term.

*Basal or basilar crackles (not to be confused with the basilar artery of the brain) are crackles apparently originating in or near the base of the lung. Bibasal or bibasilar crackles refer to crackles at the bases both the left and right lungs. Bilateral basal crackles also refers to the presence of basal crackles in both lungs. 
*
Also, rales and crackles are the same god damn thing. My PCR has a box that says Rales, not crackles. So obviously someone feels it is still an acceptable term.

And at 8am, a call for dsypnea usually has you thinking APE. Of course that doesn't mean anything till you see the patient. Its just a general size up of the call type prior to arrival.

I also wasn't aware that we only gave nitroglycerin for suspected infarctions. Last I checked it was the first line pre-hospital treatment for pulmonary edema. 

Also, please inform me how you plan to diagnose pnuemonia in the field on a patient who isn't coughing or febrile. Has rales, not rhonci and commonly gets pulmonary edema with a history of CHF. I really hope you don't show up for my grandmother.


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## R99 (Feb 23, 2012)

We use GTN for cardiogenic pulmonary edema too but I would like to confirm that this is actually cardiogenic pulmonary edema before I administer GTN

The most common cause of cardiogenic pulmonary edema is myocardial ischemia so always look for it on an ECG not a rhythm strip, they might have been acceptable during advanced ambulance aid course in 1994 but not nearly 20 years later

might not be cardiogenic pulmonary edema in which case GTN is contraindicated

if you considered other causes besides cardiogenic pulmonary edema sufficiently then fine but the very limited information you first provided did not state 

and if I may ask,what makes you better than a nurse and why is she incompetent because she does not understand your somewhat unorthodox lexicon?


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## NYMedic828 (Feb 23, 2012)

R99 said:


> We use GTN for cardiogenic pulmonary edema too but I would like to confirm that this is actually cardiogenic pulmonary edema before I administer GTN
> 
> The most common cause of cardiogenic pulmonary edema is myocardial ischemia so always look for it on an ECG not a rhythm strip, they might have been acceptable during advanced ambulance aid course in 1994 but not nearly 20 years later
> 
> might not be cardiogenic pulmonary edema in which case GTN is contraindicated




Lol what?

Next time I'll take an angiogram and chest xray before proceeding.

Sorry you can't be serious.


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## Aidey (Feb 23, 2012)

Huh, I wasn't aware that you were able to do chest x-rays in the field in NZ. 

What exactly is the difference between an ECG and a rhythm strip? 

The pt does not appear to be suffering a hypertensive crisis, and given the history I don't think she has been strangled or electrocuted so I think a cardiogenic source of the pulmonary edema is a pretty safe bet.


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## NYMedic828 (Feb 23, 2012)

Also, you would be correct in saying that 120 could be low for a person with  Hx of HTN, but it isnt low if their BP is maintained by medications at 120-140. Its still high unless they are non-compliant with meds.


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## FrostbiteMedic (Feb 23, 2012)

Wow, my first day back on the forums in a while and I get to watch a heated debate.......99 and NY, ya'll play nicely now...don't make me call in a referree


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## NYMedic828 (Feb 23, 2012)

frostbiteEMT said:


> Wow, my first day back on the forums in a while and I get to watch a heated debate.......99 and NY, ya'll play nicely now...don't make me call in a referree









He attacked me not the other way around.


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## 46Young (Feb 23, 2012)

R99 said:


> How can you possibly "know what the problem is already" without having laid eyes on the patient nor preformed an examination?
> 
> Why did you give her GTN? Did any clinical signs of myocardial ischaemia present themselves? Did your ECG show any signs of myocardial ischaemia? Did you even do a 12 lead ECG or did you just do a single lead rhythm strip?
> 
> ...



I would have ruled out inferior or rt sided ischemia via 12 lead, and started CPAP (maybe not available to the OP), but I would have treated with nitrates as well. We can give NTG for rales (we use the term "rales" in NY, Virginia, and South Carolina from my personal experience), presumed to be cardiac (there was no unilateral rales, fever, productive cough to suggest pneumonia) without the presence of Cx pain or ischemic 12 lead changes. ACS and Pulmonary Edema may be present simultaneously, or may be mutually exclusive from pt to pt. I can always get an EJ or drill an EZ-IO if I'm that worried about bottoming out the pt.

BTW, the pt's condition improved (reduced dyspnea and diminished rales (yes, rales) after the NTG admin. Apparently you overlooked that fact. The pt's Hx was CHF, Aifib, and HTN. My first differential given the pt's Hx and presentation would be cardiogenic pulmonary edema.

Your approach to giving critique on this scenario is uncalled for. If you're going to resort to name calling, directly or indirectly ("discredit you as a moron"), this forum isn't the place for you.

Hey Vene, I've used "bibasilar rales" since 2002. It must be a NY thing I guess.


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## 46Young (Feb 23, 2012)

NYMedic828 said:


> Lol what?
> 
> Next time I'll take an angiogram and chest xray before proceeding.
> 
> Sorry you can't be serious.



Yeah, this isn't an ACLS in-hospital scenario. Don't forget to order labs and seek expert consultation in the field.


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## MedicBrew (Feb 23, 2012)

Veneficus said:


> Wow.
> 
> Ummm. I still use the term "rales."
> 
> ...



That's funny sheet right there!:rofl: I read that and dang near fell out of my chair. Everyone in my office was looking at me like I'd lost my mind. 

Seriously though, loop diuretics have seriously fallen out of favor here and NTG is first line for APE, followed by CPAP if necessary. Our Medical Director has a staunch stand on the whole NO NTG w/o IV access thing, as well as an 15 lead EKG prior to ANY NTG admin. We carry NTG gtt and is the preferred method, as this affords you an easier controlled vasodilatation.


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## Aidey (Feb 23, 2012)

Would you go CPAP before nitro with an SpO2 in the acceptable range?


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## FrostbiteMedic (Feb 23, 2012)

NYMedic828 said:


> He attacked me not the other way around.



Didn't say one way or the other...I just said don't make me call in a referree. Ya'll both might end up like this.


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## MedicBrew (Feb 23, 2012)

Aidey said:


> Would you go CPAP before nitro with an SpO2 in the acceptable range?



I really think that it depends on the acuity of your patient and how they present. Several folks will not be able to tolerate the CPAP for one reason or another, requiring sedation (i.e. benzos). 

Believe it or not, we service several rural hospitals that do not have the capabilities to handle a NIV patient. I’ve brought several patients in on CPAP, just to watch them jerk it off and send the patient into flash PE. Every patient is going to respond differently.


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## MedicBrew (Feb 23, 2012)

Interesting read if you've not read it before. 

http://www.ems1.com/ems-products/co...s/articles/390568-Furosemide-Lasix-Drug-Whys/


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## firecoins (Feb 23, 2012)

rales is an acceptable term in NY as far as I know.


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## JPINFV (Feb 23, 2012)

More importantly, is rales pronounced "rails" or "rahls"? After that we can tackle "centimeters" vs "sontameters"!


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## Aidey (Feb 23, 2012)

Rails unless you are south of the Mason-Dixon line.


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## NYMedic828 (Feb 23, 2012)

Aidey said:


> Rails unless you are south of the Mason-Dixon line.



Most people pronounce it Rails, self included but I believe its original pronunciation was Rahls.

Just as angina, is An-Gina (gina pronounced like the womans name Gina)


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## mycrofft (Feb 23, 2012)

*As a RN and former EMT-A (EMT-B but ancient)*

1. Sorry you have encountered nurses who are prejudiced against prehospital providers, I've seen it and been a subject of it in the past. Or maybe some nurses did not meet your expectations.
2. Incompetence is a serious charge, grounds for revocation of license or certificate. It is also a "value judgement", which while it can start spirited debate and draw readers, is not going to be a basis for reasoned discussion.
3. One "around here" does not necessarily match another "around here", so acronyms (usually verbally tossed rapidly in a patient handoff) can cause vacant stares.
4. Same about IV before nitro, but the other way round. Probably in the ED they always start an IV because they cannot certify how much nitro or other med is already on board. You made a decision, it worked, I assume it was within protocols, it worked this time. 
5. Rales..I like rales, I say rales, but for quite a time "rales" was not in vogue. Again, might not be in the hospital's lexicon. Their " around here" did not match your "around here".
6. Doubt if they will *rip* out your IV, probably discontinue or "D/C" it. VERY common, usually due to in-house infection control issues, and nothing to take personally unless someone has a comment about the quality and site of stick etc. Might want to not say that is a reason not to start an IV if you have to testify in court, stick with your professional judgement thing. (No pun intended).

Something irks me as much as uppity nurses, and that is folks of any set of credentials who help make the working environment more strained by starting credential fights. Like "shift wars", nobody wins and takes a while to resolve, if ever.


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## JPINFV (Feb 23, 2012)

Aidey said:


> Rails unless you are south of the Mason-Dixon line.



Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...


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## Aidey (Feb 23, 2012)

NYMedic828 said:


> Most people pronounce it Rails, self included but I believe its original pronunciation was Rahls.
> 
> Just as angina, is An-Gina (gina pronounced like the womans name Gina)



My argument for the pronunciation of angina is as follows.

There is one other word in the English language (that is not a name) that ends in -gina, vagina. We don't pronounce it va-geh-na, so we shouldn't pronounce angina an-geh-na.


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## JPINFV (Feb 23, 2012)

I will never look at my Aunt Gina the same again. Thanks folks.
:'-(


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## Aidey (Feb 23, 2012)

JPINFV said:


> Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...



I know technically the Mason-Dixon line terminates at the western border of PA, and that it is only a cultural thing that it applies to the whole south. For the purposes of this conversation lets just pretend it ends at the western edge of Texas.


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## mycrofft (Feb 23, 2012)

As long as it does't sound like "rhonchii", "stridor", or "wheeze", and the reporter knows the difference.


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## NYMedic828 (Feb 23, 2012)

JPINFV said:


> Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...


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## JPINFV (Feb 23, 2012)

NYMedic828 said:


>



If you want to know something that will really blow your mind, Reno is West of Los Angeles.


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## mycrofft (Feb 23, 2012)

So's NYC if you go west far enough.
Nice photo for an avatar


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## JPINFV (Feb 23, 2012)

mycrofft said:


> So's NYC if you go west far enough.
> Nice photo for an avatar



...but it's not a trick like that...


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## mycrofft (Feb 23, 2012)

Ha ha I'm from LA. Old one. Unalaska is further west than Hawaiian Islands.
And Tulsa OK is closer to the ocean than Amarillo TX


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## Veneficus (Feb 23, 2012)

MedicBrew said:


> That's funny sheet right there!:rofl: I read that and dang near fell out of my chair. Everyone in my office was looking at me like I'd lost my mind.
> 
> Seriously though, loop diuretics have seriously fallen out of favor here and NTG is first line for APE, followed by CPAP if necessary. Our Medical Director has a staunch stand on the whole NO NTG w/o IV access thing, as well as an 15 lead EKG prior to ANY NTG admin. We carry NTG gtt and is the preferred method, as this affords you an easier controlled vasodilatation.



I just read the part I cared about, which was the history and definitions.


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## TatuICU (Feb 23, 2012)

NYMedic828 said:


> Had a call this morning in my volly area for a 94 year old female with acute on-set dsypnea at 8am. (im sure most people know what the problem is already)
> 
> Medic flycar is there before me, he takes vitals and puts her on O2. Tells me she hasn't been able to urinate x 2 days and has SOB with Rales bi-lat.
> 
> ...



I understand the frustration.  However, your report would get pulled and be up for peer review for giving NTG without a line at my former service.  Of course you could explain yourself but bottom line is according to protocol you would've been wrong.  The MD would've asked you something like "What if the pt was septic?" and just generally been a grumpy *** about it.  


This is what concerns me about your post "Nothing irks me more than nurses thinking they are better than us just because they have a higher title."

I'm a NREMT-P/RN, BSN, CCRN currently working in a CVICU and I'm not quite sure where you're getting the idea that RN is a higher title than NREMT-P. I received the same AS with my Paramedic degree as a I did with my ADN.  It wasn't until I finished my BSN (completely :censored::censored::censored::censored:ing useless BTW and got a me a hearty raise of about 9 cents an hour) that I would have considered myself as having "more education" than the average Paramedic.  As a medic you have the same degree as an ADN does, so try giving yourself a bit more credit would ya?


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## Veneficus (Feb 23, 2012)

TatuICU said:


> I'm a NREMT-P/RN, BSN, CCRN currently working in a CVICU



can you say that 5 times fast?


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## emergency123 (Feb 23, 2012)

*Nurses are dumb*

You should have Cardio-Vert......That would have been cool...REALLY???:rofl:


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## TatuICU (Feb 23, 2012)

Veneficus said:


> can you say that 5 times fast?



Dude let me tell you, our name badges are ridiculous.  They keep wanting squeeze that useless TNCC title on all of our stuff too.  I made them put my EMT-P on first, lol.  I always tell them I'm not a nurse, I'm just a medic with a nursing license


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## Veneficus (Feb 23, 2012)

TatuICU said:


> Dude let me tell you, our name badges are ridiculous.  They keep wanting squeeze that useless TNCC title on all of our stuff too.  I made them put my EMT-P on first, lol.  I always tell them I'm not a nurse, I'm just a medic with a nursing license



Tell them that you want ACLS and PALS on there too.


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## TatuICU (Feb 23, 2012)

Veneficus said:


> Tell them that you want ACLS and PALS on there too.



It's just ridiculous.  The thing is that you have to have all those certs to work in the CVICU anyway so that's like a auto mechanic wearing a name badge indicating that he can change oil, do your brakes, flush your radiator, AND rotate your tires.  Isn't that what a mechanic is supposed to be able to do?????


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## mycrofft (Feb 23, 2012)

Having made the mistake of equating the med tech career tree with the nursing career tree, I can tell you the two are quite separate. ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful areas available when you take advantage of a college education and not a tech school one. Been there, done both, although not as a paramedic per se.

My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.

Nonetheless, on the line, nurses, techs and docs all need to play nice and quit sniping.


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## ffemt8978 (Feb 23, 2012)

frostbiteEMT said:


> Wow, my first day back on the forums in a while and I get to watch a heated debate.......99 and NY, ya'll play nicely now...don't make me call in a referree


Too late, I already started reading this thread.


NYMedic828 said:


>


Wanna bet?




I've been bored lately, so I've been looking for volunteers to become the focus of my complete and undivided attention.  Am I sensing that I now have two people volunteering for that?


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## BandageBrigade (Feb 23, 2012)

mycrofft said:


> Having made the mistake of equating the med tech career tree with the nursing career tree, I can tell you the two are quite separate. ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful areas available when you take advantage of a college education and not a tech school one. Been there, done both, although not as a paramedic per se.
> 
> My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.
> 
> Nonetheless, on the line, nurses, techs and docs all need to play nice and quit sniping.



Whoa there buddy.. I have the exact same college education that my associates degree level nursing counter parts have, me minus the nursing specific courses, them minus the paramedicine specific courses. Not every paramedic school is a tech school, or just offers a certificate.


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## NYMedic828 (Feb 24, 2012)

TatuICU said:


> I understand the frustration.  However, your report would get pulled and be up for peer review for giving NTG without a line at my former service.  Of course you could explain yourself but bottom line is according to protocol you would've been wrong.  The MD would've asked you something like "What if the pt was septic?" and just generally been a grumpy *** about it.
> 
> 
> This is what concerns me about your post "Nothing irks me more than nurses thinking they are better than us just because they have a higher title."
> ...



Paramedic is not a degree in new york state. As far as I know anyway...

The nurses at the particular hospital are always self-righteous :censored::censored::censored::censored::censored:s to us. They assume that because we are a volunteer service that we must all be incompetent and half the time they could care less to hear from us what is wrong and just ask us for our paper to sign. I'm not getting a paycheck to show up to a call on my day off volunteering the least they could do is be even the slightest bit more respectful. They are a slow hospital as is. Getting patients basically annoys them because they have to do work.

The way I get treated by nurses and doctors at work vs volunteering is barely even comparable. 



In regards to the nitro, our protocol 

No IV but BP >120 systolic, can give nitro.

Yes IV, BP greater than 100 systolic, can give nitro.


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## TatuICU (Feb 24, 2012)

mycrofft said:


> ADN and Paramedic are not equivalent. Not even. Paramedics have more technical tricks but shallow if any grounding in much else. ADN (or ASN) nurses have more grounding in sciences, ethics, and potentially other useful.....
> 
> My BSN allowed me to commission in the USAF/Air Nat Guard. I actually took a small pay cut from TSgt to 2Lt but it paid off very well in opportunities...and, later, pay.




You are incorrect. I received my AS in Emergency Medical Services after having satisfied the degree requirements which included the same sciences as of my nursing program.  In fact, in terms of true usefulness, a new grad ADN is far less capable in my opinion than a new grad Paramedic.  Usually their skills suck and they still have little or no concept of why they are doing the things they're doing.  

I can't remember ever being handed a question on my paramedic exams where the answer was "Tell me more about how that makes you feel."  

As far as the BSN, while it may help you in your arena in life, by and large it does nothing for us civi nurses.  I received more of a raise for my CCRN certification than I did for my BSN.  One cost $275 for a test, the other roughly $25000.  One got me 50 cents, the other got me about 9 cents.  I believe in board certification but frankly, the more I think about it, nursing would be better served requiring a biology, chemistry, micro, etc degree in lieu of the community health, professional nursing role, etc classes that take up (notice I didn't say "make up") a BSN program.

If given the choice I would've pursued more education and board certification as a Paramedic, but EMS is so screwed up in this country that its very tough to find programs that offer that sort of thing.  Hence the move to less hours and more money as a nurse.

If you've not worked "as a paramedic per se", I would submit that perhaps you aren't the most qualified person to speak on the subject, especially if you attended a paramedic program that did not require a degree.


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## TatuICU (Feb 24, 2012)

BandageBrigade said:


> Whoa there buddy.. I have the exact same college education that my associates degree level nursing counter parts have, me minus the nursing specific courses, them minus the paramedicine specific courses. Not every paramedic school is a tech school, or just offers a certificate.



Thank you


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## Veneficus (Feb 24, 2012)

TatuICU said:


> nursing would be better served requiring a biology, chemistry, micro, etc degree in lieu of the community health, professional nursing role, etc classes that take up (notice I didn't say "make up") a BSN program.



If I could just point something out about that?

Those community health and nursing role type classes reinforce and add to the purpose of nursing. Which is to attend to the basic needs of life.

When you start moving into basic science as the focus of education for clinical nurses, you are simply duplicating something that already exists at a much more basic level.

If the practice of medicine based on scientific principle is really what you want to be doing, there is a school and a career path for that.

No patient is served better by a duplicate effort from a less capable provider.

If you remove the function and value of nurses, then all you do is eliminate them. After all, if they are no longer taking care of basic needs, what good are they?


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## 46Young (Feb 24, 2012)

NYMedic828 said:


> Paramedic is not a degree in new york state. As far as I know anyway...
> 
> The nurses at the particular hospital are always self-righteous :censored::censored::censored::censored::censored:s to us. They assume that because we are a volunteer service that we must all be incompetent and half the time they could care less to hear from us what is wrong and just ask us for our paper to sign. I'm not getting a paycheck to show up to a call on my day off volunteering the least they could do is be even the slightest bit more respectful. They are a slow hospital as is. Getting patients basically annoys them because they have to do work.
> 
> ...



I think what you meant is that NY EMS systems do not require EMS degrees for hire. Most don't.

I believe that LaGuardia and Suffolk CC both have the EMS AAS (two year) degree. I'd highly recommend getting at least that degree at the least, in case you decide one day to leave NY and work somewhere else. You may intend to do the whole 25 years right now, but things can change, priorities change. If you build off that AAS to a BA in EMS, that's really useful when applying to an out of state EMS organization as a Director or other upper management. In fact, more and more places require it nowadays. As far as credits, my local CC grants 37 credits for having my P-card (from NY Methodist '04-'05), so long as I fufill all the gen-eds and such. You can do that online at your own pace, or do KVO to be safe for sceduled classes if FDNY EMS still does that. I had a bunch of credits from Baruch ('94-'95) that expired, so find out how long your credits stay current if you do intend to take your time.

When I finished medic class, I had no intentions whatsoever of leaving NY. I nearly finished the FDNY medic hiring process, then decided to leave after one of our ex-employees came back to visit and told me how much better things were out of state.

As far as the nurses, I would suggest having your Chief, or better yet your OMD speak with nursing management or the physicians themselves to correct this undesireable practice.


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## Scott33 (Feb 24, 2012)

NYMedic828 said:


> She said this happens occasionally and she just needs IV lasix, which is available on standing orders here.



What protocols are you working under? NYC REMAC moved lasix to an MC option only, in last August's update - one of the more progressive things they have done in a while.


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## TatuICU (Feb 24, 2012)

Veneficus said:


> If I could just point something out about that?
> 
> Those community health and nursing role type classes reinforce and add to the purpose of nursing. Which is to attend to the basic needs of life.
> 
> ...



And this is where theory and actual practice begin to part from another.

Current day, in-hospital ICU nursing IS based on scientific principle.  Granted that is only one area of nursing, but for those of us who are taking care of post-op CABGs and not doing informatics work for example, the educational needs are quite different.  Nursing education does not reflect that.  There should be more than one BSN path for nurses wanting to further their career.

I'd discuss this with other nurses on a nursing forum if I were interested in discussing it, but this was not the point of my post.

I would prefer to discuss why I couldn't for the life of me find a CCEMT-P program to take and why there are such large discrepancies between EMS educations from region to region on this forum.  Or perhaps why there are those out that feel their education and job is somehow less valuable than a nurses.  I have at times been accused of being a tad self-loathing as a nurse.......not sure I would argue too hard against that.


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## mycrofft (Feb 24, 2012)

Good to hear some Paramedic programs are not mills, but not all are that good.

My four year articulated BSN included chem, organic chem, biochem, microbiology, statistics, multiple clinical assignments, basic psych plus one in the 200 series (I took two, family dynamics, and alcoholism)and an advanced (year 4) elective clinical (I took community health), plus the basic college underbrush (English, a science elective which for me was computer programming in BASIC, etc). This is blowing past the anatomy, physiology (two separate semesters we took alongside baby doc students), pharmacodynamics, ethics (included labor issues with mock negotiations!), nutrition, physical exam, etc.

I did NOT emerge ready to start IV's, place ET airways, defibrillate, or other technical aspects because there was no time for that. I did come away knowing why and when they were needed, with an idea of what was needed to do it. I was not oriented and indoctrinated to act and react to emergency situations, which has to come from being on the line.

I was also taught, through the culture, not to respect EMT's; as a semi- inactive EMT, this stung, and I always resisted it. (I was also culturally taught doctors were our natural opponents, but that was not as potentially serious).

At any rate, we all need to work together for the pt's betterment. Maybe the ED and fire service need to be brought together with a moderator, or hauled together by the EMSA, to talk things out when this sort of warring breaks out, because it drives off good practitioners and can lead to disconnects in pt care.


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## NYMedic828 (Feb 24, 2012)

46Young said:


> I think what you meant is that NY EMS systems do not require EMS degrees for hire. Most don't.
> 
> I believe that LaGuardia and Suffolk CC both have the EMS AAS (two year) degree. I'd highly recommend getting at least that degree at the least, in case you decide one day to leave NY and work somewhere else. You may intend to do the whole 25 years right now, but things can change, priorities change. If you build off that AAS to a BA in EMS, that's really useful when applying to an out of state EMS organization as a Director or other upper management. In fact, more and more places require it nowadays. As far as credits, my local CC grants 37 credits for having my P-card (from NY Methodist '04-'05), so long as I fufill all the gen-eds and such. You can do that online at your own pace, or do KVO to be safe for sceduled classes if FDNY EMS still does that. I had a bunch of credits from Baruch ('94-'95) that expired, so find out how long your credits stay current if you do intend to take your time.
> 
> ...



To be honest, while I truly enjoy my job as much as it does suck sometimes, I am in it to be a firefighter. My promotional test date is one month away from today. Been waiting a long time...

But, in the hopes of making the cut I am planning to return to school for RN on the side of working as a firefighter unless things improve for Paramedics around here first.



Scott33 said:


> What protocols are you working under? NYC REMAC moved lasix to an MC option only, in last August's update - one of the more progressive things they have done in a while.



Nassau County REMAC still allows for lasix 40mg standing order or 80mg if they are already on lasix.

I volunteer on the island work in the city. Thankfully someone made a great protocol app for the iphone so I don't make any oopsies forgetting where I am at the time.

I have never given anyone Lasix. As far as I have been taught, true fluid overload is almost never the problem causing APE. The only reason I considered it for this woman was because she stated on her own that this happens all the time, she has urinary retention and they fix it with IV Lasix. But even still, I was alone as the only medical provider on the ambulance, 5 min from an ER. It seemed a lot more practical to give a trial of nitro, and transport. By myself I would of sat on-scene for another 3-10 minutes to do an IV, reassess vitals from the nitro and draw up and administer lasix. Sure I could of done an IV enroute, but on a 94 year old woman, with squiggly veins all over...


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## TatuICU (Feb 24, 2012)

mycrofft said:


> ethics (included labor issues with mock negotiations!)



We did the same and it was the first time since I was in high school that I actually thought that a physical altercation was going break out, lol.  We had a local legislator come in and we also had one of the local scumbags from the ambulance owners association (the mob that keeps pay down and regulations loose so that they can work medics 72 hours at a time) as a guest.  Interesting to say the least


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## mycrofft (Feb 24, 2012)

5 min., pt basically stable, I agree.
RN is a good fallback from firefighter, can't swing from ropes or drive a pumper all your life. I wish I'd gone into environmental health or something like that, though. PM if you want the story posted hereabout in dribs and drabs.:rofl:


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## Veneficus (Feb 24, 2012)

TatuICU said:


> And this is where theory and actual practice begin to part from another.
> 
> Current day, in-hospital ICU nursing IS based on scientific principle.  Granted that is only one area of nursing, but for those of us who are taking care of post-op CABGs and not doing informatics work for example, the educational needs are quite different.  Nursing education does not reflect that.  There should be more than one BSN path for nurses wanting to further their career..



In theory isn't that the role of the clinical nurse specialist?

I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?



TatuICU said:


> I would prefer to discuss why I couldn't for the life of me find a CCEMT-P program to take and why there are such large discrepancies between EMS educations from region to region on this forum.  Or perhaps why there are those out that feel their education and job is somehow less valuable than a nurses.  I have at times been accused of being a tad self-loathing as a nurse.......not sure I would argue too hard against that.



I could suggest the reason is there is no state level accredidation for a level higher than paramedic.

I could also suggest that there is no recognized CC curriculum for paramedics.

As I understand, there are basically 2 seperate courses which compete for students. But these courses are measured in days. In effect being prolonged ACLS and similar courses.

(which is why I always laugh at people when  I see them put CCEMTP after their name)


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## Maine iac (Feb 24, 2012)

My protocols state "Do not delay nitro to establish IV access" for suspected adult pulmonary edema.

There are going to be slow people in every profession. Who knows, maybe that nurse got worked on the over night shift and the coffee machine is MIA.

Coming out of High School I worked in a pizza joint. Small town with D1 collegiate hockey so things could busy fast. Me and this guy would work the front together, either rolling the pizza dough or working the tiller. As soon as things got busy it was faster for me to roll the dough AND work the cash by myself and just have the guy step out of the way, because he made too many mistakes and in general slowed things down. He was a good guy to have around, but... slow.

Everybody has their niche and maybe you found the nurse who is great at pt care but just not complex pt care.


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## NYMedic828 (Feb 24, 2012)

Veneficus said:


> In theory isn't that the role of the clinical nurse specialist?
> 
> I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?
> 
> ...



Around here in NY i believe a critical care paramedic usually just has a little more pharmacologic knowledge usually things like sedative drips of propofol. They also have training in the maintenance of ventilators and balloon pumps.


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## Veneficus (Feb 24, 2012)

NYMedic828 said:


> Around here in NY i believe a critical care paramedic usually just has a little more pharmacologic knowledge usually things like sedative drips of propofol. They also have training in the maintenance of ventilators and balloon pumps.



Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?

Either way it doesn't matter for this discussion, neither are recognized.

If they have their own program, I suspect the use of the CC is just a way to identify paramedics who have been locally upskilled by the authority of local/regional medical direction.

That method is really no different than the practice of local medical autonomy, similar to places like Texas.

Outside of your jurisdiction, it really doesn't mean crap.


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## NYMedic828 (Feb 24, 2012)

Veneficus said:


> Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?
> 
> Either way it doesn't matter for this discussion, neither are recognized.
> 
> ...



Honestly I have no idea, but I think its an appointed title by the agency you work for and not a real title of any value.

North Shore for example has people who are critical care, and people who are 911.


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## mycrofft (Feb 24, 2012)

"Critical Care Paramedic" equals "We're paying someone less to do most of the work of a RN or other higher paid professional".


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## 46Young (Feb 24, 2012)

Veneficus said:


> Are they using a standard curriculum like the FP-C or the UMBC CCEMTP program?
> 
> Either way it doesn't matter for this discussion, neither are recognized.
> 
> ...



As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.

I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.

I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.


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## BandageBrigade (Feb 24, 2012)

mycrofft said:


> "Critical Care Paramedic" equals "We're paying someone less to do most of the work of a RN or other higher paid professional".



What is with you and being down on the paramedic profession? You had a bad experiance as an emt? That sucks. The medics in your area suck? Thats unfortunate. As a "CCP" in the hospital based system at my part time gig, I make the exact same as my nursing counterparts. I also have the same job description when not on transport. Your (nor my) individual experiances do not hold true for everywhere.


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## mycrofft (Feb 24, 2012)

Agreed, experiences are not universally _good or bad_,  and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?).

I work with local paramedics in community projects involving EMS, I've seen their work, and I have little/no complaints.

I'm not "down" on paramedics (or I don't feel down on them, especially since I'm not "up" enough to be "down" on a real one), I'm negative about the following:
  1. People discriminating against other people based upon the letters after their name on their name badge. (Ironic? I think not...).
  2. People wanting to find a back door to using higher levels of technique without more and thorough education.
  3. Employers using any means to keep pay and benefits down for qualified people, and utilizing techs in professional roles by writing or buying voluminous protocols is one means they use to do that.

My bad experiences were not with paramedics, but with nurses when I was an EMT-A (now "B"). Now I'm a (retired) nurse, and when I was active I was always an advocate for fair treatment of techs by professionals. I also could spot a "cowboy", be they nurse/doc/tech, and had to work to retain professionalism sometimes.

I started the thread elsewhere proposing the concept that paramedics ought to be abolished in favor of Physician Assistants taking over their duties, having a higher level of training (supposedly), not because I am against paramedics, but because the lack of structure in the titling/credentialing thing is distressing. 

(My thought about CC Paramedic: not a paramedic. A CC Tech would be the proper nomenclature, since EMT-Paramedic is the NHTSA-originated title for a PREHOSPITAL advanced life support tech. This seems picayune, but the professional/technician deal means more when you get to organizing labor and drawing up contracts).

Hope that makes things less snaggy.


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## DrankTheKoolaid (Feb 24, 2012)

mycrofft said:


> Agreed, experiences are not universally _good or bad_,  and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?).
> 
> I work with local paramedics in community projects involving EMS, I've seen their work, and I have little/no complaints.
> 
> ...




Why is a paramedic considered a "tech" and not a professional in your eyes when some of us completed the exact same pre-requisite coursework as ADN/ASN nurses?  And with the exception of  MICU/ICU/STICU/ED RN's I know, actually attempt to continue learning, instead of just settling in and being happy as the MD's puppet taking orders.

Were not the jack of all trades master of none like an RN, but we are masters of emergent pre-hospital care as we should be.  Let see that wide bottom NOC RN that is considered a professional even consider putting herself out into a unfamiliar situation and gladly accept the challenge.  You as well as I know that isn't going to happen.


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## BandageBrigade (Feb 24, 2012)

mycrofft said:


> Agreed, experiences are not universally _good or bad_,  and kudos that they are paying you what you are worth! (Is there a chance they are paying your professional coworkers less because you are there?) *Pay is comparable to other hospitals similar in size with equal services offered.*(My thought about CC Paramedic: not a paramedic. A CC Tech would be the proper nomenclature, since EMT-Paramedic is the NHTSA-originated title for a PREHOSPITAL advanced life support tech. This seems picayune, but the professional/technician deal means more when you get to organizing labor and drawing up contracts).    *CCP (In Iowa at least) Is a state recognized endorsement available to paramedics, any extra scope of practice that it gives you only applys in the hospital setting or during interfacility transport.*
> 
> Hope that makes things less snaggy.



See bolded text.


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## TatuICU (Feb 24, 2012)

Veneficus said:


> In theory isn't that the role of the clinical nurse specialist?
> 
> I am rather inquisitive, I would be interested, passed the basic A&P/pharm and some technical skills, what are you doing for these patients that c/t surg and cards intensive medicine isn't?



I don't get your meaning, we are the CVICU.  And what are we doing? Well after the patient is closed, they are wheeled up the hill to us where we recover them from anesthesia (PACU does not do CV surgical cases), get them hemodynamically stabilized (because the anesthesiologist "isn't" bumping them with phenylephrine and their pressures "don't" tank 15 minutes after they sign off the case), wean them off the vents (we generally have 2 RTs for the hospital outside ER on duty for the hospital at night), and get them up and moving ASAP.  Oh and I should mention these patients are off one to one care in 8 hours and you get to pick up another patient shortly thereafter if not 2.  

So again, not sure what you mean. After the OR closes them, the patient is ours, there is no go between.


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## TatuICU (Feb 24, 2012)

Corky said:


> Were not the jack of all trades master of none like an RN



I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable.  Not sure why you think medics are somehow more specialized.  I do both and if anyone has to be a jack of all trades, its a medic


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## DrankTheKoolaid (Feb 24, 2012)

*re*

Thats why I put the disclaimer about the specialized RN staff.  Sorry mate maybe that didn't come off as clear as I had hoped


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## NYMedic828 (Feb 24, 2012)

TatuICU said:


> I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable.  Not sure why you think medics are somehow more specialized.  I do both and if anyone has to be a jack of all trades, its a medic



Honestly, with Nurses or medic, its hit or miss with everyone.

There are plenty of medics who are absolute morons but are able to maintain certification and the same goes for nurses.

Half the city hospitals hire nurses who are off the boat from jamaica and have no clue whats going on here but at the same time they also hire very knowledgeable and capable nurses who I get along great with.

The issue that brought about starting this thread, was that at this particular hospital, they treat all EMS as if we don't matter and just want us to drop off our patient and leave without a word. It is a north shore hospital for those familiar with the region and they like to act like they are better than everyone else.


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## TatuICU (Feb 24, 2012)

Corky said:


> Thats why I put the disclaimer about the specialized RN staff.  Sorry mate maybe that didn't come off as clear as I had hoped



I see that now, I apologize.


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## Handsome Robb (Feb 24, 2012)

The whole nurse vs. medic argument has been beaten to death. Like NY said, both subsets have a wide variety of providers. Through my medic clinicals I have worked with nurses that have made me do double takes and have to reset my brain to comprehend what they just said and there are nurses that I have learned a ton from.

Nurse vs. medic makes no sense. They are two totally different specialties.


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## DrankTheKoolaid (Feb 24, 2012)

*re*

If that was directed at me, I was not bringing that old argument up.  That was a direct question to Mycroft as to his opinion why 1 is considered a professional in his eyes VS the other as a tech.


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## Veneficus (Feb 24, 2012)

46Young said:


> As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.
> 
> I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.
> 
> I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.



That is my take on it too.


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## Handsome Robb (Feb 24, 2012)

Corky said:


> If that was directed at me, I was not bringing that old argument up.  That was a direct question to Mycroft as to his opinion why 1 is considered a professional in his eyes VS the other as a tech.



Wasn't directed at anyone in particular. Just adding my thoughts to a previous statement. 

Sorry I'm a little out of it, stomach flu dealt me a swift kick in the *** this week.


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## BandageBrigade (Feb 24, 2012)

46Young said:


> As far as I know, there's no requirement, be it legal or for reimbursement purposes, to be a CCEMT-P in order to run certain types of calls. For example, at a local IFT service, there are no CC medics, so the medics can do anything within the scope of their practice so long as the sending MD gives written orders to that effect. PALS is also not required until six month after hiring, so that goes to show that the alphabet certs are not required, either.
> 
> I worked for North Shore LIJ, but I didn't go throught their CC program. The reason is, once you're a CC medic, you're no longer allowed to work in the 911 system (unless for OT), so you're basically an IFT medic 100% of the time. So, I can't compare the NY curriculum to the ones in VA.
> 
> I see the CCEMT-P cert as a band aid for the lack of clinical education in the U.S. Paramedic original program/degree, nothing more. I suppose employers feel that they're a little more safe letting medics handle vented/sedated w/ propofol titration, titrating ntg drips, etc. if they have the CC cert. Same for alphabet certs. If you have a mentally challenged medic working for you, hopefully they can run an ACLS protocol, even if they're clueles otherwise. All these alphabet certs are just to band aid an inadequate education system in our field, IMO.



I know we bill ours, as do most others that use it in the state, as a specialty transport and it is at a higher rate. That is for if a CCP or RN or RT or Doc comes along. I  am not sure of its actually classification designation.


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## usalsfyre (Feb 24, 2012)

TatuICU said:


> I take offense to that. Our CVICU nurses are all board certified and are all VERY well trained and capable.  Not sure why you think medics are somehow more specialized.  I do both and if anyone has to be a jack of all trades, its a medic



Just like I'm board certified by the BCCTPC in critical care *transport* medicine? 

While most of (not all) of the medicine is similar, the logistics of coming into and transporting a train wreck of a critically ill, technology dependent patient who may or may not have been sub-optimally managed with one or two providers in moving vehicle are vastly different than caring for them in the in-hospital environment. It's an exercise in planning ahead and at times improvisation and knowledge of alternatives. This is where an experienced and knowledgeable transport paramedic (or nurse) is worth their weight in gold. 

Could the average ICU nurse be trained to do this competently? Most likely yes. Just like I and many of my fellow transport medics could probably be trained to function as an ICU nurse. The question is why the push by nurses to move into our field? 

Nursing pushes back hard on any attempt to play in their sandbox. Yet they have no problem pushing into medicine, out-of-hospital care. Ect. If you want to know any issue with nursing as a whole I have, it's that.


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## TatuICU (Feb 24, 2012)

BandageBrigade said:


> I know we bill ours, as do most others that use it in the state, as a specialty transport and it is at a higher rate. That is for if a CCP or RN or RT or Doc comes along. I  am not sure of its actually classification designation.



Yep.  The best it was explained to me was that there are apparently a certain set of criteria that, if met, the service can bill more.  Oftentimes, whatever makes the transport "special" requires a doc, nurse, whatever


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## TatuICU (Feb 24, 2012)

usalsfyre said:


> Just like I'm board certified by the BCCTPC in critical care *transport* medicine?
> 
> While most of (not all) of the medicine is similar, the logistics of coming into and transporting a train wreck of a critically ill, technology dependent patient who may or may not have been sub-optimally managed with one or two providers in moving vehicle are vastly different than caring for them in the in-hospital environment. It's an exercise in planning ahead and at times improvisation and knowledge of alternatives. This is where an experienced and knowledgeable transport paramedic (or nurse) is worth their weight in gold.
> 
> ...




Not sure what you're talking about as it refers to myself as I was a paramedic loooooooong before I was a nurse.  Secondly, my reference to board certification was in response to another poster stating that RNs were "jacks of all trades, masters of none." 

There is no push that i know of to move into EMS by nursing.  I can't imagine anyone in their right mind wanting to work more hours for much, much, much less money and little to no respect, so I'm not sure where that's coming from.

And lastly, nursing pushes back in any attempt to play in their sandbox because they have something that is completely foreign to EMS; competent, cohesive leadership that actually advocates for nurses and protects its profession.  EMS does not have that which is why our local medics, regardless of their education , make about 10 bucks an hour and subjects to the whims of the ambulance owners association that takes care to make sure they can work them to death for no money......which is why they leave, usually for nursing. The NREMT is a U-S-E-L-E-S-S organization that does nothing to actually advance EMS as a profession, which is why its in the shape its in now.


Also, in my heart of hearts I think that a lot of this board certification process is just a racket so that these organizations can make money.  I just looked up that BCCTPC website and anyone can take that test just so long as they're willing to join the org and pay or not join the org and pay more. Same as with most, but others require letters of reference and audit their candidates.


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## mycrofft (Feb 24, 2012)

Tech versus professional. Sigh.

There are many unprofessional nurses (and doctors, lawyers, school teachers etc), and many many techs who are top-notch professionals. This blurs it.

I have participated in multiple drawn out threads here about the divide between a profession and a technical field. Nursing barely makes the cut as a profession and the more technical it gets the less of a distinct profession it is.

A unique field of research, knowledge and practice; self-governance to a degree; and the ability and expectation to make decisions and direct others based upon this field of knowledge; these are three bedrock elements. Like the difference between a 2nd Lt and a MSgt, which one has the depth of training and the expectation/duty/right to decide and lead?

Prehospital EMS (PEMS) and the use, in abrogation of the NHTSA nomenclature, of Emergency Medical Technicians (B or P) in non-emergency roles, is predicated on protocols based upon medical research, written by (or approved) and enforced by doctors. The ability to self-govern really makes the difference. If the AMA decided today to eliminate the current EMT system, there is a good change that they could really make a dent, whereas there is NO EMT association (NREMT is not) to protect EMT's or take the fight back to offending entities.

If the prep for Paramedic is the same as for nurses and makes them equal, why can't paramedics just take the NCLEX and get that RN tacked on for higher average pay, wider geographic employment opportunities, openings for administrative and research jobs? Because preparation in nursing college (read posts above by nurses) is broader and not just based upon technique. Or at least it shouldn't be. There are cram course and books to study for NCLEX to allow "nursing technicians" (nursing mill grads or nurses from countries where standards are not so high) to get their license who ought not to, in my opinion.

If you aren't a nurse, you do not know what preparation is entailed and what the difference is, but try this: if a paramedic walks into a hospital, can (s)he give a nurse an order? On the other hand, nurses in hospitals often give or pass on orders to techs. A nurse CANNOT accept a second hand/verbal order, but techs customarily do. Professional autonomy.

This sounds like the threads about guns and tattoos; when the advocates are asked pointblank, their response is "You just don't get it, do you?". 

Again and again and again: neither specialty is superior, and the people who can't cooperate and are nasty with other care team members for whatever reason (race, gender, certificates, religion, tribal or clan affiliation etc.) need to go play by themselves.

PS use SEARCH


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## mycrofft (Feb 24, 2012)

*Corky...right on about prehospital situation and nurses.*

Most (not all) nurses will either freeze or maybe go down swinging at a traffic accident...except the former-EMT-B or P's! (Or military veterans who worked in a combat zone). Hard to tell that to a dollar conscious administrator sometimes, though!


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## usalsfyre (Feb 24, 2012)

TatuICU said:


> Not sure what you're talking about as it refers to myself as I was a paramedic loooooooong before I was a nurse.  Secondly, my reference to board certification was in response to another poster stating that RNs were "jacks of all trades, masters of none."



A neither new nurse or a new paramedic is particularly specialized. 



TatuICU said:


> There is no push that i know of to move into EMS by nursing.  I can't imagine anyone in their right mind wanting to work more hours for much, much, much less money and little to no respect, so I'm not sure where that's coming from.


911 response? No. Transport medicine? Ask an ASTNA board member what they think of a dual paramedic or paramedic-led aircraft. 



TatuICU said:


> And lastly, nursing pushes back in any attempt to play in their sandbox because they have something that is completely foreign to EMS; competent, cohesive leadership that actually advocates for nurses and protects its profession.  EMS does not have that which is why our local medics, regardless of their education , make about 10 bucks an hour and subjects to the whims of the ambulance owners association that takes care to make sure they can work them to death for no money......which is why they leave, usually for nursing. The NREMT is a U-S-E-L-E-S-S organization that does nothing to actually advance EMS as a profession, which is why its in the shape its in now.


I can't say I particularly disagree, although as you note earlier, they are cohesive to the point of idiocy at times (see Jean Watson's energy theories).



TatuICU said:


> Also, in my heart of hearts I think that a lot of this board certification process is just a racket so that these organizations can make money.  I just looked up that BCCTPC website and anyone can take that test just so long as they're willing to join the org and pay or not join the org and pay more. Same as with most, but others require letters of reference and audit their candidates.


The ENA is not exactly any different with the CEN, CFRN or CTRN certifications. Pay your money, pass the test, and your certified. 

I can assure you through first hand experience the FP-C is no cakewalk.


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## DrankTheKoolaid (Feb 24, 2012)

mycrofft said:


> Tech versus professional. Sigh.
> 
> There are many unprofessional nurses (and doctors, lawyers, school teachers etc), and many many techs who are top-notch professionals. This blurs it.
> 
> ...



Thanks for your response. I know about the other threads, I was just looking for your opinion was all.

As to this, I meant the pre-requisite coursework IE Anatomy, Physio, Micro, Chem, Psych, Soc, Eng 1, Psych 1 + 14, Nutrition, Health span, etc etc etc etc. 
I know the programs themselves are completely different with completely different views and  perspectives.  The same can be said though about new grad RN's being able to pass NREMT-P with no other training, just simply wont happen in 99% of cases unless they had some other experience as their training focus is completely different.


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## Veneficus (Feb 24, 2012)

*"my nurses"*



Corky said:


> Why is a paramedic considered a "tech" and not a professional in your eyes when some of us completed the exact same pre-requisite coursework as ADN/ASN nurses?.


 
I think this is easily answered, though it might not nbe the answer you want.

You might be educated to the basic level of an RN, but many (read vast majority) of your peers are not.

In my hometown alone nearly 100 paramedics that met the state's 750 hour required education for paramedic graduate every semester.

There are many places where paramedics are supposed to be and are treated like "techs" still. Many large places. (check out some of the forum posters here)

Untill all paramedics have as a minimum education that of an entry level nurse (or other healthcare provider) then they do not possess a significant specialized body of knowledge to make the move from tradesman to professional.

Strangely enough I am reading a book on the history of surgeons that demonstrates how they began as basically less than barbers and their climb from tradesman to medical professional. There are some very striking similarities between the two groups. (too many to name here) The most striking is that at one point the were banned from medical university and then when finally admitted decried how they didn't need it. (Sounds like when paramedics tried to enter degree programs and count the vocational certificates for credit and now complain they don't need more education.)




Corky said:


> but we are masters of emergent pre-hospital care as we should be.



Sorry, but...no... You are not the master of it. If you were the master of it, you could decide what the treatments would be and when you would use them. If you were the master you could demand the practices that have been demonstrated to not work be removed as well as institute new ones when you demonstrate their value. 

As it stands, you simply cannot. Paramedics are still at the mercy of other professionals. (both nursing and medical) 



Corky said:


> Let see that wide bottom NOC RN that is considered a professional even consider putting herself out into a unfamiliar situation and gladly accept the challenge.  You as well as I know that isn't going to happen.



Nor do paramedics without extra training and education function well outside their preferred environment. 




Corky said:


> And with the exception of  MICU/ICU/STICU/ED RN's I know, actually attempt to continue learning, instead of just settling in and being happy as the MD's puppet taking orders.



I think this is a very unfortunate characterization of nurses and nursing. 

Both patients and medical staff appreciate the contributions of the bedside nurse. So much so, that giving grief to the nurses of a doctor is sort of like an attack on the King's soldiers. You will also not impress patients by criticising the nurses that took care of them either.

The point of nursing is to take care of basic life needs. (I don't know them very well offhand, because I was not exposed to them as much as nurses are) But bathing, eating, dressing, the ability to carry on some level of activity, health awareness and promotion (like public health management as an extension so people will not get sick enough to need a doctor, which is the basis for the NP angle) and helping to take the prescribed medication, along with spiritual/social interaction and the efforts to help reduce pain is the nurses body of knowledge. It is what makes them professionals. (and also incidentally what got them into anesthesia) 

The role of the nurse is to help the patient (sometimes by doing it for them) follow the instructions prescribed by the doctor and to report to the doctor the success of, failure of, complications of, and potential hazards of during the course of patient care. 

It is not the "decision making" that they assumed as the need for standing orders came about in medicine. It is not the specialized skills that they learn when functioning in the ICU or other technically advanced environment.

The role of the prehospital paramedic is to follow standardized guidlines of patient care in the absence of a physician until that person can be taken to one. 

(in fact back in the day when I went to paramedic school, a paramedic was defined as: "The prehospital care provider in the absence of a physician")

It is in my opinion terribly unfortunate that EMS is not truly part of the continuum of patient care. (lip service is paid to it, but in practicality it is not) The patients journey through healthcare oftne starts over as soon as they reach the hospital. Even when you take them directly to the cath lab or trauma surgery.

Many of the "prehospital treatments" that are perpetuated because of "the environment" and "If we didn't do this we wouln't do anything so give us something to do" would not even be considered by in house care providers. (including facilities smaller than hospitals)

I do not consider myself anti-paramedic. Actually I am rather pro-paramedic. The thing is though, I can call a spade a spade, and the medicine that US EMS has to swallow in order to become true professionals is going to taste really bad, and have a few unpleasant side effects.

But when you attack the way a nurse carries out the prescriptions of a doctor, because you do not like the treatment or method, then you are attacking the decision maker too.(the doctor) 

As a paramedic, I can tell you that you definately do not have the body of knowledge required to do that.


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## DrankTheKoolaid (Feb 24, 2012)

Veneficus said:


> Y*ou might be educated to the basic level of an RN, but many (read vast majority) of your peers are not.* Fair enough
> 
> 
> Sorry, but...no... You are not the master of it. If you were the master of it, you could decide what the treatments would be and when you would use them. If you were the master you could demand the practices that have been demonstrated to not work be removed as well as institute new ones when you demonstrate their value.
> ...


   That I know, the more I learn the more I realize I don't know jack and am the first to admit it.  But do try to improve


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## TatuICU (Feb 24, 2012)

Veneficus said:


> I think this is easily answered, though it might not nbe the answer you want.
> 
> You might be educated to the basic level of an RN, but many (read vast majority) of your peers are not.
> 
> ...



I mostly agree with this.  Now how does EMS change? Do we toss the NREMT since they have proven their existence to be utterly useless and in no way, shape, or form beneficial for EMS professionals? If they were conditions would not be as they are here in my town.  Who takes the reigns and says, "Ok, from now on we're requiring degrees, etc" ?


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## mycrofft (Feb 24, 2012)

Wish we could all pop a beer or soda and look across and realize we're in accordance.





(can't find equiv for females under fifty)


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## Veneficus (Feb 24, 2012)

TatuICU said:


> I mostly agree with this.  Now how does EMS change? Do we toss the NREMT since they have proven their existence to be utterly useless and in no way, shape, or form beneficial for EMS professionals? If they were conditions would not be as they are here in my town.  Who takes the reigns and says, "Ok, from now on we're requiring degrees, etc" ?



I started numerous threads on this and took part in many more.

the latest was a 10 year plan on how to get paramedics a 4 year degree.

By far not a perfect plan, but I described several steps which were successful for the fire service in promoting its members to get fire science degrees.

You can read it here:

http://www.emtlife.com/showthread.php?t=28207&highlight=year+plan


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## JPINFV (Feb 24, 2012)

Sigh.

The NREMT is not a professional organization. The NREMT is akin to the National Board of Medical Examiners who puts on the US Medical Licensing Exam. The NREMT develops their tests based off the standards set elsewhere, specifically the NHTSA.

The NAEMT is the current national EMS association. Want to [complain] and moan that the national EMS organization isn't progressing the trade to a profession? [Complain] and whine at the NAEMT as it's *NOT *the NREMT's job to progress EMS.


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## Canadian Travel Medic (Feb 25, 2012)

I was dispatched to transport a 73 year old male on a day pass from palliative care (over christmas), that has a Hx of Lung Ca, Emphysema and has little to no distal circulation in his extremities d/t extreme frostbite when he was younger. He's on Home 02 and ways about 115lbs and looks sick to begin with normally.  We'll I get the guy back into his room and i'm giving report to the Dr in the hallway, and this grad nurse walks in and hooks up her NIBP and Sat probe and gets a reading of 72% on 2L.  Well she loses it, pages respiratory stat and hits the code button, so me and this Dr going running in.  We get in and here's this poor guy, laying down? with an NRB on and cranked up to 15Lpm, saying he's fine and talking in full sentences with a reps rate about 20 and no audible acute distress.  I gave her the benefit of the doubt, assuming she had never seen this patient before and didn't know about his circulation problems.....she said she had him all last week.  I just laughed inside and walked away haha.


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## EFDUnit823 (Feb 25, 2012)

NYMedic828 said:


> Sorry wasn't aware it was dbag day on the forum.
> 
> Bibasilar rales is a commonly used term around here. It is entirely possible to only have fluid present in one lung and not both. The term is obviously used to distinguish between the two possibilities. Sorry they don't use such terminology out by you. Feel free to google it, it is an actual term.
> 
> ...



LoL...OWNED! On a side note, I work on an ambulance service where we work ED when not on the ambulance. I feel your pain in regard to the nurse’s sense of “superiority” over EMS!


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## jjesusfreak01 (Feb 26, 2012)

Canadian Travel Medic said:


> I was dispatched to transport a 73 year old male on a day pass from palliative care (over christmas), that has a Hx of Lung Ca, Emphysema and has little to no distal circulation in his extremities d/t extreme frostbite when he was younger. He's on Home 02 and ways about 115lbs and looks sick to begin with normally.  We'll I get the guy back into his room and i'm giving report to the Dr in the hallway, and this grad nurse walks in and hooks up her NIBP and Sat probe and gets a reading of 72% on 2L.  Well she loses it, pages respiratory stat and hits the code button, so me and this Dr going running in.  We get in and here's this poor guy, laying down? with an NRB on and cranked up to 15Lpm, saying he's fine and talking in full sentences with a reps rate about 20 and no audible acute distress.  I gave her the benefit of the doubt, assuming she had never seen this patient before and didn't know about his circulation problems.....she said she had him all last week.  I just laughed inside and walked away haha.



I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.


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## TatuICU (Feb 26, 2012)

jjesusfreak01 said:


> I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.



Whoa, intense, good thing you were to help the doc out.


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## exodus (Feb 26, 2012)

jjesusfreak01 said:


> I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.



Why not just stick him on capnography =/


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## jjesusfreak01 (Feb 26, 2012)

TatuICU said:


> Whoa, intense, good thing you were to help the doc out.


They would have eventually figured it out when the monitor started alarming hardcore. The doc's a friend of mine. I had the benefit of getting to stare at the patient for five minutes while he charted and the nurse saw to her other patients. Its a lot easier to figure out what's wrong with a patient when you get to observe them for a longer period of time.



exodus said:


> Why not just stick him on capnography =/


While a good idea, most ERs (at least where I live) do not use ETCO2 as a standard monitoring tool. In my local hospitals, only the trauma/resuscitation rooms have capnography built into the monitor.


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## Aidey (Feb 26, 2012)

exodus said:


> Why not just stick him on capnography =/



It might not be available without calling respiratory for a monitor. None of the mounted vitals monitors in our 4 local ERs originally had capnography built in. 2 of the hospitals now have a couple each but you may not get a room with one. Capnography is truly something that was adopted faster pre-hospital than in the ED.


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## 46Young (Feb 26, 2012)

jjesusfreak01 said:


> I was shadowing an ER doc at a local hospital and watching a patient (from the station) who had OD'd on Opana. The guy's O2 sat was wildly fluctuating, obviously because the guy was deciding that it was only occasionally necessary to breathe. I mentioned to his nurse about the O2 stat and she hastily decided that the SPO2 sensor must be malfunctioning. I turned to the doc and let him know my assessment... he ordered narcan immediately.



I'm suprised that sidestream quantitative capnography is not used more often to monitor the pt's respiratory status. For example, a pt on opiates can be breathing at 24/min but shallow, and will be trending towards respiratory failure. Another pt can be breathing at 8/min but deep, and be fine. SPO2 has too much of a delay; ETCO2 is in real time.


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## 46Young (Feb 26, 2012)

exodus said:


> Why not just stick him on capnography =/



Funny, I just said that, and then read your post.


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## 46Young (Feb 26, 2012)

Aidey said:


> It might not be available without calling respiratory for a monitor. None of the mounted vitals monitors in our 4 local ERs originally had capnography built in. 2 of the hospitals now have a couple each but you may not get a room with one. Capnography is truly something that was adopted faster pre-hospital than in the ED.



Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.


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## TatuICU (Feb 27, 2012)

jjesusfreak01 said:


> They would have eventually figured it out when the monitor started alarming hardcore.



Still though, always nice to avoid the apnea alarm if at all possible.


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## jjesusfreak01 (Feb 27, 2012)

46Young said:


> Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.



The only time i've seen it used in the hospital outside of a code is when ortho is doing reductions under conscious sedation. I know anesthesiology uses it, but it really just isn't used very much. I guarantee you most EMT's that work in systems using capnography know more about it than 95% of nurses in any given hospital.


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## DesertMedic66 (Feb 27, 2012)

46Young said:


> Funny story, I was doing IFT on the overnight, and we had to transfer a 2 y/o pt w/ pneumonia and RSV, who had observed periods of apnea (CA&O) . The sending RN said that she wishes they had a way to monitor the pt's respiratory rate.I explained that we can use ETCO2 with this pt to do just that. She was intrigued after I explained the NC device to her and how it works. I've yet to see ETCO2 used on conscious pt's that are not vented inside the hospital in this region. This troubles me.



We now (April 1st) have to start using ETCO2 on all our airway stuff. So now any patient on oxygen will have it.


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## DrankTheKoolaid (Feb 27, 2012)

Advanced airway i hope you mean.  Otherwise huge waste of money unless there is a reason to look that closely at a persons ventilitory status.

Dont get me wrong, I love ETCO2 and use it on all my advanced airway patients.  Sidestream for asthma/copd/CHF i can see.  But for anyone on O2?  Little over kill i think.


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## DesertMedic66 (Feb 27, 2012)

The way they were making it sound, it's going to be every patient on O2


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## TatuICU (Feb 27, 2012)

Corky said:


> Advanced airway i hope you mean.  Otherwise huge waste of money unless there is a reason to look that closely at a persons ventilitory status.
> 
> Dont get me wrong, I love ETCO2 and use it on all my advanced airway patients.  Sidestream for asthma/copd/CHF i can see.  But for anyone on O2?  Little over kill i think.



Agreed, that's some serious coin for something that certainly not every pt on O2 needs.


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## Handsome Robb (Feb 27, 2012)

We only have ETCO for advanced airways :-/ no sidestream. Flight service has it but it hasn't translated to our ground units left. 

Like corky said, using ETCO on anyone receiving o2 seems to be overkill but if that's what the MD wants thats what the MD gets


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## exodus (Feb 27, 2012)

TatuICU said:


> Agreed, that's some serious coin for something that certainly not every pt on O2 needs.



If oxygen is actually *clinically indicated* how would having an ETCo2 + capnography not be beneficial?  I doubt it will be required on patients with home O2, etc, unless their C/C is respiratory related.


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## DrankTheKoolaid (Feb 27, 2012)

No argument there, Iffffffff it's indicated.


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## exodus (Feb 27, 2012)

Corky said:


> No argument there, Iffffffff it's indicated.



Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.


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## DesertMedic66 (Feb 27, 2012)

exodus said:


> Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.



Oxygen for everyone


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## ffemt8978 (Feb 27, 2012)

exodus said:


> Our new protocol states to only give oxygen if it is clinically indicated, we'll see how that actually goes though.



What?!!?!  No more high flow O2 and high flow diesel for everyone?!?  What are we to do now?


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## Tigger (Feb 28, 2012)

TatuICU said:


> Agreed, that's some serious coin for something that certainly not every pt on O2 needs.



If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).


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## ffemt8978 (Feb 28, 2012)

Tigger said:


> If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).



5 dollars per patient adds up pretty quick, especially if insurance and Medicare deem it unneccesary and won't reimburse for it.

Sent from my Android Tablet using Tapatalk


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## Tigger (Feb 28, 2012)

ffemt8978 said:


> 5 dollars per patient adds up pretty quick, especially if insurance and Medicare deem it unneccesary and won't reimburse for it.
> 
> Sent from my Android Tablet using Tapatalk



If we are administering oxygen correctly in the first place, wouldn't it then be deemed necessary? If it can tell us that our oxygen therapy is providing a benefit, isn't it then reasonable?


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## usalsfyre (Feb 28, 2012)

They're actually about $35 apiece, and can quickly become their own line item considering a normal NC is around a dollar.


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## TatuICU (Feb 28, 2012)

Tigger said:


> If you're monitor already has the capability, is it really that pricy? I was under the impression that the nasal canula type measuring devices (forgive the vagueness in terminology, we don't have them where I work, just in the area) were really rather inexpensive (>$5).



Oh, ok.  The last EMS company that I worked at that used those NCs with the adapters guarded them like they were dipped in gold and rolled in diamonds so i figured they were fairly expensive.  Our monitors at the EMS company I work at now have the monitoring capability but we only have the ET tube adapters for it.


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## TatuICU (Feb 28, 2012)

Tigger said:


> If we are administering oxygen correctly in the first place, wouldn't it then be deemed necessary? If it can tell us that our oxygen therapy is providing a benefit, isn't it then reasonable?



Yeah you're right, but typically those patients that need it will be getting ABGs drawn once they arrive at the ER anyway. Hey, there's an idea, ABGs on scene with the iStat machines.  

Bottom line you are 100% correct that EMS companies should have them at their disposal, but if I were trying to cut costs as an admin, I probably wouldn't think too highly of them.


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## TatuICU (Feb 28, 2012)

exodus said:


> If oxygen is actually *clinically indicated* how would having an ETCo2 + capnography not be beneficial?  I doubt it will be required on patients with home O2, etc, unless their C/C is respiratory related.



Because as it sits now, alot of EMS providers give O2 "just because" and not when it is actually clinically indicated.


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## Veneficus (Feb 28, 2012)

Sounds to me like:

Rather than educate people to the proper use of oxygen and physicians not writing protocols for high flow oxygen on patients that would not benefit, ambulance operators are expected to pay more for a gadget to try and make up for poor training and medical direction. 

I can't see why anyone would pay for this.


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## mycrofft (Feb 28, 2012)

And where do we want the fulcrum for the prehospital-versus-in hospital care teeter-totter to shift to? 
Will it be frequently enough used to support amortization and skill currency? Will short transport times in urban settings make its use superfluous?
But this is about us uppity nurses....


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## triemal04 (Mar 1, 2012)

Veneficus said:


> Sounds to me like:
> 
> Rather than educate people to the proper use of oxygen and physicians not writing protocols for high flow oxygen on patients that would not benefit, ambulance operators are expected to pay more for a gadget to try and make up for poor training and medical direction.
> 
> I can't see why anyone would pay for this.


Sorry, even though I agree I couldn't help but laugh a bit when I read that.


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## MedicBrew (Mar 1, 2012)

Veneficus said:


> I can't see why anyone would pay for this.



This has become the standard of care here for specific cases.  

Just curious Veneficus, you see no benefits by utilizing EtCo2 monitoring pre-hospital?  Or did I misunderstand what you were saying?


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## triemal04 (Mar 1, 2012)

usalsfyre said:


> They're actually about $35 apiece, and can quickly become their own line item considering a normal NC is around a dollar.


Part of being a profession is being accurate and clear when speaking in public, even on small issues, and making sure that the information given is correct.

A disposable sidestream ETCO2 detector (which is what is most commonly used in both ground and air units and not uncommon to see in-hospital) is about $13 dollars give or take, for the cannual type, and even less for a t-piece for ET tubes.

A replacement for a mainstream ETCO2 detector is higher, but luckily they are reusable.

You must be getting ripped off by your supplier...I guess...


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## 8jimi8 (Mar 7, 2012)

Another thing about being clear.

Do not use abbreviations. I guarantee this is why the nurse didn't understand you.  

I didnt. I'm still wondering if you mean adult or acute pulmonary edema.  

Trying being clear an professional before you start bashing other professionals.  

Try explaining why you did something and maybe someone will learn from you 

rather than writing you off as a high and mighty jerk.  Keep in mind in the 

hospital we have more than one patient and more than one set of problems we 

are thinking about, while you are off running your mouth.

The proper professional report goes something like: demographics, history and home meds, presentation and chief complaint, then vitals and interventions. Clear communication.


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## exodus (Mar 7, 2012)

8jimi8 said:


> Another thing about being clear.
> 
> Do not use abbreviations. I guarantee this is why the nurse didn't understand you.
> 
> ...



I read this as a haiku.


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## 8jimi8 (Mar 8, 2012)

exodus said:


> I read this as a haiku.



Then My job here is

Done sans retaliation

for misplac-ed hate


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## Tigger (Mar 11, 2012)

usalsfyre said:


> They're actually about $35 apiece, and can quickly become their own line item considering a normal NC is around a dollar.



A quick google found the etCO2 NCs for five a piece. When I was first shown them by a local FD's ALS coordinator he said they were getting them for seven and that the majority of patients getting 02 would also be getting etCO2 monitoring.


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