Just started EMT-B program 3 weeks ago, any input?

woogyboogy

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I'm 24 years old, and I have wanted to become a Paramedic/Firefighter for as long as I can remember. My family has been in the medical field their entire life, however none have been in a pre-hospital setting.

I have been stalking this forum for quite some time now, just reading, and absorbing information that seems pertinent.

The EMT program I'm enrolled in is actually an "accelerated" program. They didn't inform us before hand. So it's actually 12 weeks long, with the 2 weeks at the end being final exams, so ultimately 10 weeks. It has been rather intense so far, they have thrown us a lot of information in such a short time, however most of it is basic. We just took our first FISDAP unit exam, which was an 80 question Airway and Respiratory exam. Our class of 22 students averaged a 69%. I got the second highest grade which was an 81%

We have lecture, and lab once a week, Monday (Lecture) 14:00-20:00, and Wednesday (Lab) 14:00-21:00. They basically told us at the beginning of the program, that the material you need to learn, will be up to you, with what you do on your own time. So needless to say we have a lot of chapters that need to be covered to get through a 1,600 page book in 12 weeks, not only reading it, but being able to comprehend the material.

Anyways, as far as the Lecture setting goes I feel relatively comfortable. I have a general understanding of A&P. I have completely memorized the Medical and Trauma Assessment NREMT sheets for lab. However, we have done scenarios on multiple manikins, which all have pulses, blood pressures, lung sounds, respirations (depth/quality), and can speak (Proctor). So basically our scenarios are setup to where the Proctor controls the manikin's signs/symptoms on an iPad, and we have to "arrive on scene" and properly treat their condition, and the Proctor can change the vitals at any time without us knowing.

I have a general understanding of the physiology of most of the diseases we've covered this far;
(Bronchitis Acute/Chronic, Emphysema, Cardiac Tamponade, Pulmonary Embolism, Pneumonia, CHF, Pneumothorax, Asthma, Epiglottitis, and the various shocks). However I'm having a hard time being able to properly treat them with the signs/symptoms they present within a 10-15 minute "Scenario" assessment.

For instance, yesterday in our lab scenario, I had a patient who was AOx3, complaining of shortness of breath. Pulse was 96, respirations were 26, but he was able to talk with complete sentences. I had my partner apply a non-rebreather at 10lpm. Skin condition was pink, warm, and dry. Blood pressure was 132/96. Lung sounds rales, crackly, and somewhat wet. In the SAMPLE history he explained that he had NKA, and was prescribed an Albuterol inhaler. Past pertinent history he explained that he had been diagnosed with Chronic Bronchitis. So here's where I made my mistake; I immediately assumed that since he had Chronic Bronchitis, and was prescribed Albuterol, that I should immediately help him administer it, (totally forgetting his WET lung sounds). So I ended up giving him 3 doses of his Albuterol, which inevitably made his condition deteriorate, and ultimately "flooded" the patient out by dilating his bronchioles.

Most of the diseases share the same lung sounds and signs/symptoms. So my question to you experienced EMS professionals, is what can I do to further my knowledge on differentiating between everything, and being able to react with the appropriate treatment in a timely manner?

I am all ears, and will take any criticism, constructive or not.

Thanks!
 

NomadicMedic

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What's your protocol for CHF or pneumonia?

(By the way, the idea of a CHF patient presenting with flash pulmonary edema after a couple of albuterol MDI treatments is grossly overstated in EMT class.)

It's VERY different as a paramedic.
 
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woogyboogy

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What's your protocol for CHF or pneumonia?

(By the way, the idea of a CHF patient presenting with flash pulmonary edema after a couple of albuterol MDI treatments is gross overstated in EMT class.)

It's VERY different as a paramedic.

Our "school" protocol for CHF would be to apply CPAP if rales/crackles were present upon auscultation. However signs/symptoms for CHF and Pneumonia are very similar, so to get a more definitive treatment plan, I would rely on my History taking (past, recent, hospital visits and what they were for)

I'm assuming in my scenario situation I explained earlier, the only thing I could have done as an EMT would have been Non-Rebreather 15lpm, position of comfort, and transport? Along with the reassessment.

Keep in mind, that I've only been in the program for 3 weeks, so I am absolutely the furthest from experienced.

Thanks for the response, I appreciate it!
 

NJnewbie

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I have no advice to give because I'm not starting my EMT class until the fall, but I think it's cool that you have the manikins. I hope we have that when I take the class. Also, you said you have a lot of family members in the medical field, so do any of them know anyone in a pre-hospital position who could help you out?
 

NomadicMedic

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Sure. He certainly didn't seem to be in extremis. I'd add, "if he deteriorated further, I'd consider CPAP"
 

LiveForTheTones

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I'm in an accelerated program as well. Everything was very overwhelming and fast-paced. But no matter how many times we had scenarios, nothing really stuck in my brain the way it did when I started my ride time.
Don't get me wrong. I KNEW a lot before I started rides. I wasn't going in like, "HaDUR! I don't know what to do!!" You know? But it was a struggle to remember at the drop of the hat. After every ride and the different situations, it kind of got burned in my head because it actually mattered.
I wasn't assisting with a mannequin. I was assisting with someone who was living and breathing and had an actual problem. It wasn't pretend. After that, it all just kind of clunked down in to place.
I don't know if that will bring you comfort or help you in any way. But once you start to actually DO, it will all get easier.
 

COmedic17

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12 weeks is accelerated for EMT?

...I didn't know that any EMT classes lasted longer then 12 weeks. Mine was 12 weeks and was not "accelerated".
 

Medic Tim

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The accelerated programs I have seen are 2-3 weeks.
Most Emt classes are spread out over 3-4 months and usually meet 1-2 days a week.

Either way they are 120-150 hours.
 

NomadicMedic

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Exactly. An accelerated EMT program is done in 14 days. 12 weeks is about normal pace. It's usually broken up into two weekday evenings and a Saturday skill class.
 
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EMT2015

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My first EMT program was 5 months (16 weeks) and we meet twice a week. My summer program was 2 months (8 weeks) and we meet 3 times a week. The summer program was brutal, but I did it!!!
 
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woogyboogy

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All of the programs offered in my area are usually 16 weeks. However the Summer program is 12 weeks. I wasn't aware that the average EMT program was 12 weeks, oh well.
 
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woogyboogy

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I have no advice to give because I'm not starting my EMT class until the fall, but I think it's cool that you have the manikins. I hope we have that when I take the class. Also, you said you have a lot of family members in the medical field, so do any of them know anyone in a pre-hospital position who could help you out?

Unfortunately I do not know anyone that works in the pre-hospital field. However, my girlfriend is a Cardiac nurse, so she can help me out a decent amount of Cardiology related questions, which has proven to be very helpful.
 
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woogyboogy

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Sure. He certainly didn't seem to be in extremis. I'd add, "if he deteriorated further, I'd consider CPAP"

So could you tell me what you think I should have done as far as appropriate treatment measures? NRB 15L, Position of comfort, Transport?
 
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woogyboogy

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I'm in an accelerated program as well. Everything was very overwhelming and fast-paced. But no matter how many times we had scenarios, nothing really stuck in my brain the way it did when I started my ride time.
Don't get me wrong. I KNEW a lot before I started rides. I wasn't going in like, "HaDUR! I don't know what to do!!" You know? But it was a struggle to remember at the drop of the hat. After every ride and the different situations, it kind of got burned in my head because it actually mattered.
I wasn't assisting with a mannequin. I was assisting with someone who was living and breathing and had an actual problem. It wasn't pretend. After that, it all just kind of clunked down in to place.
I don't know if that will bring you comfort or help you in any way. But once you start to actually DO, it will all get easier.

Thanks for the positive vibes! I feel as though the more we practice I will begin to get more comfortable, being only 3 weeks in, there is still a lot of information floating around that I need to gather, and use in the scenarios. I need to think about all the differential diagnosis, and narrow my options down. I think because we only have 10-15 minutes, I just feel rushed and make a decision without thinking about it (Obviously this cannot continue to happen).

I can definitely see where your going when you say that ride-times helped you pull everything together. I start my first 24 hour ride-time in 2 weeks and cannot wait.

Thanks again!
 

NomadicMedic

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So could you tell me what you think I should have done as far as appropriate treatment measures? NRB 15L, Position of comfort, Transport?

For EMT class, you did the right thing. I dont recall his SpO2, but I doubt 10 LPM of oxygen was warranted. Perhaps a NC at 2? Constant reassessment of lung sounds and the option to move to CPAP if the condition worsened. That's about all you have in the toolbox as an EMT.
 
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woogyboogy

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For EMT class, you did the right thing. I dont recall his SpO2, but I doubt 10 LPM of oxygen was warranted. Perhaps a NC at 2? Constant reassessment of lung sounds and the option to move to CPAP if the condition worsened. That's about all you have in the toolbox as an EMT.
Appreciate info, and the response!
 

NomadicMedic

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You'll want to know things like: has he had a fever? Been generally unwell recently? Any recent hospitalization. Productive cough? What color is the sputum? Any chest pain? Pain in inspiration or exhalation? Any point/pleuritic pain? What meds is he on aside from the albuterol? Has this ever happened before and if so, what did the doc say it was?

Obtainibg a good history can help you with differentials as you gain experience. A paramedic level Q&A can be done by any level. Ask questions, get answers and then put the clues together.

For example: He's got wet lungs, been unable to breathe at night, has to sleep on 3 or 4 pillows, is air hungry and takes 80mg of Lasix BID. His feet are swollen and he's coughing up lots of white/pink sputum. Smells like CHF.

CPAP and a medic, if you have them.

But if you're unsure, in the real world, there is nothing wrong with helping/fixing what you can and going to the hospital. When you get there, explain to the doc/nurse why you're unsure, what you did and ask if they have any thoughts for you. Chances are, the doc or nurse will have a pretty good idea right off the bat. Use the ones you're not sure of as a learning experience and file away the nuggets for the next time.
 
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woogyboogy

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You'll want to know things like: has he had a fever? Been generally unwell recently? Any recent hospitalization. Productive cough? What color is the sputum? Any chest pain? Pain in inspiration or exhalation? Any point/pleuritic pain? What meds is he on aside from the albuterol? Has this ever happened before and if so, what did the doc say it was?

Obtainibg a good history can help you with differentials as you gain experience. A paramedic level Q&A can be done by any level. Ask questions, get answers and then put the clues together.

For example: He's got wet lungs, been unable to breathe at night, has to sleep on 3 or 4 pillows, is air hungry and takes 80mg of Lasix BID. His feet are swollen and he's coughing up lots of white/pink sputum. Smells like CHF.

CPAP and a medic, if you have them.

But if you're unsure, in the real world, there is nothing wrong with helping/fixing what you can and going to the hospital. When you get there, explain to the doc/nurse why you're unsure, what you did and ask if they have any thoughts for you. Chances are, the doc or nurse will have a pretty good idea right off the bat. Use the ones you're not sure of as a learning experience and file away the nuggets for the next time.

Thank you so much for this post, I appreciate it! Very solid information here!
 

Brian Herzberg

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the only thing that got me through that class is a study group, flashcards, and giving up everything in your life (partys, women/or men i dont hate) haha. but seriously, your about to go into the world and help save lives, give it your undivided attention and do your best.. i sure wouldnt want a subpar emt to take care of my mom or myself and neither would you. and yes, take everything everyone is saying into consideration, but trust me, you will learn what you need to know in the field. get the basics down and pass the NREMT. then worry about what happens outside the box when you get out of it. 1 step at a time. good luck on your future endeavors!
 

squirrel15

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the only thing that got me through that class is a study group, flashcards, and giving up everything in your life (partys, women/or men i dont hate) haha. but seriously, your about to go into the world and help save lives, give it your undivided attention and do your best.. i sure wouldnt want a subpar emt to take care of my mom or myself and neither would you. and yes, take everything everyone is saying into consideration, but trust me, you will learn what you need to know in the field. get the basics down and pass the NREMT. then worry about what happens outside the box when you get out of it. 1 step at a time. good luck on your future endeavors!

Giving up everything for EMT-B class seems a little excessive to me... For medic school I could see it, but I don't think EMT was that intense.. YMMV and you might need to put more focus into, if that's the case, do so.
 
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