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  1. Akulahawk

    Documentation question

    Then you look for an assessment tab that states something along the lines of "normal for patient" or you leave it blank and describe what you see in your narrative and state that this is not abnormal for that patient. I had a patient recently who had a large depression in his head. It was normal...
  2. Akulahawk

    When to get patient contact information

    The good news is that if you're still doing paper PCRs, you don't have to worry about battery life... ;) In your instance, you just need to have your pen/notebook out and get that info early on. The vast majority of people will tell you their demographics. A few won't or can't. In my experience...
  3. Akulahawk

    When to get patient contact information

    If minimizing scene time is important, just try to get name and maybe DOB. Right then. It can be as simple as "Hey, what's your name?" "Hey, what's your birthday, my boss wants it for my chart..." "Hey, you got an ID? I've got a terrible memory..." Once you get to the Hospital, their...
  4. Akulahawk

    Documentation question

    This is exactly what should have been covered by your initial training. You don't do a full head to toe on EVERY patient. If I'm REQUIRED to put SOMETHING in EVERY field for a head to toe, then I might choose an "other" option and enter "deferred" in that field for those areas that I chose not...
  5. Akulahawk

    the 100% directionless thread

    Last week I was able to put some suspension parts upon my pickup. I installed the RAS system on my F150 and I do have to say that I am quite pleased with the improvement in how the truck rides. Unfortunately I wasn't at work (neither job) and as work doesn't have vehicle lifts of any sort, I had...
  6. Akulahawk

    Documentation

    One of the things I enjoy about running IFT calls (I'm a CCT-RN now) is that if I'm not too busy, I get a chance to read the paperwork. If I'm doing an IFT where the origin and destination are in the same system and therefore no transfer paperwork, I will usually ask for at least a copy of the...
  7. Akulahawk

    Book question

    Agreed. The book does contain all the required information specified. Some individuals can absorb the material appropriately and pass the cognitive exam. Some people will need an instructor to present that same information in a different modality to enhance the learning process. How that...
  8. Akulahawk

    Documentation

    I'm with NomadicMedic on this. If you don't carefully pay attention to the Physician's Medical Necessity Certification, you very well could inadvertently chart something that results in an insurance/Medicare denial because what you charted might well conflict with the PMNC. I'll give you a...
  9. Akulahawk

    Ultrasound IV in the field

    Yes. The 20g tip can be very hard to find compared to the 18g unless you manage to stick the vein during your initial puncture attempt... when that happens, you get a nice sudden bright spot in the center of the vein. Of course when you're being observed and this happens, you look like a miracle...
  10. Akulahawk

    Ultrasound IV in the field

    Not a fan of using a peripheral line for pressors or inotropes... but sometimes their use is necessary to buy time to get a central line in place. Edematous patients can also be an indication for a peripheral US line. I generally say that it's a lot like playing a video game. If you have good...
  11. Akulahawk

    Ultrasound IV in the field

    When I'm called, most of the usual sites have been already chewed through and/or they're vasoconstricted from either dehydration or use of vasopressors. I can go MUCH faster than that, 3-5 minutes as you do, when necessary. I happen to like the anterior forearms but I also use the cephalic vein...
  12. Akulahawk

    Ultrasound IV in the field

    I'm also very, very good at doing USGPIV's. While I can take 20-30 minutes to do one, most of that time is spent looking for an appropriate site. Once I find a site and all the tubing for a saline lock is ready, the actual time from start to finish is maybe 3-4 minutes. If I'm doing one...
  13. Akulahawk

    New scoring system, how to know if you're close to passing?

    Fair enough!! In any event, it's been so long since I've done an NREMT written that they've probably revised the test and testing process at least a couple times since I took mine on paper... Mostly, for your sake, I hope that you get some kind of report that tells you basically what areas you...
  14. Akulahawk

    New scoring system, how to know if you're close to passing?

    Far enough that you didn't pass. If the score required to pass is 950 and you got 949, you still wouldn't have passed. As far as what you didn't get correct "enough" to not pass, who knows. Hopefully you'll get some kind of report that suggests the areas of study you will likely need.
  15. Akulahawk

    Assessment Question

    I think what I was getting at in my earlier post is that checking the ABC's/Primary Survey can be completed so quickly that you flow very, very quickly into your secondary survey stuff and start treating as you discover problems. As you gain experience in assessing patients, it starts to LOOK...
  16. Akulahawk

    Assessment Question

    You probably wouldn't be applying oxygen during your primary survey as that's basically just establishing that the patient's ABC's are intact. Basically, they're breathing (and therefore airway is open) and have a pulse. If someone is actively complaining of chest pain, they're probably not...
  17. Akulahawk

    Blood pressure

    In addition to what Matt said above, one of the ways I check for proper placement of the stethoscope head is that I actually feel/palpate the location of the brachial artery. Once I find it, I KNOW exactly where to put the stethoscope head. One other way I verify that I'm in the right place is...
  18. Akulahawk

    Pupils in head injuries

    Simply put, it's a window into the state of the brain... and noting changes in the pupils can be as, or more, important than a single assessment in the setting of head injury.
  19. Akulahawk

    Supplemental oxygen in relation to Spo2

    As stated above, there are a number of instances when there's a complaint of SOB but still oxygenating well. Most SpO2 sensors that I know of are only capable of determining the percentage of hemoglobin that's bound to something (usually oxygen) or not bound to something. Carbon Monoxide binds...
  20. Akulahawk

    Shortness of breath

    In light of recent threads, and to encourage study by the OP of all these threads, I'm closing this and related threads.
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