Brand New Medic

LoadingCosta

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Hello,

As the title explains I am a brand new paramedic working 911 calls at my Fire Department. In the past I worked 911 but never really did much transporting to hospitals. The last Fire Department I worked at I was an EMT and they did not transport to the hospital. We would show up on scene and just gather vitals and help transfer the patient to the oncoming ambulance that showed up on our scene to transport our patient. Prior to becoming a paramedic I was functioning as an EMT and I would get nervous on calls that required ALS interventions but once the call got going and we were in the back of the ambulance working it started to sub-side because the eyes were not on me. I've only probably being doing legit 911 transport calls as an EMT now for about a year. Just recently about a couple weeks ago is when I obtained my paramedic license and it didn't hit home that I was going to be the leader now and eyes would be put on me. We have had a few close calls that turned out to be nothing. One call coming out as a pregnant female not breathing. When the tones dropped for that call I was beyond nervous. My heart was racing and I was constantly worried about messing up and being looked at as the paramedic that kills people. While I was in school I knew the material. I hate to say this but I barley studied in medic school. I mainly just studied the ALS AHA guidelines and my drugs and of course ECG's. I passed my psychomotor skills on my first try and pass the written exam first try at 80 questions. I feel book smart but when it comes to the street I am not sure if I am that leader that needs to be. I am a very introverted person and its hard for me to have "confidence." I'm a pretty low self esteem person and I am always constantly worried about what I may say wrong or what someone may think of me. I am always worried now about performing a procedure wrong or being completely stumped on something as simple as seeing V-tach on the monitor and forgetting to shock it because of how nervous I would be and get tunnel vision. It really demoralizes me because I really do enjoy the medical field but I do not think I am cut out for the emergency setting. Ever since I obtained my medic I am constantly worried about the tones dropping and it being a serious call such as a bad trauma (gun-shot, MVC, etc), cardiac arrest, pediatric calls, anaphylaxis shock, etc. In a calm setting I can tell you everything I would do for this but in a real life situation I get tunnel vision due to my nerves and always and I mean always second guessing myself. I always feel stupid and think to myself I should have never even passed medic school.

Its always been a goal of mine to go to PA school and specialize in sports medicine more specifically orthopedic. I obtained my paramedic to bridge to nursing because it always me to work full-time but this really doesn't matter for this thread. I'm just not sure if I am cut out for this because all other medics I have talked to say they never got nervous and think its crazy how nervous I actually get. They keep trying to convince me to stay but I believe that is because they just don't want to lose a medic because they would get back on the box. I just don't know. I wish I wouldn't get so damn nervous.
 

justin1232

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Your new. I’m same way. Been working as a medic for 4 months now and also going PA route ( but still got plenty of schooling to finish haha). We’re I work I don’t get many traumas/pediatrics but do get a lot of chronic sick calls for septic shock/etc. whoever says there never nervous is either lying or has no emotions. Everyone gets nervous. I still get nervous when I get on scene and assess the altered mental status With list of medical issues with me being the leader.
my preceptor in school told me be about a good year til you feel comfortable and other seasoned medics say same thing. i also just remember “ don’t let them see you sweat” which for me works when calming my nerves.
If you feel that nervous though due to knowledge issues I suggest keep studying material from school. I still go over my medic notes and chapters for review.
 

hometownmedic5

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You're a brand new medic. You are, if you fit the basically universal model for brand new medics, criminally incompetent.

Breathe. We're going to get through this.

We all, every one of use, started off here. You'll figure it out. Your first bad call will probably be a trainwreck. Nothing will go right, your performance will be garbage, everybody is going to look at you like you're a moron, your crew is going to laugh at you, and so on. This will probably happen more than once. It depends a lot on how you're mentored and supported, and your average volume; but you're probably going to spend about a year here. Sure, your skills will improve along with your confidence, which will improve your performance, which will improve your confidence and so on; but it takes time to be good at something, even when it's being a paramedic.

There isn't one of us who walked out of P school actually know everything. Some programs are better than other, true enough, but we all climbed this mountain. Try your best, never stop learning, and own your errors.

Or, as my clinical coordinator told me on my 6th day as a paramedic when I worked PB(as the P) for the first time, "try not to f**k it up".
 

mgr22

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LoadingCosta, two things you said that stood out to me is that you're a "very introverted person" and a "pretty low self esteem person." Those traits would make new-medic nerves even worse.

I wonder if being such an introvert is partly due to low self-esteem. If so, would being more extroverted help you feel better about yourself, even if you're forcing it? I'm thinking you could try having more conversations with patients and partners, not to the point where you're neglecting your work, but just to be sociable. You might find relating to the people around you will take some of the mystery out of EMS and calm you down a bit. That helped me.
 
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LoadingCosta

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Your new. I’m same way. Been working as a medic for 4 months now and also going PA route ( but still got plenty of schooling to finish haha). We’re I work I don’t get many traumas/pediatrics but do get a lot of chronic sick calls for septic shock/etc. whoever says there never nervous is either lying or has no emotions. Everyone gets nervous. I still get nervous when I get on scene and assess the altered mental status With list of medical issues with me being the leader.
my preceptor in school told me be about a good year til you feel comfortable and other seasoned medics say same thing. i also just remember “ don’t let them see you sweat” which for me works when calming my nerves.
If you feel that nervous though due to knowledge issues I suggest keep studying material from school. I still go over my medic notes and chapters for review.

Hey Justin1232,

Sorry it took me a couple of days to reply. I appreciate you taking the time out of your day to respond to my post. That is awesome that you are choosing to go the PA route as well. I'm excited to one day achieve the goal and I hope all the best for you as well in your journey towards becoming one!

Where I work we its kind of the same way. We get a lot and I mean a lot of sick calls. People calling for basically anything. I literally had someone call me out to ask if it is okay for them to take there medication. The crazy part about where I work is we as a department will go on a pretty good dry spell for maybe a couple of months running all the BS calls you can think of and then out of no where a gun shot, someone thrown from a vehicle, cardiac arrest, STEMI or stroke will just come with a fury.

Well it was my LT. who said he was never nervous about being a paramedic. Then again he never has to ride the box. He is always on the Engine or Tower so he never has to be that lead medic. However I did not know him when he first obtained his paramedic.

See with me I get nervous but its a different kind of nervous. Its more if I get on scene with an AMS, will I know what to do? If so will I be capable of handling it and being "tough" when it needs to be. Psych patient's are tough because its really hard for me to be tough towards you when he never really did anything to me in the first place. Trying to figure out when is the right and wrong time to Haldol something and take them to the hospital etc.

I'm always constantly studying because I am literally in the process right now of knocking out my last science core classes to get into nursing school and to bridge from my medic to RN. I just need to figure out this self esteem and lack of confidence issue. I want to be able to see something and it pop right up into my mind and I can go I need this and this and explain why and then transport.
 
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LoadingCosta

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You're a brand new medic. You are, if you fit the basically universal model for brand new medics, criminally incompetent.

Breathe. We're going to get through this.

We all, every one of use, started off here. You'll figure it out. Your first bad call will probably be a trainwreck. Nothing will go right, your performance will be garbage, everybody is going to look at you like you're a moron, your crew is going to laugh at you, and so on. This will probably happen more than once. It depends a lot on how you're mentored and supported, and your average volume; but you're probably going to spend about a year here. Sure, your skills will improve along with your confidence, which will improve your performance, which will improve your confidence and so on; but it takes time to be good at something, even when it's being a paramedic.

There isn't one of us who walked out of P school actually know everything. Some programs are better than other, true enough, but we all climbed this mountain. Try your best, never stop learning, and own your errors.

Or, as my clinical coordinator told me on my 6th day as a paramedic when I worked PB(as the P) for the first time, "try not to f**k it up".
Hello Hometownmedic5,

Thank you for taking the time to respond to my thread. Basically everything you said has to be one of my biggest fears of being a paramedic lol. I've always lived my life as someone who wants to do everything he does to the best of my ability and my performance to exceed someones else. Do not mean to sound arrogant but I just think highly of myself and want to be the best at whatever I choose to do in my life. Its hard to say I was mentored good or bad. I will say however I feel as if my paramedic school just pushed people and didn't really try to weed out people who should and should not be there. It almost as if you really had to screw up something for them to fail you. For example I never failed any of the PALS or ACLS but many in my class failed the written exam and I mean bombed it and still had multiple chances to pass it which eventually they did because unless they gave up my school just kept letting them take it. Then when I started clinical's, my preceptors were amazing don't get me wrong. The issue was lack of calls that actually required any work. All if not majority of my clinicals consisted of granny totes. I only had a few gunshots, like 5 cardiac arrests and that really is about it in my career. During those I was working as basic so it really didn't take much for me or thinking from me to really do anything. I was the driver if you will and I guess due to all this that is why I am scared to be a paramedic.

Also I will "try not to f**ck it up" lol. Thank you for your advice sir.
 
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LoadingCosta

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LoadingCosta, two things you said that stood out to me is that you're a "very introverted person" and a "pretty low self esteem person." Those traits would make new-medic nerves even worse.

I wonder if being such an introvert is partly due to low self-esteem. If so, would being more extroverted help you feel better about yourself, even if you're forcing it? I'm thinking you could try having more conversations with patients and partners, not to the point where you're neglecting your work, but just to be sociable. You might find relating to the people around you will take some of the mystery out of EMS and calm you down a bit. That helped me.
Hello mgr22,

Thank you for respond to my thread. I really do appreciate it. Yes I agree with you completely that the traits I posses do not set me up for success. I would agree that me being very introverted is due to my self esteem. I've always been the person growing up to keep to themselves and stay inside majority of the time unless me and my friends wanted to go do something sports related. Not sure if my self esteem comes from an image of myself as well. It's really hard to say if I am to be honest. I have never been the person when out in public to initiate a conversation with someone else and if someone started a conversation with me it would be hard for me to keep it going. I have my moments in the back of the ambulance when I am capable of talking to patient's just fine. I guess the self esteem issue comes into play when I my treatment or whatever I am doing is not working or if I say something and the patient looks at me like I am stupid or the pediatric population is beyond hard for me. I also do not have the ability to handle tough patient's situations very well. I hate aggressive patient's because where I work it seems as if almost all out patient's want to fight us or make our job much harder than it needs to be.
 

StCEMT

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It's going to take you about a year to feel comfortable depending on you call volume. Give yourself a few more years after that and a sense of confidence settles in for things that are genuinely difficult calls (not that you won't get humbled or completely at a loss). Most new medics don't start out the gate being the person who can handle just about anything with confidence and competence. That all takes a lot of time.

As far as being an introvert and low self esteem? The self esteem will come with experience. Hold yourself to a high standard, but realize that you're new. You're going to make mistakes. You're going to feel lost. You'll also do things right. Learn from all of those and be better. And you don't have to be outgoing. I'm not an extrovert, hell some days I don't even want to talk to people, but I can at least spit out my usual pt conversation stuff. When the call is done, I go back to reading, watching a cooking video, or just doing whatever I was doing. Other days I talk to my partner all shift. Doesn't mean you can't be effective at your job.

This is the stuff I throw a little bit of suck it up for though. Not because I don't get it, but because it gets better if you put the work in. Reference your resources, follow advice of the people you know are good, communicate with your crew after calls to find areas of improvement, and just learn. Suck it up, put the work in, and you will get there. We all have been where you are, it just takes time.
 

hometownmedic5

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Hello Hometownmedic5,

Thank you for taking the time to respond to my thread. Basically everything you said has to be one of my biggest fears of being a paramedic lol. I've always lived my life as someone who wants to do everything he does to the best of my ability and my performance to exceed someones else. Do not mean to sound arrogant but I just think highly of myself and want to be the best at whatever I choose to do in my life. Its hard to say I was mentored good or bad. I will say however I feel as if my paramedic school just pushed people and didn't really try to weed out people who should and should not be there. It almost as if you really had to screw up something for them to fail you. For example I never failed any of the PALS or ACLS but many in my class failed the written exam and I mean bombed it and still had multiple chances to pass it which eventually they did because unless they gave up my school just kept letting them take it. Then when I started clinical's, my preceptors were amazing don't get me wrong. The issue was lack of calls that actually required any work. All if not majority of my clinicals consisted of granny totes. I only had a few gunshots, like 5 cardiac arrests and that really is about it in my career. During those I was working as basic so it really didn't take much for me or thinking from me to really do anything. I was the driver if you will and I guess due to all this that is why I am scared to be a paramedic.

Also I will "try not to f**ck it up" lol. Thank you for your advice sir.
Here’s the thing though. Even if you’d been put through the wringer and done 500 trauma codes during your ride time, you’d still be a crappy medic for awhile because, just like everything isn’t “granny totes”, everything isn’t trauma codes either. This is a dynamic Job. It takes time to find all the weak spots and shore them up. If you work with and for good people, they’ll guide you along the process. If you work somewhere else, your boss is going to throw you out of the boat and most of your coworkers are going to laugh at you while you flounder.
 

CCCSD

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Stop. Take five seconds to breathe and get set before each contact. Every . Time.
There is nothing that requires you to rush headlong into it. Nothing.
Ive done that for over 40 years, in just about any situation you can think of and then some...
 
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LoadingCosta

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It's going to take you about a year to feel comfortable depending on you call volume. Give yourself a few more years after that and a sense of confidence settles in for things that are genuinely difficult calls (not that you won't get humbled or completely at a loss). Most new medics don't start out the gate being the person who can handle just about anything with confidence and competence. That all takes a lot of time.

As far as being an introvert and low self esteem? The self esteem will come with experience. Hold yourself to a high standard, but realize that you're new. You're going to make mistakes. You're going to feel lost. You'll also do things right. Learn from all of those and be better. And you don't have to be outgoing. I'm not an extrovert, hell some days I don't even want to talk to people, but I can at least spit out my usual pt conversation stuff. When the call is done, I go back to reading, watching a cooking video, or just doing whatever I was doing. Other days I talk to my partner all shift. Doesn't mean you can't be effective at your job.

This is the stuff I throw a little bit of suck it up for though. Not because I don't get it, but because it gets better if you put the work in. Reference your resources, follow advice of the people you know are good, communicate with your crew after calls to find areas of improvement, and just learn. Suck it up, put the work in, and you will get there. We all have been where you are, it just takes time.
Hello StCEMT,

Thank you for replying to my post. I greatly appreciate it! It's funny how you mention the call volume will build confidence. Whenever its a B.S call my confidence is through the roof because you know nothing is really wrong or at least its not an "emergency." The amount of B.S calls I have ran compared to legit calls its ridiculous. I barley ever run legit calls. For example last shift there was a gun shot that happened while I was on shift and the other Rescue got the call due to the incident happening in there area and then five minutes later I get toned out to a panic attack. That pretty much sums it up. However tomorrow will be my first shift ever that I am officially released as a medic and will be working with an EMT and not a paramedic anymore. I am excited but nervous at the same time.

Me and you sound very similar in regards to the extrovert and introvert. It is promising to hear how someone is similar to me and can relate. Majority of days for me I really do not even care to have a conversation with someone. I find it so mentally taxing to talk to people at times because I always trying to find the correct words to say. I function so much better not saying anything and just watching but I know in this career I need to talk.

I have really good people around me that really do care about me and want me to succeed. I honestly can't ask for a better crew and I am grateful for that.
 
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LoadingCosta

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Here’s the thing though. Even if you’d been put through the wringer and done 500 trauma codes during your ride time, you’d still be a crappy medic for awhile because, just like everything isn’t “granny totes”, everything isn’t trauma codes either. This is a dynamic Job. It takes time to find all the weak spots and shore them up. If you work with and for good people, they’ll guide you along the process. If you work somewhere else, your boss is going to throw you out of the boat and most of your coworkers are going to laugh at you while you flounder.
Hello Hometownmedic5,

Thank you for taking the time to reply sir. I appreciate it. I agree with you to some extent about the first statement. I guess for me is I would still have more confidence then I do now going in if I did run more trauma codes, codes, gun shots, etc. Not because I see them all as equal but rather because I would have the experience under my belt to start looking for things I have seen on previous calls. I look at it like the old saying practice makes perfect. The more I run certain calls the better I will do on the next call from learning if that makes sense. This absolutely is a dynamic job and I can't disagree with you there.
 
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LoadingCosta

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Stop. Take five seconds to breathe and get set before each contact. Every . Time.
There is nothing that requires you to rush headlong into it. Nothing.
Ive done that for over 40 years, in just about any situation you can think of and then some...
Hey CCCSD,

Thank you for taking the time to respond to my post. I appreciate it. That has to be one of my biggest struggles is not sitting back and actually taking a second to really evaluate. I'm always assuming the worse. For example last shift during the night we had a difficulty breathing call. Upon arrival she looked fine expect she was in a modified tripod position but no audible distress heard or nasal flaring or retractions noted. So i proceeded to ask the fellow medic to obtained a set of vital signs with a pulse ox. I proceeded to listen to the lung sounds while getting a quick history. She has a history of mild COPD with diabetes, hypertension and past history of asthma that progressed to COPD. I heard very minor wheezing upon exhaling when listening. Her pulse ox was 96%. Normally as an EMT i don't really see a need to administer drugs but I decided to give her an albuterol and atrovent treatment due to her saying she ran out of inhaler. I proceeded to place the nebuilized mask over her face and gave her the treatment. She thanked me and said it relived the tightness in her chest. It felt good but she would refuse to go to the hospital with us. She said the treatment was more than enough and did not want to go. Kinda made me feel like I treated her and I needed to take her for further evaluation but I also know I have to respect her wises as long as she is CA&O x 4.

I guess that call just made me feel like I could have done better or maybe I am just really hard on myself or maybe this job really is just the simple and its hard for me to accept that due to have to seeing all the deaths as an EMT. Who knows.
 

hometownmedic5

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... However tomorrow will be my first shift ever that I am officially released as a medic and will be working with an EMT and not a paramedic anymore....
So I lived this day in recent enough memory to be relevant for you. Here's the best advice I can give you.

1) Know when you're in over your head and say so. Whether it's a sick as s***t transfer that needs critical care(if transfers are a thing for you) or a second medic needed street call. Gone are the days when we sacrifice patient care for the sake of our own vanity. If you're in the weeds, call for help. If there's no help, find somebody to point the ambulance at the hospital and get moving. There are calls you can sort of feel your way through without endangering the patient. I'm talking about that other kind. No job is worth putting your license at risk for. If your employer doesn't want to support the operation they claim to run, you want to seek life elsewhere.

2) Yesterday, you were a basic. Tomorrow, within the confines of your truck, you're the boss. This can be awkward for everybody. Be very careful in your approach to your BLS partners and coworkers. A scant handful of early missteps can take years to overcome with the right variables. Being branded as a paragod is something that will come back around on you again and again. Balancing that with the clear and inarguable separation in scopes of practice can be challenging.

3) Respect, but don't fear your ALS skillset. Many new paramedics freeze when they get to the end of, in order of need or preference, vitals oxygen(airway) monitor IV and transport. Those are the skills they've done enough of now to hopefully be proficient in. The next steps are clinical decision-making. You know, the point of being a paramedic. Don't go slinging pharmaceuticals around without regard, but don't get analysis paralysis about every possibility either. The goal should be to improve not only their relative proximity to the hospital, but to improve their immediate health condition to the extent possible as well. Treat what needs to be treated that is within your capacity to treat. You're a paramedic now. The diesel bolus is your last resort, not your go to maneuver.

4) Keep notes. At least for a while, take a minute after every call to jot down some memorable things about it. When you have a few minutes to kill that you might otherwise spend mindlessly scrolling the internet, read through the notes. You've got a steep learning curve coming. Keeping notes will be helpful in learning the nuances of the job. As you develop the ingrained habit of doing this or looking for that or whatever, you can delete the note. Until then, jotting down that little tidbit that you picked up from that seasoned pro or interesting concept to learn about can only help you.

5) Learn who the nice nurses are. They aren't all nice. Someday, you're going to need a favor. Start identifying who your friends are. Basically the same applies to doctors. Some med con docs are all business. This is the protocol. You will do this, all of this, and nothing but this. Others are willing to stretch a bit(or a lot). Knowing the players helps you play the game.

6) Keep your chin up. In a few years, you're going to be sitting around the shop laughing about the first time you got your pants pulled down on a call. You have to go through the wringer to get there, but it's not that bad.
 

CANMAN

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Stop. Take five seconds to breathe and get set before each contact. Every . Time.
There is nothing that requires you to rush headlong into it. Nothing.
Ive done that for over 40 years, in just about any situation you can think of and then some...
This.... I have anxiety, which I always thought was kinda a BS thing until I had an episode or two where I felt mildly affected by it during work and went to talk to a counselor. Going to talk with someone about "what my problem was" was the best thing I ever did for myself. I had been a medic for 14 years at the time I started to notice it creeping in a bit, mainly when I would go to give report on a really sick patient either in an over the phone consult, or to a trauma team for example with all eyes on me. A few times I would become randomly short of breath when talking and giving my report. It frustrated me because I didn't feel nervous, hell I had been doing this for a fairly long time at that point. When I asked the counselor what my issue was and she said "you're fine, you just have anxiety" I was like no way. People I pick up on the box who are huffing and puffing, fingers are tingling, can't speak and follow commands have anxiety, I don't have that. Then she spewed off all the minor to moderate signs/symptoms and factors for anxiety and I was like "ok I have some anxiety". So with that being said, stop and take a breathe like CCCSD said, you're brand new, and 5 seconds isn't going to change someones outcome. I also think talking with a professional would be really beneficial and maybe help your self confidence. What I found was there were other things that I was stressed about outside of work that affected me functioning at work. There might be something that someone helps you think about and ways to improve it/mitigate those factors in which you will see an improvement at work. Again, it was the best thing I have ever done for myself, and will still go back maybe twice a year to touch base and chat with her.. Good luck.
 

RenegadeRiker

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So I pulled the escape rope for the first time in a long time yesterday- hypotensive 70 yo F c/o weakness, nausea, lethargy, palpitations and chest pain, Hx of really bad heart failure, multiple MIs, CABGx6 and valve problems, living life on a Milrinone infusion and relying on her pacemaker to keep her heart beating. 100/30 BP, looked sick, paced rhythm at 80 kept surging to 120/paced with some episodes of electromechanical disassociation. Apparently she couldn’t keep down her cardiac meds due to nausea so she was complaining about extra palpitations and worrying about V-tach. Sick, but stable. And wanted to go 1.5 hours away to her cardiac hospital. Totally reasonable.

So I made a command decision and flew her. Right answer? Maybe. She was stable-ish, but the deterioration potential certainly existed and I don’t have the knowledge or guidelines to really address her many issues, and most of my tools aren’t really great answers in this case. What’s wrong with her? I dunno, can’t see much through the pacemaker. And I’ve been in this 12 years. But my instincts told me to pull the rope.

point is to trust yourself and reach out and learn. I’m reading up on milrinone.
 

hometownmedic5

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So I pulled the escape rope for the first time in a long time yesterday- hypotensive 70 yo F c/o weakness, nausea, lethargy, palpitations and chest pain, Hx of really bad heart failure, multiple MIs, CABGx6 and valve problems, living life on a Milrinone infusion and relying on her pacemaker to keep her heart beating. 100/30 BP, looked sick, paced rhythm at 80 kept surging to 120/paced with some episodes of electromechanical disassociation. Apparently she couldn’t keep down her cardiac meds due to nausea so she was complaining about extra palpitations and worrying about V-tach. Sick, but stable. And wanted to go 1.5 hours away to her cardiac hospital. Totally reasonable.

So I made a command decision and flew her. Right answer? Maybe. She was stable-ish, but the deterioration potential certainly existed and I don’t have the knowledge or guidelines to really address her many issues, and most of my tools aren’t really great answers in this case. What’s wrong with her? I dunno, can’t see much through the pacemaker. And I’ve been in this 12 years. But my instincts told me to pull the rope.

point is to trust yourself and reach out and learn. I’m reading up on milrinone.
That patient probably ends up getting flown in my system too, but for different reasons.

My big city academic hospital is about an hour way, with 1 good and 2 bad diversion options along the way. It sounds like she, at that moment, was getting ready to box. Not the sickest patient alive, but headed there. Personally, with my community hospital being a big city academics country cousin with the capacity to place a central line and run a pacing wire in without the medical examiners office being involved, that's where I'm going. Yes, I'm setting up a transfer. Boo Hoo. I'd prefer not to have to code her on the side of the highway waiting for help to arrive.

The thing of it is, ground ALS in my state can't take a patient being actively paced. I can initiate pacing someone and then due to geography have to drive you two hours; but I can't take you from one hospital to another if you're being paced(internally or externally). So, since I'm going to punt this patient off to my community hospital who will transfer her out and can't do so by ALS ground, their only choices will be CC-HEMS(most likely) or CC-Ground(less likely to be available immediately, but with a little pre planning...).
 

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