EMT Tricks of the trade

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mycrofft said:
Treat the pt not the label.;)
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I have always been taught, AND Teach in my Classes, Treat the Pt NOT THE EQUIPMENT.

If you have a pt who is breathing well and no distress with no signs but the SpO2 (Pulse ox for the non geeks of the group) shows a low number.. LET IT GO. If that is the Pts Normal sats and they are comfortable with no symptoms, To hell with it move on. but continue to watch ur pt. If they begin to fall off, then move in.
 
Proud2bffemt, I hear you.

I want so badly to take all the automatic VS machines we have (Dinamap, Welch-Allyn) and throw them off the roof.
 
Proud2bffemt said:
I have always been taught, AND Teach in my Classes, Treat the Pt NOT THE EQUIPMENT.

If you have a pt who is breathing well and no distress with no signs but the SpO2 (Pulse ox for the non geeks of the group) shows a low number.. LET IT GO. If that is the Pts Normal sats and they are comfortable with no symptoms, To hell with it move on. but continue to watch ur pt. If they begin to fall off, then move in.
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So a oncologist should ignore the bright spot on the CT Scan if the patient has no outward signs of a tumor?

The Cardiologist should ignore the slight ST abnormalities on the EKG in a patient with brugada syndrome even though it causes NO symptoms until the patient just drops dead one day?

The Paramedic should ignore the ST elevation in a female patient with a mild case of upset tummy?

The mammogram should be ignored when there is a potential lesion but no somatic signs of disease? What about the PAP showing some dysplasia? The lab word showing signs of systemic disease?

The saying is wrong, and it always has been. It was made as a teaching tool to tell Basics that they should give high flow 02 even if the sp02 was normal. Even that concept is wrong in most cases. In fact, lets just do away with the monitor because we shouldn't treat it. Than we can be left with AEDs. If we do not have telemetry, we cannot have manuel defibrillators or cardiac drugs, so lets do away with the paramedics. This whole treat the patient not the monitor thing is a self serving idea perpetuated by those who do not want more education.
 
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Blow-By

Anyone here ever used blow-by to give an albuterol treatment to an infant or ped?

I was at the hospital here when the on call EMTs (Not me) brought in a baby having an asthma attack. I happened to be hanging out with respiratory therapy and she decided to give it an albuterol treatment but flipped the nebulizer around and plugged off the mouthpiece so that she was just pointing the dishcharge end at the baby's face. Seemed to do the trick.
 
I've assisted a Paramedic administer blow-by Albuterol to a 10 month old female infant experiencing an allergic reaction when I was riding along for my EMT class. It really opened up her lungs, she went from coughing and crying hysterically to being calm and quieter.
 
daedalus said:
So a oncologist should ignore the bright spot on the CT Scan if the patient has no outward signs of a tumor?

The Cardiologist should ignore the slight ST abnormalities on the EKG in a patient with brugada syndrome even though it causes NO symptoms until the patient just drops dead one day?

The Paramedic should ignore the ST elevation in a female patient with a mild case of upset tummy?

The mammogram should be ignored when there is a potential lesion but no somatic signs of disease? What about the PAP showing some dysplasia? The lab word showing signs of systemic disease?

The saying is wrong, and it always has been. It was made as a teaching tool to tell Basics that they should give high flow 02 even if the sp02 was normal. Even that concept is wrong in most cases. In fact, lets just do away with the monitor because we shouldn't treat it. Than we can be left with AEDs. If we do not have telemetry, we cannot have manuel defibrillators or cardiac drugs, so lets do away with the paramedics. This whole treat the patient not the monitor thing is a self serving idea perpetuated by those who do not want more education.
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Someone's getting a little sarcastic.

So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?

Why or why not?
 
That's why you use your diagnostic tools to develop a more complete picture of the patient's condition instead of just throwing out diagnostic results that don't match the patient's outward appearance.
 
Always keep an extra pen hidden somewhere safe. You'll eventually lose your pen or it will fail in the middle of a run and you'll have a spare one to go

xD
 
MGary said:
Anyone here ever used blow-by to give an albuterol treatment to an infant or ped?

I was at the hospital here when the on call EMTs (Not me) brought in a baby having an asthma attack. I happened to be hanging out with respiratory therapy and she decided to give it an albuterol treatment but flipped the nebulizer around and plugged off the mouthpiece so that she was just pointing the dishcharge end at the baby's face. Seemed to do the trick.
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Yes that is how you do it. You can use a neb mask but if they are alert enough they will fight it, so blow by is easier and works great if they still are moving air enough to take the meds in.
 
Sasha said:
Someone's getting a little sarcastic.

So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?

Why or why not?
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No, I do not think you understood what I wrote. Sorry for the late reply I forgot about this thread.

I was making a pass on lack of education really. In fact, if one has proper education at the advanced level, they would see that this patient would probably not need 15 L oxygen based on their understanding of the pathophysiology of the patient's underlying deceases. There are so many factors like shock, anemia, CO, etc that factor into pulse oximetry that you need a proper education to utilize it properly, but it should absolutely be used to help formulate your field diagnosis.
 
Sasha said:
Someone's getting a little sarcastic.

So are you saying if a patient has an SpO2 of 92, which may or may not be "normal" for that patient, is sitting comfortably, semi fowlers, not complaining of any discomfort or shortness of breath, NSR on the monitor, and not cyanotic, you're going to freak out and put them on 15lpm of O2?

Why or why not?
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Blanket statements like this, as you very well know, don't fit well in any patient treatment modality. I have had patients in no distress showing SpO2 in the low 90's having a AMI with NSR in lead II....again, it all comes down to a combination of your assessment and your tools. The diagnostic findings, as has been pointed out countless times in other threads, should only be a small piece in the big puzzle.
 
Another thing I learned in my paramedic practicum:

A BP cuff makes a great tool to break into a vehicle. One of the guys locked his keys in the car in the station parking lot. H was able to sneak a deflated BP cuff in the door seam at the B pillar. Pumped it enough to bend the frame back enough to sneak in with a coat hanger and manuver it to get the lock.
 
remote_medic said:
Another thing I learned in my paramedic practicum:

A BP cuff makes a great tool to break into a vehicle. One of the guys locked his keys in the car in the station parking lot. H was able to sneak a deflated BP cuff in the door seam at the B pillar. Pumped it enough to bend the frame back enough to sneak in with a coat hanger and manuver it to get the lock.
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i'll believe that when i see it
 
guardian528 said:
i'll believe that when i see it
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Something like this is available commercially

BigEasyPouch_lg.jpg


Works petty slick
 
My Five Essential Pieces of Equipment:

Duct Tape
4X4's
Towels
Cravats
Trauma Shears

Just remember - anything can be repaired with tape and medic shears.

My favorite splints - pillow splint to a backboard if you have to do C-Spine.

I know there's more, can't think right now...
 
ethorp said:
yup it works. i locked my keys in my car and the leo opened it that way
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I have a 52 pic slim jim set and a door weg (smaller version of a BD cuff) is in it.
 
well i've seen it, and i now believe it :)
 
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