the 100% directionless thread

[Handsome Robb]

Looking for a Kiwi girl are you? You know we talk funny right?

I'm a sucker for tattoos and accents.

First burn patient ever today. ~25% TBSA of superficial and partial thickness. Half his face, burned nares, clear lungs and upper airway though.

Definitely a cool call. Wasn't what I expected right out the gates on my Monday!

 

[Clare]

I'm a sucker for tattoos and accents.

I have one of those, I will leave it up to you to guess which

First burn patient ever today. ~25% TBSA of superficial and partial thickness. Half his face, burned nares, clear lungs and upper airway though.

Definitely a cool call. Wasn't what I expected right out the gates on my Monday!

Ew! I hate burns, I mean, I just hate them, they are horrible, never would I wish burns on my worst enemy. The physical, psychological and social impact of burns, particularly severe burns, is just not good.

I have been fortunate to only have one or two burn patients in my time on road both have been ~ 9% surface/partial thickness.

I seriously hope your patient makes a good recovery, poor bloke, feel very sorry for him.

 

[Amberlamps916]

My ex spoke Canadian, no accent though

 

[Amberlamps916]

Down to only 2 more skills to be tested on tomorrow......Trauma assessment and IV piggyback/Dopamine drip.

 

[Clare]

My ex spoke Canadian, no accent though

Canadians speak English eh? Mind you, so do we.

Down to only 2 more skills to be tested on tomorrow......Trauma assessment and IV piggyback/Dopamine drip.

What is IV piggyback? Never heard that term before. I wonder if you mean injecting medicines into a free flowing IV line i.e. not into a luer plug?

 

[Amberlamps916]

Canadians speak English eh? Mind you, so do we.



What is IV piggyback? Never heard that term before. I wonder if you mean injecting medicines into a free flowing IV line i.e. not into a luer plug?

Lol I was kidding about speaking Canadian. Also, IV piggyback is attaching another line to your pre-existing line.

 

[Clare]

Also, IV piggyback is attaching another line to your pre-existing line.

Some Clare-ification (I do like that term) is required, you mean like attaching another drip set to a medication port on an existing line to run two bags of fluid at once through a single catheter or something?

I am a bit lost.

 

[Amberlamps916]

Exactly, we'll have one bag of fluid going TKO macro-drip with an infusion of fluid mixed with Dopamine micro-drip flowing at a set rate.

 

[Clare]

Exactly, we'll have one bag of fluid going TKO macro-drip with an infusion of fluid mixed with Dopamine micro-drip flowing at a set rate.

How very interesting. We don't use dopamine, ICP can run an IV infusion of adrenaline for patients who need support in raising their BP (anaphylaxis, septic shock, bradycardia and neurogenic shock, I wanted to say inotropic support but I know that is not the right term sorry I can't think of the correct way to describe it but I think you know what I mean.

 

[Amberlamps916]

Contractility....I understand.

 

[Clare]

Contractility....I understand.

Maybe my accent is not so bad then, or does not carry over to what I type?

We have a British girl with us at the moment ex Londoner who has a very East End accent sometimes she is terrifically hard to understand but she can take the piss out of the way Down Underer's talk really good.

It bemuses me greatly that people still turn a bit of a head at a female crew, like somehow two female Ambulance Officers are less capable or something; I know they don't really believe that like in a sexist way but you still get a quick look or a comment or something every so often.

I do feel sorry for the two guys on watch at the moment as all the other crew are female and the guys are heavily outnumbered, mwahahahahahah!

 

[Handsome Robb]

Wait, aren't inotropic and contractility one in the same or is it 0400 and I'm loopy?

Epi infusion would be for more of a pressor effect as well as a chronotropic effect. Increased cardiac output plus vasoconstriction remembering CO=SVxHR. Whereas dope, depending on your dosing, would have inotropic effects before pressor effects and usually lack any type of chronotropic effects.

Wow I used effects way too many times in that paragraph. Told y'all I'm better at math than English

I'll hopefully hear more about my burned guy tomorrow or the next day. Last I heard was he was transferred by air to the nearest Burn Center but never required intubation.

 

[socalmedic]

At lax waiting for my flight to San Jose so I can take ITLS instructor then back to the airport to come home so I can go to work tomorrow. Am I really that crazy or just stupid?

 

[Handsome Robb]

At lax waiting for my flight to San Jose so I can take ITLS instructor then back to the airport to come home so I can go to work tomorrow. Am I really that crazy or just stupid?

Why on earth would you want to be an ITLS instructor?

Hey if you're getting paid to do it and your travel is paid for why not!?

Apparently my burn guy had worse burns than I thought. I said 25% TBSA of superficial and full thickness. I spoke with the crew that transferred him to the airport, he went by fixed-wing because our HEMS service was getting their asses kicked, and my BSA was correct but his hand, face and thighs had full thickness burns as well. I feel like I missed it :-/ but at the same time it wouldn't have changed anything I did for him or the way the hospital handled it. I've never seen anything worse than a superficial burn but I guess now I know.

Found out they didn't spin the helicopter when I activated the burn center criteria because the burn was from an "explosion" as a result of making hash in an enclosed space and they didn't want to risk JCAHO having a fit about bypassing a Trauma Center with a traumatic mechanism. Generally, from what I'm told we usually will either get a scene flight or transport to the ER and go from the rig to the helo on the pad without ever going inside provided their isn't another TC criteria met outside of the burns.

In the end he got where he needed to be and wants to come back and meet everyone that took care of him when he's all healed up.

The toughest part about this call was when he asked me if he was going to be disfigured. I didn't know what to say. I didn't want to be the paramedic who told him he'd be fine and then end up being disfigured but at the same time I didn't want him to freak out any more than he already was.

How do you even answer that question? I told him I didn't want to give him an answer and be wrong and just reassured him that I was doing everything in my power for him and talked him through the process of what was going to happen as far as initially in the ER then flying him out to the burn center and he did calm down quite a bit after that but I still didn't feel like I was able to really give him what he wanted.

I've always been told "you don't have enough narcs on your ambulance to make these patients comfortable" but 200 mcg of fent didn't even touch him, I was trying to get another 100 on board but I would've been outside of protocol as far as the time between doses goes.

 

[socalmedic]

Why on earth would you want to be an ITLS instructor?

Hey if you're getting paid to do it and your travel is paid for why not!?

Apparently my burn guy had worse burns than I thought. I said 25% TBSA of superficial and full thickness. I spoke with the crew that transferred him to the airport, he went by fixed-wing because our HEMS service was getting their asses kicked, and my BSA was correct but his hand, face and thighs had full thickness burns as well. I feel like I missed it :-/ but at the same time it wouldn't have changed anything I did for him or the way the hospital handled it. I've never seen anything worse than a superficial burn but I guess now I know.

Found out they didn't spin the helicopter when I activated the burn center criteria because the burn was from an "explosion" as a result of making hash in an enclosed space and they didn't want to risk JCAHO having a fit about bypassing a Trauma Center with a traumatic mechanism. Generally, from what I'm told we usually will either get a scene flight or transport to the ER and go from the rig to the helo on the pad without ever going inside provided their isn't another TC criteria met outside of the burns.

In the end he got where he needed to be and wants to come back and meet everyone that took care of him when he's all healed up.

The toughest part about this call was when he asked me if he was going to be disfigured. I didn't know what to say. I didn't want to be the paramedic who told him he'd be fine and then end up being disfigured but at the same time I didn't want him to freak out any more than he already was.

How do you even answer that question? I told him I didn't want to give him an answer and be wrong and just reassured him that I was doing everything in my power for him and talked him through the process of what was going to happen as far as initially in the ER then flying him out to the burn center and he did calm down quite a bit after that but I still didn't feel like I was able to really give him what he wanted.

I've always been told "you don't have enough narcs on your ambulance to make these patients comfortable" but 200 mcg of fent didn't even touch him, I was trying to get another 100 on board but I would've been outside of protocol as far as the time between doses goes.

my school paid for the class but I am off the clock and traveling on my dime. They offered to pay me to take the class if I waited till June when money was in the budget. I am doing it now because the $50/hr I am going to make teaching in the two classes before then will more than pay for all my expenses! And my county may be starting to train all paramedics in some form of trauma care, we currently don't have any letter class other than ACLS. So I stand to make a boat load of cash by taking the class on my own.


As to the burns, I had a 30% BSA 2/3* last year. I have 30mg ms and 5mg versed. The ms was dosed 5, 5, 10, 10 and it nearly got him to stop screaming. Needless to say I had to have a little chat with the md about that call. But in the end I got a pat on the back and a "never do that again " speech. We don't have conscious sedation and 20mg ms is supposed to be our max.

 

[Jon]

I will send them to you for consumption......cosmic brownies to boot.

Those are only legal for all in Colorado and Washington right meow.

 

[Handsome Robb]

my school paid for the class but I am off the clock and traveling on my dime. They offered to pay me to take the class if I waited till June when money was in the budget. I am doing it now because the $50/hr I am going to make teaching in the two classes before then will more than pay for all my expenses! And my county may be starting to train all paramedics in some form of trauma care, we currently don't have any letter class other than ACLS. So I stand to make a boat load of cash by taking the class on my own.


As to the burns, I had a 30% BSA 2/3* last year. I have 30mg ms and 5mg versed. The ms was dosed 5, 5, 10, 10 and it nearly got him to stop screaming. Needless to say I had to have a little chat with the md about that call. But in the end I got a pat on the back and a "never do that again " speech. We don't have conscious sedation and 20mg ms is supposed to be our max.

Well can't complain about that then!

I thought long, well quickly but it seemed long at the time, and hard about just blatantly violating it and explaining myself later but by the time I was done thinking about it and calculating the Parkland formula we were pulling into the ambulance bay and one of the first things they did was give him dilaudid so I guess it worked out. I'm still very new and hesitant to try to weasel my way through something like that.

 

[Jon]

We don't have conscious sedation and 20mg ms is supposed to be our max.

If they are still conscious... Is it really sedation?

I once had a limb entrapment call. 100mcg Fentanyl and 5 of Versed. Barely calmed him down enough to start the rescue. Went through most of my narcs on that call... It was a couple of hours start to finish.

 

[exodus]

Out on a knee injury, just stood up from a crouching position and it popped. Non-work related so no light duty either.... Dr thinks it may be just a sprain but if it's still hurting in a week I'm going back in for an MRI. If it's torn, it's surgery time....

Ugh. Woke up this morning and my knee is still killing me. I hope this isn't a career ender.

 

[Achilles]

Ugh. Woke up this morning and my knee is still killing me. I hope this isn't a career ender.

You could always be a Gardner