Anjel
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4 this week.
the 100% directionless thread
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DesertMedic66
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If I have to open this kit one more time this week, I'm gonna scream.
I'll gladly tube them as long as you do the paperwork...
I had my first OR shift last week, Doc was a former paramedic. Started the day off with "I feel like every paramedic is grossly unprepared for what they have to do..."
My thoughts immediately go to "ggrreeeaattt..."
Doc continues "so, we're just going to dive in so you can get the experience and you'll manage all of my patients". Ended up with 9 intubations. The final one he let me use the glide scope. I fell in love with that thing.
Also, that moment when you have to choose between getting a coffee maker for your new place or paying off the rest of your credit card... Hardest choice of my life.
My thoughts immediately go to "ggrreeeaattt..."
Doc continues "so, we're just going to dive in so you can get the experience and you'll manage all of my patients". Ended up with 9 intubations. The final one he let me use the glide scope. I fell in love with that thing.
Also, that moment when you have to choose between getting a coffee maker for your new place or paying off the rest of your credit card... Hardest choice of my life.
Also, to my also. This is the first time that I've ever had to actually chart my pts on a PCR. What's a good thing that y'all put to say that there's no clinical findings in an area, i.e. the neck and they have no complaints.
I was putting things such as "nothing noted upon assessment" then "no pt complaints", but all my charts are being sent back by my preceptors saying to fix those, but they wont tell me what they want me to put.
I was putting things such as "nothing noted upon assessment" then "no pt complaints", but all my charts are being sent back by my preceptors saying to fix those, but they wont tell me what they want me to put.
teedubbyaw
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"Examination of the neck revealed negative DCAPBTLS, a midline trachea, no JVD, JVP at _cm, no bruits heard on auscultation"
DesertMedic66
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Our ePCRs for work have a check box section that says "no abnormal findings unless otherwise noted".
FutureEMT2014
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Caffeine kick in... I need to become motivated!
They talked about someone else putting that, too. They said assessment should be pertinent, so why are we putting there is no tracheal deviation on someone with an extremity fx."Examination of the neck revealed negative DCAPBTLS, a midline trachea, no JVD, JVP at _cm, no bruits heard on auscultation"
Of course, we still have to assess it and those would be our notes from the assessment though........
We have those on our PCRs, but we were also told not to use them, since they make it look like you apparently did not assess it. Supposedly...
I swear, no matter what I put, there is no winning. I feel like this would be a whole lot less stressful if they didn't just not tell us what they want.
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You might think about actually writing "No abnormal findings, patent denies any complaint."
katgrl2003
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Just paid off my credit card, and later that day had to charge more stuff to it. I wanted to cry.
teedubbyaw
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Am I losing my mind or is this wrong??
DesertMedic66
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SLUDGEMAm I losing my mind or is this wrong??
teedubbyaw
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anticholinergic toxicity = pupil dilation, not constriction (miosis). And it wouldn't be bradycardia.
DesertMedic66
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Not the best resource but it was the first one I came up with.
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teedubbyaw
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Even wiki contradicts itself saying the SLUDGEM mnemonic stands for miosis, then saying in anticholinergic toxicity it's mydriasis.
Under the question it gives an explanation using SLUDGEM, and saying the M is for miosis.
Whatever. This is what I get for looking back 4 semesters.
Under the question it gives an explanation using SLUDGEM, and saying the M is for miosis.
Whatever. This is what I get for looking back 4 semesters.
"Rest and digest."
Parasympathetic stimulant is going to cause miosis. When you're resting, your eyes don't need to take in every single detail, so your pupils constrict. I know I worded that badly, but it's the very basic standpoint.
DesertMedic66
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Everything I remember learning in class and that i am looking up right now is saying chemical nerve agents cause miosis.
Chemical nerve agents cause your parasympathetic nervous system to not be able to "shut off" by blocking acetylchlonesterase so the acetylcholine can not be broken down. Your PSN cause constriction of the pupils, bradycardia, and the rest of the SLUDGEM, which is why our treatment for it is several mgs of atropine
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teedubbyaw
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I'm going to bed. Anticholinergic does not equal a nerve agent. 
Long day is my excuse.
Long day is my excuse.
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What are you arguing? Nerve agents cause parasympathetic stimulation, not blockade. So yes, constricted pupils (miosis) is a sign of nerve agent exposure (parasympathetic stimulation).
Edit: You apparently edited that before I submitted my post.