the 100% directionless thread

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StCEMT

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@DragonClaw what you're learning here is the reality of when teachers say the book doesn't always equal the field. In class and if you work for a very restrictive system, yes, deviation from protocols is bad. If you work for a progressive place that gives people the leeway to do their job, deviation is just a normal thing of the day.

To a degree, especially in an official capacity, it is your supervisors job to enforce policy. Some are more laid back than others and in a more private setting will acknowledge that they don't give a **** as long as your exercise discretion and don't do dumb ****. Others are just ****s and don't really know what they're talking about.

And just like with pretty much every aspect of patient care, as you will find....there are tons of opinions on how something should be done. You aren't going to get a single answer. You will also find that company policy =/= best practice, which is why the answers you are getting seem to make it even more confusing for you.
 
RocketMedic

RocketMedic

Californian, Lost in Texas
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NomadicMedic said:
I went back to work today after 4 days off.

I ran 1 call. Downgraded to BLS. Went and got coffee.

..,all in all about a perfect day ferda.
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Want to trade for 73/F/ Chest pain x 30 min?
 

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DragonClaw

DragonClaw

Emergency Medical Texan
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StCEMT said:
@DragonClaw what you're learning here is the reality of when teachers say the book doesn't always equal the field. In class and if you work for a very restrictive system, yes, deviation from protocols is bad. If you work for a progressive place that gives people the leeway to do their job, deviation is just a normal thing of the day.

To a degree, especially in an official capacity, it is your supervisors job to enforce policy. Some are more laid back than others and in a more private setting will acknowledge that they don't give a **** as long as your exercise discretion and don't do dumb ****. Others are just ****s and don't really know what they're talking about.

And just like with pretty much every aspect of patient care, as you will find....there are tons of opinions on how something should be done. You aren't going to get a single answer. You will also find that company policy =/= best practice, which is why the answers you are getting seem to make it even more confusing for you.
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Sounds like "Do things per policy/ protocol at first but with experience do what you think is right by the pt, but God help you if you do something out of policy and something bad happens"

Edit:

But as a basic in IFT there's very little I can do to actively kill a pt or harm them.

When driving code though, we're at fault for accidents and stuff so one might argue unless the pt is already dying or becoming rapidly unstable, it's counter intuitive to use priority 1 anyway and have more ground to stand on then trying to run code anyway.
 
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KingCountyMedic

Forum Lieutenant
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VentMonkey said:
In this day and age we all just about have a voice that matters, and that’s great.

But, honestly? Sometimes we’re better off just being quiet and LISTENING.
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"Keep your ears open and your mouth shut"

One of the best things I ever learned when I was a noob back in the late 80's
 
DragonClaw

DragonClaw

Emergency Medical Texan
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So the LP12 all got swapped for 15s.

But this dang machine keeps annoyingly beeping about SPO2. Poor connection and poor perfusion but his perfusion is 99-100%

How can I fix this or get it to shut up?
 
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DesertMedic66

Forum Troll
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DragonClaw said:
Skin assessment and pt general impression could be substituted, but I'd like an SPO2 if possible.

Any advice on how to get the machine to function properly or maybe to minimize false readings?
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Yeah, there really isn't a solid fix to that issue. You will learn to ignore it. What I will typically do if its a completely stable patient with no respiratory complaint, is leave the SpO2 off of disconnect it from the machine to make it stop alarming. Aside from that just the general guidelines: make sure there is no fingernail polish, make sure its not on the same arm as the BP cuff, make sure the finger is warm and there is good perfusion, avoid any outside light getting into the sensor, limit patient movement, make sure the spring in the clamp is tight so it gets good contact with the patient's finger. Just make sure you are getting a good waveform before you trust the reading it is giving to you.
 
DragonClaw

DragonClaw

Emergency Medical Texan
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DesertMedic66 said:
Yeah, there really isn't a solid fix to that issue. You will learn to ignore it. What I will typically do if its a completely stable patient with no respiratory complaint, is leave the SpO2 off of disconnect it from the machine to make it stop alarming. Aside from that just the general guidelines: make sure there is no fingernail polish, make sure its not on the same arm as the BP cuff, make sure the finger is warm and there is good perfusion, avoid any outside light getting into the sensor, limit patient movement, make sure the spring in the clamp is tight so it gets good contact with the patient's finger. Just make sure you are getting a good waveform before you trust the reading it is giving to you.
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He was respiratory and every so often would give some labored breaths, so I figured to keep an eye on him. He was stable but I wanted to make sure he didn't start desatting (or see if it does)

I've never gone off waveform, what am I looking for?
 
CCCSD

CCCSD

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You should learn how to assess a patient using your eyes, ears, nose, and mouth, before you rely on machine crutches.
 
S

StCEMT

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CCCSD said:
You should learn how to assess a patient using your eyes, ears, nose, and mouth, before you rely on machine crutches.
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Machines aren't crutches. Thats like the providers who say back bougie is a crutch. They're as pertinent as a physical assessment. If my intubated trauma patient has a sharp spike in their plateau pressure and drop in EtCO2, that's pretty helpful to know. Instead of telling people that they shouldn't use different assessment or treatment tools, we need to make sure people understand how/when/why to apply all of them to see the big picture.

Teaching people to limit themselves only limits their ability and what they can offer their patient. Teach them how to be proficient with everything and the ability to adapt to their situations with those tools, assessment skills, and intervention methods.
 
CCCSD

CCCSD

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We’re talking a basic EMT here. It always amazes me how everyone thinks that using a machine is the height of good basic pt care. It’s a tool, used as a crutch by far too many “experts” who let the machine tell them what to do. Note I didn’t say a thing about CCT providers.

So what are you going to do when you don’t have all those toys? Rely on your skills, which you don’t have?

You can’t even converse with your partner or Supervisor yet. Build BASIC skills. I see youngsters daily who can’t even take a set of VS because they don’t have an auto this or that or no WiFi to GTS what’s normal.

Yes. Use your mouth. Talk to the pt. Talk to the family. Talk to others. For you baby lickers, you missed the point. Which tells me much.
 
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