the 100% directionless thread

[Peak]

Also, because I assume you didn't catch it, one of the old hall mark pediatric questions is what to test for when a parent brings in their infant and says they taste salty when they kiss them.

 

[DragonClaw]

This right here tells me why you aren’t getting anywhere at work.

"Getting anywhere?"

More than a few experienced (20+ years) medics have told me not to piddle around and go medic once I've got more experience and have entering down, not to wait.

My supervisors do like me, they say I'm a hard worker and I make myself useful. That I'm energetic and quick to learn, that I want to be here and such.

Most of my coworkers get along great with me.

I advocate for my pts and I'm being the best provider I can be. And I'm trying to better that all the time.

I don't say everything here, so to act like you know it? Ridiculous.

 

[Seirende]

Maybe I should talk to my doctor about my apparent hypertension.

 

[VentMonkey]

So it’s been it’s been almost 6 months. I’m sure hoping one of my favorite bands gets back together (Los Lonely Boys), those dudes rock live.

 

[CCCSD]

Refer to all your posts.

 

[CCCSD]

"Getting anywhere?"

More than a few experienced (20+ years) medics have told me not to piddle around and go medic once I've got more experience and have entering down, not to wait.

My supervisors do like me, they say I'm a hard worker and I make myself useful. That I'm energetic and quick to learn, that I want to be here and such.

Most of my coworkers get along great with me.

I advocate for my pts and I'm being the best provider I can be. And I'm trying to better that all the time.

I don't say everything here, so to act like you know it? Ridiculous.

Great. Another paramedic with zero pt care skills. As for your posts, go back and reread them, several times.

 

[DragonClaw]

Great. Another paramedic with zero pt care skills. As for your posts, go back and reread them, several times.

I think you need to reread. I mentioned *after* getting experience.


Edit:

I don't know what it is with you. But you skipped my whole post to focus in on something you didn't actually read to attempt to further insult me.

It didn't work.

Any praise, you don't seem to want to accept or encourage.

Here, I think this is yours. I found a shoulder chip on the ground and I think it's yours. Your antalgic gait makes me think yours aren't even.

 

[luke_31]

DragonClaw pulse oximetery isn’t a reliable indicator of something changing with the patient at best it can show a trend up or down for if there is oxygen or CO binding to the hemaglobin. It doesn’t read the difference between the two. It’s the clinical skills of is your patient’s breathing changing that you notice first. Respiratory rate, depth, change in how it sounds, their work of breathing that you will see quiet a while before the pulse oximetry will show a change. If I could get away with not using a pulse oximeter at work I would. I get more from listening to breath sounds and watching my patient then I do from the number I see. I’ve been in EMS for 17 years now and spent the last 12 of them as a paramedic. By talking to the patient and physically assessing them I get more information than just using the devices I have. Everything has a time and place to be used, but my honest opinion is that pulse oximetry shouldn’t be used at the EMT level. EMTs just starting out in the field will use it as a crutch for not having great assessment skills that they haven’t developed yet. There is a lot more than just the number and the waveform which really only shows how well the device is getting its signal that is giving the number. I’ve seen many patients with low pulse oximetry numbers, where looking at the waveform and the patient tells me that the number should be disregarded as it’s not correct. It’s fairly obvious when a patient is going to be in the 70s or 80s when I’m looking at them and am not seeing the clinical picture that would go with those numbers. Also another point is go up to a higher elevation and at a certain point the pulse oximetry numbers will change. You can have someone who at sea level is 100% and at a higher elevation you only get a reading of 94% with no change in the patient. If you’re just utilizing the numbers this patient would need oxygen, but in reality they most likely wouldn’t. I worked in Colorado for a little bit as a medic and I would get readings on myself of 94% regularly while just chilling in the ambulance and would see the same with patients who had no respiratory problems either. I say this as an example of how using pulse oximetry numbers isn’t always going to be accurate. If you were to document the pulse oximetry number of 88% because that’s what was on the monitor, but when you looked at your patient they were sitting there eating a sandwich and carrying on a full length conversation with you, would you believe that number? If you didn’t document all the information of what you were seeing to show that they had no evidence of respiratory distress that number alone would raise red flags on the QA/QI process.

 

[PotatoMedic]

Welp... Had a midterm last night. Didn't study for it at all till yesterday. Think I did well actually. I really need to get myself in gear and just finish this semester well. It is the last semester of multiple classes and next semester is just my one capstone class and I'll be done. Problem is I have not had any motivation this semester, thinking I'm flirting with some depression right now with how much I'm working, my full time school load and managing being a good dad and husband.

 

[Seirende]

Registered for a learner's permit exam prep class next week and my DOT physical is the 17th. If all goes well I'll start learning on the trucks at the end of the month.

 

[NomadicMedic]

DragonClaw pulse oximetery isn’t a reliable indicator of something changing with the patient at best it can show a trend up or down for if there is oxygen or CO binding to the hemaglobin. It doesn’t read the difference between the two. It’s the clinical skills of is your patient’s breathing changing that you notice first. Respiratory rate, depth, change in how it sounds, their work of breathing that you will see quiet a while before the pulse oximetry will show a change. If I could get away with not using a pulse oximeter at work I would. I get more from listening to breath sounds and watching my patient then I do from the number I see. I’ve been in EMS for 17 years now and spent the last 12 of them as a paramedic. By talking to the patient and physically assessing them I get more information than just using the devices I have. Everything has a time and place to be used, but my honest opinion is that pulse oximetry shouldn’t be used at the EMT level. EMTs just starting out in the field will use it as a crutch for not having great assessment skills that they haven’t developed yet. There is a lot more than just the number and the waveform which really only shows how well the device is getting its signal that is giving the number. I’ve seen many patients with low pulse oximetry numbers, where looking at the waveform and the patient tells me that the number should be disregarded as it’s not correct. It’s fairly obvious when a patient is going to be in the 70s or 80s when I’m looking at them and am not seeing the clinical picture that would go with those numbers. Also another point is go up to a higher elevation and at a certain point the pulse oximetry numbers will change. You can have someone who at sea level is 100% and at a higher elevation you only get a reading of 94% with no change in the patient. If you’re just utilizing the numbers this patient would need oxygen, but in reality they most likely wouldn’t. I worked in Colorado for a little bit as a medic and I would get readings on myself of 94% regularly while just chilling in the ambulance and would see the same with patients who had no respiratory problems either. I say this as an example of how using pulse oximetry numbers isn’t always going to be accurate. If you were to document the pulse oximetry number of 88% because that’s what was on the monitor, but when you looked at your patient they were sitting there eating a sandwich and carrying on a full length conversation with you, would you believe that number? If you didn’t document all the information of what you were seeing to show that they had no evidence of respiratory distress that number alone would raise red flags on the QA/QI process.

jeez. Paragraphs dude.

 

[GMCmedic]

It's really hard to open those plastic security boxes they keep DVDs in.

No I didnt steal a movie. Walmart had one cashier with 12 people in line and 15 open self checkout lanes, so i went to self check out and took the whole thing home.

 

[VentMonkey]

It's really hard to open those plastic security boxes they keep DVDs in.

No I didnt steal a movie. Walmart had one cashier with 12 people in line and 15 open self checkout lanes, so i went to self check out and took the whole thing home.

Even I know how to stream now

 

[GMCmedic]

Even I know how to stream now[emoji38]

We cut the cable cord and have most of the streaming services, but I refuse to buy digital copies of movies.

I keep telling myself that one day ill build or buy a computer or digital media center, whatever they call them, but for now I prefer hard copies.

 

[VentMonkey]

We cut the cable cord and have most of the streaming services, but I refuse to buy digital copies of movies.

I keep telling myself that one day ill build or buy a computer or digital media center, whatever they call them, but for now I prefer hard copies.

Noted. I still like my version better, but noted.

In other news, I took about a 2 hour nap and my son is still sound asleep drooling. I sure love that lil’ guy more and more each day.

 

[RocketMedic]

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.

If I’m working/moving in the back you are driving Miss Daisy.

 

[RocketMedic]

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?

Lifepack SPO2 alarms cannot be disabled by user. Recommend getting a good, saw-tooth pleth waveform to get rid of that error.

 

[StCEMT]

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.

Yes, we are. But that line is used for ALS providers all too often too. I was told by a CRNA to not use a stylet in the OR because it was a crutch. There are people who don't like video laryngoscopes because "they're a crutch". Also, understanding plateau pressure and EtCO2 isn't just a CCT thing..... Nor do my machines tell me what to do. They give me information and it is up to me to determine what to do with that information.

Now I don't disagree that not being able to perform basic skills is a problem, it absolutely is. But the solution isn't to paint something as a crutch, because EMS has a tendency to do that with things that are actually helpful. That's an education and training issue and should be treated as such. This is true regardless of the person's level.

 

[CCCSD]

Learning the Basics is key. The rest are monkey skills.

 

[Jim37F]

Well just talked to one of the EMT instructors about that transition course to HI State licensure. One of the requirements is clinical ride time, and apparently the State wants 911 agency, so local AMR op is out, and City&County EMS has a 9 month backlog for clinical ride times.

Its possible I could get the hours in with AMR in a neighboring county where they are the 911 unit earlier, but of course that requires getting over to another island and finding room and whatnot, so we'll see.

Plus the 2 week classroom portion of course.