the 100% directionless thread

[VentMonkey]

@Jim37F you’re the most committed and proactive EMT I know. Good on you. Get your medic and work the AMR island.

 

[Jim37F]

Thanks. Part of it is that I could really use a part time job, especially when OT here dries up, and after dealing with Uber, I'd rather fall back on AMR in the future.

Combined with my slow station, I seriously feel the rust on our EMS calls, like I'm def out of practice.

So it just kinda makes sense to have a part time job that sharpens those skills, and part time at AMR would work with my Fire schedule better than just about any other part time job I can think of. (Ok, Uber is the most flexible, but I really don't feel like spending all my free time tooling around in my own vehicle burning my own gas for the wages they pay...)

 

[CCCSD]

What a cluster. Thanks for taking one for the team!

 

[jgmedic]

@Jim37F I used to want a job with HNL EMS but they make it so damn hard to bring your medic over there. Not to mention the pay does not seem to be enough to raise a family on. HFD would be cool but I can't see myself at a BLS dept.

 

[Jim37F]

They quoted $50-70K/yr for EMT at EMS. Which is right around/maybe a little less than my FF1 pay. Of course I am the one hunting for a part time job, tho I have a fair bit of debt (when I was younger and dumber with credit cards heh).

But yeah, it is expensive to live out here, and reciprocity is a pain to say the least.

 

[RocketMedic]

Steak and eggs for dinner, and I took an amazing poop earlier today #winning

 

[Peak]

What number on the Bristol stool chart?

 

[RocketMedic]

What number on the Bristol stool chart?

Three

 

[SandpitMedic]

jeez. Paragraphs dude.

I didn’t even read it when I saw that long winded post. Hahaha.

 

[luke_31]

jeez. Paragraphs dude.

Yeah after I posted it I realized I should have broken it up into them

 

[CALEMT]

Hurray for payday... that is all.

 

[Aprz]

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?

If nobody mentioned it yet, turn the knob over where it says the SpO2 (not the pleth wave, but the percentage). Select that and change it to high sensitivity. I tend to try different spots as well, like a different finger or even the toes. I absolutely despise the LifePak no matter how much other people like it. I felt like the Philips MRx was all around superior.

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.

Gosh, that is so crazy how people are. I know a doctor at one hospital who is actually against even putting pillows under the patient's head to put them in the sniffing position. Crutches, lol. He think you should just lift with the laryngoscope, which to me blows my mind... He's a strong muscular go so I guess he cannot sympathize with people like me who could barely open a can of soda. People try to make things harder than they need to be and don't understand why it's so "hard". They need to put their ego out of the way and try to increase their chance of success. In the past year and a half, I've been working hard to get good at airway, and I feel like I am getting pretty proficient with intubation (11/11 so far in the past year and a half, 8 using direct and 3 with video). I personally am really digging the video, and I think it comes with its own unique problems (particularly the camera getting covered and lack of control where the bougie/tube goes in a channel blade). I think uncomplicated intubation is extremely easy, beyond easy, and it blows my mind I used to find it hard. When I practice or think about intubation, it's about trouble shooting problems like why isn't the bougie going where it is going, looking for land marks when my video laryngoscope gets mucked up, or what can I do to improve the Cormack Lehane scale when I am doing direct (eg ask someone to apply cricoid pressure or do external laryngeal manipulation, suction, put more pillows under the patient's head, maybe I am in too deep if I see no landmarks, switch blades size/type). It's kind of like being a pilot, using automation and sensors to do things, but when things go wrong, I need to recognize it and correct it. For me, that's practicing and going over it every once in awhile.

 

[CCCSD]

 

[Carlos Danger]

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.

I wouldn't say that stylets or VL are "crutches". In fact I would say that for unplanned airway management where a good pre-anesthetic assessment was not performed, those devices should probably be used routinely. At least by anyone who doesn't intubate very frequently.

However, I would agree that not using those things in the OR is probably a good idea. As a paramedic, how often do you get to intubate a stable, NPO, well-preoxygenated patient in a controlled environment with expert backup just a few feet away? That's the time to practice single-handed and two-handed mask ventilation, and challenge yourself a little by intentionally taking away things that make intubating easier or more efficient. I'm not talking about emergent or sick patients who you need to be sure to get intubated immediately, of course.

The thing about not using a stylet is that you have to rely more on properly aligning the laryngeal, pharyngeal, and oral axes since it's more difficult to manipulate the tube. It's good practice.

 

[Tigger]

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.

In what sort of clinical environment are you practicing in?

 

[DragonClaw]

In what sort of clinical environment are you practicing in?

What's VS or VL and GTS

 

[Tigger]

What's VS or VL and GTS

VS=vital signs.
VL=video laryngoscopy
GTS=???

 

[CALEMT]

GTS

Google that s**t?

 

[Tigger]

Google that s**t?

Maybe? I read it another thread and could not really make heads or tails of it. If I was laying in the street bleeding out and had no idea what to do, maybe I would google that?

 

[DragonClaw]

Maybe? I read it another thread and could not really make heads or tails of it. If I was laying in the street bleeding out and had no idea what to do, maybe I would google that?

I think that's what GTS is