the 100% directionless thread

Peak said:
Not a single patient in the ED or call for the Transport team after 0100 last night. None of those cursed words brought anything.
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My last shift I went 72 hours without turning a wheel for a call. You have no power here.
 
I’ve got 6 hours left and I’ve only had one call.
 
I’m a goddam Albino cloud. The other EMTs I have been working with for the past three days or so haven’t had shifts this uneventful since last year once I showed up.
 
DragonClaw said:
I've been jamming out to Golden Earring, White Snake, Asia, Van Halen, Eddie Money, Etc....

Good stuff
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You can't help but to jam out to Dire Straits... especially money for nothing.
 
Found out our patient was diagnosed at the Trauma Center with a hairline spinal fracture (didn't say where) but is not paralyzed thankfully)
 
Yay, I finally got access to the IA Med flight course. I am happy to get CEs to get my paramedic renewal out of the way and hopefullh prepare for FP-C.
 
Oh dang, we must be burning through some CARES Act funding or something... new Special Notice out today states that Suppression Personnel will be issued 3M Versaflow Healthcare TR-300+ PAPR Kits 😳
 
So my company FTOs don't think I have enough experience to do 911 (I've only had 7-8 months of IFT so I figured this might happen) so they're sending my to do transport, but I'm stuck doing wheelchair since I don't have my PA cert yet. Yay $5 cut in pay for the next few weeks. >.>
 
Fezman92 said:
So my company FTOs don't think I have enough experience to do 911 (I've only had 7-8 months of IFT so I figured this might happen) so they're sending my to do transport, but I'm stuck doing wheelchair since I don't have my PA cert yet. Yay $5 cut in pay for the next few weeks. >.>
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im sending you a message.
 
One of the teacher's assistants in school is a medic, he helps with labs.

During a medical assessment scenario with chest pain, I did basically everything right but when asked about starting a line, I agreed I could do that and verbalized it.

Then he was like "Well what if you can't get a peripheral IV?"

In the scenario, The pt is currently stable, we're running emergency traffic to ED. Maybe 10-15 minutes ETA. Chest heaviness and high BP prior to nitro and aspirin. Put him on high flow O2 and such. Heart rate a little elevated. But he's stable.

"I was like, uhh, then I didn't get it...?"

"You did learn how how to IO"

"Yeah. I did"

"You could IO him"

".... I'm not gonna IO a stable pt just because I couldn't get a line. That's a more invasive procedure"

"Yeah but what if his BP continues to fall?"

"Then if he starts to decline, then I'll drill him if I need to. But I'm not going to drill him just because I couldn't be start a line. Ambulances aren't sterile fields and I don't want to risk an unnecessary procedure/ pain when he's stable"

"So you'd just show up to the ED and say you couldn't get a line?"

"Uhh yeah. The service I was at did it all the time if they couldn't get a line"

".... *is frustrated*"

Am I wrong? Are you gonna drill someone just to get vascular access when you have no intention of pushing anything right now and pt is stable?

Edit: I guess I could have gone normal traffic in the scenario. But other than that I wouldn't change my answer
 
DragonClaw said:
One of the teacher's assistants in school is a medic, he helps with labs.

During a medical assessment scenario with chest pain, I did basically everything right but when asked about starting a line, I agreed I could do that and verbalized it.

Then he was like "Well what if you can't get a peripheral IV?"

In the scenario, The pt is currently stable, we're running emergency traffic to ED. Maybe 10-15 minutes ETA. Chest heaviness and high BP prior to nitro and aspirin. Put him on high flow O2 and such. Heart rate a little elevated. But he's stable.

"I was like, uhh, then I didn't get it...?"

"You did learn how how to IO"

"Yeah. I did"

"You could IO him"

".... I'm not gonna IO a stable pt just because I couldn't get a line. That's a more invasive procedure"

"Yeah but what if his BP continues to fall?"

"Then if he starts to decline, then I'll drill him if I need to. But I'm not going to drill him just because I couldn't be start a line. Ambulances aren't sterile fields and I don't want to risk an unnecessary procedure/ pain when he's stable"

"So you'd just show up to the ED and say you couldn't get a line?"

"Uhh yeah. The service I was at did it all the time if they couldn't get a line"

".... *is frustrated*"

Am I wrong? Are you gonna drill someone just to get vascular access when you have no intention of pushing anything right now and pt is stable?

Edit: I guess I could have gone normal traffic in the scenario. But other than that I wouldn't change my answer
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No. Hospitals have ultrasounds, they can get an IV that way. If he gets bad, sure....drill. but a generic chet pain? Nah.

If it makes you feel better, I had a patient that just completely **** the bed on me today that I didn't expect at all and I didnt have a line ready. Because of transport time (I dont have much at all), trying to address his shortness of breath first, and trying to troubleshoot equipment problems, they got nothing. He just fell off that cliff as we got on campus and there wasn't time. Had I had another few minutes I would have, but sometimes all you can do is get to a hospital and provide what information you have.
 
Finally got my foot in the door as a skills instructor at a local EMT program. Stoked when I finish my BA next year, I can work on getting into the community college programs.
 
StCEMT said:
No. Hospitals have ultrasounds, they can get an IV that way. If he gets bad, sure....drill. but a generic chet pain? Nah.

If it makes you feel better, I had a patient that just completely **** the bed on me today that I didn't expect at all and I didnt have a line ready. Because of transport time (I dont have much at all), trying to address his shortness of breath first, and trying to troubleshoot equipment problems, they got nothing. He just fell off that cliff as we got on campus and there wasn't time. Had I had another few minutes I would have, but sometimes all you can do is get to a hospital and provide what information you have.
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Placing an IO in that guy is a great way to take an ischemic event to an infarction very quickly...as is continued futile stabbing away with a needle...
 
StCEMT said:
No. Hospitals have ultrasounds, they can get an IV that way. If he gets bad, sure....drill. but a generic chet pain? Nah.

If it makes you feel better, I had a patient that just completely **** the bed on me today that I didn't expect at all and I didnt have a line ready. Because of transport time (I dont have much at all), trying to address his shortness of breath first, and trying to troubleshoot equipment problems, they got nothing. He just fell off that cliff as we got on campus and there wasn't time. Had I had another few minutes I would have, but sometimes all you can do is get to a hospital and provide what information you have.
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No shame in my IM med admin game.
 
I don't know if it is just Arrow EZ IO, my county, or my company, but I feel like they are pushing for us to be more and more lenient with using IO when we cannot get an IV. Our protocol just says that IO should not be used for prophylaxis purposes and that you should be intending on using it if you do it. They make it seem like it is not a big deal, even in a conscious patient. They always bring up how it doesn't hurt until you just flush, but just slowly push Lidocaine, let it sit in the bone arrow, and then use it. My county/company is weird because they brought in the Arrow EZ IO people to teach us and those guys contradicted our protocols telling us it was crazy, which makes me go ugh. Arrow EZ IO recommends slowly pushing 40 mg Lidocaine IO over 2 minutes and letting it sit in the bone marrow before use. Our county's protocol says push 40 mg over 30-45 seconds and you're good to go, lol. I have never ever done a conscious IO ever. I also personally just don't like IOs. I feel like it's so hard to push medications into it, the whole humeral IO that they are now pushing is awkward with the arm position and I find difficult to do (I've never done it, I feel like I have a hard time finding the land mark other than it is easy to remember to point to the butt cheek on the other side), fluids start to backup in the chamber so it's not that useful if I decided to hang a medication drip, and I don't think the hospital ever tries to draw labs out of it. Usually the first thing the hospital does, if we don't have an IV or EJ, is they a line and draw labs from it. So on my cardiac arrests (our protocol prefers IO over IV in cardiac arrest...) or critical calls, IV or EJ is my preference. I get not every patient is going to be easy or worthwhile to search forever looking for a vein, but most patients seem easy enough. I don't get too many cardiac arrest, like one a month, and I have yet to use an IO on a single one. I think the IO is a great tool in a pinch, the studies shown to me (ehem, but the Arrow EZ IO guys) seem to show it does well administering fluids quickly when done humeral, I just feel like it is kind of overrated and more problematic compared to IV and EJs.
 
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