The Cutting/Drilling/Poking stuff

[CANDawg]

**Disclaimer: I DID do a search before posting this thread, but couldn't find anything that was similar in nature that wasn't 3+ years old. Extra points for me!

I'm moving into an EMS career, and for the most part I have a pretty strong stomach, and don't freak out in emergencies. I can handle blood and gore (the internet is a good way to test that... :wacko, and I've been through two robberies in my career in banking, both times I was able to easily take control of the situation, and seemed to be the only one not freaking out.

That said, I still grimace a bit when I think about myself performing something relatively invasive (comparatively speaking). I'm talking about things like cricothyrotomy, thoracentesis, pericardiocentesis, even urinary catheterization. Needles & IVs don't cause me issue, but once you start to get any deeper than a vein, I get uncomfortable.

Question: Is this something that can be overcome relatively easily? In Alberta (and most jurisdictions I assume), those procedures are only performed by an EMT-P, which means I would have at least a couple years experience under my belt before I even start having to practice them.

I'm in this to go all the way, not to have to stop at EMT-A because I'm not sure I could handle the additional skills required in the EMT-P scope.

 

[EpiEMS]

Question: Is this something that can be overcome relatively easily?

It's a fair question. Now, granted, I haven't done those procedures, but I was certainly freaked out when I heard that I'd be breaking ribs during CPR and realigning deformed limbs. Having now done those things, I'm not so freaked out –:censored:and I was able to do them only because (a) I was working with people who were calm, (b) I knew the academic aspect of it, and (c) I was following protocol. If you feel confident in your knowledge, you can do anything in your scope – even if the idea grosses you out, I think.

Didn't realize EMT-Ps in Canada could do pericardiocentesis. Interesting!

 

[Handsome Robb]

You get over it pretty quickly. If you are doing something like the procedures you listed the last thing on your mind is how "gross" the procedure you are doing is.

Ok foley caths are nasty, no way around that one, and generally not a do or die skill.

Also you really wont be doing those skills all that often, if ever, in your entire career. A couple of times each, if you are lucky.

 

[Medic Tim]

You get over it pretty quickly. If you are doing something like the procedures you listed the last thing on your mind is how "gross" the procedure you are doing is.

Ok foley caths are nasty, no way around that one, and generally not a do or die skill.

Also you really wont be doing those skills all that often, if ever, in your entire career. A couple of times each, if you are lucky.

This^^.


I am not 100 % familiar with Alberta scope but pericardiocentesis would only be done to my knowledge by a critical care Medic in the er or icu setting.

 

[CANDawg]

I am not 100 % familiar with Alberta scope but pericardiocentesis would only be done to my knowledge by a critical care Medic in the er or icu setting.

Didn't realize EMT-Ps in Canada could do pericardiocentesis. Interesting!

Alberta doesn't have a CCP scope, EMT-P is the highest it goes. It's in there, but you're right: I highly doubt it would be something done in the back of an ambulance doing 110kph on the highway. :wacko:

A Paramedic will:
I-18-1 Demonstrate knowledge of indication for pericardiocentesis:
• Relieve cardiac tamponade; • Trauma
• Infection
• Neoplastic disease
• Myocardial rupture.
I-18-2 Demonstrate knowledge and ability to perform pericardiocentesis:
• Subxiphoid approach;
• Beck’s triad.
I-18-3 Demonstrate knowledge of contraindications and complications of pericardiocentesis:
• Cardiac dysrhythmias;
• Puncture or laceration of the cardiac chambers;
• Puncture or laceration of the coronary arteries;
• Hemorrhage from myocardial or coronary artery puncture.

http://www.collegeofparamedics.org/media/66522/aocp_emtp_full.pdf. Page 150.

 

[CANDawg]

You get over it pretty quickly. If you are doing something like the procedures you listed the last thing on your mind is how "gross" the procedure you are doing is.

Ok foley caths are nasty, no way around that one, and generally not a do or die skill.

Also you really wont be doing those skills all that often, if ever, in your entire career. A couple of times each, if you are lucky.

This is probably true. My only POV right now is what I've read and watched on youtube. Necessity has a way of making things easier to stomach, haha.

That's what I assumed, but its nice to have confirmation. Thanks.

 

[mycrofft]

I used to get queasy watching training films but get blood up to my wrists without flinching (pre-AIDS). You are too busy doing things right to identify with the pt and get nauseous.

 

[RustyShackleford]

Not that squeamishness has ever been a problem of mine but as has been stated when it has to be done you aren't worried about the blood and or guts you just do your job and move on.

 

[Tigger]

For what it's worth I know a few people that can't stand the sight of actual blood but can watch the must messed up videos on the internet without even batting an eye. The only way to know what really affects you is to see it firsthand. Obviously starting an IV is different than watching one but generally if you can stand watching it you can stand doing it.

 

[Handsome Robb]

Alberta doesn't have a CCP scope, EMT-P is the highest it goes. It's in there, but you're right: I highly doubt it would be something done in the back of an ambulance doing 110kph on the highway. :wacko:

I'm not saying you will or wont do it. If it's in your scope you need to be proficient and competent and willing to do the procedure when it's indicated.

My point was if you are to the point of doing a pericardiocentesis the last thing on your mind is going to be "this is nasty".

That's my opinion at least. My thoughts are usually "what can I do to keep this person from dying right in front of me." First example that comes to mind is a nasal tube that I was trying to pull the trigger on but deferred it due to our close proximity to the ER and a doctor with paralytics and sedatives.

 

[EpiEMS]

I used to...get blood up to my wrists without flinching (pre-AIDS).

Oh my.

That's scary. Not the blood, exactly, but the blood being on you and maybe getting in you. Sounds like the stories I hear from others folks who've been in the business for a while.

 

[samiam]

I can handle blood and gore (the internet is a good way to test that... :wacko, .

I dont think the internet could ever do a thoracotomy justice....my first one was frikin awesome!!