There is nothing more irritating than incompetent nurses...

[JPINFV]

More importantly, is rales pronounced "rails" or "rahls"? After that we can tackle "centimeters" vs "sontameters"!

 

[Aidey]

Rails unless you are south of the Mason-Dixon line.

 

[NYMedic828]

Rails unless you are south of the Mason-Dixon line.

Most people pronounce it Rails, self included but I believe its original pronunciation was Rahls.

Just as angina, is An-Gina (gina pronounced like the womans name Gina)

 

[mycrofft]

As a RN and former EMT-A (EMT-B but ancient)

1. Sorry you have encountered nurses who are prejudiced against prehospital providers, I've seen it and been a subject of it in the past. Or maybe some nurses did not meet your expectations.
2. Incompetence is a serious charge, grounds for revocation of license or certificate. It is also a "value judgement", which while it can start spirited debate and draw readers, is not going to be a basis for reasoned discussion.
3. One "around here" does not necessarily match another "around here", so acronyms (usually verbally tossed rapidly in a patient handoff) can cause vacant stares.
4. Same about IV before nitro, but the other way round. Probably in the ED they always start an IV because they cannot certify how much nitro or other med is already on board. You made a decision, it worked, I assume it was within protocols, it worked this time.
5. Rales..I like rales, I say rales, but for quite a time "rales" was not in vogue. Again, might not be in the hospital's lexicon. Their " around here" did not match your "around here".
6. Doubt if they will rip out your IV, probably discontinue or "D/C" it. VERY common, usually due to in-house infection control issues, and nothing to take personally unless someone has a comment about the quality and site of stick etc. Might want to not say that is a reason not to start an IV if you have to testify in court, stick with your professional judgement thing. (No pun intended).

Something irks me as much as uppity nurses, and that is folks of any set of credentials who help make the working environment more strained by starting credential fights. Like "shift wars", nobody wins and takes a while to resolve, if ever.

 

[JPINFV]

Rails unless you are south of the Mason-Dixon line.

Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...

 

[Aidey]

Most people pronounce it Rails, self included but I believe its original pronunciation was Rahls.

Just as angina, is An-Gina (gina pronounced like the womans name Gina)

My argument for the pronunciation of angina is as follows.

There is one other word in the English language (that is not a name) that ends in -gina, vagina. We don't pronounce it va-geh-na, so we shouldn't pronounce angina an-geh-na.

 

[JPINFV]

I will never look at my Aunt Gina the same again. Thanks folks.
:'-(

 

[Aidey]

Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...

I know technically the Mason-Dixon line terminates at the western border of PA, and that it is only a cultural thing that it applies to the whole south. For the purposes of this conversation lets just pretend it ends at the western edge of Texas.

 

[mycrofft]

As long as it does't sound like "rhonchii", "stridor", or "wheeze", and the reporter knows the difference.

 

[NYMedic828]

Geographically, California is South of the Mason-Dixon line, but politically (as in "political map" type "political") is north of it...

 

[JPINFV]

If you want to know something that will really blow your mind, Reno is West of Los Angeles.

 

[mycrofft]

So's NYC if you go west far enough.
Nice photo for an avatar

 

[JPINFV]

So's NYC if you go west far enough.
Nice photo for an avatar

...but it's not a trick like that...

 

[mycrofft]

Ha ha I'm from LA. Old one. Unalaska is further west than Hawaiian Islands.
And Tulsa OK is closer to the ocean than Amarillo TX

 

[Veneficus]

That's funny sheet right there!:rofl: I read that and dang near fell out of my chair. Everyone in my office was looking at me like I'd lost my mind.

Seriously though, loop diuretics have seriously fallen out of favor here and NTG is first line for APE, followed by CPAP if necessary. Our Medical Director has a staunch stand on the whole NO NTG w/o IV access thing, as well as an 15 lead EKG prior to ANY NTG admin. We carry NTG gtt and is the preferred method, as this affords you an easier controlled vasodilatation.

I just read the part I cared about, which was the history and definitions.

 

[TatuICU]

Had a call this morning in my volly area for a 94 year old female with acute on-set dsypnea at 8am. (im sure most people know what the problem is already)

Medic flycar is there before me, he takes vitals and puts her on O2. Tells me she hasn't been able to urinate x 2 days and has SOB with Rales bi-lat.

BP 164/82
HR 80 Irregular (a-fib)
RR - 18
SPo2 - 96 on room air.
ECG - A-fib stable.

Patient takes a cornucopia of meds but has Hx of CHF, A-fib and HTN.

She said this happens occasionally and she just needs IV lasix, which is available on standing orders here.

I gave her one nitro tablet 0.4mg SL.

After the nitro she said she felt worlds better, I asked her if she felt another would help and she said no she feels ok now. (Rales still present but improved)

Bp dropped to 144/62

Due to the stability of her condition, and being 5 minutes from the ER I opted not to bother starting a line to give Lasix. The Lasix didn't seem necessary pre-hospital. (the ER is just going to rip my line out to do their own anyway, and I didn't want this poor old lady to get poked for no real reason)

So I walk into the ER and this nurse asks what is going on. I told her

"Shortness of breath secondary to APE with bi-basilar rales"

She gives me a completely blank stare has no idea what im talking about. I put it into English for her and just said "Fluid in the lungs."

I then told her I gave 0.4mg of nitro and she still has rales but feels better. She then gave me this attitude over the fact that I felt it was wise to give nitro without starting an IV.

Since people don't take their own nitro without an IV at home all the time or anything... Its not like I gave nitro to a hypotensive she was 160 systolic.


Sorry just had to get all that off my chest. Nothing irks me more than nurses thinking they are better than us just because they have a higher title.

I understand the frustration. However, your report would get pulled and be up for peer review for giving NTG without a line at my former service. Of course you could explain yourself but bottom line is according to protocol you would've been wrong. The MD would've asked you something like "What if the pt was septic?" and just generally been a grumpy *** about it.


This is what concerns me about your post "Nothing irks me more than nurses thinking they are better than us just because they have a higher title."

I'm a NREMT-P/RN, BSN, CCRN currently working in a CVICU and I'm not quite sure where you're getting the idea that RN is a higher title than NREMT-P. I received the same AS with my Paramedic degree as a I did with my ADN. It wasn't until I finished my BSN (completely :censored::censored::censored::censored:ing useless BTW and got a me a hearty raise of about 9 cents an hour) that I would have considered myself as having "more education" than the average Paramedic. As a medic you have the same degree as an ADN does, so try giving yourself a bit more credit would ya?

 

[Veneficus]

I'm a NREMT-P/RN, BSN, CCRN currently working in a CVICU

can you say that 5 times fast?

 

[emergency123]

Nurses are dumb

You should have Cardio-Vert......That would have been cool...REALLY???:rofl:

 

[TatuICU]

can you say that 5 times fast?

Dude let me tell you, our name badges are ridiculous. They keep wanting squeeze that useless TNCC title on all of our stuff too. I made them put my EMT-P on first, lol. I always tell them I'm not a nurse, I'm just a medic with a nursing license

 

[Veneficus]

Dude let me tell you, our name badges are ridiculous. They keep wanting squeeze that useless TNCC title on all of our stuff too. I made them put my EMT-P on first, lol. I always tell them I'm not a nurse, I'm just a medic with a nursing license

Tell them that you want ACLS and PALS on there too.