Ok, so I haven't been super forthcoming recently. I blame school, and a general sense of malaise about the whole school thing. No, I'm not burnt out (except on school), but I am getting heartily bored of going to clinicals and getting shafted as far as calls go. Not that I'm wishing ill on anyone, but someone has to get sick or hurt in order for me to garner enough checks in the boxes to make the NR-EMT folks happy enough to let me test.
So, over semester break, I spent a lot of time at my volunteer house. Didn't get too many calls (my white cloud-ness continues even there), but the few I got were interesting. I did get to look all smart and stuff when we got a call for a lionfish sting (there was an episode of Bones that involved a lionfish stinging someone to death). It was literally around the corner from my station, and I googled it on my fancy new Android phone as we were pulling up to the place. Luckily, the patient had also used superior google-fu (though I suspect it was the kids who did it) and was already treating things in the correct manner. The patient could have gotten to the hospital on their own, but they were newish to the area, and hadn't had the pleasure of needing our lovely local ER's, and were unsure of how to get there. So, we had a lovely drive down, where I continued to google 'lionfish stings' and found that what happened was not so uncommon after all.
I also had the pleasure of seeing a patient in SVT (going from sinus tach to SVT) and helping the medic push adenosine, which failed to have the desired effect, but the patient converted anyway. I swear I see more interesting things at my own station with the medics than I do when I am at clinical.
Point in case: at a recent field clinical (in a system where the medics run everything from hangnails to heart attacks, and I'll leave it to you to guess which is more common), all but one of our calls was a BLS call. I did get the hard IV stick when called on, so the day wasn't lost completely for me. However, the last call took the cake, and was so ridiculous I couldn't find anything to warrant writing it up to count. The patient called because they had been constipated for several days and their back hurt. The patient had actually gone to work earlier in the day, and a family member was kind enough to ride to the hospital with us, leaving their perfectly good car at home. REALLY?????? Just when I think people can't amaze me anymore, I am proven wrong.
In other news, I've been busy training. Not just for paramedic school, oh no. Because I don't have enough on my plate right now, what with finishing school, attempting to graduate, studying for the NREMT-P tests, and planning a wedding, I have decided that it would be an excellent idea to begin training for a triathlon. this from someone who is woefully out of shape and has a hard time running up the stairs. I have started a Couch to 5K program (C25K), have a cheap, beat-up road bike on a bike trainer, and have been swimming at the pool on campus. Thankfully, my class schedule this semester allows for a bit more time in the mornings, which I take advantage of. It also gets me on campus earlier so I can get a good spot.
So I am looking at scheduling a mini-sprint triathlon locally. It's at the end of March, and is a bit backwards so no one freezes (generally the routine is swim, bike run...this one will be run, bike swim), with small distances (1.4 mi run, 4 mi bike, 250 m swim) that I think I can do without killing myself. The bad part is right now I have what I think is tendonitis in my right knee. My yearly physical is conveniently on Thursday, so I will be able to ask my doc what she thinks.
The general plan is that not only will the triathlon training get me motivated enough to keep working out, thus losing weight for the wedding, but it will also get me in sufficient shape to test for a fire department over the summer. At least, that's the plan, should any departments in the area actually scrounge up funds to hire a class.
Monday, February 21, 2011
Friday, December 10, 2010
It's the end of the semester as we know it....
Today is my last day of clinicals. I am spending my day in a firehouse in Smaller County (that I hope to possibly get hired in when they open applications this month), attempting to defrost my hands. Who decides it's a good idea to wash the ambo in sub-freezing weather anyway? My sleeve is wet where the water ran down from the hose. I miss the sauna in McMurdo's Station 1.
Anyway, as stated, it's the end of the semester, and I have a chance to breath. Facebooking has been possible, but that's about all I've been able to muster. While this semester hasn't had the intensive class time and tests of last year, it has been a study in time management, of which I am a poor student. Three days of clinicals a week, several papers, and a couple of tests thrown in for good measure have had me hopping around like a headless frog the past few months. I have had some interesting calls, which I will regale you all with once the semester is done for good next week and I have time to take a breath and actually think. Next Monday is ACLS class (finally!), and Tuesday is my final presentation for my research class.
I will say that I find myself endlessly frustrated by the seemingly arbitrary skills and the number of times we have to perform each skill in order to finish our ride-along time. In apparent direct contrast to the new AHA guidelines, we are required to record the number of patients we ventilate, (one patient=one ventilation) and we are required to ventilate 20 patients. However, we are not required to track or have a certain number of patient's we perform compressions on. I don't know about anyone else, but most working codes, where one would be performing ventilations, tend to come in late at night, generally after we are forced to be out of the firehouses. Not to mention that even as a live-in at a relatively busy, non-medic staffed station I didn't have 20 working codes in an 8 month period. So please explain to me how I am supposed to get 20 ventilated patients between September and December (and then again in February to April). I am quite frustrated.
Add to this that I seem to be the ultimate 'white cloud.' Medics breath a sigh of relief when I walk through the door, knowing that the next 8-12 hours will be easy. The most calls I have run on a medic unit in a 12 hour period was 5, and only one of those was an ALS call that required more than a bandaid and a bit of comfort. Not that those things aren't important, but as a student who is required to have a certain number of specific skills (IV starts, ventilations, medication administrations, etc) these type of calls do not really help, aside from the assessments (which, admittedly are also important, as I need assessments for things such as respiratory distress, chest pain, altered mental status, syncope, psych, OB, etc). Most of these I have, but we just don't run that many trauma calls (most of those being of the BLS type). Therefore, I find myself behind in trauma, psych, and AMS assessments. I have a plethora of respiratory calls, but very few chest pain calls. The OB calls will come when we do our L&D rotation next semester, and I find myself hoping that I will be able to get more hospital time next semester to attempt to check the appropriate boxes. However, even the nurses at the hospitals are happy to see my wander in, as my presence guarantees a quiet 8 hours.
All told, I am not unhappy. In fact, I have had several calls that were excellent teaching opportunities, both as far as assessments, skills, and interpersonal relations go. I've learned lots of what not to do, and some of what to do. How to deal with difficult nurses and doctors, when to treat and when to let it ride, and so on. Riding at my home station isn't quite as good, because I can't practice as an ALS provider, but the medics there know I'm in school and let me ride with them to work on my assessments. One of the medics (I seem to be the only one who likes her) is an excellent provider, and quizzes me on what to do next, and basically runs through the call with me, what I would do next, medication dosages and so on. It's very nice to have that extra help.
But I am very glad the semester is nearly over. Just 4 more short months, and I'll have my second BS degree, and be a licensed paramedic. Then it's just a matter of finding a job.
Anyway, as stated, it's the end of the semester, and I have a chance to breath. Facebooking has been possible, but that's about all I've been able to muster. While this semester hasn't had the intensive class time and tests of last year, it has been a study in time management, of which I am a poor student. Three days of clinicals a week, several papers, and a couple of tests thrown in for good measure have had me hopping around like a headless frog the past few months. I have had some interesting calls, which I will regale you all with once the semester is done for good next week and I have time to take a breath and actually think. Next Monday is ACLS class (finally!), and Tuesday is my final presentation for my research class.
I will say that I find myself endlessly frustrated by the seemingly arbitrary skills and the number of times we have to perform each skill in order to finish our ride-along time. In apparent direct contrast to the new AHA guidelines, we are required to record the number of patients we ventilate, (one patient=one ventilation) and we are required to ventilate 20 patients. However, we are not required to track or have a certain number of patient's we perform compressions on. I don't know about anyone else, but most working codes, where one would be performing ventilations, tend to come in late at night, generally after we are forced to be out of the firehouses. Not to mention that even as a live-in at a relatively busy, non-medic staffed station I didn't have 20 working codes in an 8 month period. So please explain to me how I am supposed to get 20 ventilated patients between September and December (and then again in February to April). I am quite frustrated.
Add to this that I seem to be the ultimate 'white cloud.' Medics breath a sigh of relief when I walk through the door, knowing that the next 8-12 hours will be easy. The most calls I have run on a medic unit in a 12 hour period was 5, and only one of those was an ALS call that required more than a bandaid and a bit of comfort. Not that those things aren't important, but as a student who is required to have a certain number of specific skills (IV starts, ventilations, medication administrations, etc) these type of calls do not really help, aside from the assessments (which, admittedly are also important, as I need assessments for things such as respiratory distress, chest pain, altered mental status, syncope, psych, OB, etc). Most of these I have, but we just don't run that many trauma calls (most of those being of the BLS type). Therefore, I find myself behind in trauma, psych, and AMS assessments. I have a plethora of respiratory calls, but very few chest pain calls. The OB calls will come when we do our L&D rotation next semester, and I find myself hoping that I will be able to get more hospital time next semester to attempt to check the appropriate boxes. However, even the nurses at the hospitals are happy to see my wander in, as my presence guarantees a quiet 8 hours.
All told, I am not unhappy. In fact, I have had several calls that were excellent teaching opportunities, both as far as assessments, skills, and interpersonal relations go. I've learned lots of what not to do, and some of what to do. How to deal with difficult nurses and doctors, when to treat and when to let it ride, and so on. Riding at my home station isn't quite as good, because I can't practice as an ALS provider, but the medics there know I'm in school and let me ride with them to work on my assessments. One of the medics (I seem to be the only one who likes her) is an excellent provider, and quizzes me on what to do next, and basically runs through the call with me, what I would do next, medication dosages and so on. It's very nice to have that extra help.
But I am very glad the semester is nearly over. Just 4 more short months, and I'll have my second BS degree, and be a licensed paramedic. Then it's just a matter of finding a job.
Thursday, November 11, 2010
Faking it...
Honestly, if you're going to insult my intelligence by lying so blatantly to me, the worst you can do with your sob story is gin up some real tears. A two-year old can come up with better crocodile tears than you.
Last night proved a classic example of pain. I read a book once, You're Never the Same Once the Air Hits Your Brain, written by a neurosurgeon (sorry, can't remember the author's name) where the good doctor, as a young medical student/intern, learned the difference between real pain and 'fake' pain. Note: when I say 'fake' pain, I don't necessarily mean that the patient is faking being in pain. They may very well be in pain, and usually are in some discomfort, and therefore, must be treated as such (never tell anyone they aren't in pain. No one feels pain the same, and what may be a 10/10 to one patient could be a 4/10 to another). But 'real' pain vs 'fake' pain patients will differentiate themselves.
Patient one called for abdominal pain, due to gallstones. A previous attack had shown what the pain was, and, though surgery was scheduled, another attack came on. The patient complained of pain at a 10/10, and could not find a comfortable position. The entire 25 ride to the hospital was spent with the patient moving around constantly on the captain's chair (no stretcher by patient's request, as it would restrict movement too much), stretching, breathing, sighing, and doing everything to not cry. The patient couldn't describe the pain very well, only that it 'hurt badly' and was so distracted by the pain that she couldn't even remember her age, could barely walk, and just could not find a comfortable position. When asking the patient questions, we had to frequently remind her of the question we asked, or ask several times, as she was so distracted by the pain that she would forget within seconds of what we asked.
Patient two actually called for chest pain, but arrival on scene showed it was a frequent flyer patient with a history of back problems and general muscle pain and spasms. Frequent flyer-ism is not unusual with chronic pain patients, as they call when something happens to disrupt their homeostasis; they run out of meds, have a particularly bad day (weather can do this), or overstretch themselves, and need more relief than they can get from their home meds. This patient had a history of spinal issues after a recent (within the last year) car accident. This car accident was reported to be the patient's fault but the patient was currently suing everyone involved, from the other driver to the police and EMS departments for poor handling of the case. A laundry list of medical history accompanied her. The entire call consisted of much screaming and yelling, and then crying as she related her story, complete with embellishments I'm not sure are ever possible. Her story was related with a lot of detail, including dates and names of those involved. By asking our own questions, we were easily able to distract the patient from her pain complaints, and when we asked about pain in general, we got an answer of 'It's the same.' However, if we immediately asked about a specific body part ('What about your big toe?), the answer was a scream or wail of how it hurt so badly.
Do I doubt either patient was in pain? No. Again, pain is extremely subjective, and who are we to say that a patient has pain or not? Chronic pain patients often have high pain tolerances, and acute exacerbations of their pain are often accepted with resignation and familiarity, and they tend to not trend towards the dramatic side of the scale. Patient in 'real' pain are often unable to describe the pain unless prompted with suggestions, because all they know is that 'it hurts.' Patients in 'fake' pain often use colorful imagery, such as ' it's sharp, like miniature elves are running up and down my legs, stabbing me with red hot pokers.'
Again, this is all very subjective, and I tend towards the treatment rather than not. Patients in pain are in pain, and whether they are trying to sucker you for drugs or for insurance-itis or they are totally and completely really in pain, they all should be treated the same. Keep a high index of suspicion, but don't discriminate.
Another note: I have minor chronic pain. Severe carpal tunnel in both hands, constant shoulder pain that has only been partially relieved by rotator cuff surgery, and lower back pain are my friends. I am no where near some of these patients level of pain, but I also have a high pain tolerance (my rotator cuff was torn for over a year before it was repaired, and that was a year of push-ups and weight lifting and firefighting). So, I'm just saying I have a very slight view of what some patients go through.
Last night proved a classic example of pain. I read a book once, You're Never the Same Once the Air Hits Your Brain, written by a neurosurgeon (sorry, can't remember the author's name) where the good doctor, as a young medical student/intern, learned the difference between real pain and 'fake' pain. Note: when I say 'fake' pain, I don't necessarily mean that the patient is faking being in pain. They may very well be in pain, and usually are in some discomfort, and therefore, must be treated as such (never tell anyone they aren't in pain. No one feels pain the same, and what may be a 10/10 to one patient could be a 4/10 to another). But 'real' pain vs 'fake' pain patients will differentiate themselves.
Patient one called for abdominal pain, due to gallstones. A previous attack had shown what the pain was, and, though surgery was scheduled, another attack came on. The patient complained of pain at a 10/10, and could not find a comfortable position. The entire 25 ride to the hospital was spent with the patient moving around constantly on the captain's chair (no stretcher by patient's request, as it would restrict movement too much), stretching, breathing, sighing, and doing everything to not cry. The patient couldn't describe the pain very well, only that it 'hurt badly' and was so distracted by the pain that she couldn't even remember her age, could barely walk, and just could not find a comfortable position. When asking the patient questions, we had to frequently remind her of the question we asked, or ask several times, as she was so distracted by the pain that she would forget within seconds of what we asked.
Patient two actually called for chest pain, but arrival on scene showed it was a frequent flyer patient with a history of back problems and general muscle pain and spasms. Frequent flyer-ism is not unusual with chronic pain patients, as they call when something happens to disrupt their homeostasis; they run out of meds, have a particularly bad day (weather can do this), or overstretch themselves, and need more relief than they can get from their home meds. This patient had a history of spinal issues after a recent (within the last year) car accident. This car accident was reported to be the patient's fault but the patient was currently suing everyone involved, from the other driver to the police and EMS departments for poor handling of the case. A laundry list of medical history accompanied her. The entire call consisted of much screaming and yelling, and then crying as she related her story, complete with embellishments I'm not sure are ever possible. Her story was related with a lot of detail, including dates and names of those involved. By asking our own questions, we were easily able to distract the patient from her pain complaints, and when we asked about pain in general, we got an answer of 'It's the same.' However, if we immediately asked about a specific body part ('What about your big toe?), the answer was a scream or wail of how it hurt so badly.
Do I doubt either patient was in pain? No. Again, pain is extremely subjective, and who are we to say that a patient has pain or not? Chronic pain patients often have high pain tolerances, and acute exacerbations of their pain are often accepted with resignation and familiarity, and they tend to not trend towards the dramatic side of the scale. Patient in 'real' pain are often unable to describe the pain unless prompted with suggestions, because all they know is that 'it hurts.' Patients in 'fake' pain often use colorful imagery, such as ' it's sharp, like miniature elves are running up and down my legs, stabbing me with red hot pokers.'
Again, this is all very subjective, and I tend towards the treatment rather than not. Patients in pain are in pain, and whether they are trying to sucker you for drugs or for insurance-itis or they are totally and completely really in pain, they all should be treated the same. Keep a high index of suspicion, but don't discriminate.
Another note: I have minor chronic pain. Severe carpal tunnel in both hands, constant shoulder pain that has only been partially relieved by rotator cuff surgery, and lower back pain are my friends. I am no where near some of these patients level of pain, but I also have a high pain tolerance (my rotator cuff was torn for over a year before it was repaired, and that was a year of push-ups and weight lifting and firefighting). So, I'm just saying I have a very slight view of what some patients go through.
Monday, November 1, 2010
WEEEE!!! It's Stream of Consiousness time!
Why yes, I am still alive. Clinicals are eating my life. And yet, I do so little at them. The past few weeks have been full of medic unit clinicals, with less than 20 calls to show for it. And today, I sit at a station far from home, bored to tears. Only one call all day thus far, and it was a BlS run, which netted me ZERO patient contact credits.
I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.
I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.
I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.
Though I didn't help my case much by having a dozen buffalo wings for lunch today.
I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.
Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.
In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.
By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....
I'm not saying I want people to get hurt. Remember, I am a firm believer in the fact that a bored medic is a happy medic. However, in order to fulfill the requirements of the National Registry, not to mention the much higher (as in double, because 'we're better than everyone else) requirements of my program, I NEED patient contact hours. I NEED people to have the worst day of their lives so that I can graduate and be grateful that they aren't having that day.
I actually like the medics I'm with today. They are including me in their activities (which basically include watching movies and sleeping) and generally being very nice to me. Much more than I get from most crews I end up with, who usually are irritated that they have yet another student to babysit. I'm slowly learning shift days, and have found myself carefully arranging shifts as best I can to coincide with the crews I like and actually learn from.
I only wish I was either closer to my clinical sites or had better hours because I am getting ZERO triathlon training in. I have convinced my mother to forgo purchasing things off The Engineer's and my registry and instead buy me an indoor bike trainer so that I can work out early in the morning before clinicals or classes, or when I get home and the gym is either closed or otherwise inaccessible to my schedule.
Though I didn't help my case much by having a dozen buffalo wings for lunch today.
I am heartened by the fact that tomorrow is the election, which means that once tonight is done, the horrid, pervasive and otherwise boring (and boorish) political ads will be gone. I would say they would be gone for another year, but experience and cynicism leads me to dread that we will only have a few months respite before the next round begins anew.
Speaking of politics (and I heartily try not to), I have several friends who made their way to the rally in DC this weekend. I declined their invitations to go because I don't like crowds, particularly large, pressing crowds where you don't know the people around you. In fact, my normal feelings of 'anti-large groups of people' have intensified by several large factors since returning from The Ice several years ago. At any rate, some friends of mine returned from the rally with a story that nearly made me wish I was there so that I could set people straight. It seems that at some point, an ambulance was dispatched for some emergency in the crowd. As often happens with large crowds and large vehicles, at some point the large white box with flashing lights and loud noises reached a choke point, and was unable to go any further. The paramedics got out of their vehicle and, grabbing their bags, made their way through the crowd on foot to the patient. Some in the crowd, evidently irritated that their moderate vantage point was blocked, and they were thus inconvenienced, decided that the ambulance made a far better perch than the spot of ground they were on, and climbed up. To the roof. Per my friends, there were approximately 20-30 people on the roof or hood of the ambulance, and were reaching down hands to help others up. Now, while I can't confirm the actual number of people (20-30 seems an awful lot of people to be crammed on the roof of an ambo), I have several issues with this. I'm not sure of the rating of the roofs of the boxes of ambulances, but I'm fairly sure that even 10-20 will stress the metal and other structural elements of the roof. Even if you assume that there is some sort of structural element to prevent crushing in a roll-over accident, that does not extend to the 'skin' between those structural elements. Not to mention that the roof of an ambulance has several antennae on it for communicating with the world. I've been on the top of an ambo, and they are not the most sturdy of pieces of equipment. The third thing I have issue with is this: WTF is wrong with people? Even my friends, who are in no way, shape or form associated with medicine other than being consumers and patients, would never ever even consider such a thing. I can say that if I were there, I would likely have said something that would have been seen as at the minimum, moderately provoking. I am not the most tactful of creatures on the best of days, and seeing such a flagrant disregard and disrespect for a public safety vehicle would likely have put me over the edge.
In other news, I am already becoming frustrated with wedding planning. So much to do, and so little time, or motivation. We have the site, we have the hotel for people. We have colors picked out and the registry done (though there is a present we need to return, since we don't know the people that sent it). We still have to pick officiant, photog (though there is a woman in my dog's obedience class who is a photog, so we are thinking of choosing them), DJ, cake, meal, etc. In addition, I am not looking forward to dress shopping, as I am a strange shape, and, if I can get training to better mesh with my schedule, likely to drastically change shape quite a bit over the next few months. Still, the wedding date itself is now 341 days away, and as much as I am much more concerned over finishing school and getting a job, I should get my butt in gear. Oh, and I am sick and tired of people asking "Are you excited about the wedding?" If I had time to think about it, yes I would be, but I am much more concerned with finishing assignments, getting enough patient contacts, and getting a job than I am about my impending (in a year) nuptials. And I'm tired of everyone telling me that I'm weird or strange or wrong to think this way.
By the way, who the hell calls 9-1-1 for swollen and sore gums post-tooth pulling x 2 years ago? Really? Come on....
Sunday, October 3, 2010
Eyebrow raiser
Clinicals are still eating my life. I think I'm putting in more hours/week than if I was actually working.
Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.
If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.
So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.
So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.
Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.
So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.
I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).
I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.
I will be better than that in the future.
Anyway, reading Rogue Medic's post about HEMS, I got to thinking about a call I ran over the summer or last spring, or sometime like that. Mutual aid to the next county over, I ran with a firefighter driver (ie, the guy is an EMT, but never rides the box, leaving that to lesser mortals such as me), and a woman who has been an EMT before, but let it lapse and doesn't ride much anyway. The call was for a MVC, we were the second ambulance.
If I remember right, there wasn't much damage to either vehicle. Our patients (there were two of them) were in the same car. Both had been out of the car walking around until the cops or firefighters or whoever told them to sit back down. Patient 1 was complaining of knee pain in one knee. Patient 2 was complaining of lower back pain.
So the first thing that irritated me was that while I went over to assess my patients, the other two immediately got out the cot and 2 backboards with all the trimmings. I believe totally in being prepared, but seriously? You just can't tell with car wrecks these days, the way cars fall apart at the littlest hit.
So I assess my patients. Patient 1 was the driver, c/o knee pain in one knee, no loss of consciousness, no neck or back pain, no tenderness (except on the knee). Speed was nothing, as they were stopped at a stoplight and were rear-ended. Patient was wearing a seatbelt, and is now out and about, walking around.
Patient 2 was the front seat passenger, c/o knee pain and lower back pain. No loss of consciousness, no neck pain, lower back pain is lateral to the spine, just above the hips. Patient denies midline spine tenderness. Patient was wearing a seatbelt, was out walking around the scene, and was told to sit back down in the car by a firefighter. Patient bent over to indicate where the leg pain was and did not have any problem moving. The patient has no extremity numbness, and neither patient was suspected of drugs or alcohol.
So my driver brings over the backboards and such, and I mention that I don't think we'll need them. After all, neither patient meets the criteria in our state protocols for the need for C-spine immobilization. He asks what the patients are presenting with, and I tell him. His response is that the hospital will be upset with us for bringing in a back pain patient from a car wreck who isn't on a backboard. He says that the hospital has threatened multiple providers with their license for such things.
I'd like to say I stuck to my guns and didn't backboard the patients, but I caved. I backboarded the passenger and the driver rode in the captain's chair. I don't know the hospitals around here well enough to argue with them. I didn't get a chance to ask them, since as soon as we got there, they took the patient off the backboard (left the collar on), and we left (this hospital doesn't take report from us generally).
I have to say I'm disappointed in myself. I should have stuck up for my patient and not backboarded the passenger, because there really wasn't a need. Per our state protocols, we are to backboard and collar a patient if they have "experienced a traumatic mechanism which couls cause a cervical spine injury and meets ANY of the following": loss of consciousness or history of such, altered mental status or disorientation, distracting injury, midline cervical spine tenderness, EtOH or drug use suspected, focal neurological deficit, or a child less than 8 years of age. I very easily could have argued my case successfully. But I was afraid, and feared for my license. I can say that I hung my head in shame (metaphorically) and rehashed the situation for days afterwards. I am better than that.
I will be better than that in the future.
Monday, September 20, 2010
Really? That's it?
Papers are eating my brain.
In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).
Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."
Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????
You might as well spray that morphine in the air for all the good it's going to do the patient.
OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).
I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).
In other news...patient with moderately severe eye injury, to be taken to eye center at Big Fancy Hospital. Patient is in a lot of pain. Hospital says "Vitals are stable. Go ahead and drive the 1-1.5 hours up here." (This is the first WTF, as it pulls a medic unit out of the area for a minimum of 4 hours).
Medic says "Uh, ok. Oh, patient is in a lot of pain. Request permission to give 2mg morphine."
Patient is about 85-90kg. Granted, patient did admit to 'a few drinks' but still....2 mg morphine? For an EYE INJURY???? For a 1.5 hour DRIVE??????
You might as well spray that morphine in the air for all the good it's going to do the patient.
OYE! And I can't say or do a damned thing, as I have my NREMT-I, but cannot get licensed in this state because I am not a member of a dept that has ALS volunteers (a rant for another day).
I was reminded of Rogue Medic's take on pain management in the prehospital (and sometimes hospital) setting (well, one of his takes, at least).
Friday, September 3, 2010
Right then....
First of all, a huge CONGRATS!!!! to Epi on passing her NREMT-P and becoming a full-fledged medic! So proud of you, girl, and I hope to be able to write the same thing next June.
School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.
This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).
My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.
Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.
I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.
School is back in session. Classes started this past week, though things don't really get rolling for another week or so. This year is all about clinicals and paper writing. All my my actual classes are management-type classes, and thus the paper writing. One class, Senior Seminar, meets 3 times this semester, and is all about case presentations.
This year's exciting clinical roster includes the cardiac cath lab, 2 different ER rotations, peds ER rotation, a turn with Big-Name-Hospital's critical care transport team (either in-house transports or inter-facility, we have yet to find out), a rotation in the OR with anesthesia for intubations, L&D (something that NO ONE is looking forward to), ICU, and perhaps a psych rotation. All this and ambulance too! We are scheduled to do 3 clinicals/wk, which means that we do one 8 or 12 hour clinical on Mon, Wed, and Fri. This is much better than last semester when I struggled to cram in all my clinical time on Fridays, Saturdays and Sundays. And it's a good thing we have our weekends free this semester, cause those papers are going to be a PITA. Luckily, The Man is back in town for the foreseeable future, so I don't have to stress about the dogs. Plus, it's really really nice to actually have him around. We will finally be able to spend a consecutive year together for the first time in 3 years! Clinicals don't actually start till 9/13, so I have next Friday clear as well. Wednesday is ACLS class (we did most of ACLS last semester, so it's really just a refresher).
My volunteer station has been something else. I've gotten maybe 3 or 4 calls over the summer, because while I didn't do much this summer, every day seemed to be busy. When I was at the station, I was The White Cloud. Not just A white cloud...THE WHITE CLOUD. The last few times I've slept in, we haven't turned a wheel. Once I slept in and the medics ran all night, but the BLS truck didn't turn a wheel. I'm helping with training, and found out this week that our training officer was in the hospital with chest pain, and in testing they found multiple masses on her liver. Obviously, this is putting a crimp in training. Next week is no training due to the business meeting, but I'm hoping she's ok and ready to go week after next, cause I don't have the time to take over.
Triathlon training is also going. The last 2 days have been a wash, thanks to some lingering knee pain and a migraine. No clear weight loss, but I suspect that has to do with my poor eating habits (mostly clean eating, but either too much or not enough). I can definitely tell a difference in my bike riding though. Endurance, both muscular and cardiac, is slowly getting better, which is the primary goal of this month's program.
I'd post more interesting stories and tales of the glorified cab, but nothing's been going on. Hopefully once clinicals start, I'll have some good stuff to write about. For now, it's about finishing laundry and heading to the station for a good heavy bag workout and some duty before dinner with friends this evening.
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