At least there's catchy music...

Having been reminded that the state protocol updates take effect tomorrow, I realized that I really should waste 30 minutes of my life and view the 'update rollout videos' before I'm taking off riding status. I suppose I should be grateful that they've put it up online so we don't have to go through classes face to face, wasting a whole day.

New in this year's update for BLS providers is the permission to give more than one tube of oral glucose to a diabetic patient who does not respond to the initial tube of glucose (prior, we had to call medical command to give a second tube of glucose), and the clarification that a medical director can allow BLS providers to use glucometers, rather than having the family do it, or wait for an ALS provider to get on scene (thankfully, the medical director for the region I'm in currently has faith that his BLS providers are intelligent enough to use a glucometer). Also new is the removal of the option of intubation for patients with an EMS DNR-A. The belief of The Powers That Be is that this will cause a swing in the number of DNR-B patients to DNR-A patients, as many patients only selected DNR-B because of the intubation issue. My personal belief is that it'll only make a difference to patients who aren't in nursing homes (most of whom do not have DNR's anyway), as those in nursing homes won't get the appropriate information to make the change. Not that it matters anyway...in my experience, ALS turfs all DNR patients to BLS, regardless of the level of DNR, and the hospitals generally disregard the EMS DNR's, and do everything short of intubation and CPR anyway.

Continuing the state's obsession with helicopters, this year's protocol update also included a review of the medevac protocol, with a couple of updates on just who is allowed to fly (though the little provision at the end of the 'trauma decision tree' that states 'paramedic discretion' is used as a catch-all). We were also treated to a safety discussion on creating landing zones and where it is dangerous around the helicopter.

But the most interesting change in the protocols is that BLS units now carry acetominophen, and can administer it to patients for pain control only. Which gives me a huge WTF, personally. While I would like to say "Who the hell doesn't have tylenol in their house?" experience has taught me better. What I will say, is that if tylenol is sufficient to control your pain before I get you to a hospital, did you really need 911? And if you have tylenol in your house, do you really need someone else to tell you to take it? And if your pain is sufficient that you called 911, you should require a paramedic with morphine.

And yes, I know all the arguments about 'they don't know it's not an emergency' and all that, so please, save me your speeches. I know common sense is not so common, but I am really starting to believe that there should be a class in high school on what constitutes an emergency.

*sigh* No wonder I feel as if I am constantly surrounded by the dregs of EMS. Don't get me wrong, there are spectacular people that I've worked with and that I've attempted to model myself after. But when we continue to dumb down our protocols so that we are covering every little tiny issue that may happen, we are removing the ability of the providers to exercise their brains, and making sure that all we really do have are ambulance drivers, not EMT's and paramedics.

At least the protocol rollout has catchy music...

PASS!!!

I am officially an NREMT-I!!!

Now I don't have to worry about it till next year with the NREMT-P test.

By the way, what the heck is with the security for the written test? ID, fingerprint, palm print, photo, signature. Can't take anything into the test area with you, not even chapstick. What the hell? How is my chapstick a security concern? I mean, really? I know that they administer tests for people other than NREMT, but is there really a need for all this? I thought they were going to ask for a DNA sample next!

Waiting....

In case anyone was wondering, I passed my practical NREMT-I test on Friday. I only had to retest IO, since I had a minor equipment issue (unknown if it was brought about by operator error or not. I chose not to challenge it, and just retest the station). So yes, I passed. Happy day.

The day before the test I didn't have time for terror, since my laptop gave up the ghost, and I spent much of the day running around on errands, and getting a new computer. Now all I need to do is get a sled so I can move all my files from the old hard drive to the new one. It isn't a huge deal, but it would be nice to have my wedding information instead of having to redo the budget, guest list, etc all over again. I also have to finish moving my music, since iTunes was being sullen and didn't get all my music from the external hard drive, leaving me to transfer everything myself. It's good, in a way, since it will allow me to go through and erase all the duplicates and so on. I am a bit miffed about the loss of all my playlists, though.

So, at 0800 this morning, I took my NREMT-I written test. I was done in just over an hour, and took another 20-30 minutes to review all my work and the flagged questions. There are still a few I am nervous about, and I left feeling that I either knew my shit or didn't know anything at all. I should get results sometime this afternoon.

Since I had to be in the glorious County of Monkeys this morning for my test, I decided to meet my old co-workers for lunch. I've come to realize over the past year and some that getting laid off was probably the best thing that could have happened (something I voiced then, but didn't quite believe). I enjoyed working for that company, mainly due to the people there, but felt trapped. It was a vicious cycle I went through on a fairly constant basis, becoming excited about a new project and working as hard as I could on it for several weeks, only to gradually become disenchanted with it when it dragged on too long. I would slack off, get depressed, and then something would happen, or I would think of something that would take me back to that excited, busy state again. It was like I was manic depressive, but only about my job. During my low periods, I would constantly talk about leaving and going back to school to become a paramedic, just as soon as I'd paid off more bills. Well, you know how that goes...For years I never left, aside from the trip to Antarctica, and one of the main reasons I didn't go back to the Ice was because I felt it would be pushing my luck to leave again less than a year since I'd been back.

Ironically, I was laid off a month short of my year anniversary of being back from the Ice.

So today, the day I took my test and took one more step towards fulfilling my dream (I'll consider it a full step when I find out if I've passed), I am once again meeting with my co-workers, my tie to my former life. It's a strange circle I feel I've come to, honestly. I readily admit that there is a part of me that still misses working there, but I think it's more for the loss of the camaraderie and those other intangibles other than the work itself (in fact, I'm sure of it). I miss the verbal sparring, the joking, and laughter we shared. I miss being surrounded by people mostly my own age, and, truth be told, I miss being 'the kid.'

Don't get me wrong...I'm enjoying where I'm at now, and I enjoy (mostly) my classmates. But being a full generation older than everyone but my instructors (one of my instructors is a year younger than I am) is wearing. At least at my old job, while I was younger than most, I had a good appreciation of things the people older than me enjoyed. My current classmates have very little appreciation of what came before, and I find it discouraging to make jokes and have only the instructor laugh. It's depressing to have to constantly explain things to the children in my class.

All the same, I am happy where I am now.

But I'll be happier when I know I've passed my test.

Terror

We went to the Joint Services Open House at Andrews AFB this weekend. I am now peeling like a snake. My face got extremely burnt, thanks to some expired sunscreen and a whole day on the flight line. My back got sunburned the day before, gardening in a tank top. See pictures here.

In other news, my NREMT-I practical exam is on Friday. I am terrified. The last time I took it, I failed the medical, trauma, and both cardiology stations. This time, I feel fairly confident in everything except dynamic cardiology. We haven't had much time in class to do actual practice in class; most of our dynamic practice has been more of a 'practice by committee' kind of thing. So today we finally got a chance to actually sit down with our instructor and do a dynamic station. I did it twice. And failed twice. And we don't have practice time tomorrow, because our instructors are setting up the test.

I am in terror. I don't know how I'll handle it if I fail. I feel confident about all the other stations, and feel confident that I will fail dynamic cardiology.

To make matters worse, The Fiance will not be in town this weekend, which means I have to get up at 0330 Friday morning in order to be at the test site at 0800 (it's 1.5 hours away, which means, at rush hour times, I need to budget at least 2 hours, if not 2.5 to get there).

I'm hoping to get to the firehouse tomorrow, in the dream that someone there can run me through some dynamic cardio scenarios.

On the plus side, in happier news, The Fiance got word today that once his exile in NJ is complete, he will be placed on a project here at home, that will last for at least a year and a half. Which means he will be in town for the wedding. And my senior year of this program (assuming, of course, I pass my NR test, and make it to senior year).

Right-sided MI's

So, I was responding to a post by RevMedic over at EMS Haiku (go there to see the actual strip) who was talking about a right-sided MI he might have caught through careful assessment and so on. I was talking about a tip that I got from a doc during a clinical on the medic unit, and realized Hey! This is one of those things I could put in my blog!

So here it is. Thinking logically, the lead V1 in a 12-lead EKG is the exact reciprocal of the lead placed on the back in a 15 of 18 lead (I don't know which one, since we haven't studied them, only talked about them briefly). Therefore, if you see a depression in V1, you should expect that there is reciprocal elevation in that lead on the back. Thinking further, the lead on the back is pretty much directly over the right ventricle, and therefore it makes sense to see elevation there.

So yeah. While it is not diagnostic by any means, seeing ST depression in V1 lead, when you don't see reciprocal elevation in any of the reciprocal leads, should lead you to suspect a right-sided MI, and move your leads over to double check.

A small light

I'm beginning to get excited. Only 2 more clinical shifts left for this semester. It's been fun, but I'm heartily tired of waking up at 0500 or earlier every damned morning, including weekends.

This weekends clinicals were relatively boring. A pseudo-busy shift at the hospital (you know the ones, where you are running around all day, but at the end of the day you look at your paperwork and say 'Wow, I hardly did anything today!') and 2 days at the same medic unit (a total of 24 hours) with only 3 calls. Luckily, I don't have to worry quite so much about patient contacts this semester, but it would be nice to get at least a little ahead of the game.

On the plus side, I cranked out the last 4 trauma homework assignments, finished my take-home test, and did almost all of my clinical paperwork yesterday and today. The only school work left is 2 papers, various tests (of course), a presentation, and the NREMT-I test. There are some other issues that I have to work out, which is it's own ranty post, so stay-tuned.

Paper due Thursday, paper due Monday, then a bit of a breather till May 12th. There is a small light at the end of the tunnel, for this semester at least.

I think my IQ just dropped a few points...

Look, I am all for making mistakes. It's how we learn best. I am all for asking questions so you DON'T make mistakes. But seriously people...use your brain. It's that organ located in the lump 3 feet above your ass. If you occasionally engage that organ, you can save yourself from a lot of mistakes, and make yourself look less like a fool, and more like someone I'd want treating my family.

For my hospital time clinical, I go to a large, well-known university hospital. They also have a peds ER upstairs from the adult ER, but the critical care rooms (trauma rooms) are down in the adult ER. So whenever there is a consult for the peds ER, the adult ER listens in, just in case they end up coming to the adult ER.

As an aside, any paramedic student doing time in a hospital should listen in when a medic unit does a consult. Not only does it let you know if there are any traumas or serious medical cases coming in that you could look in on, but it also shows you the difference between a good consult and a bad one.

Any way, yesterday I heard the box go off, and listened in with the charge nurse. It was a consult for peds, but we listened in. The information was as follows:
12 year old male picked up from school with chest pains and trouble breathing. Unknown medical history per patient and school nurse. All vitals unremarkable (BP something like 120/80, P 80 something, R 18, O2 sat 100% ra). EKG shows NSR, IV with lock.

All sounds ok right? Then the medic consulting dropped the bomb. "Given that the patient is past the age of puberty, we would like to know if we should give NTG and ASA."

WTF?????? Are you serious? With vitals like that, and a kid who's 12, you want to give NTG and ASA? First of all, per MD protocols, a child is considered pediatric until age 15. Secondly, per MD protocols, NTG is no indicated in children. Thirdly, haven't you ever heard of Reye's Syndrome? You know, what possibly happens in children who are given aspirin? (Granted, I don't know the time frame and dosages required to give a child Reye's Syndrome, but still).

But the biggest problem here is this. Regardless of the age and so on, look at the vital signs. There is ZERO sign of any kind of heart problem, and, absent any concrete history, I'd be hesitant to give ANYTHING.

So yeah, I think my IQ dropped a few points listening to that consult.

At any rate, the rest of the clinical on Friday went well. The clinical Sunday went well too. Not as many skill check-offs as I would like, but several good medical patients that were serious head-scratchers and a good experience to sit in on.