If you’ve run on an ambulance for more than a week, you probably have a nursing home story. I’m sure there are some great nursing homes out there but unfortunately I have not had the pleasure of visiting one. Instead, we usually encounter staff who are anything but nurses. They seem to know just enough to have a slight grasp on the terminology but don’t seem to have a clue about caring for the patient and often don’t even know a thing about the patient they are calling us for. My most recent call there was for a gentleman whose SpO2 was in the sixties. Once I finally got one of the staff to show me what room he was in (yes, the patient they called 911 for was alone is his room – their excuse: it was shift change) she explained that they were concerned because his O2 was so low, and here’s the kicker, “even though we have him on 3 liters of O2 with a cannula.” Are you kidding me? Ever heard of Hi-Flow O2? We immediately pulled of the cannula and put him on 15lpm via non-rebreather, then proceeded to transport him to the ED.
DCAPBTLS
It’s an EMS Thing.
If in Doubt, Immobilize!
I was doing a clinical in the ER when an ambulance brought in an elderly male patient who had fallen in the bathtub and was complaining of neck pain. I heard the radio report and a flag went up when I heard the medic say he had a cervical collar on the patient, but did not have the patient fully immobilized. I made a mental note to ask about that later, because I could think of no reason to apply the collar without the rest of the immobiliztion equipment. Indeed, I could find no one who could tell me when a collar would be appropriate without all the accompaniments.
A little while later the x-rays came back and revealed the patient had a C2 fracutre.   Not all jurisdictions allow providers to chose not to immobilize. If working in one that gives you the choice and the protocol, err on the side of caution and if in doubt, immobilize.
ITLS Weekend
ITLS (International Trauma Life Support) is included in the curriculum of the shock trauma class I’m taking in school this semester. It was held on a weekend over two full days rather than being incorporated into regular class meetings. I’d like to say it was a good class, and it probably was, but I was still recovering from the flu so the last place I wanted to be all day for two days in a row was the classroom. Between fighting to maintain the energy to stay awake and the churning in my belly, it was a long weekend. The good news is that a vast majority of course was material we had recently covered in our regular class. Sure, it was redundant but since I was physically less than 100% it was a help to have a preview of the topics. Despite the bug’s attempts to bring me down, I managed to get through the whole course and passed.
Provider, Student, and Instructor
I’ve been an EMT for awhile. For the last nearly two years I’ve been a paramedic student. If that wasn’t enough I recently completed the instructor course which will allow me (with my other credentials) to teach EMS courses. It was a grueling course and I really didn’t have time for it, but it only comes to my area about every 4 years so I toughed it out and made it through. Afterward I had the pleasure of doing my student teaching at the college I attend. I’m teaching students who have absolutely no EMS experience whatsoever. The first day, during my first moments at the podium I scanned the room and saw all these faces looking at me like I knew what I was talking about. For about ten minutes I was terrified. What if I get something wrong? What if I don’t know what to say about something? What if I forget everything I know?
Since I was in the front with all those eyes on me I couldn’t really sneak out the door or change my mind and take a seat. I just kept telling myself to press on and follow the lesson plan. I’m glad I did because as the time went by I became more and more comfortable and by the time the class was over I felt like I was at home in front of the class. It was so awesome to share knowledge and to answer the questions that I once asked. I continued to do my student teaching with the same class and even ended up doing more than what was required just for the extra practice (and because I liked it so much!)
ECG Rhythym Interpretation
This semester in cardiology we began with a review of the A&P of the heart (I’m good there) and then went into some cardiac issues and treatments (easy enough) and then we started on interpreting EKG strips (Houston, we have a problem!) I have an outstanding instructor who really knows this stuff inside and out – he’s taught and practiced it for years. In class I feel like I’m understanding, but when I get home alone with the homework it all swirls around in my head and random things fall out.
The rules of interpretation seemed clear, logical, and methodical which are all things I appreciate. I understand the basic elements, but then they tell me that in atrial flutter the P’s are P’s at all, now they are F’s. Then I’m looking for an underlying rhythm and find out that with blocks, you don’t do that. I started out wondering how those squiggly lines would ever mean anything to me. Now I can decipher at a novice level, but much mystery remains! More confusing is that oftentimes I can look at a rhythm and know what it is without following the rules of interpretation but have a hard time articulating why it is what it is. I feel like I’m right on the edge of “getting it” but still so far away. I’ll keep working with my flash cards, test rhythms, and reading until I’m confident with it. My instructor says to relax, it’ll all come together… I hope he’s right!