Paramedic?

[emttim]

So basically last night I ran a call that really shined a light on how friggin' useless EMTs are for the most part as far as any medically-related call goes...not much we can do outside give oxygen. I'm thinking of doing paramedic school as a result if I don't get into med school the first time around, just because by that time I'll have been an EMT for 3-4 years and I don't think I can take having such a limited scope of practice for much longer than that. What do you guys think? The time, stress, commitment, etc. of medic school worthit if you don't get in the first time to med school, when you potentially could the second time around, and obviously one year difference would barely be enough time to even finish the program and get your P-card?

Oh, if anyone's curious about the call, here's the details:

82 y/o male going from SNF to ER with a C/C of poor intake/lethargy per RN...lethargy, decreased appetite, SOB and trouble swallowing x2 days, SOB resolved, rest of symptoms remaining. Pt w/delayed cap refill, skin signs are pink, cool and dry, 105/50, HR 74, RR 16, = LS bilat, IV line setup on L hand, pupils PERRL, airway open, breathing labored, circulation regular. Pt c/o pain in all four abdominal quadrants, due to lethargy, unable to ascertain quality or severity of pain...pt believed to also c/o chest pain, although I couldn't get a straight answer out of him. Pt was placed on 2 lpm O2 via NC simply because of the labored breathing (I know RR and LS were fine but had a bad feeling about this call)...enroute pt repeatedly tried to close his eyes and go to sleep, second set of vitals right outside hospital were 110/50, HR 76, RR 22...bumped O2 up to 4 lpm as we were going in the door. Right before we transferred care, pt also c/o his "head feels hot", although his skin temp was very cool to the touch.

Medical history: Peritoneal mass, UTI, HTN, GERD
Meds: Protonix, Verapamil, Prednisone, Tylenol, Vicodin
Allergies: NKDA

Asked a few EMTs with a lot more experience, sounds like it might have been hypokalemia, which would explain the symptoms, and prednisone is known to predipose the user to hypokalemia. If I was a medic, I could of at least started a line and given some fluids, since the pt was obviously dehydrated, if nothing else since as it stands, all I could do was give oxygen, and it annoyed me to no end.

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[viostorm]

It does not sound like being a paramedic would have helped this patient. Sounds like lymphoma or some sort of metastatic cancer.

What are you grades and MCAT and perhaps we can advise you on if you should wait or not.

Basically, if you are a competitive applicant you should wait to get into med school. Others will disagree, but being a paramedic may sidetrack you and in my experience is of little to no value as a med student. If, on the other hand, it is unlikely you will be a successful medical school applicant and want to pursue other parts of medicine then go get your paramedic. Its a good profession and often a starting point for many people becoming RN's, a few people going to PA, and a few of us going to MD.

 

[emttim]

It does not sound like being a paramedic would have helped this patient. Sounds like lymphoma or some sort of metastatic cancer.

What are you grades and MCAT and perhaps we can advise you on if you should wait or not.

Basically, if you are a competitive applicant you should wait to get into med school. Others will disagree, but being a paramedic may sidetrack you and in my experience is of little to no value as a med student. If, on the other hand, it is unlikely you will be a successful medical school applicant and want to pursue other parts of medicine then go get your paramedic. Its a good profession and often a starting point for many people becoming RN's, a few people going to PA, and a few of us going to MD.

Well, I haven't taken the MCAT yet, in my 3rd year of college so I'm transferring to UCSB next year, but right now I have a 3.94 cumulative GPA and 4.0 science GPA. I interview pretty well, no idea how good the LORs I get will be. It's not so much that I think I'm not going to be a competitive applicant, but I realize how random and ridiculous this process can be, and plenty of competitive applicants get turned down. Hence, I'm pondering whether paramedic school after I get my bachelor might be a good idea to pass the time since I like emergency medicine.

I'll have to look up lymphoma and metastatic cancer...just kinda curious what happened with that patient.

 

[viostorm]

That is awesome about your GPA. If you can keep it up for another 1.5 years do it! I wouldn't do anything that would throw you off the track of keeping such an awesome GPA (ie going to paramedic school). Get a killer MCAT and keep a great GPA. Go over to the non-trad site and see how people are struggling with GPA's in the 2.x's if you need motivation on staying focused. With a 3.94 and a 30 on MCAT you will definitely get in somewhere.

I agree that after you have all your stats put together then consider doing the EMT-P. They have great accelerated programs out there, some as fast as 6 months (Tidewater Virginia Community College).

 

[greytmedic]

So basically last night I ran a call that really shined a light on how friggin' useless EMTs are for the most part as far as any medically-related call goes...not much we can do outside give oxygen. I'm thinking of doing paramedic school as a result if I don't get into med school the first time around, just because by that time I'll have been an EMT for 3-4 years and I don't think I can take having such a limited scope of practice for much longer than that. What do you guys think? The time, stress, commitment, etc. of medic school worthit if you don't get in the first time to med school, when you potentially could the second time around, and obviously one year difference would barely be enough time to even finish the program and get your P-card?

Oh, if anyone's curious about the call, here's the details:

82 y/o male going from SNF to ER with a C/C of poor intake/lethargy per RN...lethargy, decreased appetite, SOB and trouble swallowing x2 days, SOB resolved, rest of symptoms remaining. Pt w/delayed cap refill, skin signs are pink, cool and dry, 105/50, HR 74, RR 16, = LS bilat, IV line setup on L hand, pupils PERRL, airway open, breathing labored, circulation regular. Pt c/o pain in all four abdominal quadrants, due to lethargy, unable to ascertain quality or severity of pain...pt believed to also c/o chest pain, although I couldn't get a straight answer out of him. Pt was placed on 2 lpm O2 via NC simply because of the labored breathing (I know RR and LS were fine but had a bad feeling about this call)...enroute pt repeatedly tried to close his eyes and go to sleep, second set of vitals right outside hospital were 110/50, HR 76, RR 22...bumped O2 up to 4 lpm as we were going in the door. Right before we transferred care, pt also c/o his "head feels hot", although his skin temp was very cool to the touch.

Medical history: Peritoneal mass, UTI, HTN, GERD
Meds: Protonix, Verapamil, Prednisone, Tylenol, Vicodin
Allergies: NKDA

Asked a few EMTs with a lot more experience, sounds like it might have been hypokalemia, which would explain the symptoms, and prednisone is known to predipose the user to hypokalemia. If I was a medic, I could of at least started a line and given some fluids, since the pt was obviously dehydrated, if nothing else since as it stands, all I could do was give oxygen, and it annoyed me to no end.

I just have some questions about your call. First, this is a BLS service, correct? The one thing that really sticks out is the amount of oxygen you placed to pt on. If you "had a bad feeling about this call" why did you only put the pt on 2l/m by NC? Even if the RR and lung sounds are equal, if the pt has apparent labored breathing and lethargy why not go with 15l/m NRB? Are you able to get a pulse ox? Also, do you guys carry glucometers? I know some BLS scopes allow this, some don't. Prednisone also can cause hyperglycemia. Also, do you know if hand grasps were equal, any slurring speech, pronator drift? Was the pt not able to give you a straight answer on pain because he was confused or he just went back to sleep before he finished his answer? I know you said that lung sounds were equal, but were there any adventitious sounds? Who knows what the SNF was trying to get him to eat/drink when he had trouble swallowing

Anywho, as far as getting your paramedic between application years, it is probably not worth it. First off, that is an excellent gpa. Just put time and effort into studying for the MCAT. If you keep up your gpa, can relate your clinical experience as an EMT, and even get a middle of road MCAT you should get accepted somewhere. My suggestion is to stay away from the pre-allo forum at all costs. It will only increase your anxiety with no real benefit. Once you get into medical school you will look around at some of your fellow students and wonder what the heck you worried so much about.

 

[emttim]

I just have some questions about your call. First, this is a BLS service, correct? The one thing that really sticks out is the amount of oxygen you placed to pt on. If you "had a bad feeling about this call" why did you only put the pt on 2l/m by NC? Even if the RR and lung sounds are equal, if the pt has apparent labored breathing and lethargy why not go with 15l/m NRB? Are you able to get a pulse ox? Also, do you guys carry glucometers? I know some BLS scopes allow this, some don't. Prednisone also can cause hyperglycemia. Also, do you know if hand grasps were equal, any slurring speech, pronator drift? Was the pt not able to give you a straight answer on pain because he was confused or he just went back to sleep before he finished his answer? I know you said that lung sounds were equal, but were there any adventitious sounds? Who knows what the SNF was trying to get him to eat/drink when he had trouble swallowing

Anywho, as far as getting your paramedic between application years, it is probably not worth it. First off, that is an excellent gpa. Just put time and effort into studying for the MCAT. If you keep up your gpa, can relate your clinical experience as an EMT, and even get a middle of road MCAT you should get accepted somewhere. My suggestion is to stay away from the pre-allo forum at all costs. It will only increase your anxiety with no real benefit. Once you get into medical school you will look around at some of your fellow students and wonder what the heck you worried so much about.

Well, thanks for the kind word guys, although I try to stay away from the pre-allo forum anyway just because there's so many ignorant statements made there that it makes my blood pressure spike.

We only placed the pt on 2 lpm O2 because the nurse stated the pt's O2 sats were up to 99% that day, so the only thing that could have possibly indicated the need for oxygen was somewhat labored breathing (it wasn't real obvious labored, just somewhat labored), so that's why we didn't do the NRB. Although in retrospect, I think that was a mistake. Next time I do plan to use a NRB in a situation like this.

We aren't allowed to use glucometers in California. No slurred speech, hand grasps were roughly equal but very weak. Pt was unable to give me answer on pain because he just wanted to go back to sleep; I asked him to open his eyes and try to stay awake at least ten times during transport. I'll flat out admit that I'm not experienced enough as an EMT to recognize any adventitious lung sounds...they sounded clear to auscultation bilaterally to me. I do agree that the SNFs often exacerbate the problem by giving the pt something they shouldn't, but in this case, I'm not sure whether they gave him anything or not.

 

[DonkeyD]

That earlier call doesn't make me want to be a paramedic, it makes me want to be a doctor. What could a paramedic have given that you couldn't?

Tonight's call was different. I work transport so I'm not a real deal emergency type dude, but I'm taking a lady to a hospital with ob/gyn with severe bleeding from her vagina. I'm reading the ems run report from earlier today and at pt contact her vitals screamed hypovolemic shock. bp in the 60's, hr in the 120's, pt is usually hypertensive. That's the type stuff where being a basic would get to me...knowing this lady needed a bunch of saline and not being able to give it.

 

[Dienekes]

If he was hypokalemic, giving fluids would not have helped. In fact, it could make things worse. This is especially true seeing as many medics are very overzealous in their administration of fluid. The field is no place to be dicking around with someone's electrolytes (particularly trying to elevate someone's potassium), although whether that was the issue here is open to speculation. You did fine at the level of care you could deliver. Honestly, as others said, this was beyond the scope of care of any prehospital provider. Remember, our job is not to fix the chronic problems but to stabilize and hand the patient off in as viable a state as possible.

 

[Dienekes]

That's the type stuff where being a basic would get to me...knowing this lady needed a bunch of saline and not being able to give it.

I suggest you find Ken Mattox and ask him about fluid resuscitation in the face of ungoing hemorrhage. The last thing you need to do is aggressively fluid resuscitate a patient who has uncontrollable (in the field) bleeding. To be quite honest, to raise her BP much above 60-80 systolic probably would have hurt her more than it helped.

 

[FoughtFyr]

I suggest you find Ken Mattox and ask him about fluid resuscitation in the face of ungoing hemorrhage. The last thing you need to do is aggressively fluid resuscitate a patient who has uncontrollable (in the field) bleeding. To be quite honest, to raise her BP much above 60-80 systolic probably would have hurt her more than it helped.

Actually, I have met, had dinner with, and discussed his theories with Ken. Two points come to mind. First, they are theories, outside of Parkland a SBP of > 90 is the goal. Second, an OB bleed as described is a different case altogether. The ACOG would recommend high volume fluid resuscitation. There aren't clots to displace and DIC is likely.

Keep in mind that Ken approaches things from the trauma surgery perspective. He is fantastic at what he does, but there is a reason that EMS is the purview of the emergency physician, not the trauma surgeon.

- H

 

[Dienekes]

There aren't clots to displace

Would the increase in BP not increase the rate of bleeding from the uterus? That would seem to be logical.

 

[canjosh]

Permissive hypotension has been studied in a small scope (trauma). Fluid resuscitation with NS or LR is still the widely accepted standard of care in the field, ED, and the OR. Additionally, hypokalemic patients are often intravasculary dry, and have other electrolyte issues. Fluid resuscitation, followed by correction of K+ once it is known is an acceptable proposition.

 

[viostorm]

Passive hypotension has been studied in a small scope (trauma). Fluid resuscitation with NS or LR is still the widely accepted standard of care in the field, ED, and the OR. Additionally, hypokalemic patients are often intravasculary dry, and have other electrolyte issues. Fluid resuscitation, followed by correction of K+ once it is known is an acceptable proposition.

I have to agree with Canjosh.

Regardless of what 1 particular individual opinions are regarding fluid resucitation, the standard of care is that SBP < 90-100 should receive 20cc/kg fluid bolus.

Your patient probably had placental abruption.

Remember, there is VERY LITTLE in EMS that has been shown to change patient outcome (from a evidence based perspective) beyond early defibrillation which as you know is an EMT skill. So my advice is don't stress too much.

 

[leviathan]

We only placed the pt on 2 lpm O2 because the nurse stated the pt's O2 sats were up to 99% that day, so the only thing that could have possibly indicated the need for oxygen was somewhat labored breathing (it wasn't real obvious labored, just somewhat labored), so that's why we didn't do the NRB. Although in retrospect, I think that was a mistake. Next time I do plan to use a NRB in a situation like this.

If he isn't a COPD pt. it never hurts to give high flow O2 in the face of an altered LOC and dyspnea. Even if the SpO2 reads 100% it may be inaccurate, and it says little about the possibility of respiratory failure, developing hypercapnia and respiratory acidosis (which may also be contributing to altered LOC). Mind you, increasing FiO2 will do nothing to alleviate CO2 levels anyhow, but depending on how he looked you might consider bagging him. From what I gather, it sounds like you said he wasn't in that much distress anyhow?

 

[leviathan]

Passive hypotension has been studied in a small scope (trauma). Fluid resuscitation with NS or LR is still the widely accepted standard of care in the field, ED, and the OR. Additionally, hypokalemic patients are often intravasculary dry, and have other electrolyte issues. Fluid resuscitation, followed by correction of K+ once it is known is an acceptable proposition.

IV fluids in general have been shown to have little effect (or even a detrimental effect) in pre-hospital care, yes/no?

Not only are you possibly displacing clots, but you are diluting the plasma and its clotting factors + platelets by giving IVF. Protocol here is to bolus and titrate up to a SBP of 90.

 

[FoughtFyr]

Would the increase in BP not increase the rate of bleeding from the uterus? That would seem to be logical.

It is a balance between the bleeding and maintaining perfusion to the brain, heart, kidneys, you know, important stuff. Permissive hypotension is NOT approved for obstetrical bleeding. Nor is it in the widespread use that Ken would like it to be.

- H

 

[Dienekes]

If he isn't a COPD pt.

Even if he is, if they are altered, there is NO reason to withhold highflow O2. Hypoxic drive is NOT a factor in most COPD patients. This is one thing I can speak authoritatively about as COPD is my area of expertise in my current profession.

 

[Dienekes]

Our protocol was to titrate to an SBP of not more than 80 mm Hg (assuming other symptoms) via IVF. I was under the impression (courtesy of the chief surgeon at a hospital several years ago who bitched me and my partner out for fluid resuscitating a patient similar to what was described), that permissive hypotension was considered the approach to be used in these patients. Thank you for correcting my misconceptions.

 

[leviathan]

Even if he is, if they are altered, there is NO reason to withhold highflow O2. Hypoxic drive is NOT a factor in most COPD patients. This is one thing I can speak authoritatively about as COPD is my area of expertise in my current profession.

Hmm, I'll have to double check on our protocols. We definitely will give high-flow O2 to people with COPD if their sats are low, but once they are above 95% (or whatever their baseline is) we will hold back the FiO2 to maintain it at that level.

 

[emttim]

Even if he is, if they are altered, there is NO reason to withhold highflow O2. Hypoxic drive is NOT a factor in most COPD patients. This is one thing I can speak authoritatively about as COPD is my area of expertise in my current profession.

I'm not sure if you guys are still talking about my patient or not, but he wasn't ALOC, he was lethargic...big diff.

 

[greytmedic]

I'm not sure if you guys are still talking about my patient or not, but he wasn't ALOC, he was lethargic...big diff.

Lethargic is not his normal level of consciousness, so he is altered from his normal LOC. If he kept going back to sleep and you had to wake him up, wouldn't you agree he is responsive to verbal stimulus? It is not much of a difference but his GCS would go from a "opens eyes spontaneously" to a "open eyes to verbal stimuli" (4 to a 3 for eye opening).

 

[emttim]

Lethargic is not his normal level of consciousness, so he is altered from his normal LOC. If he kept going back to sleep and you had to wake him up, wouldn't you agree he is responsive to verbal stimulus? It is not much of a difference but his GCS would go from a "opens eyes spontaneously" to a "open eyes to verbal stimuli" (4 to a 3 for eye opening).

Right, he was responsive to verbal stimulus, not alert, however the nurse stated that he's normally lethargic anyway...he was just more lethargic lately. So his normal mental status /is/ ALOC, so for him, being lethargic technically isn't altered since that's his baseline.

Take a dementia patient for example...if they're A&Ox1, but that's how they normally are, not really altered.

In either case, I agree that the pt probably could have used more oxygen, say 10 or 12 lpm, so next time, pt like that is getting a NRB.

I actually put his GCS down for 13 instead of 14 too, because his eyes dropped one for opening eyes to verbal stimulus only, and I marked him off one on motor response as well since he localized pain but did not obey commands.

 

[leviathan]

Right, he was responsive to verbal stimulus, not alert, however the nurse stated that he's normally lethargic anyway...he was just more lethargic lately. So his normal mental status /is/ ALOC, so for him, being lethargic technically isn't altered since that's his baseline.

Take a dementia patient for example...if they're A&Ox1, but that's how they normally are, not really altered.

In either case, I agree that the pt probably could have used more oxygen, say 10 or 12 lpm, so next time, pt like that is getting a NRB.

I actually put his GCS down for 13 instead of 14 too, because his eyes dropped one for opening eyes to verbal stimulus only, and I marked him off one on motor response as well since he localized pain but did not obey commands.

Was he oriented while lethargic? If not, drop him off another point for verbal response...

 

[Dienekes]

Altered mental status- any neurological state which represents a departure from the known normal for the patient....

Just to clarify what the definition of altered mental status, I though this might be a good thing to post.

 

[youngtraumadoc]

So basically last night I ran a call that really shined a light on how friggin' useless EMTs are for the most part as far as any medically-related call goes...not much we can do outside give oxygen. I'm thinking of doing paramedic school as a result if I don't get into med school the first time around, just because by that time I'll have been an EMT for 3-4 years and I don't think I can take having such a limited scope of practice for much longer than that. What do you guys think? The time, stress, commitment, etc. of medic school worthit if you don't get in the first time to med school, when you potentially could the second time around, and obviously one year difference would barely be enough time to even finish the program and get your P-card?

Oh, if anyone's curious about the call, here's the details:

82 y/o male going from SNF to ER with a C/C of poor intake/lethargy per RN...lethargy, decreased appetite, SOB and trouble swallowing x2 days, SOB resolved, rest of symptoms remaining. Pt w/delayed cap refill, skin signs are pink, cool and dry, 105/50, HR 74, RR 16, = LS bilat, IV line setup on L hand, pupils PERRL, airway open, breathing labored, circulation regular. Pt c/o pain in all four abdominal quadrants, due to lethargy, unable to ascertain quality or severity of pain...pt believed to also c/o chest pain, although I couldn't get a straight answer out of him. Pt was placed on 2 lpm O2 via NC simply because of the labored breathing (I know RR and LS were fine but had a bad feeling about this call)...enroute pt repeatedly tried to close his eyes and go to sleep, second set of vitals right outside hospital were 110/50, HR 76, RR 22...bumped O2 up to 4 lpm as we were going in the door. Right before we transferred care, pt also c/o his "head feels hot", although his skin temp was very cool to the touch.

Medical history: Peritoneal mass, UTI, HTN, GERD
Meds: Protonix, Verapamil, Prednisone, Tylenol, Vicodin
Allergies: NKDA

Asked a few EMTs with a lot more experience, sounds like it might have been hypokalemia, which would explain the symptoms, and prednisone is known to predipose the user to hypokalemia. If I was a medic, I could of at least started a line and given some fluids, since the pt was obviously dehydrated, if nothing else since as it stands, all I could do was give oxygen, and it annoyed me to no end.

Being an EMT B for 5 years, going to medical school in Fall 2008 and currently in EMT I class - the prehospital care needed by most patients is usually very basic. There are the occasional ones such as WITNESSED codes, FBAO, allergic rxns, OD, OB, seizures,... and the like that an ALS provider can intervene at the scene and provide care that truly would impact the patients life. Your sicker patients, such as yours, generally require rapid transport. A good example is a patient displaying signs of a heart attack - RAPID TRANSPORT and a CATH LAB is what will save the patient (although a little nitro, aspirin and an IV is nice). The mantra in EMS remains that prehospital care providers begin the caring/treatment phase (recognizing life threatening problems) but the hospital is where definitive care is obtained.

 

[DOCTOR MIA]

HI I AM A STUDENT IN COLLEGE STUDYING TO BECOME A PARAMEDIC AND THEN MOVE ON TO BECOME AN RN PREVIOUS TO THIS SITE I HAD NO IDEA THAT STUDENTS HAD TOOKEN THAT SAME ROUTE IM TAKING BEFORE. I NOTICED THE CLOSER I GET TO COMPLETING MY DEGREE IN EMS I GET INTIMIDATED, IS THIS FEELING NORMAL? I GUESS I"M AFFRAID OF NOT BEING ABLE TO HELP SOME ONE WHEN IN TIME OF NEED I MEAN JUST LIKE THE PREVIOUS PERSON SAID HOW MUCH CAN YOU DO INSIDE THE AMBULANCE TO SAVE A PERSON'S LIFE?

 

[MedicFL]

HI I AM A STUDENT IN COLLEGE STUDYING TO BECOME A PARAMEDIC AND THEN MOVE ON TO BECOME AN RN PREVIOUS TO THIS SITE I HAD NO IDEA THAT STUDENTS HAD TOOKEN THAT SAME ROUTE IM TAKING BEFORE. I NOTICED THE CLOSER I GET TO COMPLETING MY DEGREE IN EMS I GET INTIMIDATED, IS THIS FEELING NORMAL? I GUESS I"M AFFRAID OF NOT BEING ABLE TO HELP SOME ONE WHEN IN TIME OF NEED I MEAN JUST LIKE THE PREVIOUS PERSON SAID HOW MUCH CAN YOU DO INSIDE THE AMBULANCE TO SAVE A PERSON'S LIFE?

So what you are going to paramedic school then RN school then Medical school? Why all the different jobs if you want to be a doctor? Finish your medic go to school forget nursing, and go to medical school...

 

[nsx]

hi i am a student in college studying to become a paramedic and then move on to become an rn previous to this site i had no idea that students had tooken that same route im taking before. I noticed the closer i get to completing my degree in ems i get intimidated, is this feeling normal? I guess i"m affraid of not being able to help some one when in time of need i mean just like the previous person said how much can you do inside the ambulance to save a person's life?

nice avatar!! Dem forums look good.

 

[fiznat]

Ah, zebra hunting aside, didn't anyone else read about this patient and think "BS" or "who cares?" The guy is 82 years old, stable, and has really lame/nebulous symptomology ("difficulty swallowing," "decreased appetite," etc). Likely it is another UTI (he has a history), dementia, or some other non-acute problem. Maybe he as a pneumonia working up, but honestly none of it is unstable, and most of it is boring. Hum dum IV Monitor O2 until you can get to the hospital and maybe do a few labs/studies before he gets discharged back to the SNF.

Am I really alone on this, or am I just that burnt out already?

 

[229685]

HI I AM A STUDENT IN COLLEGE STUDYING TO BECOME A PARAMEDIC AND THEN MOVE ON TO BECOME AN RN PREVIOUS TO THIS SITE I HAD NO IDEA THAT STUDENTS HAD TOOKEN THAT SAME ROUTE IM TAKING BEFORE. I NOTICED THE CLOSER I GET TO COMPLETING MY DEGREE IN EMS I GET INTIMIDATED, IS THIS FEELING NORMAL? I GUESS I"M AFFRAID OF NOT BEING ABLE TO HELP SOME ONE WHEN IN TIME OF NEED I MEAN JUST LIKE THE PREVIOUS PERSON SAID HOW MUCH CAN YOU DO INSIDE THE AMBULANCE TO SAVE A PERSON'S LIFE?

Hey, I am in the middle of my internship phase of paramedic school and I had some similar fears that you did. During my internship these concerns have mostly disappeared, even though I had some pretty critical calls my first night. Are you in a year long program? Do you work as an EMT-B? If so, do you mostly run transfer calls?

 

[189362]

Well, thanks for the kind word guys, although I try to stay away from the pre-allo forum anyway just because there's so many ignorant statements made there that it makes my blood pressure spike.

We only placed the pt on 2 lpm O2 because the nurse stated the pt's O2 sats were up to 99% that day, so the only thing that could have possibly indicated the need for oxygen was somewhat labored breathing (it wasn't real obvious labored, just somewhat labored), so that's why we didn't do the NRB. Although in retrospect, I think that was a mistake. Next time I do plan to use a NRB in a situation like this.

We aren't allowed to use glucometers in California. No slurred speech, hand grasps were roughly equal but very weak. Pt was unable to give me answer on pain because he just wanted to go back to sleep; I asked him to open his eyes and try to stay awake at least ten times during transport. I'll flat out admit that I'm not experienced enough as an EMT to recognize any adventitious lung sounds...they sounded clear to auscultation bilaterally to me. I do agree that the SNFs often exacerbate the problem by giving the pt something they shouldn't, but in this case, I'm not sure whether they gave him anything or not.

Non Rebreather all the way - unless the pt could not stand it. Protocol in my state says NRB always unless pt cannot stand the NRB then nasal cannula 4l/m Especially with Pts Resp rate at 22 No significantly above the norm but factor in the Past medical history - easy 10-15l/m NRB.

O2 transport is what we do.

The other day I resusitated an 55yr old male from complete cardiac arrest sans AED First time I actually performed CPR on a call- damn it fell good to bring in the pt with a pulse, we were still assisting ventialtions but his ticker was ticking and I felt good about it.

EMTB has its day if you are looking for the same excitement in emergency medicine as a Medic look elsewhere. Unless your are chief resident at Bellvue your trauma calls arent every call. A lot of the times you get some serious BS chief complaints. So many ER docs have told me even as an EMT in a high call volume cty ( I volunteer in, Newark NJ) I probably see just as much trauma as they do. Obv their interventions are a bit more extensive. Take your MCAT then decide on what you are to do.

 

[189362]

Ah, zebra hunting aside, didn't anyone else read about this patient and think "BS" or "who cares?" The guy is 82 years old, stable, and has really lame/nebulous symptomology ("difficulty swallowing," "decreased appetite," etc). Likely it is another UTI (he has a history), dementia, or some other non-acute problem. Maybe he as a pneumonia working up, but honestly none of it is unstable, and most of it is boring. Hum dum IV Monitor O2 until you can get to the hospital and maybe do a few labs/studies before he gets discharged back to the SNF.

Am I really alone on this, or am I just that burnt out already?

OBV. dehydration is apparent. Other factors would work into it to determine the severity, but none the less he is a medical patient who would do well to have a blood work up - esp. at his age.

 

[229685]

It does not sound like being a paramedic would have helped this patient. Sounds like lymphoma or some sort of metastatic cancer.

What are you grades and MCAT and perhaps we can advise you on if you should wait or not.

Basically, if you are a competitive applicant you should wait to get into med school. Others will disagree, but being a paramedic may sidetrack you and in my experience is of little to no value as a med student. If, on the other hand, it is unlikely you will be a successful medical school applicant and want to pursue other parts of medicine then go get your paramedic. Its a good profession and often a starting point for many people becoming RN's, a few people going to PA, and a few of us going to MD.

I agree with you about P-school somewhat but there are some definite benefits. Having almost finished P-school and canceling my MCAT test date to get through it I regret doing P school from a GPA and stress standpoint. I found the classroom section much harder than any college class I have ever taken and soon realized that I had a lot of weaknesses that could be a problem as a doctor. However, I have learned to think and remain calm under pressure and am glad to have had the opportunity to learn about such a broad variety of topics. Moreover, the clinicals really have given me a better understanding of what it is that doctors do--especially doing ETT tubes in the OR. I have a lot of respect for surgeons and anaesthesiologists--especially the risk for malpractice.

The experiences I have had definitely solidified my decision to go into medicince and will fuel me to work as hard as I can to get a high MCAT score. I also have improved immensely with my ability to assess, perform differential diagnoses and work effectively under pressure. I'm pretty sure that these skills are good to have going into medical school and to discuss in front of an admissions board.

Finally, I was hoping to at least get a letter of recommendation from one of my preceptors or set up a follow-up where I could shadow one of the doctors who oversees the paramedic program, but so far I really don't see any letters from these experiences as helping me get into medical school or "explaining" my experience to an admission board. I spoke with one doctor from the program earlier about just writing a letter to explain the paramedic scope and how it might convey a better understanding of medicine and he asked if I would later schedule some clinicals with him. Well now I have clinicals scheduled with him and let him know that I was going to apply for 2010 instead of 2009. He sort of changed his mind about mentoring me and basically explained that he won't write a letter for someone unless he works side-by-side with them for a long time (he recommended working for a hospital that has their own paramedics to accomplish this). So now I am frustrated in that I still need personal letters and will probably ask the other doctor, my paramedic field preceptor and possibly one of the anaesthesiologists I met (if I shadow them) for a personal letter. If worse comes to worse, I can always ask my medical director for my agency after I gain a good reputation.

Overall, this experience should help set me apart from other applicants, but my GPA definitely suffered from the strange curve on the exams (96 and higher is an A, 85 to 95 is a B and less than 80 is an F) and I missed taking the MCAT when I wanted. However, I met my goals in advancing my side career to help pay for bills and loans until I get into medical school (and get things figured out with getting married in the next couple years).

Do you have any advice on gaining a good reputation with doctors or in securing personal letters of recommendation?

 

[deleted92121]

I'm a paramedic in a busy 911 service. I am also an undergrad working on getting all my classes together for medical school and the MCAT. I love working as a medic because it is medicine in a very basic form. We cannot diagnose, but we know what is going on 65%-85% of the time. It really is fun to start IVs, intubate, decompress a chest, etc. Also medical schools won't penalize you for being a medic, but alot of MD schools won't put any real emphasis on it. However, DO schools like it enough to give you a few extra points. And before anyone argues this, I have already spoken to a few schools about it and they love it.

Spending a few years as a medic is worth it. And remember, if in doubt, it is a UTI.

Be safe!

dxu

 

[MedicFL]

I'm a paramedic in a busy 911 service. I am also an undergrad working on getting all my classes together for medical school and the MCAT. I love working as a medic because it is medicine in a very basic form. We cannot diagnose, but we know what is going on 65%-85% of the time. It really is fun to start IVs, intubate, decompress a chest, etc. Also medical schools won't penalize you for being a medic, but alot of MD schools won't put any real emphasis on it. However, DO schools like it enough to give you a few extra points. And before anyone argues this, I have already spoken to a few schools about it and they love it.

Spending a few years as a medic is worth it. And remember, if in doubt, it is a UTI.

Be safe!

dxu

You forgot to mention with it being a UTI means the nursing home needs to send out the patient at 3am to the ED

 

[deleted92121]

You forgot to mention with it being a UTI means the nursing home needs to send out the patient at 3am to the ED

thanks for throwing that it there...how could I forgot that. Maybe I am a little altered today. Better call 911 for my UTI.

 

[howelljolly]

Non Rebreather all the way - unless the pt could not stand it. Protocol in my state says NRB always unless pt cannot stand the NRB then nasal cannula 4l/m Especially with Pts Resp rate at 22 No significantly above the norm but factor in the Past medical history - easy 10-15l/m NRB.

O2 transport is what we do.

The other day I resusitated an 55yr old male from complete cardiac arrest sans AED First time I actually performed CPR on a call- damn it fell good to bring in the pt with a pulse, we were still assisting ventialtions but his ticker was ticking and I felt good about it.

EMTB has its day if you are looking for the same excitement in emergency medicine as a Medic look elsewhere. Unless your are chief resident at Bellvue your trauma calls arent every call. A lot of the times you get some serious BS chief complaints. So many ER docs have told me even as an EMT in a high call volume cty ( I volunteer in, Newark NJ) I probably see just as much trauma as they do. Obv their interventions are a bit more extensive. Take your MCAT then decide on what you are to do.

The assistant chief of Trauma at Bellevue used to be an EMT. Just thought Id throw that in there.