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Nervous when it comes to practicals and working with a partner

Discussion in 'Pre-Hospital [ EMS ]' started by sylus, Mar 28, 2007.

  1. sylus

    sylus Dorian Gray

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    Hey guys, so I am getting closer to finishing my EMT-B course and am doing really well. My problem lies in the practicals. Yesterday my teacher had us work with partners and run through a scene and while we saved our patient, I think we were both nervous the whole time. We accidently used a rebreather instead of a nonrebreather and made a few other silly mistakes because we were nervous. (We fared better than another group, though, who apparently accidently shocked the victim's family memeber with the AED) I think one part is, for me at least, I was unsure of myself working with someone else. I had trouble trying to keep everything straight between narrating what I was doing for my instructor, communicating with my partner, and treating the patient. Can anyone give any tips both for in-class practicals and once I'm out in the field treating real patients? Any advice at all about communications and things they've found that work for them and how to combat nervousness. Anything at all you feel would be helpful. :)

    Thanks for any help!
     
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  3. greytmedic

    greytmedic Faster than you

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    Air goes in and out, blood goes round and round, and blue is bad. If you make it to paramedic class, just remember if you don't know the rhythm, shock it till you do.

    Seriously, just practicing will help a great deal, that is why you practice in class. If you have friends in the class, get together outside of class and just run through made up scenarios to get comfortable. One of the hardest part about practical testing is verbalizing everything you do. It can be a little annoying to have to verbalize things you are actually demonstrating, but that's just so there is no chance of the evaluator interpreting things differently from person to person.

    Once you get to the field the most important advice I can give you is that if you don't know something, just ask. Don't worry about being inexperienced when you start out. Everyone will know that you are green and expect you not to know some things. You will earn more respect by asking questions than fumbling around looking like a dud. You may be given a hard time, but everyone was in that position at one point in time and it's all in fun. Second piece of advice, if you can't get a bp don't make one up. That's all I have to say about that.
     
  4. Unlimited415

    Unlimited415 New Member

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    In scenarios, as well as live calls where things go well, I tend to detach from things. Go in my head about what the patient needs, what I need to do, think about the bigger picture and related questions & treatments. That way I'm not feeling the pressure of this being a scenario or real call with people watching.

    Just think about each thing you do before you do it and do a check to make sure you're doing it right. Take pauses before each step and each decision. Even if they make it a fast paced scenario, you slow it down even for a second at a time.
     
  5. SB100

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    Well for one thing, practicals evaluate each person individually according to their tasks. Person A does one thing, Person B does another, then they switch. If there's something you know your partner should or shouldn't be doing, it's perfectly fine to direct them.
     
  6. dxu

    dxu the great one

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    First thing, know your role in a given scenario. If it is a stroke scenario, are you the one testing for pronator drift and asking the pt to repeat "the skies over Cincinnati are blue"? Are you taking the vitals? SAMPLE?

    Next, don't be afraid to take charge. And if it is a cardiac arrest, for the love of all that is holy, have a bystander call 911 and find you an AED (b/c you don't carry one on your truck...:rolleyes: )

    Finally, just stay calm. A little bit of advice for in the field, don't run around frantic like a chicken with it's head cut off. If you don't know something or don't know how to get somewhere (it happens a lot...to all of us), ASK! If they yell at you, don't take it personally, unless you do something really freaking stupid, and panicking does not help save a single soul. One minute usually will not make or break whether or not a pt will live or die.

    No matter what, you're going to get your butt handed to you at some point, but everyone has been there. Suck it up and do your best. Good luck!

    dxu
     
  7. igcgnerd

    igcgnerd Hawkeye

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    during a practical scenario or heck and real life call ur given a role. ur either the lead or you are not. if ur the lead; ur doing the assessment and delegating what u want ur assistant to do. For instance while ur assesing the patient u could have ur partner taking a bp. If ur on a bls rig ur going to be doing this. For a testing situation, ur partner shouldn't distract u, if u have any doubts in their abilities, delegate what u know they can do.

    DXU: u dont have aed's on ur bls rigs? All the bls rigs I use to work did. Though I only had to use it on a bls transport once and all the other times I was involved on a code were on an als.
     
  8. TerraMedicX

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    All great advice!! I'd also add that you need to remember to expose EVERYTHING you assess!! If you can't see it, you didn't check it!

    For real-life, also remember to listen to breath sounds on every patient so you can get a better idea of what "normal" sounds like so the abnormal stuff will jump out at you more! As Greytmedic said above, no one expects you to know everything when you start, and (hopefully) no one will let you kill anyone by being new! Just keep an open mind about learning what the "real world" is like and you'll do fine!

    Nate.
     
  9. dxu

    dxu the great one

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    Well in the scenario for the test (for me, PA State), when we came across an unconscious individual or a patient went unconscious, we had to tell a bystander to call 911 and to find an AED. I don't know why it is structured this way, but it doesn't really matter b/c I passed...haha.

    Anywho, we do have an AED on our truck. We actually have the whole monitor and AED package. All our trucks have them since there are no designated BLS trucks. This is nice b/c on BLS, we just use the monitor to get our BP, Pulse, SPO2.

    Here is a hint to any newbies out there: Always find the pulse yourself and get the BP as well. These may seem simple, but try finding a pulse on an 120kg woman...not that easy!

    dxu
     
  10. igcgnerd

    igcgnerd Hawkeye

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    I hated it when my partner made me get the manual bp before i got one off of the monitor. Whats the point of doing both? If I got the manual, there was no need to do another one on the monitor 2 min later! Now after working in the hospital and using automated monitor bp's a 100 times a day, I was asked a week ago to take a manual and I had to think about it for a moment before I remembered.:D
     
  11. TerraMedicX

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    I refuse to use the automated BPs on our monitors...absolutely REFUSE! I have had horrible luck with them. Either they just run for ever and ever and then fail to actually give you a number...or you get a BP that's completely wrong. I ALWAYS take manual BPs! Heck, I'd rather have a palped BP then one off the monitor! That being said...in a clinical setting its completely different. I blame most of the problems with automated BPs on monitors on noise issues in the back of a moving ambulance. In hospital, you don't have these problems so they usually work.

    Nate.
     
  12. dxu

    dxu the great one

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    Like I mentioned, always get a BP by palp when riding with the patient. On transfers I will get a BP by palp at least once. However, I recommend more vigilance on pts that just don't look good. We had a transfer the other day where the woman had a hx of COPD, MI, TIA, in other words she was not even close to healthy. She was very flushed and just didn't look good. Those are the pts you make sure you get vitals on every ten minutes.

    However, if you are on an ALS call (for example, cardiac arrest) you will put the BP cuff from the monitor on and use that. End of story.

    On a side note, here is some advice to newbies who have yet to experience a full blown cardiac arrest. The first one you will be scared (and the second, and third...get my drift) and you really won't have a lot to do, especially if CPR had already been started before your arrival. EMTs on cardiac arrests are useful for maybe 6 things:
    1) Spiking a Bag
    2) CPR
    3) Gophering (Go-For-Ing)
    4) Prepping Epi and Atropine Vials
    5) Lifting
    6) Driving

    Only 1-2% of calls are cardiac arrests, so don't worry. But when they do happen, it is okay to be scared. Ask questions of your medic, they may get mad or yell sometimes, but they take their job seriously and its all part of the game. Have fun!

    dxu
     

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