Sometimes you get patients who ask if you're studying to be a nurse or doctor.
No, actually, I'm a double major in International Relations and Geography.
They usually ask how you got in to this.
My friends made me do it. Peer pressure and all.
But sometimes you get patients who spend the next three hours discussing the economic sustainability of the European Union with you. :)
Sunday, May 30, 2010
Thursday, May 27, 2010
Nebulizers and Albuterol
NYC REMSCO BLS Protocols state that Albuterol via Nebulizer is indicated in patients over 1 year of age presenting with exacerbation of asthma/wheezing. Albuterol is the only medicine EMT-B's in NYC can give via Nebulizer. Refer to the 2010 protocols if you want more details.
This is how you do it, for those of you who didn't learn in tech school.
1. Gather the necessary equipment.
2. Assemble the nebulizer kit.
3. Instill the premixed drug (such as Albuterol or other approved drug) into the reservoir well ofthe nebulizer.
4. Connect the nebulizer device to oxygen at 4 - 6 liters per minute or adequate flow to produce asteady, visible mist.
5. Instruct the patient to inhale normally through the mouthpiece of the nebulizer. The patientneeds to have a good lip seal around the mouthpiece.
6. The treatment should last until the solution is depleted. Tapping the reservoir well near theend of the treatment will assist in utilizing all of the solution.
7. Monitor the patient for medication effects. This should include the patient’s assessment of his/her response to the treatment and reassessment of vital signs, ECG, and breath sounds.
8. Assess and document peak flows before and after nebulizer treatments.
9. Document the treatment, dose, and route on/with the patient care report (PCR).
(Randolph County, NC, EMS System Standards Procedure - Because really, I couldn't have said it better myself.)
Here are some video links if you're a visual learner like me. The narrator is using an actual Nebulizer machine rather than an O2 tank, but it's the same concept. It's a series if you want to see every last detail (and how to use Nebulizer masks), but these are the parts relevant to what I carry on my ambulance.
How to Get Nebulizer Ready for Use
How to Load Medicine in Nebulizer
How to Use Nebulizer Wand With a Child
This is how you do it, for those of you who didn't learn in tech school.
1. Gather the necessary equipment.
2. Assemble the nebulizer kit.
3. Instill the premixed drug (such as Albuterol or other approved drug) into the reservoir well ofthe nebulizer.
4. Connect the nebulizer device to oxygen at 4 - 6 liters per minute or adequate flow to produce asteady, visible mist.
5. Instruct the patient to inhale normally through the mouthpiece of the nebulizer. The patientneeds to have a good lip seal around the mouthpiece.
6. The treatment should last until the solution is depleted. Tapping the reservoir well near theend of the treatment will assist in utilizing all of the solution.
7. Monitor the patient for medication effects. This should include the patient’s assessment of his/her response to the treatment and reassessment of vital signs, ECG, and breath sounds.
8. Assess and document peak flows before and after nebulizer treatments.
9. Document the treatment, dose, and route on/with the patient care report (PCR).
(Randolph County, NC, EMS System Standards Procedure - Because really, I couldn't have said it better myself.)
Here are some video links if you're a visual learner like me. The narrator is using an actual Nebulizer machine rather than an O2 tank, but it's the same concept. It's a series if you want to see every last detail (and how to use Nebulizer masks), but these are the parts relevant to what I carry on my ambulance.
How to Get Nebulizer Ready for Use
How to Load Medicine in Nebulizer
How to Use Nebulizer Wand With a Child
Babysitting
I had a partner practically fresh out of tech school today, so we did the following:
NOT feeding the driver. >:(
1 highway flagdown a la 1 off-duty cop on motorcycle + 1 minivan driver about to miss their exit = 1 off-duty cop not on their motorcycle.
1 3-flight stairchair, with lift assist.
Attempting to feed the driver. Attempt FAIL.
Driver now caffeinated.
1 long distance interstate transport.
No food while driving 65 mph. :(
1 emergency call for respiratory distress.
15 mins waiting for NH elevator. >:(
Getting 1 hr of OT a la extended triage.
Driver so hungry they are no longer hungry.
DONE.
NOT feeding the driver. >:(
1 highway flagdown a la 1 off-duty cop on motorcycle + 1 minivan driver about to miss their exit = 1 off-duty cop not on their motorcycle.
1 3-flight stairchair, with lift assist.
Attempting to feed the driver. Attempt FAIL.
Driver now caffeinated.
1 long distance interstate transport.
No food while driving 65 mph. :(
1 emergency call for respiratory distress.
15 mins waiting for NH elevator. >:(
Getting 1 hr of OT a la extended triage.
Driver so hungry they are no longer hungry.
DONE.
Tuesday, May 25, 2010
Sunday, May 23, 2010
Security, I like you. I really do. But when I tell you that I can transfer a psych patient without an escort, it means that I can transfer a psych patient without an escort. It means, I've read the medical history. I've read the summary of events leading to the present hospitalization. And I'm telling you that this kid is going through a rough patch, but they're a kid. In fact, they're a downright sweet kid who got dealt a really tough family situation and a little bit of bad genetics.
So please, security, do not start telling me that I need an escort because kids like this might burst out. Do not tell me that all they know is violence.
Do not start telling me that in front of my patient.
Because you have never been on the other side of that. You have no idea how bad he's already hurting.
How do you think I got out of the hellhole I was born in?
There was a psych ER involved.
And do you really want to know what that kid told the doctors?
"I just want to help people."
So please, security, do not start telling me that I need an escort because kids like this might burst out. Do not tell me that all they know is violence.
Do not start telling me that in front of my patient.
Because you have never been on the other side of that. You have no idea how bad he's already hurting.
How do you think I got out of the hellhole I was born in?
There was a psych ER involved.
And do you really want to know what that kid told the doctors?
"I just want to help people."
Saturday, May 22, 2010
Thursday, May 20, 2010
GPS...
...EMS style. :)
All 911 Ambulances in NYC have their own full-size computer-screen call-receiving GPS units installed (volunteers excluded). They've even got time-stamp programs. It's big. It's shiny. I mostly kind of want one.
We've got a pager, and a GPS installed in the truck so dispatch can track the truck.
Clearly, that doesn't help us much.
Hello, TomTom.
Why Paramedics Should Use GPS Navigation - Everday EMS Tips
GPS Technology Will Change EMS Response Times - EMS EXPO
GPS Computer Navigators To Shorten EMS Response And Transport Times - American Journal of Emergency Medicine
All 911 Ambulances in NYC have their own full-size computer-screen call-receiving GPS units installed (volunteers excluded). They've even got time-stamp programs. It's big. It's shiny. I mostly kind of want one.
We've got a pager, and a GPS installed in the truck so dispatch can track the truck.
Clearly, that doesn't help us much.
Hello, TomTom.
Why Paramedics Should Use GPS Navigation - Everday EMS Tips
GPS Technology Will Change EMS Response Times - EMS EXPO
GPS Computer Navigators To Shorten EMS Response And Transport Times - American Journal of Emergency Medicine
Things you don't expect to see on your day off:
Another private ambulance company dropping off a patient in your house.
As in: your landlady's mother.
So glad I came down to do laundry after they were done with the stairchair, since you can't just walk by without asking if they need a hand.
And when I got back from the laundromat her husband finally introduced us, since I've told him before that they can knock on my door anytime.
And then she gave me a mango juicebox.
WIN.
Another private ambulance company dropping off a patient in your house.
As in: your landlady's mother.
So glad I came down to do laundry after they were done with the stairchair, since you can't just walk by without asking if they need a hand.
And when I got back from the laundromat her husband finally introduced us, since I've told him before that they can knock on my door anytime.
And then she gave me a mango juicebox.
WIN.
Monday, May 17, 2010
Saturday, May 15, 2010
Dear partner(s),
Yes, I will be incoherent for the first half hour of the shift. I don't care what time we're starting. I just rolled out of bed. Wait 'til I finish my donut and OJ.
Yes, we will be doing 5-6 jobs a day. You will be working for your paycheck.
Yes, I will sing along to every song I know on the radio. And maybe even the ones I don't. You had better like everything from Jay-Z and Ke$ha to Bruce Springsteen and Queen.
Yes, you had better be singing along, too.
Yes, I will buy a 1 lbs bag of ice the instant the temp or humidity goes up. And I will eat it, too.
Yes, you will automatically gain weight from being in my presence. Please see above regarding pints of ice cream. And boxes of 1 dozen donuts from Dunkin' Donuts. And entire Entemann's chocolate cakes.
Yes, I can lift. Yes, I will be taking bottom on both stair chair and stretcher.
Yes, I like to tech. I like hanging out with patients in the back.
Yes, we will be stopping at totally random delis. I'm involved in an epic search for the perfect roast beef and provolone hot on a hero.
Yes, I do love OT.
And most importantly:
Me + psych patients = happiness. Keep your mouth shut. I can sweet talk them into anything.
(No, seriously, I love psych calls. LOVE.)
Yes, I will be incoherent for the first half hour of the shift. I don't care what time we're starting. I just rolled out of bed. Wait 'til I finish my donut and OJ.
Yes, we will be doing 5-6 jobs a day. You will be working for your paycheck.
Yes, I will sing along to every song I know on the radio. And maybe even the ones I don't. You had better like everything from Jay-Z and Ke$ha to Bruce Springsteen and Queen.
Yes, you had better be singing along, too.
Yes, I will buy a 1 lbs bag of ice the instant the temp or humidity goes up. And I will eat it, too.
Yes, you will automatically gain weight from being in my presence. Please see above regarding pints of ice cream. And boxes of 1 dozen donuts from Dunkin' Donuts. And entire Entemann's chocolate cakes.
Yes, I can lift. Yes, I will be taking bottom on both stair chair and stretcher.
Yes, I like to tech. I like hanging out with patients in the back.
Yes, we will be stopping at totally random delis. I'm involved in an epic search for the perfect roast beef and provolone hot on a hero.
Yes, I do love OT.
And most importantly:
Me + psych patients = happiness. Keep your mouth shut. I can sweet talk them into anything.
(No, seriously, I love psych calls. LOVE.)
Wednesday, May 12, 2010
Thursday, May 6, 2010
A-Fib (On Coumadin)
A-Fib (Atrial Fibrillation) is the most common type of cardiac arrythmia. 1 in 4 Americans over 40 have a risk of developing A-Fib. You can recognize it from the moment when you go to take a radial pulse and it's nowhere near a predictable rhythm. 8% of adults over age 80 have A-Fib. Some people have spontaneous A-Fib spells, some suffer from A-Fib during exertion, and some have continuous (chronic) A-Fib. Approximately 30% of A-Fib patients don't know that they have A-Fib.
Simply, there's extra electrical impulses going on in your heart, and the atria are beating faster than the ventricles, creating arrythmia. It's not life-threatening on it's own, but it can cause palpitations, fainting, chest pain, CHF, and most importantly, strokes.
Patients with A-Fib are 7 times more likely to have strokes than the regular population. Blood can pool and clot due to inadequate contractions of the atria. A-Fib strokes are therefore typically ischemic.
35% of patients with A-Fib will suffer strokes if untreated.
15% of all stroke patients have A-Fib
25% of A-Fib stroke patients have no prior diagnosis of A-Fib
23% of A-Fib stroke patients die (compared to 8% of non-A-Fib stroke patients)
44% of A-Fib stroke patients suffer serious neurological damage
Now that I've overwhelmed you with numbers, enter Coumadin. Coumadin, or Warfarin, as we all know, is an anti-coagulant (blood-thinner). Anti-coagulants prevent clots. Therefore, your patient with a PMH of "A-Fib (On Coumadin)" most likely has chronic A-Fib and other risk factors for stroke.
Some A-Fib patients may use Aspirin, Heparin, or Dabigartan for the same effect. Aspirin is more common in younger A-Fib patients.
They may also be on medications to control their heart rate such as: Metoprolol, Atenolol, Bisoprolol, Diltiazem, Verapamil, or Digoxin. (I see the first and last regularly with my geriatric patients, even if they don't have a PMH of A-Fib. More on those some other post.)
See also:
Atrial Fibrillation - Wikipedia
Atrial Fibrillation - a-fib.com
Simply, there's extra electrical impulses going on in your heart, and the atria are beating faster than the ventricles, creating arrythmia. It's not life-threatening on it's own, but it can cause palpitations, fainting, chest pain, CHF, and most importantly, strokes.
Patients with A-Fib are 7 times more likely to have strokes than the regular population. Blood can pool and clot due to inadequate contractions of the atria. A-Fib strokes are therefore typically ischemic.
35% of patients with A-Fib will suffer strokes if untreated.
15% of all stroke patients have A-Fib
25% of A-Fib stroke patients have no prior diagnosis of A-Fib
23% of A-Fib stroke patients die (compared to 8% of non-A-Fib stroke patients)
44% of A-Fib stroke patients suffer serious neurological damage
Now that I've overwhelmed you with numbers, enter Coumadin. Coumadin, or Warfarin, as we all know, is an anti-coagulant (blood-thinner). Anti-coagulants prevent clots. Therefore, your patient with a PMH of "A-Fib (On Coumadin)" most likely has chronic A-Fib and other risk factors for stroke.
Some A-Fib patients may use Aspirin, Heparin, or Dabigartan for the same effect. Aspirin is more common in younger A-Fib patients.
They may also be on medications to control their heart rate such as: Metoprolol, Atenolol, Bisoprolol, Diltiazem, Verapamil, or Digoxin. (I see the first and last regularly with my geriatric patients, even if they don't have a PMH of A-Fib. More on those some other post.)
See also:
Atrial Fibrillation - Wikipedia
Atrial Fibrillation - a-fib.com
Tuesday, May 4, 2010
Monday, May 3, 2010
Children's Tylenol, Motrin, Zyrtec and Benadryl Recalled
Just so you're aware, ladies and gents.
Children's Tylenol and Other Drugs Recalled - NYT
The full recall list is here:
McNeill Product Recall
Don't panic. Nothing terrible has happened yet, just violations during a factory inspection leading to a voluntary recall. But if your peds patient is acting funny, and they took one of these, maybe mention it to the triage nurse? Or even better, grab the bottle, so that you or one of the ER nurses can check the product lot number. Even if it's just to tell their parent(s) that they should toss it.
Children's Tylenol and Other Drugs Recalled - NYT
The full recall list is here:
McNeill Product Recall
Don't panic. Nothing terrible has happened yet, just violations during a factory inspection leading to a voluntary recall. But if your peds patient is acting funny, and they took one of these, maybe mention it to the triage nurse? Or even better, grab the bottle, so that you or one of the ER nurses can check the product lot number. Even if it's just to tell their parent(s) that they should toss it.
Sunday, May 2, 2010
Saturday, May 1, 2010
Your daily PSAs.... :)
Four out of six patients agree, it's pneumonia season.
If I'm driving lights and sirens on the left-most lane of the highway, please merge with the lane to your right. Pulling left and stopping accomplishes nothing. I will not fit between you and the speeding traffic to my right.
If you have the bariatric stretcher in your bus, you will have at least one patient that weighs over half a ton.
Walking into the same ER four times in one day will make you wonder when you see that CHF patient you brought in at 11am in the exact same place at 6pm, and that migraine patient stops you to ask if they can get a ride home now.
If you're going into OT on a call, you will have to wait 45 mins on both ends for a lift assist.
Getting back to base 2hrs late with 700 L of O2, no NRBs and no nasal cannulas. Yes, it is most definitely pneumonia season.
Telling your partner, "Dude, you should auscultate my lungs. Now that's some freaky ronchi," will result in, "They probably caught it from you. You're seriously infecting everyone."
:)
Four out of six patients agree, it's pneumonia season.
If I'm driving lights and sirens on the left-most lane of the highway, please merge with the lane to your right. Pulling left and stopping accomplishes nothing. I will not fit between you and the speeding traffic to my right.
If you have the bariatric stretcher in your bus, you will have at least one patient that weighs over half a ton.
Walking into the same ER four times in one day will make you wonder when you see that CHF patient you brought in at 11am in the exact same place at 6pm, and that migraine patient stops you to ask if they can get a ride home now.
If you're going into OT on a call, you will have to wait 45 mins on both ends for a lift assist.
Getting back to base 2hrs late with 700 L of O2, no NRBs and no nasal cannulas. Yes, it is most definitely pneumonia season.
Telling your partner, "Dude, you should auscultate my lungs. Now that's some freaky ronchi," will result in, "They probably caught it from you. You're seriously infecting everyone."
:)
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