Cardiology has been going surprisingly better than I anticipated. We've had 2 quizzes (out of 4 total) in this unit, and I got an 81 on one and an 88 on the other. No complaints here. My course coordinator seemed proud. I'd like to say I'm in the home stretch, but that's not really true...I have quite a ways left to go. All of May and all of June, but the class final is June 28th. So I guess I'm closer to done than to the start.
I usually don't talk about things in fears that I'll "jinx" them, but I'm in the hire process to be a James City County firefighter/medic. It would be a great position, but it's also very competitive. It's the only medic job I've applied so thus far because they were more than happy to take my application for the position even though I haven't obtained my medic certification yet. By the time I do finish the class, the hiring process still won't be over.
I realized after I got past a hurdle last week in the hiring process that the next big thing was the CPAT - Candidate Physical Ability Test. It's a series of very difficult obstacles designed to test your ability to be a firefighter, basically. I found a trainer at my gym that specializes in training public service professionals, and I feel like I might have a chance working with him. He has me on a rigorous plan, and I'm sore. All over. My food is very strictly regulated...I need to go walk for an hour, and then I get an apple, some almonds, and one serving of organic peanut butter. Lunch is chicken salad, a big green salad, and wheat toast with coconut oil and raw honey.
Labs in class tonight - transcutanous pacing and cardioversion. As one of my instructors says, "make 'em ride the lightening!"
Wednesday, April 21, 2010
Friday, April 9, 2010
Advocate
I was down in my rural EMS agency for 24 hours riding with their career paramedics yesterday. One of the career medics is also a lab instructor in my class, so I really enjoy the benefit of spending time on a unit with him.
We had one call from a nursing home for a man who had vomited 3 times 5 hours earlier in the day. No n/v/d on our arrival. We ran some fluid and took him in. He was pretty tachy, but I think he was just nervous for the ride.
Our second big call came out in the early evening for a teenager involved in a car-hit-tree accident. It was the first time I've seen real, full windshield, starring. The patient was originally entrapped, but sitting straight up when we got there. We packaged her very quickly and got on our way down south to a major Level I trauma center. She seemed pretty stable with A,B,C's intact - the two very concerning things were repetitive questioning and loss of memory and also an obviously broken and dislocated jaw. There was blood pooling out of her ear, something else I had never seen. The medic and I got things done well and very quickly in the back.
The most rewarding part of that call was when she could remember her Aunt's phone number (she couldn't remember her Mom's). I called and talked to both Aunt and then Mother on the phone while reassuring her the entire time. I felt like I was really doing something for this family in their time of need. The first question the mother asked me through repetitive sobbing was "Can my daughter breathe?" I assured her yes. When we were rolling her into the ER and then into the Trauma/Resuscitation Bay, I asked her if there was anything I could do for her. She said "Please just stay with me." I took her hand and didn't let go until the trauma docs forced my partner and I out of the room so they could do their jobs.
Nothing we did for that girl medically compared to the little comfort we were able to provide her and the conversation I had with her family members. It felt like I really did some good for a distressed patient.
I've been in and out of clinicals lately. I've seen some interesting things - a teenage burn patient, a no-PMH woman that was going into recurrent v-tach and felt "dizzy", a rapid A-Fib at a rate of over 200 (I initially misidentified it as SVT...always more to learn!), and a teenage knee dislocation. Lots more standard things too.
We took our fourth unit test on Wednesday, and I got a 94%. There are only six unit tests in class, plus the exams for ACLS, PALS, and ITLS and the final. We have 8 hours of cardiology lecture tomorrow.
We had one call from a nursing home for a man who had vomited 3 times 5 hours earlier in the day. No n/v/d on our arrival. We ran some fluid and took him in. He was pretty tachy, but I think he was just nervous for the ride.
Our second big call came out in the early evening for a teenager involved in a car-hit-tree accident. It was the first time I've seen real, full windshield, starring. The patient was originally entrapped, but sitting straight up when we got there. We packaged her very quickly and got on our way down south to a major Level I trauma center. She seemed pretty stable with A,B,C's intact - the two very concerning things were repetitive questioning and loss of memory and also an obviously broken and dislocated jaw. There was blood pooling out of her ear, something else I had never seen. The medic and I got things done well and very quickly in the back.
The most rewarding part of that call was when she could remember her Aunt's phone number (she couldn't remember her Mom's). I called and talked to both Aunt and then Mother on the phone while reassuring her the entire time. I felt like I was really doing something for this family in their time of need. The first question the mother asked me through repetitive sobbing was "Can my daughter breathe?" I assured her yes. When we were rolling her into the ER and then into the Trauma/Resuscitation Bay, I asked her if there was anything I could do for her. She said "Please just stay with me." I took her hand and didn't let go until the trauma docs forced my partner and I out of the room so they could do their jobs.
Nothing we did for that girl medically compared to the little comfort we were able to provide her and the conversation I had with her family members. It felt like I really did some good for a distressed patient.
I've been in and out of clinicals lately. I've seen some interesting things - a teenage burn patient, a no-PMH woman that was going into recurrent v-tach and felt "dizzy", a rapid A-Fib at a rate of over 200 (I initially misidentified it as SVT...always more to learn!), and a teenage knee dislocation. Lots more standard things too.
We took our fourth unit test on Wednesday, and I got a 94%. There are only six unit tests in class, plus the exams for ACLS, PALS, and ITLS and the final. We have 8 hours of cardiology lecture tomorrow.
Thursday, April 1, 2010
OR / Anonymity
Today I was in the OR all day.
The morning started out badly. When my alarm went off I groaned and thought "20 more minutes of sleep won't kill me. I should still get to the hospital 15 minutes early as long as I only take 20 minutes to get ready." The bad thing about sleep-induced decisions?
To commute to the hospital where we have to do our OR rotations, I have to commute up the I-95 North corridor towards Washington, D.C. Surprise - backed up traffic for miles! I took a bunch of back routes and made it there on time. I went to get changed to OR scrubs, which didn't really do much for my 5'2 height.
I loved the OR. The routine, the focus, the control, the precision. The sheer power of the people in the Operating Room - a surgeon, an anesthesiologist, the scrub nurse, the OR nurses. The silence.
Basically the exact opposite of everything I'm used to in the ER and on the rig! I can think of exactly one sterile field - the surgical cric kit. Everything else has a mere hope of aseptic or "medically clean". The noise is constant, the control varies, and there always seems to be at least one agitated, annoyed, or irate person.
Would I trade my environment for a clean OR room? For a day or two, it might be nice. In the long run? Absolutely not!
I learned a lot today. Watched part of a T&A on a 4-year-old and a multiple dental restoration on a 2-year-old. The 4-year-old got nasotracheal intubation. That was interesting to observe. The child's EtCO2 went from 38 to 49 after Rocuronium. I want to study that a little when I get the time. That's a high number.
I then had an adult, 39-year-old, R ear Myringotomy (ear tube insertion). She got some Propofol, but didn't need to be intubated - just a nasal cannula for support. Her oxygen saturation stayed at 100% and her EtCO2 between 32 and 34 for the length of the procedure, which was maybe a total of 2 minutes. I usually tried to exit the surgical suite after everything got underway, because I was there to primarily concentrate on airway procedures. I wanted to get to the next operating suite before a new patient came in. This one though, I didn't even have time to extract myself before the entire procedure was done! The anesthesiologist told me she'd be gone within the hour.
The last procedure I was in for was a direct laryngoscopy and rigid esophogoscopy with a possible tonsillectomy. This woman in her 50's had esophageal cancer after never smoking a day in her life. I was surprised that her airway structures were so clear; I expected some kind of swelling or blockage or something. About 2 minutes after her Propofol and Succinycholine for RSI, she got a little tachy and her blood pressure went down. EtCO2 stayed steady around 35.
It was an interesting day; I really feel that I learned a lot. I'd like to return to the OR again.
___________________________________________________
On another quick subject.
Something I've noticed a lot in the ER and now the OR is the relative anonymity of patients. I'm not saying that's bad, and I don't think it makes much difference to the patients. But, come on, how often to we near healthcare staff referring to the "chest pain in room 15" or "that loud baby with a cold in 20"?? You know it happens. And in the OR, they aren't even referred to by their procedure, as that would often take too much breath to accomplish. They become "the 10:30 in OR 1." And just in case you forget the time or room or procedure, it's all written on a wall-long white board right before the entrance to the sterile area. Hey, however you keep track of everything, right?
But let's us remember that while we have our patients, they're our only responsibility. They don't have to be anonymous. They're not a set of orders or a bed...they're "Mrs. Smith" from "123 Anywhere Street", that beautiful old house on the corner. They're just not feeling well tonight and want to go to the hospital for a nice checkup. And, by the way, did you notice all the afghans on the living room couch that she made herself?
Give them their time to be the only focus and responsibility before they become a hospital statistic.
The morning started out badly. When my alarm went off I groaned and thought "20 more minutes of sleep won't kill me. I should still get to the hospital 15 minutes early as long as I only take 20 minutes to get ready." The bad thing about sleep-induced decisions?
To commute to the hospital where we have to do our OR rotations, I have to commute up the I-95 North corridor towards Washington, D.C. Surprise - backed up traffic for miles! I took a bunch of back routes and made it there on time. I went to get changed to OR scrubs, which didn't really do much for my 5'2 height.
I loved the OR. The routine, the focus, the control, the precision. The sheer power of the people in the Operating Room - a surgeon, an anesthesiologist, the scrub nurse, the OR nurses. The silence.
Basically the exact opposite of everything I'm used to in the ER and on the rig! I can think of exactly one sterile field - the surgical cric kit. Everything else has a mere hope of aseptic or "medically clean". The noise is constant, the control varies, and there always seems to be at least one agitated, annoyed, or irate person.
Would I trade my environment for a clean OR room? For a day or two, it might be nice. In the long run? Absolutely not!
I learned a lot today. Watched part of a T&A on a 4-year-old and a multiple dental restoration on a 2-year-old. The 4-year-old got nasotracheal intubation. That was interesting to observe. The child's EtCO2 went from 38 to 49 after Rocuronium. I want to study that a little when I get the time. That's a high number.
I then had an adult, 39-year-old, R ear Myringotomy (ear tube insertion). She got some Propofol, but didn't need to be intubated - just a nasal cannula for support. Her oxygen saturation stayed at 100% and her EtCO2 between 32 and 34 for the length of the procedure, which was maybe a total of 2 minutes. I usually tried to exit the surgical suite after everything got underway, because I was there to primarily concentrate on airway procedures. I wanted to get to the next operating suite before a new patient came in. This one though, I didn't even have time to extract myself before the entire procedure was done! The anesthesiologist told me she'd be gone within the hour.
The last procedure I was in for was a direct laryngoscopy and rigid esophogoscopy with a possible tonsillectomy. This woman in her 50's had esophageal cancer after never smoking a day in her life. I was surprised that her airway structures were so clear; I expected some kind of swelling or blockage or something. About 2 minutes after her Propofol and Succinycholine for RSI, she got a little tachy and her blood pressure went down. EtCO2 stayed steady around 35.
It was an interesting day; I really feel that I learned a lot. I'd like to return to the OR again.
___________________________________________________
On another quick subject.
Something I've noticed a lot in the ER and now the OR is the relative anonymity of patients. I'm not saying that's bad, and I don't think it makes much difference to the patients. But, come on, how often to we near healthcare staff referring to the "chest pain in room 15" or "that loud baby with a cold in 20"?? You know it happens. And in the OR, they aren't even referred to by their procedure, as that would often take too much breath to accomplish. They become "the 10:30 in OR 1." And just in case you forget the time or room or procedure, it's all written on a wall-long white board right before the entrance to the sterile area. Hey, however you keep track of everything, right?
But let's us remember that while we have our patients, they're our only responsibility. They don't have to be anonymous. They're not a set of orders or a bed...they're "Mrs. Smith" from "123 Anywhere Street", that beautiful old house on the corner. They're just not feeling well tonight and want to go to the hospital for a nice checkup. And, by the way, did you notice all the afghans on the living room couch that she made herself?
Give them their time to be the only focus and responsibility before they become a hospital statistic.
Wednesday, March 31, 2010
All I Have...
I'm exhausted. ER, class, OR, class, ER...no sleep. Naps in the car if I get to a shift early.
Nothing holds much interest or sparks much anymore - on the way home from class, excited to get 5 hours of sleep tonight, I ran into a ton of traffic. I merely thought "what an interesting curio" and half closed my eyes.
Getting much better at IV sticks. Pt in septic shock today; I wish I knew if he made it. He was very unstable when I left ER clinical this afternoon with a pretty low MAP and compromised circulatory system. Maybe I will ask when I go back to that ER.
Other than that, routine things. Kidney stones, chest pain, sports injuries, abdominal complaints...it all runs together.
I need sleep now.
Nothing holds much interest or sparks much anymore - on the way home from class, excited to get 5 hours of sleep tonight, I ran into a ton of traffic. I merely thought "what an interesting curio" and half closed my eyes.
Getting much better at IV sticks. Pt in septic shock today; I wish I knew if he made it. He was very unstable when I left ER clinical this afternoon with a pretty low MAP and compromised circulatory system. Maybe I will ask when I go back to that ER.
Other than that, routine things. Kidney stones, chest pain, sports injuries, abdominal complaints...it all runs together.
I need sleep now.
Thursday, March 25, 2010
Edge
I'm very on edge, and I think I can expect to feel the same way until the 10th of July.
It started on the rig a couple nights ago. I ended up without a preceptee, so I got to run my own calls with two assistants. The first call was a typical nausea/vomiting/abdominal pain...easy and quick transport. The second call, around 4am, was dispatched as an "Emergency Illness", and the dispatcher told me it was for a sciatic nerve. I didn't know anything about a sciatic nerve, but my Blackberry internet service bailed me out. I still felt bad. Rescued by technology.
In case anyone's interested, sciatica results in extreme back and lower leg pain secondary to some kind of problem with the sciatic nerve - in my patient's case, a herniated disc.
Yesterday, I had to go to a hospital about 45 minutes away to get a badge made to do rotations there. I got all the way to the hospital HR office only to realize that I left my rotation paperwork at home in a binder I hadn't brought with me. Luckily, I had an extra copy in the car. However, my homework that was due in class was also in that binder - the 150 question unit homework assignment due in less than 3 hours. I rushed to a library near class to redo the homework. I didn't have the time to study that I wanted to.
So, therefore, I didn't do as well on the quiz as I wanted to. A lot of it was respiratory physiology, which I didn't expect. I thought it would be more practical information - ETT placement, Combitube, RSI, surgical airways, BLS airway management, etc. I expected questions on lung sounds and assessment findings. I didn't expect over half the quiz to be on physiology.
The only redeeming factor was nailing all my practical stations. I haven't missed a dummy intubation yet. Still, it wasn't a great day overall.
Today I have several errands to run and some important things to take care of. I also really need to study, and I don't even know where to start. I guess respiratory physiology would be a good place! Tonight, I was suppose to hop on a unit down south again. I think I will, but only because in the morning, one of my instructors will be there for his career job. He offered to let me ride with him. It would be beneficial to stick around there for a few hours and learn some things.
But then, I really MUST study for Saturday's test.
What am I going to do when the Cardiology unit hits in 1 week??
It started on the rig a couple nights ago. I ended up without a preceptee, so I got to run my own calls with two assistants. The first call was a typical nausea/vomiting/abdominal pain...easy and quick transport. The second call, around 4am, was dispatched as an "Emergency Illness", and the dispatcher told me it was for a sciatic nerve. I didn't know anything about a sciatic nerve, but my Blackberry internet service bailed me out. I still felt bad. Rescued by technology.
In case anyone's interested, sciatica results in extreme back and lower leg pain secondary to some kind of problem with the sciatic nerve - in my patient's case, a herniated disc.
Yesterday, I had to go to a hospital about 45 minutes away to get a badge made to do rotations there. I got all the way to the hospital HR office only to realize that I left my rotation paperwork at home in a binder I hadn't brought with me. Luckily, I had an extra copy in the car. However, my homework that was due in class was also in that binder - the 150 question unit homework assignment due in less than 3 hours. I rushed to a library near class to redo the homework. I didn't have the time to study that I wanted to.
So, therefore, I didn't do as well on the quiz as I wanted to. A lot of it was respiratory physiology, which I didn't expect. I thought it would be more practical information - ETT placement, Combitube, RSI, surgical airways, BLS airway management, etc. I expected questions on lung sounds and assessment findings. I didn't expect over half the quiz to be on physiology.
The only redeeming factor was nailing all my practical stations. I haven't missed a dummy intubation yet. Still, it wasn't a great day overall.
Today I have several errands to run and some important things to take care of. I also really need to study, and I don't even know where to start. I guess respiratory physiology would be a good place! Tonight, I was suppose to hop on a unit down south again. I think I will, but only because in the morning, one of my instructors will be there for his career job. He offered to let me ride with him. It would be beneficial to stick around there for a few hours and learn some things.
But then, I really MUST study for Saturday's test.
What am I going to do when the Cardiology unit hits in 1 week??
Tuesday, March 23, 2010
Overdrive
I've been studying advanced airway management in class, so CPAP has certainly been weighing on my mind. I keep thinking about different things I want to write about it, but haven't had a real chance to sit down and think it through yet.
I've been slammed with class and the start of rotations lately. I got a 92% on the exam last weekend (couldn't believe it!), which enabled me to start my clinical rotations. We have about 300 hours to do to pass the class, and they're all divided up into different units. I spent all of Saturday in class, then 12 hours of Sunday on an ER shift, and 8 hours yesterday in the Psychiatric unit before going to 4 hours of class. Today I had "off" to study for a quiz and catch up on a little sleep. Unfortunately, I didn't end up doing much of either.
I got the pediatric IV access I needed to check off. It was on a 17 year old, but it still counts! I've administered a lot of medications in a variety of different routes. I had to give a shot (IM administration) in the behind! I felt a little bad because he didn't speak much English so I'm not sure I conveyed well how much it would hurt - Bicillin. Very thick. We had a lot of respiratory cases (I need 10 cases of adult and 4 of children), so it got repetitive but at least served a purpose. I like the routine of emergency care. Most of the time, I'm starting to be able to anticipate what treatment the patient will get.
Quiz tomorrow on advanced airway, then a test on the same on Saturday. Friday I have another 12 hour ER shift. Getting tired. I feel like I'm constantly in overdrive and can't calm down. July 10th - National Registry test day - can't get here fast enough.
On the rig tonight as AIC, but I have a preceptee. Hoping for a mostly restful night.
I've been slammed with class and the start of rotations lately. I got a 92% on the exam last weekend (couldn't believe it!), which enabled me to start my clinical rotations. We have about 300 hours to do to pass the class, and they're all divided up into different units. I spent all of Saturday in class, then 12 hours of Sunday on an ER shift, and 8 hours yesterday in the Psychiatric unit before going to 4 hours of class. Today I had "off" to study for a quiz and catch up on a little sleep. Unfortunately, I didn't end up doing much of either.
I got the pediatric IV access I needed to check off. It was on a 17 year old, but it still counts! I've administered a lot of medications in a variety of different routes. I had to give a shot (IM administration) in the behind! I felt a little bad because he didn't speak much English so I'm not sure I conveyed well how much it would hurt - Bicillin. Very thick. We had a lot of respiratory cases (I need 10 cases of adult and 4 of children), so it got repetitive but at least served a purpose. I like the routine of emergency care. Most of the time, I'm starting to be able to anticipate what treatment the patient will get.
Quiz tomorrow on advanced airway, then a test on the same on Saturday. Friday I have another 12 hour ER shift. Getting tired. I feel like I'm constantly in overdrive and can't calm down. July 10th - National Registry test day - can't get here fast enough.
On the rig tonight as AIC, but I have a preceptee. Hoping for a mostly restful night.
Monday, March 15, 2010
New Protocols!
It's been a long couple days studying for a quiz in class tonight on pharmacokinetics/dynamics and Alpha/Beta therapy. Amazingly, I got a 100% - how good it felt!
My council got some new protocols today, several of which I was very glad to see. The highlights -
Medication - dosages for Valium and Dopamine changed.
Clinical Procedures - decompression is now allowed at the EMT-Enhanced level (a certification probably unique to my state with only 80 hours more than an EMT-B has), as long as the provider has current PHTLS or ITLS certification. Naso/Orogastric tube protocol added. Impedance Threshold Device protocol added (yay!). Protocol for the EZ-IO added.
...and the big one, which I'm happiest about, is that an EMT-B or EMT-Enhanced can now use CPAP with the medical control permission. A Medic doesn't need permission.
Now I'm more even inclined to make CPAP my #2 wish. Even though it's in protocols, my agency doesn't have it and doesn't look to be getting it any time soon.
Stay tuned - next post will be on CPAP!
My council got some new protocols today, several of which I was very glad to see. The highlights -
Medication - dosages for Valium and Dopamine changed.
Clinical Procedures - decompression is now allowed at the EMT-Enhanced level (a certification probably unique to my state with only 80 hours more than an EMT-B has), as long as the provider has current PHTLS or ITLS certification. Naso/Orogastric tube protocol added. Impedance Threshold Device protocol added (yay!). Protocol for the EZ-IO added.
...and the big one, which I'm happiest about, is that an EMT-B or EMT-Enhanced can now use CPAP with the medical control permission. A Medic doesn't need permission.
Now I'm more even inclined to make CPAP my #2 wish. Even though it's in protocols, my agency doesn't have it and doesn't look to be getting it any time soon.
Stay tuned - next post will be on CPAP!