Even with US guidance being the standard now?
Moron CNA's
- Thread starter ilemtbwantn2bTXEMT-P
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It is not standard.
And in a moment of pride I would like to say that my manual skills are consistantly better than those using ultrasound.
But when you look at the complications of an IJ or subclavian should something go amiss, compared to the femoral, it really is no comparison at all.
VFlutter
Flight Nurse
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A CNA program is only 5 weeks (100ish hrs) as well
5x40 hours is 200 hours. Meaning their education is nearly double that of the EMTs that often disdain them. Not to mention they have far less autonomy.
(Holy crap that sounded Ventmedicish :blink: :wacko
Frozennoodle
Sir Drinks-a-lot
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5x40 hours is 200 hours. Meaning their education is nearly double that of the EMTs that often disdain them. Not to mention they have far less autonomy.
(Holy crap that sounded Ventmedicish :blink: :wacko
They don't get trained in emergency medical care. They have BLS CPR but their focus is on longterm rehabilitation and care. It's apples and oranges.
Sasha
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It doesn't matter. OP still jumped the gun and sounded pretty immature in his rant.
ahem!
Mr.Brown before you start giving me attitude. Maybe you should think about something. You don't know me. I don't know you. You don't know where I work or who I work for. I really don't care who you work for.
You want interactive exchange of ideas then you do not insult people new to a site. If I have to explaine to you the necessity of oxygen in a possible altered patient then maybe you need a refresher course.
I came here looking for intellectual and interesting conversation. If all I get is grief and insulted then I shall bid good day to everyone here. Have a nice life!
Mr.Brown before you start giving me attitude. Maybe you should think about something. You don't know me. I don't know you. You don't know where I work or who I work for. I really don't care who you work for.
You want interactive exchange of ideas then you do not insult people new to a site. If I have to explaine to you the necessity of oxygen in a possible altered patient then maybe you need a refresher course.
I came here looking for intellectual and interesting conversation. If all I get is grief and insulted then I shall bid good day to everyone here. Have a nice life!
Aidey
Community Leader Emeritus
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He wasn't insulting someone new to the site, he was questioning someone who appeared to be regurgitating debunked, out-of-date information.
You said "oxygen would be the big thing" without any explanation of why you believed that to be true. Exchanging ideas means that you're going to have to defend those ideas.
You said "oxygen would be the big thing" without any explanation of why you believed that to be true. Exchanging ideas means that you're going to have to defend those ideas.
Sasha
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He wasn't giving you attitude. Sorry, if you're looking to be spoon fed and coddled, this isn't the place. We have no problem telling you if you're wrong, and even so this is still the nicest EMS forum out there. The other ones can get quite brutal.
Sasha
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I can explain it! "The book says so, so it is written, so it must be done!!!!"
Tommerag
What day is it?
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Everyone gets 15 lpm via NRB. Duh
That's great, but without seeing the thought process and rational it is very difficult to convince adult learners initial education was flawed.
18G
Paramedic
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I personally would not have been real excited over this patient and screaming "shock" based on the info presented so far.
As far as the blood pressure I always try to ascertain a baseline and look at the medications the patient is taking to determine if there is an acute change in BP and if so to what degree.
A B/P of 100/70 is on the low end for most people and would be cause to increase your awareness of the patients perfusion status but in and of itself it isn't gonna make me get excited.
One important point about assessing blood pressure is don't just look at the systolic value. In a patient experiencing a compensatory response with arterial vasoconstriction your gonna see an increase in the diastolic value and have a narrowing of the pulse pressure (difference between systolic and diastolic) which occurs pretty early on. 100/70 is low but the pulse pressure is ok and doesn't indicate the arterial side is constricting to maintain perfusion. This isn't always absolute but is something to assess always.
A pressure of 114/96 (pulse pressure of 18) would be concerning to me in a bleeding patient. It appears to be a decent pressure but in the grand scheme of things its saying something else.
To the OP... it sounds like you jumped the gun by a long shot. Calm down, ASSESS your patient, and understand that L&S rarely ever saves an amount of time that makes any difference in patient outcome.
Nursing homes are a unique little playground. Learn the dynamics of the nursing homes you go to frequently and be assertive in getting the staff to get you the information you need to establish your patient's baseline. If your not assertive, 9 out of 10 times your not gonna get it just by asking the CNA or nurse in the room when you get there.
As far as the blood pressure I always try to ascertain a baseline and look at the medications the patient is taking to determine if there is an acute change in BP and if so to what degree.
A B/P of 100/70 is on the low end for most people and would be cause to increase your awareness of the patients perfusion status but in and of itself it isn't gonna make me get excited.
One important point about assessing blood pressure is don't just look at the systolic value. In a patient experiencing a compensatory response with arterial vasoconstriction your gonna see an increase in the diastolic value and have a narrowing of the pulse pressure (difference between systolic and diastolic) which occurs pretty early on. 100/70 is low but the pulse pressure is ok and doesn't indicate the arterial side is constricting to maintain perfusion. This isn't always absolute but is something to assess always.
A pressure of 114/96 (pulse pressure of 18) would be concerning to me in a bleeding patient. It appears to be a decent pressure but in the grand scheme of things its saying something else.
To the OP... it sounds like you jumped the gun by a long shot. Calm down, ASSESS your patient, and understand that L&S rarely ever saves an amount of time that makes any difference in patient outcome.
Nursing homes are a unique little playground. Learn the dynamics of the nursing homes you go to frequently and be assertive in getting the staff to get you the information you need to establish your patient's baseline. If your not assertive, 9 out of 10 times your not gonna get it just by asking the CNA or nurse in the room when you get there.
Sasha
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Assertiveness doesn't change the "I don't know, this is my first night with this patient"
18G
Paramedic
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Sure it does.
Being assertive means that the CNA or nurse in the room goes and finds the charge nurse or goes to the nurses station and copies the information from the chart and brings it to me.
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Aidey
Community Leader Emeritus
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If I attempted to get a chart myself they would be on the phone with my supervisor faster than I could spell the patient's name. I have never seen a place that had the charts in an open area where anyone could walk up and grab one. If it is sitting on the tabel in the room, sure I might snag it, but I'm not going to go to the nurse's station and start pawing through stuff.
18G
Paramedic
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When I'm assessing and treating my patient it's not my job to "get off my butt" to go get the chart. For one, I am not "on my butt" since I am actively doing my job and trying to put the pieces of the puzzle together to figure out what is wrong with the patient. And I don't make it a habit of leaving my patient once they are under my care.
After almost 20yrs of experience in dealing with nursing homes on a regular basis, the charge nurse does know how to get the information I need from the chart. You just have to clue them in on the importance and they get it.
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