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  1. Gurby

    Thinking about being a Paramedic

    Paramedic -> MD here (surgery). I think Emergency Medicine as a field has a lot of problems. Burn out is high, compensation is trending down, there is an over-supply of EM doctors and more and more PA/NP's are staffing ED's in rural areas and eating up those jobs, pressure from admin to see more...
  2. Gurby

    EMT Wrist Watch - Taking Pulse with No Second Hand

    Or check pulse for 6 seconds and multiply by 10 to get in the ballpark.
  3. Gurby

    Thoughts on this EKG?

  4. Gurby

    Continuing my career with marfans?

    Ignoring a diagnosis of Marfan syndrome will lead to an earlier ending, (from ruptured aorta). There have been a lot of advances in medicine and surgery and a lot can be done for these patients to allow them to live long and fulfilling lives. I was...
  5. Gurby

    Continuing my career with marfans?

    People with Marfan's can live long, happy, reasonably healthy lives. Average life expectancy is not that much lower than general population. Yes, you will need to take blood pressure meds, will likely need to have your entire aorta replaced with goretex sometime during the next 40 years, and...
  6. Gurby

    Continuing my career with marfans?

    Aortic dissection is what I would be most nervous about, with regards to heavy lifting / EMS work:
  7. Gurby

    Continuing my career with marfans?

    Life expectancy with Marfan's is ~70 years these days, though you're probably in for a lot of big cardiac/vascular surgeries to make it that far. Unfortunately, one of the things you really want to avoid with Marfan's is straining as you would do with lifting heavy weights. EMS often involves...
  8. Gurby

    Is Smoking Part of Medical History?

    I think you were correct back then, but technically correct now. It depends on the context. Yes, when charting, smoking goes in the social tab. But it is often relevant enough that it should be thrown in along with other PMH in your handoff: "55m w/PMH TD2M, HTN, 50 pk/yr current smoker...
  9. Gurby

    Coronavirus Discussion Thread

    That fatality rate is creeping up though, at 1.8% across the country now. NYC was holding at 0.5% for quite a while but now they're up to 1.6%. I remember reading somewhere that in China it was taking around 14 days on average from symptom onset to death, in those who will die. I'm worried...
  10. Gurby

    Coronavirus Discussion Thread

    I can say that my SHTF closet is going to be filled out quite a bit more in the future. I feel like this pandemic has made me acutely aware of how close we are to anarchy at any given moment. People have been literally fighting over toilet paper. My local grocery store is completely unable to...
  11. Gurby

    Coronavirus Discussion Thread

    Thanks for writing this all out, this side of the argument feels a lot more reasonable to me now. My hospital is getting hit pretty hard, and the panic in the press makes it easy to forget that the sky is not falling everywhere.
  12. Gurby

    Coronavirus Discussion Thread

    What should the country do, if not lock down? Do we shrug and say "oh well, guess a bunch of people will just have to die" as the virus burns itself out? How are hospitals supposed to handle the surge of patients? I think I asked the same questions a while ago, and you said the virus wasn't...
  13. Gurby

    Coronavirus Discussion Thread

    Excellent, this hits it right on the nose.
  14. Gurby

    Coronavirus Discussion Thread

    I wonder if you guys believe this is real yet? My small, rural hospital is absolutely getting smashed, and half of our nurse+physician staff is out on quarantine for possible exposures. We have only had a couple confirmed positive patients so far and it's already a mess. There aren't enough...
  15. Gurby

    Coronavirus Discussion Thread

    You work in a hospital right? Is your facility not being affected by this? How do you think the US government should respond?
  16. Gurby

    Resp failure ift pt

    When in doubt about whether you should take a transfer that seems over your head, IMO you should call medical control. Push the liability onto someone higher up the food chain. Let the MD decide whether the transfer is appropriate or not.
  17. Gurby

    premptive strike on the NREMT

    Make flash cards of info you want to remember from class, and review them every day.
  18. Gurby

    QI can be heartbreaking

    As a partner of mine used to say... Some people are just meant to dig ditches...
  19. Gurby

    NREMT Paramedic 5th attempt, need help!

    I always recommend people find a tutor. It's always worth it to sit down with someone 1-on-1 who can evaluate your thought process and see where your holes are. Ideally it would be better to find someone in real life - if you're working as an EMT-B right now, maybe you could find a medic that...
  20. Gurby

    Treatment for patient with Moderate hypothermia and Major Frostbite

    2 hours is plenty of time to call medical control and see if they have any comments/questions/concerns.