First Call by Myself

[Veneficus]

What if the patient went into a seizure and while falling hit her C2 or C3 and injured them. What would be one of the outcomes?
Inability to breathe using chest muscles or diaphragm. Therefore, she would not be breathing. Could this cause cardiac arrest? Yes. Would C-spine stability help this patient? Most likely..

You are such an optimist, I like that.

But let me offer something more likely.

If the patient actually had cord or phrenic nerve damage with paralysis of the diaphragm, c-spine or not, the outcome is a vent dependant, perhaps quad who will lay in a nursing home until she dies from complications of a decubitus ulcer or pneumonia.

 

[JJR512]

Oh' and to clear up on the text book it's Prehospital Emergency Care 9th Edition chapter 10 Airway Management, Artificial Ventilation, and oxygen. It's not a CPR titled chapter, but it does deal with CPR. It is also mentioned ina couple other chapters, but I sold my book back to the school so I don't have it for chapter reference anymore. Just the mybradykit website.

This all may very well be perfectly true. But I did say, "Therefore, there is no chapter for it in my EMT book." The book you are talking about is not my text book. And no, I do not mean it's not the actual one that's sitting right next to me right now—I wouldn't be that childish. I mean it's not the same title and/or edition. You see, a big part of my point was that clibb should not be telling me (or anyone else) what I'm thinking about, or what's going on in my class, or what my book says, when he has no way of knowing what's going on in my mind, he's not in my class so he doesn't know what has or hasn't been discussed, and he doesn't know which book I'm using—just as you don't. So don't tell me what's in my book if you don't even know which book I have. They are not all the same.

 

[JJR512]

clibb, I hope you can realize that it's not you, personally, that I don't like. What I dislike is being misunderstood, especially if someone wants to argue with me over something I never said. And I also dislike people tell me (or anyone else) what I'm thinking or wishing.

So I hope the part of this thread where you interpret feelings I never expressed, and my defense thereof, is concluded. I hope you can agree to move on from that. Because now, I am very interested to see what, if any, response you have to what Veneficus has just said. He has raised an interesting point and I am interested in seeing what discussion stems from it, and perhaps learning something.

 

[NetMatrix]

This all may very well be perfectly true. But I did say, "Therefore, there is no chapter for it in my EMT book." The book you are talking about is not my text book. And no, I do not mean it's not the actual one that's sitting right next to me right now—I wouldn't be that childish. I mean it's not the same title and/or edition. You see, a big part of my point was that clibb should not be telling me (or anyone else) what I'm thinking about, or what's going on in my class, or what my book says, when he has no way of knowing what's going on in my mind, he's not in my class so he doesn't know what has or hasn't been discussed, and he doesn't know which book I'm using—just as you don't. So don't tell me what's in my book if you don't even know which book I have. They are not all the same.

Trust me I wasn't attacking what you said about the EMT book. I was stating what was in my book which is a new book to the market for EMT. I know not all EMT books have CPR items in it. I was making a point on what you said about CPR being required to do the EMT class and that's how it was with us, but that didn't happen and OUR book had CPR stuff in it. That's where I was going with what I posted. I agree 100% that yes you should know CPR before getting into the class, but with us it didn't happen like that. I just put on here what book I had to use in case anyone wanted to take a look at that book to see what all it had to say.

 

[JJR512]

I don't necessarily agree that one should need to know CPR before getting into the class. I understand why the curriculum is set up that way, though, and it has more to do with the curriculum designers trying to find ways to cram more information into the course without increasing the number of hours it takes. They did that by taking other parts out, like CPR, and making them prerequisites instead of core components.

The book you're using is designed to meet NREMT-B standards. The book I'm using is designed to meet US-DOT standards. There's a member of my station who became an EMT-B in California, and she used the same book you have. I only got a look at it once, but noticed it had a lot more info and detail on the different breath and lung sounds. I would actually like to get a copy of that book, partly because I plan to take the NR test right after I'm done with my class, and partly because I think one can learn more when one studies from more than one source. It's a lot more expensive than the book my system uses, though.

 

[NetMatrix]

I don't necessarily agree that one should need to know CPR before getting into the class. I understand why the curriculum is set up that way, though, and it has more to do with the curriculum designers trying to find ways to cram more information into the course without increasing the number of hours it takes. They did that by taking other parts out, like CPR, and making them prerequisites instead of core components.

The book you're using is designed to meet NREMT-B standards. The book I'm using is designed to meet US-DOT standards. There's a member of my station who became an EMT-B in California, and she used the same book you have. I only got a look at it once, but noticed it had a lot more info and detail on the different breath and lung sounds. I would actually like to get a copy of that book, partly because I plan to take the NR test right after I'm done with my class, and partly because I think one can learn more when one studies from more than one source. It's a lot more expensive than the book my system uses, though.

I like the book personally. Yes it has a lot more information in it, and there is some information in there that I think is pointless. Like with Environmental Emergencies it has 2 pages about being struck by lightening, but all it is really telling you in those 2 pages is what month is worse, what day of the week is worse, and a whole bunch of other things. Then again all text books has some information in there that just isn't needed in my personal opinion. I learned a great deal from that book, and from the instructor. I enjoyed being int hat class, and now January 19th I have to take the state test that I'm doing a little bit more studying for just to be 150% prepared for that test. I have full confidence that I'll pass the state test with out any problems, but still have to study.

 

[dixie_flatline]

Just a quick note - and I hate to fan any flames since we've gotten fairly well away from OP's original premise, but in my EMT class in Anne Arundel Co MD, we were specifically told never to perform CPR on a cot/stretcher. If necessary, the patient is rolled over and a short board inserted underneath them. (I don't believe AACo has the luxury of AutoPulses like Howard does.)

 

[JJR512]

Just a quick note - and I hate to fan any flames since we've gotten fairly well away from OP's original premise, but in my EMT class in Anne Arundel Co MD, we were specifically told never to perform CPR on a cot/stretcher. If necessary, the patient is rolled over and a short board inserted underneath them. (I don't believe AACo has the luxury of AutoPulses like Howard does.)

Yeah, they didn't have them when I was there, but that was four years ago. At least not that I ever knew of or heard about, anyway.

When and where did you take your class? Who was your instructor? What station are you with? I was at Ferndale (34) back in 2006, took EMT with Nina Totaro, Russ Zachary, and Jack Hulet as the instructors.

 

[Sassafras]

Hmmm, our class was US DOT guidelines as well, but we had CPR and it did say not to use the cot. It recommended short board or long board. I specifically remember our instructor saying "now this is what your books says, but in all reality if your patient craps out while on the stretcher you aren't going to unstrap him, roll him and stick a board under him. You are just going to start compressions".

My first cardiac arrest I went as a newly certified FR and the team called for the long board as well. It enabled them to continue compressions until the 1 second maneuver to lift him onto the cot then compressions continued again. We do not have an auto pulse though and I would honestly have no idea what to do with one as I've never even seen one.

 

[JohnsFutureWife]

I have two comments, both based on the parts of your quote that I highlighted.

1. "diffubilater" This has got to be the bestest misspelling of defibrillator that I've ever seen.

2. Why was the patient put on a long board? Doesn't seem indicated to me.

What if the PT fell before she stopped breathing and went into Cardiac Arrest. It wouldn't hurt to take precautions and immobilize. If I didn't know the MOI/NOI exactly I'd immobilize to be on the safe side.

 

[firemedic07]

What if the PT fell before she stopped breathing and went into Cardiac Arrest. It wouldn't hurt to take precautions and immobilize. If I didn't know the MOI/NOI exactly I'd immobilize to be on the safe side.

id use the board because it would make it easier to do compressions. but if the pt. dfo on my stretcher im not gonna unstrap em and waste time. thats one of them nice things to have if you have the resources and time. and equpiment avaliable at that time,

 

[legion1202]

Yep it's a life threatening situation. It would be documented on the paperwork as a trauma.

I`m going to just go ahead and say it since everyone is beating around the bush... Did you dream this since you were studying your emt book?

 

[Veneficus]

I`m going to just go ahead and say it since everyone is beating around the bush... Did you dream this since you were studying your emt book?

Since technically all trauma is medical in nature, it is either a basic mistake or a very advanced level of thinking.

A thrombolitic event like an MI is caused by physical damage of the coronary vasculature.

Embolisms are also traumatic by definition.

Aside from these examples, the seperation of trauma and medical is strictly a memory aide which artifically seperates that which is not.

 

[legion1202]

You are right but I do not think he was applying that. From different protocol books that I have read they define trauma pretty good... You usually have a MOI with a trauma... Like Bullet entering chest.. Meteorite falling on someone.. A fall can even be a MOI and equal a trauma. A medical would be something that the body would do to its self. Like a blood clot in the head or AAA.. Something other then direct outside causes (I would think).

Yes a medical could be a trauma if that fall caused a punctured lung.. But from what i`ve learned... A Trauma "CALL" would have to have some MOI.. You could also have a medical resulting a fall... equaling now a trauma

 

[Veneficus]

You are right but I do not think he was applying that. From different protocol books that I have read they define trauma pretty good... You usually have a MOI with a trauma... Like Bullet entering chest.. Meteorite falling on someone.. A fall can even be a MOI and equal a trauma. A medical would be something that the body would do to its self. Like a blood clot in the head or AAA.. Something other then direct outside causes (I would think).

Yes a medical could be a trauma if that fall caused a punctured lung.. But from what i`ve learned... A Trauma "CALL" would have to have some MOI.. You could also have a medical resulting a fall... equaling now a trauma

forgive me, but you are trying to refute an intensive medical concept with EMS protocol books?

The more you learn about medicine, the more insignificant the seperation is. The pathology is exactly the same. Not surprisingly, the treatment options and modalities are also the same.

 

[legion1202]

If you want to debate medical terminology with a P2 student find another student to debate with you. All i was trying to say is via text books, some protocol books, instructors, etc.. In EMS... There is a difference for a medical call and a trauma call.

Maybe your right with further training there inst a difference.

Off of what this guy said your going to C-collar, backboard someone with a asthma attack that was brought on by a severe cold...Not a Trauma which I refer to as a fall or a shooting.

I`m not saying I think you are wrong because you are Right.. A MI is a trauma towards the body its self... I am not a cardiologist so I will not know the MOI of this sudden MI.. This is a medical condition to me...

 

[Veneficus]

If you want to debate medical terminology with a P2 student find another student to debate with you. All i was trying to say is via text books, some protocol books, instructors, etc.. In EMS... There is a difference for a medical call and a trauma call.

Maybe your right with further training there inst a difference.

Off of what this guy said your going to C-collar, backboard someone with a asthma attack that was brought on by a severe cold...Not a Trauma which I refer to as a fall or a shooting.

I`m not saying I think you are wrong because you are Right.. A MI is a trauma towards the body its self... I am not a cardiologist so I will not know the MOI of this sudden MI.. This is a medical condition to me...

Wasn't trying to argue, just wanted to see if I understood your position.

 

[legion1202]

Like I said I agree with you and it is a very clever way of thinking... Happy holidays!

 

[EMT-IT753]

In our area, ALL patient's that we are performing CPR on, are secured to a longboard and then put on the cot. Is it possible to perform adequate compressions on just the stretcher mattress? Possibly, but they are much better when done on either a longboard or short CPR board.

Also, as far as the OP responding to a call without having completed his EMT course- BIG DEAL. As long as a person is CPR qualified that is all that really matters. Around here, that type of call would have been coded as an ECHO response and anyone with training would have been expected to respond.

Call me a "whacker" or whatever you feel, but I would have and have responded to several situations exactly like the OP did. My department, co-workers, and the patients' families were all thankful for the quick response. To sit and nit-pick on everything the OP did and said on here is really pointless. Are there that many people on here with the "holier than thou" attitude?

I enjoy coming to this site but my instructor has told me many times, " If you ever get the ParaGod attitude, I will personally kick your tail." It seems there is a lot of that mentality on here at times. How about instead of criticizing everyone, try to encourage newcommers and offer a little praise?

 

[jjesusfreak01]

The only difference between trauma and medical calls are the treatments for specific conditions. If there is possible spinal injury, they get immobilized. If they meet trauma criteria, they get sent to a trauma center. There's no reason to argue the difference between trauma and medical calls.