Rubber meets the road tomorrow

rhan101277

rhan101277

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Well I start my ambulance rides tomorrow, then the next day it is off to the ER for my 10 hour shift. I am pretty excited about it, our instructor is very strict but I like it. He says he doesn't just want to just give people a breeze through, because what if it is his daughters on the side of the road?

Anyhow only 7 people passed (out of 17) the test we took tonight, it was on diabetic emergencies and allergic reactions. Plus other stuff we already covered. It was 90 questions. I mad a 87 I am pretty happy about it.

Anyway I just wanted to post, I have been talking months about going to do this and here I am 2 months into the course. It is definitely not a breeze.
 
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Hastings

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rhan101277 said:
Well I start my ambulance rides tomorrow, then the next day it is off to the ER for my 10 hour shift. I am pretty excited about it, our instructor is very strict but I like it. He says he doesn't just want to just give people a breeze through, because what if it is his daughters on the side of the road?

Anyhow only 7 people passed (out of 17) the test we took tonight, it was on diabetic emergencies and allergic reactions. Plus other stuff we already covered. It was 90 questions. I mad a 87 I am pretty happy about it.

Anyway I just wanted to post, I have been talking months about going to do this and here I am 2 months into the course. It is definitely not a breeze.
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I'd be happy with an 87 too.

Enjoy the rides. I always had a blast. Remember to - after they show you how things are done - to take an active role and make every attempt to participate. Ask if you can do the assessments, etc. Even if you bomb it, it's cool.
 
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rhan101277

rhan101277

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Hastings said:
I'd be happy with an 87 too.

Enjoy the rides. I always had a blast. Remember to - after they show you how things are done - to take an active role and make every attempt to participate. Ask if you can do the assessments, etc. Even if you bomb it, it's cool.
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These are 911 emergency calls, I am really not sure how much they will let me do. I am just going to do the best that I can. Tomorrow I am going to be there two shifts worth because I am the only one signed up for tomorrow.
 
Sasha

Sasha

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My preceptors sat back and said:

Youre running all the calls. Im not saying a word or getting you a thing unless you ask

On 911 calls. Why did he do that? That is the only way you learn. If the patient was super critical, he took it but I still got to attempt all the skills (almost got to do an IO once, but I wasnt comfy with it so I didnt )
 
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Shabo

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Talk to the staff on you clinicals (amb or ER) and ask questions. Once they know that your sincerely interested they will seek you out when something interesting comes in. I've had nurses that would come find me for stuff when I was assigned to another section of the ER.

As for the 3rd rides 1st impressions mean a lot. Be early, ask questions, be ready to help, and above all ASK TO HELP. The faster the medic gets comfortable with you, the more they will let you do. I learned more on 1 shift being put in the lead position then I did on all of my other clinicals combined.

Good luck.
 
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Hastings

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rhan101277 said:
These are 911 emergency calls, I am really not sure how much they will let me do. I am just going to do the best that I can. Tomorrow I am going to be there two shifts worth because I am the only one signed up for tomorrow.
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I'm not talking about the technical skills, like intubating, starting IVs, Defibrillating, or even lifting the patient. But assessment is something that IS safe for a student to do, and something you should be asking to do.
 
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rhan101277

rhan101277

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Thanks for everyone's input, I woke up a little early. Time to go back to bed and get a couple extra hours sleep.
 
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apagea99

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Awesome stuff! I hope you get a chance to use all you've learned.

I can't wait to get to where you are now......
 
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rhan101277

rhan101277

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Well I did clinicals from 7am until 10pm tonight. I was assigned to a ALS truck with a driver who was also in my class. We had 4 calls, I think only one or maybe two will count towards my five.

911 calls:

68 y/o not breathing, in route we found he hasn't been breathing for over a hour and a half. We get there and he is obviously passed away, we run a EKG strip, check for heart sounds, lung sounds. Also checked his pupils and you could tell they were dried up. I didn't get to do much because this guy was passed away already and it was a small room with a lot of family around. This guy also had CHF and h/o lung cancer.

82 y/o seizure, get there at the nursing home. She is not seizing anymore more. She is AOx2, she can move her limbs fine. We get her on the stretcher and in the back of the ambulance. She has a history of diabetes and other things. Her blood sugar is 98 mg/dL, she has a-fib on the EKG with history of a-fib. Blood pressure is good, the medic gets a IV in her and we get her to hospital

Transport:

83 y/o from the hospital back to the nursing home. His breathing is labored and shallow due to is COPD. He is sitting up incline in the stretcher to help his breathing. Since his system is using hypoxic drive due to his COPD issue, we put him on a cannula at 2L/min. I check his breath sounds.

6 y/o critical care transfer. We meet a children's hospital jet at the airport and load in the crew. Head to the hospital. Child had vomited several times and then seized and became un-responsive. He was on a automatic ventilator, you could set tidal volume etc. on it, the flight crew did all this. I think he was pretty well sedated, his heart rate was 106bpm which is good for ped, but is BP was 90/52, after the call I asked the medic about this and he said the sedated probably did this. I imagine they had him sedated so he wouldn't fight the tube, apparently his breathing on his own wasn't sufficient. Anyhow all the tests done up at the hospital turned up negative. It was rough seeing the parents upset, hope I can find out if he was ok.
 
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Hastings

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Sounds like a pretty typical first day. It sounded like a good experience, even if it wasn't the "most exciting."

How hard did your heart start beating when you got that call for patient not breathing?
 
V

VentMedic

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rhan101277 said:
This is what the medic told me. Due to him having COPD he is not able to get appropriate gas exchange. So when he breaths his CO2 doesn't go down as it should normally. Then the backup 02 is looked at, this is why you can't put them on high flow 02 for hours, they may stop breathing. If this stuff is wrong let me know.
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Review COPD and hypoxic drive as well as how many COPD patients are actually CO2 retainers.
 
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Jon

Jon

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rhan101277 said:
Yeah I am reading up on it, I guess the only way to know for sure is a blood gas test.
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BINGO!

If the patient is in respiratory distress - they get O2.


EDIT:

PS:
Vent - Can capnography help?
 
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