the 100% directionless thread

[fma08]

So you shouldn't give aspirin to patients with asthma because it can trigger a asthma attack? Is that right? If they are having chest pain and you suspect a MI not asthma can you still give it or no? I have read some books that say asthma is a contradication for aspirin and others that haven't mentioned it!

The theory (from what my teachers said the other week) is that due to the block in the prostaglandin production pathway, there is increased leukotriene production.. LTC4 D4 and E4 aren't really helpful to those with reactive airways.

 

[Aprz]

Heh, I remember in paramedic school, we were doing patient's assessments. I know that I am going to be tested using the National Registry format so I was going by that, and the paramedic instructor dinged me because I didn't attempt to give aspirin after the patient stated their chief complaint "chest pain". I said brought up Samter's triad, told him that I should at minimum at least ask the patient if they are allergic or have any sensitivity to aspirin prior to administering it. He disagreed with me saying I should always give aspirin. I also brought up that per the National Registry format, I need to wait until after the initial impression prior to providing any treatment unless it fixes immediate life threats, which he also disagreed.

Same instructor disagreed with me when I wanted to push calcium chloride IV in a patient who already had labs done K+ 6.9, z-folds / sine waves on the monitor, and was in pulseless not breathing. He wanted me to go through ACLS algorithm administering epinephrine, do chest compressions, and transport. He told me he did this on a real patient, and the patient survived.

His friend advised me not to push 150 mg Amiodarone IV over 10 minutes in a patient with ventricular tachycardia, not enough time for that. His friend also told me to give dopamine wide open and titrate based on how the patient tolerates it, not a time to calculate the drip rate or look it up in the charts that they provide us in the protocol booklets. He also told me "Welcome to street medicine".

So many bad memories in paramedic school. <_< Gotta make sure to keep my mouth shut during my internship. I'll do my best to mimic my preceptor, but I still kinda feel like I am struggle to pass. I actually did keep it shut during my clinicals, but still managed to get in trouble in other ways, ugh. Called in sick to clinicals, but somebody claimed they saw me at work that day, and my preceptor refused to believe me or look at my schedule showing that I called in sick to work too. Preceptor thought I wasn't very personable, that I'd be a great flight medic because most of patients would at least be vegetables and I probably wouldn't have to talk with them. :\ Only good thing she had to say about me was "clinically sound".

Which all of this reminds me... I hate seeing 911 units because after almost four years of being an EMT (three working in the field), I still can't get a 911 job. 911 EMTs get almost x2 the pay a IFT EMT makes here. I've studied so hard and put so much effort into this field, and it has definitely not paid off. Very dissatisfied. I want to blame others, blame the 911 companies, as the reason why I haven't gotten hired there, but it's likely me. I'm doing something wrong. Or I just tell people it's a lottery. I frequently feel like quitting and starting fresh with a different field, I feel like I need to give up this mistake sooner than later. I wasn't bad at programming before this. I still seem to remember some stuff. I stay cause I do like the subject, I feel like I know my stuff, and I do enjoy wearing a uniform, being in an ambulance, and I do like driving red lights and sirens (I know it's not safe, I know it doesn't save time, but to me, it's still fun... probably cause I do it only once in 1-2 weeks). I'm good at many things though. Just because I can play the piano does that mean I should be a pianist? No. I dunno.

 

[chaz90]

One hopes this comment in JEMS about "What one item in your kit could you not live without?" is a joke. So many things wrong with a single sentence...

 

[Anjel]

One hopes this comment in JEMS about "What one item in your kit could you not live without?" is a joke. So many things wrong with a single sentence...

Wow... You use a 14g that much? You're an *** hole then. I've never used one. Could of but used a 16 or 18 instead.

 

[Aprz]

I've read that there really is no correlation between the size of the needle and pain ie using a 14-gauge isn't more painful than using 20-gauge. Truth?

 

[Anjel]

I've read that there really is no correlation between the size of the needle and pain ie using a 14-gauge isn't more painful than using 20-gauge. Truth?

I can tell the difference between the 16g when I donate blood and the 22 when I get blood drawn in the doctors office. 14gs are like coffee stirrers.

 

[Anjel]

I can tell the difference between the 16g when I donate blood and the 22 when I get blood drawn in the doctors office. 14gs are like coffee stirrers.

14gs have their place. But I could live without it.

 

[lightsandsirens5]

I've read that there really is no correlation between the size of the needle and pain ie using a 14-gauge isn't more painful than using 20-gauge. Truth?

Personally, when I am blindfolded and stuck, I cannot tell a 22, 20, 18, 16, and a 14 apart. I got curious during medic school, so I got my classmates to practice on me.

 

[Handsome Robb]

I put a 14g in between a dudes hand a pointer finer a few weeks back back after he punched my partner in the face and spat on me.

I'm against vindictive medicine, but...he asked for it.

 

[DrankTheKoolaid]

Fail......

 

[DrankTheKoolaid]

I've read that there really is no correlation between the size of the needle and pain ie using a 14-gauge isn't more painful than using 20-gauge. Truth?

I would imagine that has to due with the number of nerve ending per sq in in the area bring stuck.

Because I am positive if you stick your finger tip with a 24ga vs 14ga you WILL know the difference

 

[Handsome Robb]

Fail......

Yea, probably wasn't the nicest thing to do. Not a habit or something I'm proud of. We could've pressed charges and stuck him with a multiple year prison sentence instead...

 

[Aprz]

I would imagine that has to due with the number of nerve ending per sq in in the area bring stuck.

Because I am positive if you stick your finger tip with a 24ga vs 14ga you WILL know the difference

Lets do an unofficial EMTLife blind fold experiment.

Good point about the number of nerve endings in a given location, but I'm still not entirely convinced actually. I'm trying to think about how I perceive pain. When I get a cut or puncture, location matters, that's true, but I'm not really sure if size matters. There is like a jolt initially, and then kinda of a throbbingness afterward sometimes. It's not like the part that is damage is the only part that hurts, the pain radiates around the injury usually, and usually where the pain radiates seems to hurt more for me, and where the damage actually is just feels funny/odd if I touch something, if I put pressure on it, may make another jolt and temporarily worsen the throbbingness.

Anyhow, I am more interested in being able to tell the difference in needle size in more common locations like the hand, forearm, and antecubital, may be interested in less common locations like the feet, subclavian, and external jugular.

How ironic that some paramedics may be trying to inflict more pain on a patient by using a larger needle size, but in reality, the patient may not even be able to notice a difference. The paramedic doesn't get the desire outcome, and they just end up looking like a (censor).

 

[DrankTheKoolaid]

Lol we actually studied this in physiology.

Simply take 2 sharp objects and poke yourself simultaneously. Then spread them apart and repeat until you can discern 2 separate pokes.

Now do the same in another part like your fingertip and see how closely they can be for you to feel the 2 needles.

That is why you would be able to tell the difference is needle gauges.

But you go first driving that 14ga into your finger tip


Since I just read your post remember you will also feel the stretch not just the poke itself

 

[Aprz]

Lol we actually studied this in physiology.

Simply take 2 sharp objects and poke yourself simultaneously. Then spread them apart and repeat until you can discern 2 separate pokes.

Now do the same in another part like your fingertip and see how closely they can be for you to feel the 2 needles.

That is why you would be able to tell the difference is needle gauges.

But you go first driving that 14ga into your finger tip ��


Since I just read your post remember you will also feel the stretch not just the poke itself

Did you guys have somebody else poking you to do this? I would like to do this. Obviously I won't have somebody puncturing my skin. Just pushing on it to feel using likely a very dull needle/stick, maybe something like a pen without ink.

 

[DrankTheKoolaid]

Yeah with our eyes closed

 

[Aprz]

For the fingertip, if not simultaneously poking, you think somebody could tell the difference? What about for the hand, forearm, or antecubital? Sometimes it's really easy to notice differences when you are comparing side to side (or feeling at the same time), but not when they are side to side. I have a twin, and people can't tell the difference when we aren't together, but when we are together, they can spot all the difference "Oh, he's a little taller, he has a birthmark there, his hair is slightly longer", etc.

 

[DrankTheKoolaid]

Try it out on different areas and check it out. It was a bit surprising when we did it. And it made perfect sense why we don't need to discern small points in areas such as the thighs

 

[Aprz]

And when will AMR San Mateo start hiring again? Hahaha! I should've applied the first time, but thought I had (Santa Clara) County EMS for sure. That's what I get for putting all my eggs into one basket.

 

[DrankTheKoolaid]

Keep checking the website for sure, it's a great crew and we have lots of very bright and experienced people.