The anxiety-driven kiddo is back. The one who posted a month ago (check post history if you're curious)

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lolwhatarewedoing

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I did end up passing my EMT course with a 98% and my NREMT a few days ago at 70 questions. Y'all were truly right that I had nothing to worry about. Though, I do have a concern.

At the end of the course (after we all passed the NREMT psychomotor), we were all basically given "death" scenarios. Basically, these scenarios basically were extremely complicated and all of our patient died one way or another. For example, my simulated patient presented with diffuse abdominal pain. Naturally, I decided to palpate his abdomen. Immediate pain relief. Flatline and pulseless a few seconds after. Did 3 rounds of CPR before the instructor said "you can stop now" and said "there's no way you could have known that abdominal pain only was due to an aneurysm. Your patient had an AAA that you ruptured when you palpated."

That stung like a *****. Had that been a real patient, a brother, boyfriend, father, or whatever would have lost their life leaving their loved ones in shambles. Due to my stupidity.

My friends also got death scenarios but handled it quite well emotionally. They said "welp, it is what it is" What am I missing?
 
lolwhatarewedoing said:
I did end up passing my EMT course with a 98% and my NREMT a few days ago at 70 questions. Y'all were truly right that I had nothing to worry about. Though, I do have a concern.

At the end of the course (after we all passed the NREMT psychomotor), we were all basically given "death" scenarios. Basically, these scenarios basically were extremely complicated and all of our patient died one way or another. For example, my simulated patient presented with diffuse abdominal pain. Naturally, I decided to palpate his abdomen. Immediate pain relief. Flatline and pulseless a few seconds after. Did 3 rounds of CPR before the instructor said "you can stop now" and said "there's no way you could have known that abdominal pain only was due to an aneurysm. Your patient had an AAA that you ruptured when you palpated."

That stung like a *****. Had that been a real patient, a brother, boyfriend, father, or whatever would have lost their life leaving their loved ones in shambles. Due to my stupidity.

My friends also got death scenarios but handled it quite well emotionally. They said "welp, it is what it is" What am I missing?
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What your missing is just experience, specifically the difference of when to use empathy and when to use dark humor and deflection to deal with no win scenarios or patients
 
lolwhatarewedoing said:
I did end up passing my EMT course with a 98% and my NREMT a few days ago at 70 questions. Y'all were truly right that I had nothing to worry about. Though, I do have a concern.

At the end of the course (after we all passed the NREMT psychomotor), we were all basically given "death" scenarios. Basically, these scenarios basically were extremely complicated and all of our patient died one way or another. For example, my simulated patient presented with diffuse abdominal pain. Naturally, I decided to palpate his abdomen. Immediate pain relief. Flatline and pulseless a few seconds after. Did 3 rounds of CPR before the instructor said "you can stop now" and said "there's no way you could have known that abdominal pain only was due to an aneurysm. Your patient had an AAA that you ruptured when you palpated."

That stung like a *****. Had that been a real patient, a brother, boyfriend, father, or whatever would have lost their life leaving their loved ones in shambles. Due to my stupidity.

My friends also got death scenarios but handled it quite well emotionally. They said "welp, it is what it is" What am I missing?
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That's the most ignorant scenario I've ever heard of. Borders on hazing if they were actually serious.
 
lolwhatarewedoing said:
I did end up passing my EMT course with a 98% and my NREMT a few days ago at 70 questions. Y'all were truly right that I had nothing to worry about. Though, I do have a concern.

At the end of the course (after we all passed the NREMT psychomotor), we were all basically given "death" scenarios. Basically, these scenarios basically were extremely complicated and all of our patient died one way or another. For example, my simulated patient presented with diffuse abdominal pain. Naturally, I decided to palpate his abdomen. Immediate pain relief. Flatline and pulseless a few seconds after. Did 3 rounds of CPR before the instructor said "you can stop now" and said "there's no way you could have known that abdominal pain only was due to an aneurysm. Your patient had an AAA that you ruptured when you palpated."

That stung like a *****. Had that been a real patient, a brother, boyfriend, father, or whatever would have lost their life leaving their loved ones in shambles. Due to my stupidity.

My friends also got death scenarios but handled it quite well emotionally. They said "welp, it is what it is" What am I missing?
Click to expand...
Not sure what the point to such a scenario would be, other than a sense of superiority for the instructor.
 
lolwhatarewedoing said:
At the end of the course (after we all passed the NREMT psychomotor), we were all basically given "death" scenarios. Basically, these scenarios basically were extremely complicated and all of our patient died one way or another. For example, my simulated patient presented with diffuse abdominal pain. Naturally, I decided to palpate his abdomen. Immediate pain relief. Flatline and pulseless a few seconds after. Did 3 rounds of CPR before the instructor said "you can stop now" and said "there's no way you could have known that abdominal pain only was due to an aneurysm. Your patient had an AAA that you ruptured when you palpated."

That stung like a *****. Had that been a real patient, a brother, boyfriend, father, or whatever would have lost their life leaving their loved ones in shambles. Due to my stupidity.
Click to expand...
You know what a AAA is? they are ticking time bombs. And even if you do everything right, the patient might still die. It's not your stupidity, you did your job. and if you hadn't palpated it, you don't know what you would have missed and your instructor would have killed the patient because you didn't palpate it... it was a lose/lose situation, and doesn't really help you become a better provider.

Let me me give you an example from my past, ~15 years ago of a patient who actually had a AAA...

I was doing a shift with a 2 person paramedic flycar; we were dispatched for an unconscious person, and when the BLS ambulance got there, the patient was conscious, but every time the patient was sat upright, he passed out.. history of smoking, but quit years ago. BP was tanking, pulses were not in sync on each arm and we were 20+ minutes from the nearest hospital on a good day. Alex, who was the treating paramedic, one of the better clinicians and experienced providers I had worked with, said he suspected a AAA, but remember, a AAA is a ticking time bomb, so our options were limited. Anyways, he started 1 IV in the right arm with 1L of fluid, while his partner did another IV in the left arm. We actually stopped halfway through the transport, so they could grab extra bags, just in case they administered all of the fluid.

And what happened? We made it to the hospital, with nothing eventful happening. It was a Level 1 trauma center, with some of the best surgeons in the state... Alex gave his report to the doctor, and we transferred care. I think he was in the ER for maybe 10 minutes before he was wheeled up to surgery.

We dropped off another patient a few hours later at the hospital... ER attending said our AAA patient died on the operating table.

Moral of the story: when it's your time to go, even if you do everything right, and the stars all align, and you have the best clinicians doing everything they can, when it's your time to go, there is nothing in modern medicine that can change that.
 
DrParasite said:
You know what a AAA is? they are ticking time bombs. And even if you do everything right, the patient might still die. It's not your stupidity, you did your job. and if you hadn't palpated it, you don't know what you would have missed and your instructor would have killed the patient because you didn't palpate it... it was a lose/lose situation, and doesn't really help you become a better provider.

Let me me give you an example from my past, ~15 years ago of a patient who actually had a AAA...

I was doing a shift with a 2 person paramedic flycar; we were dispatched for an unconscious person, and when the BLS ambulance got there, the patient was conscious, but every time the patient was sat upright, he passed out.. history of smoking, but quit years ago. BP was tanking, pulses were not in sync on each arm and we were 20+ minutes from the nearest hospital on a good day. Alex, who was the treating paramedic, one of the better clinicians and experienced providers I had worked with, said he suspected a AAA, but remember, a AAA is a ticking time bomb, so our options were limited. Anyways, he started 1 IV in the right arm with 1L of fluid, while his partner did another IV in the left arm. We actually stopped halfway through the transport, so they could grab extra bags, just in case they administered all of the fluid.

And what happened? We made it to the hospital, with nothing eventful happening. It was a Level 1 trauma center, with some of the best surgeons in the state... Alex gave his report to the doctor, and we transferred care. I think he was in the ER for maybe 10 minutes before he was wheeled up to surgery.

We dropped off another patient a few hours later at the hospital... ER attending said our AAA patient died on the operating table.

Moral of the story: when it's your time to go, even if you do everything right, and the stars all align, and you have the best clinicians doing everything they can, when it's your time to go, there is nothing in modern medicine that can change that.
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Well glad we don’t treat AAAs like that anymore.
 
Tigger said:
Well glad we don’t treat AAAs like that anymore.
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Since I'm out of the loop, how do they get treated? because I went to https://emedicine.medscape.com/article/1979501-treatment#d10, and the site said the following:
Patients older than 50 years with sudden onset of abdominal pain should be presumed to have a ruptured AAA and should receive attentive airway management and vigorous fluid resuscitation, as indicated. However, in patient with ruptured AAA, permissive hypotension is preferred where the systolic blood pressure is deliberately made lower than normal while still maintaining vital organ perfusion is preferred.
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is there a better treatment prehospitally?
 
Not giving liters of fluid to the bleeding patient is the better treatment, despite one article saying “aggressive fluid resuscitation.” The patients can and should be left hypotensive to the degree possible. No hemorrhage patient benefits from multiple liters of normal saline, it creates coagulation issues and hypothermia.

Thankfully prehospital blood continues to expand in availability.
 
E tank said:
No patients benefit from multiple liters of NS...
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In my goal to be contrary and find an exception... Burn patients.
 
PotatoMedic said:
In my goal to be contrary and find an exception... Burn patients.
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Crystalloid is a finicky thing in general...Normal Saline is anything but normal...If I'm anticipating giving anyone more than 2 liters (extremely rare) it's Plasmalyte or Normosol, and those just to prime a rapid infuser device. In my experience those two make managing the acidosis/hemodynamics of catastrophic blood loss so much easier even than with LR. NS is poison. In the pre-hospital setting where IV fluid resuscitation has become less of a factor, I think EMS's have moved back to NS just because not a lot is indicated any more and it's good enough and cheap. Don't know what San Francisco is doing these days but in the 80's/90's it was plasmalyte and a lot of it.
 
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Carlos Danger said:
Even their fluid requirements are often exaggerated and exceeding them significantly can be very detrimental.
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E tank said:
Crystalloid is a finicky thing in general...Normal Saline is anything but normal...If I'm anticipating giving anyone more than 2 liters (extremely rare) it's Plasmalyte or Normosol, and those just to prime a rapid infuser device. In my experience those two make managing the acidosis/hemodynamics of catastrophic blood loss so much easier even than with LR. NS is poison. In the pre-hospital setting where IV fluid resuscitation has become less of a factor, I think EMS's have moved back to NS just because not a lot is indicated any more and it's good enough and cheap. Don't know what San Francisco is doing these days but in the 80's/90's it was plasmalyte and a lot of it.
Click to expand...
Yeah pasta water isn't good for much besides making pasta.
 
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