almost there....

Wow. I didn't realize my last post was in May. oops.
It has been way too busy lately, but we are close to the end of class so I should be able to breathe soon. It has been an interesting 2 months. Our instructor resigned a few weeks ago, citing medical and personal issues. So the last few lectures have been split up among various people who have been assisting with teaching.

I'm almost done with clinical time. Maybe 40 hours left, give or take a bit.
I'm in Phase 3 in my ride time. hopefully I'll get into Phase 4 next week. I have to have everything done and turned in by 8/11. Our PSE is 8/12.
I can't believe I've been in this class for almost a year now. I REALLY can't believe that i'm gonna be a paramedic in a month. I'm just hoping i can continue improving with my ride time and get signed out.

It's been an interesting few months with ride time.
Since i've been in phase 3, I've had 2 DOA's, several BLS runs, several routine ALS runs, a few sign-offs. Monday i got to do a transfer that had Dopamine running and then tuesday we had a disabetic wake-up.

The DOA's were pretty obvious. The first one, we were told on dispatch that the Pt had expired 20 minutes prior and the family wanted it confirmed. He was in bed, ART, hooked up the monitor, Asystole in all 3 leads, disconnected, talked to PD, talked to family, and went on our merry way. The other one came in as a possible unattended. We got there, went into the bathroom, and there he was. Buck naked, doing a backbend over the toilet with his head and shoulders crunched into the corner next to the tank, complete with cold, moist skin, and lividity from the shoulders up and the calves down.
My preceptor sent me in the bathroom with the monitor to confirm the guy while he talked to the family. As my preceptor was talking to the family, telling them that the man was dead and answering their questions, I put the guy on the monitor, turned it on, and... Oh Mylanta, I see a PVC! And another one. And then what looks like a run of V-Fib. I'm looking at our Pt. who is obviously dead as a hammer and looking at the monitor which appears to have a workable rhythm. WTF is going on here? I'm nowhere near the leads and the guy is obviously not moving, so I did what any level-headed paramedic student in my situation would do. I semi-urgently called out my preceptor's name. He promptly showed up at the bathroom door as i was printing out the strip. He looked at it, got a slight pucker-factor look about him, looked from the leads to the monitor, and said, "Let go of the monitor for a second." I did and lo and behold, there appeared the asystole that matched the obvious state of the Pt. Turns out that if you put a Lifepak 12 on the bathroom sink, hook it up to a dead person, and then steady said Lifepak 12, the minute movement of the moniter produces PVC and V-fib look-alikes. I knew you could produce such artifact by playing with the leads, but i wasn't moving the leads. I just had my hand on the moniter. Good to know for next time though.

This past friday i was riding with my preceptor at another agency he works for (he works for a busy, city-based agency where i mainly ride and also an agency in a small village with a decent sized coverage area, but much less call volume.) We had a cancelled MVC in the Wal-Mart parking lot, then we got called mutual aid a few districts over for another MVC, this one a roll-over with 3 pts. We arrived just as the primary rig of the agency we M/A'ed to was getting ready to leave. They told us that they had the younger girl and the mother, and that our pt, the 17 y/o girl who was driving was right over there on the backboard, ready to go. So we got her loaded up and headed for the trauma center. She wasn't really hurt, which was amazing after I saw the damage to the SUV that had rolled at least twice and was barely visible from our position on the road, but due to the rollover and the speed and everything, we went to the trauma center. Her only complaint was a seatbelt burn. It was a pretty uneventful ride, we just chatted and stuff along with the usual BLS work-up.

After that we had a Difficulty breathing call which went pretty smoothly. Routine ALS, Duo-neb treatment, O2, half-hour wait at the hospital. when we got there there were 4 ambulances already there. we got inside and couldn't even get in the ED because there were 3 stretchers ahead of us. So we got to sit there for a half hour, 40 minutes until a bed opened up.

Monday, I was riding in the city. It was a pretty calm day, call-wise. We had a BLS pt. who had fallen out of her wheelchair and was stiff and sore because she was on the floor for an hour or so.
Then we got called for a transfer from the hospital in the next city north of us down to the ped's ICU about 30-40 miles away for an 18 y/o girl on Dopamine. That kind of raised our eyebrows. We picked her up and the Dopamine was on a pump, so I didn't really get to use it, but i did some med math with it. The math I came up with said 30 mcg/kg/minute. I thought that was a little high. Then i realized i forgot a decimal point in the mg/mcg conversion. Oops. Good thing the pump was giving the drugs and not me. That's a med math mistake I won't make again. She was really only on 3 mcg/kg/min.

Then yesterday (Tuesday) we had a few calls. We started the day out with an unresponsive Diabetic. "Sweet!" I thought. The whole way there I was plotting out my Course of Action. Got to the house and the family met us outside and told us that he was pretty bad. They found him on the floor, "barely conscious and moaning". I got inside and he was showing classic hypoglycemia signs. Pale, cool, very diaphoretic, and he had a GCS of 4/2/4. I had the EMT check the vitals, my preceptor put on the monitor, and i went for the IV. That's when it took a short downward spiral. It was relatively low light in the house, but I found a decent AC. The first IV needle i picked up fell out of the needle gaurd onto the floor. I picked it up and started looking for a place to set it down out of the way. I started reaching towards the used alcohol prep to set the needle down and my preceptor thought i was going to wipe it off and use it. He said "Do NOT reuse that thing!" to which I replied, "I wasn't planning on it." I grabbed another 18, I got a good flash on it, but it wouldn't advance, so there's negative IV x 1. Dammit. We did use that for a Chemstick with showed a blood sugar in the low 40's. My preceptor then said, "Let's get him out of the house and into the rig and we'll try again." We got him out to the rig into some better light and promply found a pipe of an AC vein which I hit with an 18 ga., no problem. Pushed an Amp of D50 and 5 minutes later the guy was bright eyed, bushy tailed, A&Ox3, etc. etc. I love D50. It never ceases to amaze me how fast people come around when they need that stuff and get it. We transported him without any problems. Once we turned him over, my preceptor asked how i felt that call went. I told him "Could have been better, could have been worse." He said "Yeah, you're right. A couple things: That first IV was just atrocious (which i did agree with). First i thought you were going to use the one you dropped, then you had problems with the one you started in the house. The one in the rig was just about perfect though." He then proceeded to tell me that it's best to get the Pt. out of the house and into the rig, which is a more controlled environment. What irritated me was that I totally agree with that and that's been my game plan all along. I've ridden with a few medics who have spent over half an hour in the house of a Pt. doing the IV and everything else. Personally, I prefer to get them in the rig ASAP especially if they have a serious issue going on, that way I have all my stuff right there and I'm "on my own turf" where it's a lot more controlled. The fact that I got some tunnel vision going on and forgot that really irritated me.
He also pointed out the fact that I forgot to put the guy on O2. We did put him on O2 pretty soon after we got to him, but my preceptor was looking for me to point out specifically that we needed it, instead they put him on it without my saying anything. There wasn't any delay in him getting it, but i did overlook it right off the bat. Just gotta remember, BLS before ALS, and ABC's always start out BLS. What really irked me about that call is that if i had done better on it, that call probably would have put me into Phase 4. Oh well. Hopefully we can get there next week.

All in all, i'm doing pretty well. My IV technique is really improving. I was pretty close to earning the nickname "Bloodbath" and I also had an ER nurse threaten to put a tourniquet around my neck. Up until recently, my IV's had a tendency to bleed all over the place. Mainly because i'd forget to take off the tourniquet, then i'd take the needle out of the cath before i was ready to put on the line or the lock. I've got that all figured out now though and they are getting alot cleaner and a lot more organized. And I now remember to take off the tourniquet right after i advance the cath. The only other issue i really have is "The leadership role". It took me some time to get used to the idea of walking in and taking control of the call and treating my preceptor like an assistant, but that's what he wants. He wants me to delegate tasks, etc. I'm getting better at it though. The diabetic call started out great in the leadership department. It's a shame that some of the other stuff kinda went a little downhill. It all worked out though and no one got hurt, so that's a good thing and a learning experience.

The past several calls (the BLS calls and the Routine ALS calls, anyway), we've gotten in the rig with the Pt. and he has said "let me know if you need anything" and he sits down in the captains chair. Most of the calls we've had, he hasn't had to jump in and add anything, so that's good. It's kind of nerve-wracking at times, but I figure that if i do something wrong or miss something, he'll jump in.

So yes, I have until 8/10 to get this stuff done. Hopefully it continues to go well and improve and hopefully I can rid myself of tunnel vision. The nice thing is that i'll be riding with another ALS provider with QVA for a while before i start riding as the Lead ALS. It won't be one of those deals where I ride a few shifts and then get thrown in as the only ALS provider. Or so I hope, anyway. Knowing my luck, the first call I go on solo will involve a black cloud and an elevated pucker factor.

In other news, I might have a new job soon. I took the civil service exam for a job with County Dispatch. I scored in at Numero Uno on the Civil Service exam and then I passed the typing/info entry test pretty smoothly. I got a canvas letter, sent it in, and I had an interview Thursday of last week. 2 available jobs, 4 people interested in those 2 jobs. My interviewer said that I was the only person who had dispatching experience (When i was younger I did some dispatching for the volunteer ambulance agency i used to run with) plus i've got 7 years in the fire service and 5 as an EMT. Plus I've worked days, evenings, and nights before and am willing to work any shift. He said that they would be making their decisions this week and they'd let me know either way. It would be cool to have that job. It would make paramedic be a part time job for now, but that's ok.
So I will keep you all posted about the progress on that job.
In the meantime, be safe and have fun.