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Confessions of an EMS Newbie

Confessions of an EMS Newbie is a weekly podcast for beginning EMS providers. As Ron goes through paramedic school he’ll sit down and discuss what he’s learning with experienced Paramedic and writer Kelly Grayson. Anyone new to being an EMT will enjoy getting the strait scoop and accurate information from someone who has been there over and over. Ron’s perspective as knowing next to nothing means we’ll keep it understandable and practical.

Latest Episodes:

75 Real Medic Stuff Now Jan 17, 2012

Show notes

(45:44) We’re back from a long break and the Newbie has been busy. Ron started his clinical internship and have now done 4 24 hour shifts with one crew at the Harris County Emergency Corps.

He’s learning a lot, here’s some of the thing Ron and Kelly talk about:
How to use the IV cath right
How to do CHART. I now understand it and even take notes in it.
Running calls. Lasted about 30 seconds in my first call.
Turns out it was likely a AAA( Or was it? Listen to Kelly’s comment), but it was seizures with a fall to start and I just didn’t know what to do.
Vs ran my first MVC yesterday and did pretty good. A little too much scene time. Not enough delegation.
My preceptor is really good. She reviews calls after I run them, gives good feedback. Let’s me beat myself up only so much.
Also gives me homework. Quizzing me on my ALS.

Calls:
1/6 = 6
1/12= 3
12/29 = 6
1/4 = 6

Started my new job.
Service is really different.
Big difference between a 2 paramedic truck and a Paramedic/Basic truck.
Kelly do you do truck chores? Or is that all on the other guy?
New experiences there:
System status management.
Working 12 instead of 24.
Going to prison.
Not having 2 level 1 trauma hospitals at your beck and call.

Sorry for not keeping up with the show, but as you see Ron and been doing something every day. Now we’re both on weird EMS schedules, so expect Newbie will be on a weird schedule too. Not more releasing on a particular day, because we may not be able to record on a regular one.

Get complete information on the The Confessions of an EMS Newbie Podcast.
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74 The Final Final Dec 19, 2011

Show notes

(21:58) Ron goes through his final final and some skills testing. No more lectures, no more teacher’s dirty looks.

What I Did This Week

Clinicals

Paper work. What a pain.

Mentions:

Bob Page on Stethoscopes

Listener Questions

I had originally planned to contact Kelly directly, but then realized his answer would probably be useful for EMS Newbie fans as well.

Hey Kelly, I know that you’ve blogged on this topic many times and I’ve got a quick question for you. Since you’re apt to transport some rather sick (yet not entirely time sensitive) patients without lights, sirens, and guns a blazin’, do you sometimes still describe your transport as “emergent” when giving radio report to ensure the receiving staff understands that the patient is sick? It would sure be nice to trust that painting a clinical picture would be enough to alert the nurses that they should plan on placing the patient a corner or hallway, but having spent a lot of time working in the department, I fear the staff would sometimes be too busy and distracted to pick up on less overt signals. Even with a fairly obvious description, our nurses are often multi-tasking while taking radio report, and it would be very easy to assume: “The patient can’t be that sick, I didn’t hear any sirens and they’re non-emergent.” As always, thanks for the podcast,
– Vince

Hi Ron, hope you are well. I was just wondering if either you or kelly had heard of the ‘lethal triad’ with regards to trauma and whether this was something that you guys were being taught about on your course or whether you thought it should be?

Warm regards from a cold england
Jamie

On the GI symptoms relating to anaphalaxis, I had heard that people with a new food allergy will often go through a progression of allergy symptoms to a certain stimulus before reaching full-blown anaphalaxis, often starting with GI symptoms. My understanding was that they would consume the food and have nausea, vomiting and/or diarrhea but not necessarily an airway issue, so it might be written off as “bad food” or stomach bug or something similar. Next time they ate that food, maybe they had worse GI symptoms but still did not connect the issue. Eventually it progresses up to true anaphalaxis with airway issues. Have y’all heard anything similar? Andaew – Hey, In regards to stethoscope is there really a difference from a low end stethoscope and a high end stethoscope? If there is a difference how much of a difference is it and would it be worthwhile purchasing a higher quality stethoscope? Get complete information on the The Confessions of an EMS Newbie Podcast.
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73 Environmental Emergencies Dec 12, 2011

Show notes

(29:40) Ron has his last lecture of paramedic school and it is about Environmental Emergencies.

What I Did This Week

Medical Emergencies

Environmental Emergencies
Heat
Cold
Do you have a low temperature thermometer?
We’ll see hypothermia in Houston because there are lots of ways to have it happen, but she said not going to see frostbite. Then my wife posted to FB it was snowing in Abilene.
Drowning
Fresh vs saltwater
Fresh washes away surfactant.
Since salt water is osmotic, do you risk hypovolemia?

Special Populations

Final review

Clinicals

Final paperwork

Mentions:

ALTE University of Chicago

Listener Questions

Hey Kelly and Ron. Or is it Ron and Kelly? I’ve been following he podcast since the beginning as I was starting EMT B right after Ron. It was a cool experience to go through the class while listening to Ron’s show at the same time. Now I am half way through P school. My school is segregated in to thirds. Didactic-Clincals-Externship (intern). Unfortunately I have become extremely unmotivated during my clinicals. I know this is an important part of the learning process but it’s really dragging me down. I know the general answer to many issues is to “man up”, but I was wondering if this is common and if you have any advice on making it through this phase. In my EMS experience there is nothing I dislike more than working in an ER. I really appreciate the folks who can spend a career in there.

Russell

Could y’all talk about ALTE’s? It relates to the blue baby that resolves prior to EMS arrival. After having one of these, I did research on it and it apparently can be a precursor to SIDS. Our protocol mandates that we always, always, always transport these kids due to that risk. Is this related to the cardiac conditions Kelly discussed, or is it different?

We discuss airway obstruction beyond the vocal cords.

What was your first Oh $#!T moment as a EMT and as a paramedic What did you learn from it? – Andaew Michael wrote:
Kelly, Are you one hundred percent positive that 250 mLs of D5W has the same of amount of dextrose and D50. My math shows that 250 mLs of D5W would have 12.5 g of dextrose (glucose). Just curious. Get complete information on the The Confessions of an EMS Newbie Podcast.
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72 Hematology and Burn Out Dec 05, 2011

Show notes

(33:54) Blooooodddd, maybe this should have been the halloween episode. Ron learns about blood diseases. Its also scary how burned out everyone in class is getting at this point. Only 3 weeks to go.

Ron gets his textbook changed. He also gets an EMS job, find out what’s scary about that on this week’s episode.

What I Did This Week

Got something added to the new addition of Paramedic Care, Testicular Torsion

Had a Job interview – I got the job

Medical Emergencies

Another test. Are they trying to trick us?

Special Populations

Skills lab – Which do you think is the most challenging skill when testing?

Airway lab

Clinicals

Giving Glucagon IM when you can’t get a vein for Dextrose

Christine asked about it. Someone on FB asked about it.

I had an interesting situation with Oral glucose when we could’t get a vein.

Listener Questions

Please help settle a debate that has torn my partner and I apart. We’ve argued in many different hospitals, stations, and nursing homes about pushing D50 through an IO. It’s not actually a situation we run into often; I think we just like to argue.

One of us argues that pushing D50 via IO is practically a guarantee that the patient will lose a limb. The other thinks we would have heard about all these limbs going necrotic by now, and that it would be discussed in EMS more or perhaps popping up in a new protocol.

Thanks in advance,
James

Hi Ron and Kelly. I have an answer, a question and a comment for you all.
The answer to the question Kelly was asking on episode 66 is the McMartin Preschool trial, which took place in California.

The question is I am an EMT student and our program has just released us to do ambulance ride alongs. What are the best things I can do to have an effective ride along experience and help, rather than hinder my preceptors?

Finally the comment- I’ve been listening to your podcast since episode one and it, along with your can do approach is a significant reason why this 40 something guy believed that it would be possible to become an EMT.

Thanks and keep up the good work!

-Marc

Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.

71 2011 Texas EMS Conference Nov 28, 2011

Show notes

(27:30) This week Ron and Kelly podcast live from the 2011 Texas EMS Conference. They discuss the different lectures and sessions they attended, which were good, which were packed so full of information it was tough to keep up and which left the brain as soon as the feet left the room.

There’s talk of C-PAPP, the number one reason of geriatric altered mental status, another episode of “This week in firearms”, retrograde intubation, and the new myths of EMS by Dr. Brian Bledsoe.

Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.

70 Toxicology and Abuse Nov 21, 2011

Show notes

(42:15) Ron and Kelly talk about overdoses and antidotes, how to deal with calls that have signs of domestic abuse, and we hear that Ron’s white cloud, may be getting a bit more grey…

What I Did This Week

Medical Emergencies

*What are typical overdoses?*
Do you carry any antidotes?
Warming activated charcoal?
Carry ipecac syrup? Use it?
Given/use Flumazenil for Benzodiazepines OD?
Cyanide anti-dote kit?
Huffers use gold paint.
CO-oximetry?
Procardia – not given because people would OD it in gel tablet sublingual.
Calcium Channel we give calcium to fix
Beta-blockers we don’t give beta-agonist
Why?

Special Populations

Abuse

Clinicals

Lots of calls. Last EMS. Funny crew.

Mentions:

Harris County Emergency Corp

Listener Questions

This a random question for Ron: Do you plan on advancing any further once you get your paramedic? Like maybe to a PA or nurse, or go the route Kelly took and specialize in a particular branch of EMS?I’m still loving the podcast!
-EMS FREAK Get complete information on the The Confessions of an EMS Newbie Podcast.
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69 NICU and Geriatrics Nov 14, 2011

Show notes

(24:42) Ron and Kelly talk about the upcoming Texas EMS conference, Syncopal episodes in geriatric patients, the rainbow of newborns and why or why not there can be male L&D nurses.

What I Did This Week

Medical Emergencies

Had a test. Don’t know what I made, but still improving.

Special Populations

Geriatrics
What’s the most common reason you see for syncope in older people?
How obvious do you see the signs for a CVA?
Transporting TIAs?

Clinicals

NICU
Still no vaginal birth
Saw 3 C-sections
Baby color
NICU nurse who said, “I can’t be an L&D nurse. Moms are too picky.”

Mentions:

Listener Questions

My name is Danny and I work for BC Ambulance in British Columbia, Canada. I am a Primary Care Paramedic, which roughly aligns with an EMT in terms of qualifications. I listen to your podcast weekly and heard your appeal for more listener questions. I gave it some thought and came up with the following.
—–
In school I was taught “wet side down” in reference to packaging a trauma patient with a penetrating chest wound. Also, we have protocols that state a patient with a pneumothorax should be positioned affected side down. I’m not sure, but I think the rationale to support this thinking is, keep the good lung up so it is in the best position to promote ventilation and, therefore, has the best chance of oxygenating the body.
While I was in the ED at our local hospital, I observed a doctor drain 2 liters of fluid from a patient’s lung. The doctor began asking me patho questions. He wanted to know how I would position his patient for best perfusion. I bumbled through the “wet side down” theory, thinking it applied to this situation.
He had no time for the affected lung down theory. He graciously explained how the bad lung should be positioned up in order to allow the greatest blood flow to the good lung. He talked about shunting… how the ineffective lung was still receiving oxygen poor blood, but was unable to oxygenate that blood. Positioning the good lung down ensured the greatest amount of venus blood flowed past the good lung, increasing the percentage of total blood oxygenation.
—–
I was hoping Kelly could comment on the “wet side down” way of thinking and why one might choose that patient positioning.

Also, it would be interesting to hear a comment regarding when your protocols do not align with good thinking or sound statistics. Examples of this might be 30 to 2 cpr compared to uninterrupted compressions or using D50 rather than D10 in the hypoglycemic patient. It’s hard for me to think about doing something that is detrimental to my patient in the name of following our treatment guidelines.
– Danny

Also, can I get some suggestions for pulse oximeters, what are some tips you have when someone either has fingernail polish or other problem with there finger. Would a toe work? I have seen the side of a finger. Maybe an ear? Any suggestions would be greatly appreciated.

Love the show,
Sam

On the podcast, Kelly said something about EMS shouldn’t do CPR on
traumatic arrest patients. Last week, a girl stabbed 20 times, who
arrested three times en-route, was discharged today. Given this story
shouldn’t EMS do CPR on traumatic arrest patients?

http://www.seattlepi.com/news/article/Doctors-describe-teen-stabbing-victim-s-injuries-2242373.php
Timothy

Since you said you haven’t had many listener questions, i figured i would ask one for the heck of it. Here in west michigan, we are serviced by AeroMed flying a Sikorsky S-76, (Apx. 52ft in length, with a 44ft wingspan.) From what i’ve been told, it’s pretty darn big for a Medical Chopper. What do you usually see down there, and what are the advantages for a large chopper and for a small one?
Thanks! – Ryan Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.

68 Kidneys and Geriatrics Nov 07, 2011

Show notes

(42:07) This week we talk note taking technologies, nephronology, bio-chemistry, greek god’s wooden parts, and army medics. Kelly also points out lucrative markets for lawyers in EMS that might change it for the better.

What I Did This Week

Ron wwitched note taking and recording technologies. Livescribe to Evernote

Medical Emergencies

Nephronology
1% per year after 40
Dialysis
Acetamenophen and alcholol and there is a drug/hormone/enzyme given to handle it.
Missing testicular torsion
Greek good Priapus
I’m Dr Google’s assistant

Pharmodynamics – PD – drug on the body
pharmacokinetics – PK – body working on the drug, ADME – Absorption, Distribution, Metabolism, Excretion 28:00

Special Populations

Geriatrics
This is going to be if not already is our biggest patient population
Do you does drugs different on a regular basis based on patient age?
DNR bracelets – lack of understanding in EMS?

Clinicals

None, but I did pick the person I want for my clinical internship.
And I applied to work for a service here in Abilene.

Mentions:

Evernote
Livescribe Smartpen
GEMS – Geriatric EMS
FAST 1
Fort Sam Houston Military Medical Education and Training school
Texas DNR law

(i) Out-of-Hospital DNR Identification devices. As an optional means of identification, a patient may obtain, at patient’s expense, an OOH-DNR device. An OOH-DNR device, as approved by the Department of State Health Services, must meet the following requirements:
(1) An intact, unaltered, easily identifiable plastic identification OOH-DNR bracelet, with the word “Texas” (or a representation of the geographical shape of Texas and the word “STOP” imposed over the shape) and the words “Do Not Resuscitate,” shall be honored by qualified EMS personnel in lieu of an original OOH-DNR order form.
(2) An intact, unaltered, easily identifiable metal bracelet or necklace inscribed with the words, “Texas Do Not Resuscitate – OOH” shall be honored by qualified EMS personnel in lieu of an OOH-DNR order form.

Listener Questions

My second topic is, I have worked with a few people who have either ridden along or have gone on the call while volunteering with a fire department where they have been kicked of the rig for one reason or another. Either it be misconduct, or freezing up on a scene. Have you ever had to kick anyone off your ambulance for their actions or misconduct and why did you do it? – Joseph I was wondering about online paramedic schools and your thoughts? – Phillip Do they teach medics how to do a FAST 1? I would assume it’s not much different from using an EASY IO, but, i figured i would ask. – Ryan What do you guys think of EMS providers carrying a concealed handgun on their person while responding and providing care. As Firearm enthusiast do you Cary or have you considers carying while on the truck for self defense.

67 Gastro Intestinal Distress Nov 01, 2011

Show notes

(44:59) Kelly has an abdominal complaint just for the show, so Ron tries not to make him laugh.

What I Did This Week

Medical Emergencies

Gastric emergencies
What’s the most common gastronomic complaint you see? Phergan vs Zofran
What’s the most common missed gastro complaint? Kidney stones

Special Populations

Test and scenarios

Clinicals

Road with CCEMS
Different services, different methods.
Different catheters
Always drive in the left lane
Turn off siren when blocked at intersection
Bad Question
“What can you do?” Legally? Competently?
“How long have you been doing this?” Don’t ask this right after someone screwed up.

Mentions:

Benign Paroxysmal Positional Vertigo
Bledsoe practitioner levels

Listener Questions

Can good multitasking skills be learned?
Timothy Kelly made a comment about attending a seminar called fever is your friend. Do you then reccommend people not to take ibuprofen?
what did the doctor giving the seminar say?

What about volunteering my services as an EMT? Recently I worked the Chicago marathon on the medical team. It was amazing. But the following week I volunteered for another smaller marathon and wondered what you guys had to say about volunteer emt work.

It would also be interesting to know if you had any resources for volunteering abroad as an EMT?

I was wondering about online paramedic schools and your thoughts?
– Phillip

I love the show. I see that you haven’t had a lot of questions so I figured I would send a few of them. I plan to go to paramedic school after leaving the army and I know that you have been in the business for a while, so I was curious if you have any tips or suggestions on what you have done in the past to prepare for interviews with EMS agencies. What are the things that you have seen candidates do that makes them unattractive to hire?

Joseph Baker

Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.

66 More Pediatrics Oct 24, 2011

Show notes

(29:26) What I Did this week:

Medical Emergencies
Tests and scenarios

Special Populations
Dextrose IO?
How do you recognize child abuse?
Most common household substance for pediatric poisoning?
Meningitis exposure. If you treat a patient you get treated?
Cushing’s triad metaphor
Bandaging the neck by running it under the arm

Clinicals
None but a volunteer shift and my busiest shift ever
Baby turns blue then goes back to pink, then codes

Tetralogy of fellot
Blue baby syndrome – Jules Scadden at the Texas EMS Conference in November.

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