Confessions of an EMS Newbie

83 Newbie JD Meyerdirk Aug 29, 2012

(23:49) Ron’s not going to be a paramedic in the near future so we are talking with some other newbies. JD Meyerdirk is getting ready to start paramedic school and we sit down with him to talk about it.

We also talk about Kilted to Kick Cancer a lot. It starts September first and Kelly’s got another contest with even more great prizes.

Mentions:

Kilted to Kick Cancer
Kilted to Kick Cancer Texas
Livestrong
Prostate Cancer Foundation
BlueCure
Alt Kilt
Kilt This
Blinn College

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82 NREMT-P Jun 29, 2012

(25:00) Despite many many failures, Ron has finally come to the end of his Paramedic training experience. This week he retook the skill he failed, and took his NREMT-P cognitive exam. Listen to find out the results.

What I Did This Week

On Saturday I went to the ALERT Academy in Big Sandy Texas and retook my pedi-vent skill. A very nice female paramedic gave me a test prep book. Which I only had one day to use and didn’t really get all the way through it.

I really haven’t studied a lot. Took a number of tests on MedicTests.com. That was really it, and not even the number they suggested.

On Monday I took the test fully expecting abject failure. I even convinced my wife I was going to fail. I told her if I finished at 70 questions, I know I’ve failed.

Mentions:

EMT-Paramedic (P) PreTest Self Assessment and Review

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81 NREMT Skills Testing May 21, 2012

(34:56) Ron passed his oral boards but didn’t pass all of his skills. This week we talk about pediatric airways and prepping for the written exam. Also mentioned, doing drug math, paramedic test prep books and CPR HD.

Mentions:

MedicTests.com

Listener Questions

Matt asks:

I will be graduating college this coming December with a bachelors degree in Political Science and French (yes, I know my major in strange for a person interested in medicine!) I’m also hoping to be done with my Paramedic program around that same time. I’m really interested in research, what kind of opportunities are out there for EMS research?

EMS FREAK
What are some of the major differences between a rual EMS system as opposed to one set up in a major city? JP Asks:
My question is do you have to be great at math to be a medic. I really struggle in my algebra classes in high school. Through out my emt-b program I haven’t seen very much math, but will it come back to haunt me in my medic course? I appreciate any advice you guys give me and look forward to your answer. Get complete information on the The Confessions of an EMS Newbie Podcast.
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80 Not So Done Apr 13, 2012

(22:48) Well I thought I was done, but it turns out I was living an illusion.

What I Did This Week

I did not pass my orals, as a matter of fact I failed them miserably.
12 Lead and ECG interpretation
Drug Doses

Hit the stress wall and flamed out during PALS.
Failed PALS

Doses are my nemesis

Mentions:

MedicTests.com

Listener Questions

I wanted to find out more about becoming a paramedic or EMT. At what level do these positions stop being volunteer and start becoming paid positions? What training and experience is necessary to become a paid EMT or paramedic?
– Sacha Really a listener answer.
Kelly and Ron,
As an avid listener of the show, I can’t help but comment on some of what was said on the last podcast.
Firstly, any automated reading algorithm is prone to incorrectly measure the QT interval when the t wave is low voltage or biphasic. It’s important to manually check if the T wave ends past the mid-point between R waves (for heart rates about 60-100 bpm). It’s usually at this point that the QT becomes clinically significant.
Secondly, the risk of torsades with prolonged QT is exaggerated. While all patient who go into torsades have a long QT, most patients with a long QT will not go into torsades. (see Severe QTc prolongation under mild hypothermia treatment and incidence of arrhythmias after cardiac arrest–a prospective study in 34 survivors with continuous Holter ECG.Storm C, Hasper D, Nee J, Joerres A, Schefold JC, Kaufmann J, Roser M.Resuscitation. 2011 Jul;82(7):859-62. Epub 2011 Mar 15. PMID: 21482009; and Droperidol, QT prolongation, and sudden death: what is the evidence? Kao LW, Kirk MA, Evers SJ, Rosenfeld SH. Ann Emerg Med. 2003 Apr;41(4):546-58. Review. PMID: 12658255)
Third, the function of a pacemaker magnet is to turn off any sensing functions and cause it to pace at a fixed rate. This used to be how the battery was checked (the pacing rate with magnet correlated to battery charge). If the patient has an underlying rhythm, this can be dangerous because it creates the potential for an r on t. The pacer magnet is most often used when attempting to diagnose a pacemaker mediated tachycardia in an atrial sensing pacer. When the magnet is placed on a device configured as ICD only, any anti-tachycardia pacing and cardioversion functions are disabled.
Pacemaker mediated tachycardia has two common causes. The first occurs in a pacemaker that is configured to trigger the ventricles when it senses an atrial beat. A ventricular paced beat has retrograde atrial capture, which is sensed by the pacemaker as an atrial beat, so it triggers a ventricular beat that causes another retrograde atrial beat, which is sensed by the pacemaker, etc etc etc. The second occurs when the device is set for rate modulation. Some devices are configured to increase the rate of pacing when an accelerometer senses movement (eg going up stairs). If the patient is shaking from anxiety or is having muscle spasms, it can trigger the pacer to fire too fast. This theory can be tested with a pacer magnet, and treated with your favourite benzo.
—
Mat Goebel, NREMT-P
ED-EKG Liaison
Intermountain Heart Institute EKG
Intermountain Medical Center Get complete information on the The Confessions of an EMS Newbie Podcast.
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sarahAndI — **SP09 My Clinical Preceptor – Sarah Francis McClure** Mar 26, 2012
(58:06) In this episode Ron talks with Licensed Paramedic Sarah Francis McClure his paramedic clinical internship preceptor about the time they spent together.

Tell us a little about you and how you became a paramedic.
What are your memories of your own clinical internship? How do they effect how you interact with students?
You have a lot of students on your truck, what’s the biggest mistake they make? What do they do right? What advice would you give them in general?

What did you think when I asked you to be my preceptor? I’m your first right?
What do think was the biggest problem I had starting out?
What was the biggest change you saw in me?
What do I still need to work on?
What was the hardest part of being my preceptor?

What did you learn from being my preceptor? Would you do it again? What would you do differently?

Any questions for me?
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79 Finished Paramedic School Mar 20, 2012

(46:21) For Ron paramedic school is over. Finished his clinicals including getting his vaginal birth, took his department’s oral board exam and 180 question final.

Ron and Kelly noticed today that this podcast has become a lot less newbie friendly because he now understands all those terms he didn’t earlier in his school time, so we make a special effort to explain things in a new student friendly kind of way.

What I Did This Week

Assessment Based Management

Orals
Final

Clinicals

Finished Clinicals
How often do you have to wait a significant amount of time with a patient at the ER? Do you have fentenyl wear off? Do you administer more while waiting?
Birth
DKA – Kussmauls

If you are a newbie and interested in being on the show, contact us. contact@emsnewbie.com.

Mentions:

HHNK
DKA
Zofran – contraindicated with wide QT interval
Phenergan – give with fluid
Quicktrach
EMS Pocket Guide
Vagus Nerve Stimulator

Listener Questions

Christopher asks
Have you used the quick-trach and if so what was your experience with it? I used it on a recent call and was shocked at how difficult it was to insert. I was pushing in hard with both arms before it went in. Placement/location probably wasn’t the issue (ER MD said placement was correct). Matt asks:

First of all, I follow both of you on Twitter and saw that Ron passed his final, so congratulations!

I have three questions for y’all:

1) How do you tell the difference between Biot’s and Cheyne-Stokes respirations? All the definitions I’ve seen describe them as being very similar, other than the causes.

2) Do you know why Atropine when given in small doses or very slow can cause paradoxical bradycardia? I’ve asked my Paramedic instructor (who Kelly writes occasionally with for EMS World) and he didn’t know, but said he has seen it happen before. I’m fortunate enough to attend an University with a Medical School on campus and I went to their library to do some research but didn’t come up with much more information than I already knew.

The only think I could come up with, and this is purely a guess is that maybe with small dosages/slow administration of the Atropine there isn’t enough atropine (either in the total dose or concentrations of it in the blood) to fully inhibit the vagus nerve stimulation, thus lowering the HR. If y’all are interested I can send some PDF files of the studies that I read on the subject.

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78 Plug The Holes Mar 04, 2012

(35:31) Ron finally had that call he was so worried about when he started EMT Basic all those years ago. He’s almost done with paramedic school, finishing up clinicals and classes over the next couple of weeks.

What I Did This Week

Assessment Based Management

Learned from one of the instructors – stick by what you decided. Don’t doubt yourself.
The oral station on the paramedic skills test is D&D for paramedics.

Clinicals

Plugged a hole in the side of someone’s head so air wouldn’t come out.

One of my biggest fears was dealing with the super gross.

Getting good at identifying dead. Well maybe not so much.

Being comfortable. Getting aggressive.

53 calls. 265 hours.

Listener Questions

Ryan
Have you or kelly ever treated a patient with Fibrodysplasia Ossificans Progressiva (FOP)? How would you go about treating a patient? Sam:
Hey Ron & Kelly, are any of you going to be at EMS Today in Baltimore, MD. Like to meet you both, I live in Baltimore and am A Volunteer EMT here Rob asks:
“Ok I have a question then on documentation what do we mark a transgender patient as? If they look like a male but have female parts or vice versa ” Get complete information on the The Confessions of an EMS Newbie Podcast.
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77 Breakdown Feb 16, 2012

(38:42) Ron has a bit of an emotional breakdown during a clinical this week and we talk about the effects of fatigue and how you handle not knowing what to do. Also how do you know when you are ready?

What I Did This Week

Assessment Based Management

More scenarios and I’m wondering a little how much it is helping.

Clinicals

You know you are in EMS when you have to stop asking your patients what day of the week it is because you don’t know the answer.
Both days my first call was run at 0558. Walk in the door and get toned out.
Tip to other newbies, be ready when you walk in the door. Have you stuff in your pockets.

Lost it after a call on Monday.
What do you do when you don’t know what to do?

One thing from scenarios, sometimes there isn’t anything you can really do, so you just support ABCs.

Mentions:

Listener Questions

[MedicTests.com spot]

Hey Ron and Kelly:

I am a very hot-natured person. In my current A-EMT Class we are required to wear uniforms that consist 5.11 pants, a t-shirt and a uniform shirt. We are to always have both shirts on. Is there a way I can stay cool in this uniform instead of sweating like a pig in the middle of a classroom and especially during my clinicals? I have heard that Under Armour keeps you cool but I have also heard it holds the heat in. Do you have any suggestions for a fat southern boy that sweats when its only 70 degrees here in Georgia?

Thanks

Tim “Future NR-AEMT”

Andrew
Question for Kelly,
I recently purchased your book and read the chapter “Crying Wolf”. Could you explain more about the “White Lead CPR” and any other quirks that you may know about when messing with the leads on the ECG? Thanks! Ryan
Learned something new today, but wanted to hear your opinion on the matter.

Had a patient who was hyperventilating, and seeing as how we are unable to use the paper bag method, the medic decided to use a NRB on 4lpm. This method did help to slow the respiration rate from about 40bpm to around 28bpm.

Have you ever heard of doing this before, or do you have any other ideas on what one could do?

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SP08 – National Test Prep Feb 12, 2012

(26:25) This week the Newbie sets down with Joseph Storm of MedicTests.com and talks about preparing for the national registry EMT and Paramedic tests. Joe gives some really great tips on taking and passing the test. What are the most common questions about Incident Command? What is the most common acidosis question and answer? Listen to this episode and find out.

Did you know current neuroscience says studying at a certain interval makes you more likely to learn the material. Listen to find out what that interval may be.

Mentions:
MedicTest.com Blog
Brain Rules Book.

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76 Calling In Reports Jan 31, 2012

(32:01) Starting a new semester with testing. And doing medic things everyone does, but that he hasn’t learned yet.

What I Did This Week

Assessment Based Management

Tested all our paramedic skills.
The one that got the most people was Static Cardiology.
I got all the rhythms, but mess-up 2 drug doses
Also you have to treat the patient, meaning if they have a bee sting and no cardiac issue treat an allergic reaction

Clinicals

First time to call in reports to hospitals.
On the phone.
Wrote it down first

Mentions:

6 Second ECG
No Guts No Glory Blog Post

Listener Questions

peter
Hello guys. I am a teenager who is taking the EMT course in just a week. For the past 2 years I have been listening to podcasts, reading books, talking to EMTs, and other stuff to prepare me with a thirst to help others. However I watched a video in drivers ed today about a student from my high school who during his Junior year got severely injured in a car accident. In this video they interviewed the EMTs from my local EMS service, who I personally know. In that moment it hit me, I might have to see someone my age get severely inured and I became sick to my stomach, almost fainting. and doubting in the first time in over 2 years that I want to be an EMT. Do either of you ever have the same idea as me? If so what do you do about it? Thanks, EMT Soxfan
Hey there, I have an odd question maybe. I’m a super-green EMT at a fire dept. I was on one of my first shifts (24hr) and being at the station ate dinner with everyone. Shortly after the meal, when going to bed I started to get really nausiated and woke up several times to throw up. We had a call come in at 3AM-ish and I had not idea what to do. I didn’t want to be a wimp so I shut up and just went to the call, figuring it was just food poisoning anyway and wouldn’t endanger the patient. Fought back the up-slushie through the transport and threw up the second we got back. What should I have done? Was this bad EMS etiquette? Bad for the px? Didn’t know where to ask- I’m too embarrassed to bring it up at the station… Jason
Catching up on the podcast and listened to 73 where you asked about ALTE and studying for peds par of the registry. We require PEPP for our medic students when we do PHTLS and ACLS at the end of the programas refreshers going into the exam. PEPP is an all ob/peds emergency class that covers ALTE and also counts for all registry recert hours. Give it a shot its a good class. ken wrote:
great show guys. Question for you Kelly. Have you seen before any type of sticker for your car windshield that states the driver is diabetic & to call 911 if you suspect the driver is having a diabetic emergency?? I was walking into a local store and noticed a car parked in the handicapped spot having one of these stickers on the corner of the windshield on the drivers side. Ron and Kelly,
Will you two continue the show after Ron has graduated from Paramedic school? Is there a chance of a future “EMS Newbie” coming aboard? I’m starting Paramedic school myself in January, and this show has been a great resource. Thanks for all that you guys do, and keep up the good work!
Happy Holidays!,
Nate Mike
I’m another 40 something photographer that is getting into EMS. In fact I know two other photographers that are paramedics. I got my basic a year ago and just finished my intermediate. Now I want to decide between medic school or nursing school. What are some of your greatest challenges as an older student starting in a new field. Do you still plan on doing photography work once you get out of school? shannon
Dear Kelly and Ron, I noticed that you have not done Mother and Speed reference yet, which is odd considering the intro to the show. Love the show, I am an EMT in LA and have been listening for almost a year. Question for Kelly, any tips on getting published? Get complete information on the The Confessions of an EMS Newbie Podcast.
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75 Real Medic Stuff Now Jan 17, 2012

(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.

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74 The Final Final Dec 19, 2011

(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

(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

(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

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71 2011 Texas EMS Conference Nov 28, 2011

(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.

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70 Toxicology and Abuse Nov 21, 2011

(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

(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.
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68 Kidneys and Geriatrics Nov 07, 2011

(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

(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.
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66 More Pediatrics Oct 24, 2011

(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.

65 Defenses and Pediatrics Oct 17, 2011

(45:41) Lots of stuff on pediatrics and the body’s defenses. Let’s try a slightly different version of the show notes. Here’s my actual outline from the show.

From last week’s episode

Laryngospasm
Article about post op laryngospasm and management
1. succacoline does stop laryngospasm
2. ultimately they used lidocaine and did a “bilateral superior laryngeal nerve block”

What I Did this week

Medical Emergencies

Review of system defenses, mostly at the cellular level
Antigens and antibodies
Why you get a fever. An increase in temp makes bacteria unable to replicate their cell walls.
Anaphylaxis

Special Populations

Pediatrics
Continuing education: PALS, PEPP, APLS, PPC
Have you heard that sugar has a sedative effect on neonates?
“Don’t give them a glove to play with”
What do you talk to preschoolers about?
“Promote a sense of control, but don’t negotiate” – Kelly Grayson
PAT and TICLS
CUPS “We’re all good at extremes. A skilled provider is finding the middle and stopping it before it gets worse.”
EDD is contraindicated in pedi intubations
DOPE – what to check with ET isn’t working, Displacement, Obstruction (secretions), Pneumothorax, Equipment Failure
Do you use a Buratral
Foreign Body Airway Obstructions
Give St John’s a break. You do do back blows in pedi FBAO. (Responsive Infants – this isn’t under 15 months)

Clinicals

No babies being born
Kelly rants about L&D nurses.
Benydrill as a local anesthetic

Starting to review for Med Emergency exam on Monday
Tips on learning drugs and doses

Out of Side Kicks

Mentions:

Peter Gabriel – Sledgehammer video
St John’s Popcorn Video
The Management and Treatment of Recurrent Postoperative Laryngospasm (Full Text PDF)
KidO’s Bear
NIC the Dragon
Pediatric Advanced Life Support (PALS)
PEPP
APLS
ENPC – Emergency Nursing Pediatric Course
PPC appears to now be EPC
The Sexual Assault Nurse Examiner – SANE

Listener Questions

None this week, send us yours

Get complete information on the The Confessions of an EMS Newbie Podcast.
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64 Hormones Oct 10, 2011

(49:11) 2 tests two fails. Ron says, “The ICU scares me.” Kelly talks about how is GSW, first ICU patient, and first dead body transport were the same person.

In Pediatric IO how do you hold the leg? In Newborn resuscitation, using the ET for suctioning, do you use a new tube each time you go in? In the past it was “baby is pink, baby is good”, now AHA has preductal PSa02 values

Kelly learns something new, you can use alcohol to stop labor because it decreases ADH and oxytocin.

Ron studied the endocrine system this week and discovered just how many of our drugs are hormones.

Mentions:

Guillain-Barre syndrome

Listener Questions

Mike
Hi guys, I’ve got a hell of a stupid question for you 2. Since getting my EMT-B back in July, I’ve been debating whether or not to get my intermediate. My sole reason is IVs. The thought of sticking a needle in through my skin makes me cringe. I absolutely hate getting IVs and getting blood drawn. And I know that in the case of EMT-I & Paramedic courses they make you practice on each other. Having been on the receiving end of an IV catheter, and being a rediculously bad stick, I was wondering if you both had opinions as to 2 things: 1 Is it possible to get through EMT-I without having anyone stick you? I absolutely HATE and DETEST getting IVs stuck in me by experienced medical providers, let alone beginners at sticking IVs. And 2. any suggestions as to how to get over this fear? I absolutely love EMS and I want to be the best provider I can be, but I am the absolute worst patient that any medical provider would want to have.

(Side note: when I got my wisdom teeth taken out, the original plan was an in-office procedure. Well, since the oral surgeon decided to use a pedi needle on me, she missed 3 times and I had to go to an OR to get it done. Even there, 1 nurse missed in my arm, and the anesthesiologist eventually got me in the hand. Apparently my veins hide.)

Richard
My old 56 year old self went and done it. Enrolled in P school. Starts in January. In A and P now. My question is .Is there a good place for buying the books to put on a E reader type device. I am to elderly to carry around all those books. Thanks and I have gotten set up with Medic Tests as well;. Great Site. Thanks and kind regards. Get complete information on the The Confessions of an EMS Newbie Podcast.
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SP 07 Wilderness EMS Oct 05, 2011

(29:02) In Special Episode 7, Ron interviews Jeff Isaac from Wilderness Medical Associates.

Ron and Jeff discuss how wilderness doesn’t necessarily mean deep in the back country or in a cave, how the definition has changed over the years, and why WEMT is useful for all EMT and Paramedic practitioners.

Jeff is a physician assistant with a particular interest in backcountry and marine medicine. His 30 years of professional experience includes service as an ambulance and fire/rescue crewman, professional ski patroller, and medical staff in hospital emergency departments and ski area trauma clinics. He has also been a senior instructor and course director with the Hurricane Outward Bound School and has worked as mate and licensed captain aboard sail training vessels from New England to Trinidad.

Listener Questions

Bruce asks…
Most EMS personell say that WEMT is a waste…have you found that to be the attitude? Andy W asks…
Does the Wilderness EMT program cover special considerations to take during cave rescues? Caitlyn
When would wilderness protocols take effect? Get complete information on the The Confessions of an EMS Newbie Podcast.
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63 More Birth’n Babies Sep 21, 2011

(41:29) We’re talking birthing babies, vomit and poop this week. Ever seen a breech deliver? Heard the term “Macro peds”? The changing rules of suctioning meconium babies. Projectile vomiting and being covered in vomit. Kelly discusses laryngo-spasm.

Mentions:

Episode 10 – Don’t Know Nothing About Birth’n No Babies
Black Box warning from FDA on Terbutaline Sulfate for tocolysis.

Listener Questions

Hey Kelly and Ron. I’m a Paramedic Student and I was wondering what were your fears as you were going through paramedic school and even starting out as a newly minted paramedic? The biggest fear of mine is having an EMT partner look up to me asking me what to do next and me not knowing what to do for the patient. – Andrew O2 ain’t what it used to be.
We’re hearing heaps of studies come out relating to O2 therapy for cardiac issues, and increasingly for the treatment of stroke as well. What’s the deal with post-ictal patients, haven’t been able to find anything – any clues?
Cheers,
Flo Transport Jockey asked about going from a Rural to Urban service. Get complete information on the The Confessions of an EMS Newbie Podcast.
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61 Live from Las Vegas (Audio) Sep 14, 2011

(37:17) The EMS Newbie Podcast live from Las Vegas at the 2011 EMS World expo.

Thanks again to ProMed for bringing us to Las Vegas and doing a great job netcasting all the podcasts done from there.

Now on to the kilted ones.

62 EMSWorld Expo Recap Sep 14, 2011

(27:11) Ron missed the first week of school because off EMSWorld Expo, so the guys talk about what happen there. Answering questions like, “What’s the most memorable thing that happen to you at the expo?”, “See any cool gadgets at the show?” and “What’s it like to be kilted in Vegas?”

Mentions:

Ron’s Kilted to Kick Cancer Page
Kelly’s Kilted to Kick Cancer Page
Kilted to Kick Cancer
Video of EMSWorld Expo show.

Listener Questions

Hey guys –
Totally off topic, but a burning question – do you remove fishhooks?

Our medics have been doing this “forever” except there’s one small problem – it’s not in our protocols. (and apparently our medical director was livid when the paramedics & EMT-I’s admitted to doing this)

We have a rural practice – over an hour by land to a community hospital, over an hour by air to a level 2 trauma center.

I’m an Emergency Medical Responder currently, but even I realize there is a difference between a fishhook in the finger, just through the skin, and one embedded in an eye or a “true impalement” Like a shark hook in the gut.
I would like to get both your takes on this.

Thanks!

A. Ranger

Well, I must admit Ron and Kelly were my first experiences in EMS. I listened to all 60 of the podcasts before actually beginning my EMT-B class. I was originally supposed to be taking the class in March, but some technical difficulties made me postpone my actual program start date until September 27th, 2011.

Although I had considered myself fairly internet savvy, I have no experience in the blogosphere. After listening to the Newbie podcasts, I then started listening to the EMS Garage podcasts.

I see the websites of ems1.com, JEMS, Happy Medic, TOTWTYTR, but I am painfully inexperienced with the whole blog world. I have also never heard of “RSS feeds.”

The Oregon EMS conference is coming up and is actually the three days prior to my EMT-B 105/106 accelerted course beginning.

I need help connecting with the blogosphere community, especially in my area. I plan on attending the conference as a student, which is acceptable as long as I show my registration, but I will be attending before every stepping foot inside of a classroom.

I fount the OregonEms.Org’s facebook and requested to join their group.

Basically, what I need is help beginning my hopefully long-term connection with the EMS online “scene”, especially local. It would be great to connect on the internet with some of the attendees of the conference so I can have someone to meet once I get to Salem, if at the very least to give me an EMS welcome, hi, hug, or high-5. I am nervous, brand new, and have no resources. With the ridiculous amount of information I have devoured in the preceeding months, I am sure this is for me.

Please help connect me to “scene”, I know its out there, in full force.

Sincerely,
Morgan Godvin

Adam in Chicago asked about Nitro and inferior wall MIs. Get complete information on the The Confessions of an EMS Newbie Podcast.
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61 Live from Las Vegas Sep 11, 2011

We’re having some issues right now with getting our audio episodes out. There will be an audio version out of this episode, but we wanted to give you something, so here’s the video of the recording from the ProMed Network. You can read ProMed’s blog post about the EMS Newbie episode on their site.

Thanks again to ProMed for bringing us to Las Vegas and doing a great job netcasting all the podcasts done from there.

Now on to the kilted ones.

60 Licensed To Raise The Dead Aug 26, 2011

(25:57) Ron has his cardiology finals. Both the written, which was a third of my grade, and the practical which was 3% and got him his ACLS card. But it was 3% if you don’t pass, you don’t pass the course.
Now he’s asking Kelly, is cardiology really that hard?
Do you know when you are stressed out? Turns out the Newbie didn’t.

This episode sponsored by MedicsTest.com

Listener Questions

Mitchell

On the last podcast y’all talked a little about CPAP. Our CPAP protocol says to use our ETCO2 monitoring equipment which resembles a nasal cannula. I would think that using that would prevent a seal around the mask, defeating the purpose of using CPAP. What are your thoughts?

Lastly, say you have a patient with a respiration rate of 40 with a hx of COPD, and they are unable to speak in complete sentences. They have diminished lung sounds, however you can hear wheezes in the upper right lobe, slight cyanosis in their lips and nail beds, initial sat was 84% after a NRB with 10 LPM it comes up to 92%. Would you give a neb treatment to see if they improve or would you go ahead and attach the CPAP? I’m sure that I’m probably in the minority for EMS providers but my philosophy is to do the least invasive treatment which in this case would be CPAP before I begin to administer drugs.

Ron: Since you have been doing the schooling and have gone on a few calls, how has your view of EMS changed from your orginal thoughts of EMS in general? If so, what about?

Kelly: After all the years of schooling and the many calls you have run, has your thoughts or views on EMS as a whole changed, and if so, what about?

EMS Freak

Get complete information on the The Confessions of an EMS Newbie Podcast.
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59 12 Leads Aug 17, 2011

(36:47) Ron learned the basics of 12 leads finally. We also talk about equipment failure on scene, and changing stethoscopes.

Listener Questions

Newbie resource page.
3M Littmann 2632 Master Classic II Stethoscope

Listener Questions

Gary Stewart posted on Confessions of an EMS Newbie’s Wall.
“Just received my card in the mail so now I’m looking for a job in EMS. Any tips on resume presentation, job search,etc.?” Mitchell

Anyways my first question is regarding drugs for nebulizer treatments. The protocols at my EMS service for COPD/dyspnea include giving neb treatments with 2.5mg of albuterol mixed with 4mg of dexamethasone sodium phosphate (AKA: decadron). I’ve researched information on the drug but cannot find any literature on using it in combination with albuterol for nebulizer treatments. The usual EMS usage for decadron seems to be for cerebral edema, anaphylaxis, and COPD. Yet, it is given either IV or IM. It seems like the standard EMS neb treatment is albuterol and atrovent. What’s are your thoughts on using decadron vs atrovent?

What’s the deal with mean arterial pressure?
I’ve heard a map of 60 means everything is perfusing. Is it a number worth knowing or will I embarrass myself if I try to slip it into an ER report? Get complete information on the The Confessions of an EMS Newbie Podcast.
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58 CHF Aug 11, 2011

(36:33) This week Ron studied CHF and asks “Why do they call it congestive heart failure?” He also had Exam III cardiology. He and Kelly discuss how traing for a code is different for nurses and paramedics.

Last week we talked about how everyone shouldn’t get oxygen and Ron mentioned his medical director sent out a protocol memo saying almost the exact some thing. Then there is a brief discussion of how great HCEC’s medical director Dr. George Kiss is.

On the ambulance this week Ron collected my first strip. He could actually look at it and know something was wrong and have an idea what it was.Saw his first use of CPAP and first NPA insertion.

Mentions:

Harris County Emergency Corp
Medscape’s Interesting EKG Compilation
EMS12lead.com
Kilted to kick cancer

Listener Questions

MariannaI am an older, brand spanking new EMT with my local EMS service. We are all volunteer. My issue is with my co-workers who are young enough to be my kids. While they have been on the job for years and their skills are flawless, they are almost rude and disrespectful to elderly, DEAF, and mentally ill folk. Not to mention their disrespectful comments about their patients after the call is over. I have only run a few shifts and have kept my mouth shut, but this really bugs me. I know it’s just a generational thing but I could really use some tips on how to “bridge” the generation gap. They want respect, I want it too for myself as well as for some of our patients, esp. since I have 30 years of work experience (not EMS related). Do you have any suggestions? Thanks so much, love your show. Marianna Ryan Klackle- “You should do an NREMT-B Prep podcast with things people should know, what they should study, and what to expect. I know it would help me out a lot.”
Daniel’s research question – cardiovascular effects of recreational and illicit drug use. Get complete information on the The Confessions of an EMS Newbie Podcast.
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57 A Cute Syndrome Aug 04, 2011

(25:26) Stroke and Acute Coronary Syndrome were the ACLS topics of the week. Kelly talks about AHA’s sorid past with stroke, and Ron talks about medics that missed his father in law’s stroke.

“Everyone gets Oxygen” Really? Kelly doesn’t think so. Nor does the AHA.

Hey Nurses, what the mass of a grain? Doesn’t matter, cuz Kelly says any doc that still perscribes it that way should be avoided.

CEVO or Defensive Driving? Hard for Ron to tell the difference.

Mentions:

Kilts for a Cure

Listener Questions

White Rush, do you have it? Caitlin: A question for Kelly and Ron. What is your favorite drug and why? Looking forward to hearing Kelly’s answer especially because I bet it’ll be funny. Get complete information on the The Confessions of an EMS Newbie Podcast.
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56 Cardiology Exam II Jul 27, 2011

(21:40) Ron took his second cardiology exam this week. Also learned about aberrant conductions rhythms, and practiced the pushing of adenosine. During listener questions you will learn two ways for paramedics to do 2 finger CPR.

Mentions:

Listener VinceD’s comment on Kelly’s comment on hypomagnesemia.
PHTLS blanket extraction technique

Listener Questions

David ask if we have any tips for preparing for paramedic school. Ryan – Hey, the other day we had to back board someone on a blob. In case you don’t know, a blob is like a giant air pillow in a lake, and you jump on it. Anyway, we ended up having to do a clothes drag after applying a c-collar. I was wondering if kelly had any suggestions on how he would have handled it. Get complete information on the The Confessions of an EMS Newbie Podcast.
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55 Ventricular Rhythms Jul 20, 2011

(36:05) Continuing on learning the language of the heart Kelly & Ron discuss Battlestar Galactica (the original series) as well as places further down the heart. Ventricular rhythms, the pulseless part of the algorithm (PEA), why to give drugs or epi first, when to use Edison therapy, or when it is time to all in to end efforts. Also, Kelly discusses how things one learns in school, and the algorithms for giving drugs, can be very very different than what may happen in the field.

Listener Questions

EMS Freak asks how strong, physically, does one need to be to be successful in EMS. Get complete information on the The Confessions of an EMS Newbie Podcast.
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54 Junctional Rhythms Jul 13, 2011

(42:27) Move’n on down the heart we get to the AV node and junctional rhythms this week. We also talk about the ACLS tachicardiac algorithm and stable vs non-stable patients.

Also Kelly summarizes all the pediatric course like PALS in 30 seconds.

Mentions:

Six Second ECG
Sex Relationships and the Cardiac Conduction System
Taigman’s Advanced Cardiology (In Plain English)
PEPP
PALS
ACLS

ENPC

Listener Questions

Susan – I live in los angeles and really want to go to UCLA paramedic school however the cost is significantly more than other schools in the area . How important is the place you choose for P school to an employer?. If they are all accredited then are they all the same in value. I want to make sure I’m marketable once I graduate, but it might mean waiting a lot longer to start since I’ll need to save more money. I’d love to hear your thoughts.. The public EMS system I work for leans towards the paramilitary side of the spectrum. We’re talkin’ dress uniforms with plenty of bling (including a badge), assigned “ranks” for each position in the organization, and a thick policy book dictating behavior and dress at special events (down to the placement of name badges, award pins, and so on). While this can be cool for the medics and EMTs who enjoy that type of thing, I just don’t see how this benefits the patient. My question: how common is it for EMS systems to be paramilitary? And what is the justification for being this way? How is it supposed to help the patient? – Alex Scott – Hi, I’m in paramedic class, we jus t finished the cardiology section a couple weeks ago but recently I had an interesting case on ED clinical. I tried asking my instructors about it, but they said they would just call command for answers. How would you handle this in the ambulance?

75 yom complaining of chest pain, you initial impression is that he going down the crapper. On the monitor you see a paced rhythm at a rate of 56 beats per minute (with electrical & mechanical capture). All signs point towards that the heart isn’t beating fast enough to adequately perfuse the body. BP floating around 85/50.

Would you trans-q pace the patient? The crew that brought the pt in didn’t nor did the ED doc.

Kelly, I just took PHTLS this last week & talking with the instructor, they DON’T have a separate test for EMT-B’s they take the same test as Medics & are scored on ALL the questions including the ALS ones. when I was team leader for the scenarios we had I would say that I would have one of my medic partners handle the ALS procedures(starting IV’s, doing needle crics, & chest decomps, etc) & I stuck with doing the BLS ones. One question though, I was thinking about taking either PALS or ACLS, since I’m a Basic would I be in way over my head if I took either one of those ?? I’m also thinking about taking AMLS would that be a good idea as well – Kenneth Get complete information on the The Confessions of an EMS Newbie Podcast.
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53 Sinus Dysrhythmia Jul 06, 2011

(31:01) This week Ron learned about dysrhythmia – and wonders whether the interpreting of rhythms is an art or a science. Ron and Kelly discuss different methods of reading strips, whether or not Ron should have multiple sources for learning to read them, and the difference between ECG and EKG.

Mentions

Basic Arrhythmias by Gail Walraven
Rapid Interpretation of EKG’s by Dale Dubin
Taigman’s Advanced Cardiology (In Plain English) by Syd Canan, Charly D. Miller, Mike Taigman

Pocket Reference to The 12-Lead ECG in Acute Coronary Syndromes by Tim Phalen, Barbara J Aehlert
12-Lead ECG for Acute and Critical Care Providers by Bob Page
Tom Bouthillet’s EMS 12-lead blog

Assessing Mental Status article

Can they really refuse your care? by Kelly

Listener Questions

An anonymous caller asks about how to navigate being the new guy, when there are HIPAA violations and other questionable practices in the service where they are employed. Harry Ford sends in an interesting cheat/trick when checking uniformity in a rhythm strip. Kelly comments on the idea. Can a basic take PHTLS? Get complete information on the The Confessions of an EMS Newbie Podcast.
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52 Cardiac Monitors Jun 29, 2011

(29:01) This week the newbie learned how to break up, interpret, analyze, something EKG wave forms. We talk about the algorithm he learned and some tips from Kelly.

And Kelly says he loves poo poo.

Ron was also shown three cardiac monitors and we talk about the good and the bad of monitors.

Mentions:

Interpreting Algorithm
Rhythm – regular/irregular
Rate – how do your calculate it normally? Look at the machine. Count 6 seconds. Count small squares.
P Waves (PUPUR) – Present, Upright, Preceeding, Uniform, Ratio
PRI – Constant/consistant, in normal range?
QRS – Equal duration, What is the duration? Normal range? What do they look like? Eptoics.
ST Segment – T Waves

Lifepack 12 and Lifepak 15 from Physio Control
Phillips HeartStart

Listener Questions

Hey Kelly and Ron -I was driving in upstate New York and saw a vehicle, slightly larger than a mini van, that said “Ambulette” on the side, with an address and phone number – all the letters in those peel and stick things you get at the hardware store and make any vehicle look completely fly-by-night. What the heck is an ambulette?
Marc Get complete information on the The Confessions of an EMS Newbie Podcast.
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51 Cardiac Anatomy Jun 22, 2011

(21:10) Ron talks about learning the electrical parts of the heart, as well as the different chambers, and the part of the heart that looks like a Bishop’s mitre hat.

Kelly talks about why one needs the anatomy of the heart even though it isn’t used directly all that often.

There is also discussion of syncytium, and intercalated discs.

Ron also had an interview for an EMS job and talks about how to answer interview questions.

Listener Questions

EMS Freak: In a previous episode Kelly discussed a good pulse taking technique using two fingers – which is the finger with which you apply more pressure and why is it better? Elias: I am getting a new tattoo and want it to be an EMS logo and a slogan…looking for somthing witty yet poignant…suggestions? Get complete information on the The Confessions of an EMS Newbie Podcast.
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50 Wii CPR Jun 15, 2011

(48:11) Ron started cardiology this week and they went back to basics CPR. For about 6 hours this week. He and Kelly discuss changes to CPR. We talk about the Phillips cardiac monitor “hockey puck” and the Zoll AED’s talking. Survivor Paramedic has Ron’s class down to 7 students, but we supplemented by 8 nursing students, meaning there are more women than men in the class.

Also is “neurologically intact” a good measure of resuscitation success? What do they track when gauging success? Can you intubate while someone is compressing the chest?

Also talked about how Ron’s White Cloud Fu overcame an entire district of EMS calls on Saturday.

Mentions:

EMS Newbie Podcast DVDs
Philips Q-CPR (video with “hockey puck”) [Their EMS Cardiac monitor page is broken right now, should be here]
ZOLL AED Plus with CPR-D-padz

Kelly’s medic math post
Peter Canny’s Streetwatch – Notes of a paramedic

“The National Registry of Cardiopulmonary Resuscitation (NRCPR) was developed by the American Heart Association to provide a better understanding of the circumstances surrounding in-hospital cardiac arrest.17 Although the primary purpose of the NRCPR is quality improvement, it is a robust database that includes objective assessment of neurological status by cerebral performance category (CPC). The CPC is a valid measure that defines function using a simple scale, where CPC-1=good cerebral performance, CPC-2=moderate cerebral disability, CPC-3=severe cerebral disability, CPC-4=coma or vegetative state, and CPC-5=certified brain death.18 Our objective was to use the NRCPR to identify factors associated (positively or negatively) with CPC-1 or -2 at discharge (henceforth referred to as “neurologicallyintact survival” [NIS]) for patients with acute HF who suffer an in-hospital cardiac arrest.” –Circulation: Heart Failure. 2009; 2: 572-581

Listener Questions

Sam KatzBurg’s Question on High Vis vests. Anne: Hi there, I am about to start volunteering as an EMT-B for my first time. I’m really nervous, and not feeling very confident. What do the both of you think is something good to keep in mind when you’re starting out? I’m especially nervous about seeming like I don’t know what I’m doing to patients and fellow EMTs. How did you become comfortable with what you were doing when you started out?
Special Episode 3 with Dr Bill Drees of LoneStar College North Harris EMS Program. ak – HI I’m currently in paramedic class and in my externship and I was wondering what your thoughts are on use of capnography on Pts that are not intubated I have heard from some medics that they think its a great tool but its only going to tell me that the Pt is having broncospasms which you can hear by listening to lung sounds via wheezes and that they’re trapping co2 and i was wonder what your thoughts on cpap are Hi Guys, I’m an Student Paramedic in Queensland Australia. I note in the last PODCast you had a question and discussed handovers. We are taught and use AMIST. This stands for Age and name of patient, Mechanism of injury, Injury, Signs and symptoms (outside of normal parameters) Treatment and Transport criticality.

For Example chest pain – Bill, 45, woke from sleep app 7AMLeft sided chest pain radiating to Left arm. on arrival pale sweaty, hypotensive,tachycardic, ECG -ST elevation lead 2,3, AVF. we’ve given oxygen @ 4l/m nasal, Aspirin 300mg, IV access morphine 10mg good effect transport code 1 ETA 10min. On pre arrival call only change is we add last name and date of birth so a file can be made or retrieved if previous patient.

Same AMIST for Trauma patients. EG. Bill 45, riding bike fell hit headon concrete, no helmet. ALOC upto 10min, vomit x2 nil resp distress, laceration Right occipital, normotensive, tachycardic, we’ve immobilised, oxygen IV access, metoclopramide 20mg IVI code 1 ETA 10min.

physician given chance to ask questions when handing over in resus or trauma room. This seems to work well.

Also , in response to some discussion on your health reforms and potential increase in workload for ambulances. We have free ambulance to residence as subscription is included in there electricity rates. So we get alot of taxi jobs. We do however get to leave some people at home if there is no clinical or social reason to go to hospital by ambulance. This is the secret to free health provisions- clinical knowledge to point out ambulance transport is not warranted. In saying that our hospitals are overflowing as it is cheaper to go to hospital than see a GP.

Thank you for the podcasts I do enjoy them

Jeff

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SP 06 Paramedic Doctor Ryan Hodnick Jun 10, 2011

(22:40) Ever wonder what it is like to go from paramedic to doctor? Well in this episode you will find out. Ron interviews Dr Ryan Hodnick a resident in Emergency Medicine at UNLV medical school in Las Vegas. He answer’s Ron’s questions about why ER docs do things and what EMS can do to help them. Also talks about what it is like to change from paramedic to doctor.

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49 Best of Paramedic Semester 2 Jun 01, 2011

(48:42) It is the end of Ron’s second semester in Paramedic school, and time for another best of episode. Here are some of the best clips of the last few months.

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Paramedic Doctor Questions May 26, 2011

This evening I’m interviewing a Emergency Medicine Resident who used to be a paramedic before medical school for the show.

I know it is short notice, but if you have any questions about how things look from the other side leave a comment. Interview starts at 6:30 PM Central time.

48 Listener Questions May 25, 2011

(39:57) School is over and Ron has taken his EMT-I exam…but does not yet know the results. And so we devote an entire episode to listener questions!

And don’t forget to write your entry into the…
EMS Newbie EMSWorld Essay Contest

Links to the other Podcast in which Ron is appearing:

Ron:
In the Rabbit Hole (Urban Survival Podcast):

Listener Questions

Matt:

I’m curious to see how you to react to religion. I, myself, am an atheist so I’m not exactly sure how to feel when someone asks you to pray with them. Also, how do you feel exposed to different religions that determine treatments – for example Jehovah’s Witness’ and blood transfusions.

Simon:

I was reading the Western Australia Ambulance Services’ Medical Director presented a study on pre-hospital use of adrenalin in cardiac arrest – the PACA trial. It showed that while adrenaline is useful in ROSC it showed no significant difference in 28 day outcome. Wat are your thoughts on adrenalin?

Peter

Why don’t cops ever get any credit for their contribution to EMS?

Jamie

Do Ron or Kelly have a certain structure or mnemonic when you are giving a handover to the nurse or doc at the EED?

Flobach:

1) Why do you believe acid/base balance to be an important topic?

2) Talking about International EMS and looking beyond your own horizon – I’m currently touring the UK and North America and what an eye opener it is to experience different systems.

EMS Freak:

First, would you say that having moderate asthma that is well controlled with medication and moderate scoliosis be a problem working as a paramedic?

Just Some Kid:

You often say, when discussing spinal motion restriction, to place the board higher than the patient. Would you still do this with a very tall person?

Justin:

Given where you two are in classes and careers, if you could go back and tell yourself one tip, trick, or lesson, to help yourself before starting your EMT-B course…what would it be?

Kenneth Reed:

I ran into my old partner the other day and he related to me a call that he had. The patient had an obvious ankle fracture and the patient was wearing over the ankle style work boots. My former partner elected to leave the boot in place and use a pillow splint to immobilize the ankle. When the BLS truck arrived on scene (they) proceeded to undo the pillow splint and remove the boot without giving the patient any pain medication first…and used an air splint…My question to Kelly is, have you ever had this problem before and what would be the reason for removing the boot if it was helping to maintain immobilization?

Mike:

1) Besides a pelvic fracture, when would you use a scoop stretcher instead of a stair chair?

2) Any tips on patient assessment (in testing situations)?

3) From an EMT-B standpoint, what makes a good handoff report?

4) What are your opinions on the status of EMS in the United States today and in your views, where does it need to go?

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47 Finals Again May 18, 2011

(29:10) It was finals week at the end of Ron’s first year of paramedic school. In this episode we go back do an overview of the classes he took and what we thought of them.

EMS Newbie EMSWorld Essay Contest

Listener Questions

JulesThere is a tip offered at the end of the commentary on this app. I would be interested in hearing comments about this.
(We aren’t linking to this.) MedicDan wrote:

I have a question for your next episode. I had a call today, a woman in her early 30’s had some breathing problems. The patient had bilateral ronchi in lower lobes. No wheezing heard. The patient has cystic fibrosis. The senior paramedic did an albuterol treatment. Not that I really disagree with that treatment, I wanted to know what would be an ideal treatment for an acute CF attack. I checked on the patient later on and it turns out she actually had pneumonia. Was albuterol the ideal treatment, or could this made a patient worse?

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46 Almost Intermediate May 11, 2011

(29:00) More trauma skills testing, EMS Ops test, and a volunteer shift, for Ron this week. He also has some questions about how long it is before the new paramedic becomes the in-charge. Clinical internship – should you do it with your own service?

Mentions:

EMS Newbie EMSWorld Essay Contest
Listener Questions Episode Post

Listener Questions

AJ – Hello! I have a question about overdose. I am an EMT-B, but I am very interested in physiology and toxicology. I was recently called to a pt who had tried to kill himself using standard medicine cabinet – 1/2 bottle of exedrine, 1/2 bottle of aleve, 12 tablespoons of robutussin, unknown number of an unknown type of sleeping pills prescribed to someone else. Pt had consumed them over an hour ending 1/2 an hour before calling EMS. When we arrived, pt had HR at 100 and bounding, BP 150/60, skin pink, warm, diaphoretic, RR16 and adequate, only complaint was dizziness. My partner and I have been debating about O2 on this call. He says “it can’t hurt, and might help.” I say the mask would freak him out, and I would rather not have to cuff him to get him in the bus, unless he starts having trouble breat hing or showing sings of hypoxia. What are your thoughts? Follow protocol, and lose your pt’s compliance, or get him in the bus, monitor vitals, and be ready? Will O2 be physiologically helpful? Get complete information on the The Confessions of an EMS Newbie Podcast.
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Ep 45 Intermediate Testing And Crime Scenes May 05, 2011

(55:38) Ron is starting to think he’s on “Survivor: Paramedic School” as classmates seem to be leaving in droves. He took is National Registry EMT-I skills tests this week, listen to learn how he did.

In EMS Operations he studied Crime Scenes and asks Kelly “How do you handle crime scenes? What about cases where you aren’t sure there is a problem? How often does this come up? How do you keep your awareness up? How do you balance safety and paranoia?”

Mentions:

Listener Questions

Ryan Klackle – What do you think of private Ambulance services such as AMR? It doesn’t seem logical to only want to be treated by a single ambulance service. am i understanding the concept incorrectly? or is this just something that is just in Michigan. Also, what is the difference between a wilderness first responder and an EMT-B or EMT-I? Thanks! Love the Podcast BJ – We have been having some…odd mega codes in our paramedic class and i was wondering what the two of your oppinions would be. Here is an example of one i had yesterday.

17yo Male that OD’s on grandma’s tricyclic antidepressants, in the garage where he get’s organophosphate poisoning and downs a bottle of benzodiazepines after getting bitten by a poisonous snake, then falls from a ladder and gets bilateral femur fractures?

Chris – Have either of you ever experienced EMS as a patient yourself? Without getting too personal , I’d like to hear about how this changed your views on patient care and comfort (if at all.) Did your medical knowledge comfort you or make you more anxious as a patient? Just curious. Cam – I was just reading En Route and was curious if Kelly called out Dr. Bryan Bledsoe when he was on your show about glove flutter valves, as well as tape sticking to petroleum gauze? thanks Get complete information on the The Confessions of an EMS Newbie Podcast.
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Ep 44 Abdominal Trauma Apr 27, 2011

(39:41) This week we talk about abdominal trauma, shock and weight, and Ron’s last EMS shift of the semester. We also answer a number of listener questions.

Mentions:

An article on Assessing the Abdomen by Kelly.
The last episode where we talked about C-spine was Ep 41
Hartwell Vacum Mattress
CDC Field Triage Decision Scheme
EMSEducast Ep where CDC Triage was mentioned

Listener Questions

Jorge Romero
hey guys i got another question for you, this ones for kelly sorry ron lol. kelly what are your thoughts about emt-b and paramedic courses sought out in technical institutes and vocational schools rather than colleges and university. Mike
Yes, I got another question. Sorry if I keep asking stupid questions, but I’m almost all the way through EMT-B class (3 weeks left, then the state practical, wait a month, month and a half, then the state computerized test. I was wondering, since I have friends who are EMTs now who are having trouble finding a private ambulance gig, how different is it to be an ER or in-hospital tech? I’m considering as another place to apply on top of the private ambulance services, but what exactly is a tech responsible for? The job listings I have currently found are rather vague in what exactly one does in this position. And I’m starting to seriously consider it as a job opportunity, instead of a backup to a private ambo gig. Brandon Wehner – Fargo, ND
Anyways, while we were there, one of our crews asked the medic giving the tour about a call they had gone on. From what the crew said, they went on a rollover car accident where the car was down in a ditch, and they had to walk through about 4 feet of snow to get to the patient. They had taken c-spine and put a c-collar on the patient before the arrival of the ambulance. Once the medic got to the patient, he removed the collar and proceeded to clear c-spine. C-spine was clear and they walked the patient through the snow back to the road.

This incident got us talking at the station about your opinions on immobilizing the spine and how there is no evidence to support its use. Obviously we still backboard our patients because that’s what our protocols tell us to do, but we would like a refresher on how you think backboarding may harm a patient (which I know you’ve talked about before, but I can’t recall all the reasons), and if it would do harm to a patient, how would you move the person, assuming they for sure had a spinal injury.

I know this has been a long way to ask a question, so feel free to shorten it for the show. If you feel that you’ve covered this point a lot already and would rather not answer it again on the podcast, maybe you can point me to the show that it was in so we can listen to it there. Thanks for a great podcast.

Hey guys,
I was wondering if I could get your opinions on what you find more reliable when taking a blood pressure. I have been working as an EMT basic for about 5 years and have always been confident in my ability to get accurate b/p readings, but as I am progressing through paramedic school I am finding that when I auscultate a blood pressure my reading is consistently lower (although not much) than the reading I get from an auto cuff. As an example; I recently had a patient who’s auscultated blood pressure was 88/46 but the auto cuff reading was 99/50.
So I was curious what both of you thought was a more reliable method.
Thanks for your help
Aaron Get complete information on the The Confessions of an EMS Newbie Podcast.
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Ep 43 Rescue Apr 20, 2011

(34:42) Kelly saves drowning woman! News at 11!

And other great EMS rescue stories.

Ron did some more scenarios and managed not to kill the patient this time, but most of his week was spent studying rescue in EMS Operations. Learn about the different kind of rescues Kelly has been a part of over the years.

Mentions:

EMS Newbie EMSWorld Essay Contest
Robert Nixon Essay Contest for Non-Newbies

Listener Questions

Vince DiGiulio (Dee-Joule-E-O)
In every EMS class, they teach you that the field treatment for a flail chest is a “bulky dressing,” but having never seen the condition in person, I was curious what kind of effect that actually has. I know that back in the day they used sandbags as the the tool of choice, but those didn’t do a whole lot of good and thus we graduated to a bulk of dressing taped to the chest. Physiologically, to me, it just seems like directly supporting the flail segment from above with plain tape would offer slightly more support against the pull of negative intrathoracic pressure as the patient inhales. I was just curious about Kelly’s take on the matter and if he has any advice since he’s probably seen a couple more than me in his time as a medic. Jorge Romero
What do you guys think about the american heart association guidlines concerning the new CAB methed for cpr. compressions, airway and breathing instead of ABC starting with securing the airway and providing 2 rescue breaths. Doesnt it make sense to provide oxygen to the blood before
giving compressions Tina
Great podcast! Kelly, back in the old days, before I was born, before you started EMT school what was it that made you want to go into EMS? Why did you choose to become a Paramedic and what do you love most about your job? I really like the fact that you and Ron take time to answer questions from the listeners. Keep up the good work! Get complete information on the The Confessions of an EMS Newbie Podcast.
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Ep 42 Thorax Apr 13, 2011

(35:21) After obscure references to comedic science fiction, Kelly and Ron talk about Thoracic Trauma and answer some listener questions. Chest decompression, sucking chest wounds, and pericardialtamponade, oh yeah.

Mentions:

EMSWorld Newbie Essay Contest

Listener Questions

From Kevin T:
Hello, I’m almost finished with my EMT-B class and I was wondering, when I finish the course and get my certification, is it better to work as an ER Tech or volunteer with the fire department to get experience?? Mike wrote:

Kelly & Ron, do I have a question for you guys this time.

I know this is a *oh so wonderful* subject close and dear to Kelly’s heart, but for spinal immobilization, if the patient has an injury on their back that prohibits you from laying them supine, how do you secure them to the backboard on their side? Honestly curious, because my EMT textbook shows nothing on how to properly immobilize a patient in that position, and well, even though research has proven backboards suck at their jobs, I don’t need a lawyer coming down on me further down the road. Especially in my state of Massachusetts.

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Ep 41 Rescue and Big Events Apr 06, 2011

(45:33) Has it only been a week since our last episode? For Ron it seems like a month. Here everything you wanted to know about spinal immobi….oops I mean spinal motion restriction. Kelly will tell you how he really feels about strapping people to backboards.

We also talk rural medicine. Get a cool tip on Rapid Trauma Assessment.

Ron also spent some time looking for the lost, hanging upside down, and falling down in 6 inches of water last weekend. Learn a little about search and rescue. Then he spent a day dealing with trauma at a big even in Houston on Sunday.

Enough with the teasing, this week we announce the EMS Newbie EMS World Essay contest.

Mentions:

CT staffing company
Joe Paczkowski’s Comment on Spinal immobilization comment with good references.
Paramedicine 101 Correction to Spine Immobilization in Penetrating Trauma: More Harm Than Good
Farm Medic Course
Rescue Training International

Listener Questions

I’m a new fan of your podcast; thanks for this resource! I’m a new EMT-B and looking for a position with an ambulance company, but I can’t seem to find anything open. Do you have any advice for find a job as an EMT?
-Joshua in CT I was also wondering what your thoughts were on the way billing is done in EMS. Whether it is paid medical transport, paid 911 or volunteer 911. The squad I work for is mainly medical transport, and the insurance company that overlooks medicare medicaid reimbursement refuses to cover the cost of equipment on the call unless three vitals are taken for each patient. Although at first this seems like a good guideline to follow especially for unstable patients, majority of out patients are stable, CAOx3 and have less than a 6 minute transport time between facilities from bed to bed aka dialysis appointment, outpatient appointments etc.
This leads to the case of myself or my partner in the back simply waiting outside the destination facility for a few more minutes just to get a legitimate set of vitals and several other emts go as far as to make up a set and move on, since they feel that delaying care is worse for the patient. What do you feel is the solution to such big brother attitudes shown for insurance companies regulating medical transport or inter facility transports. Thanks again for answering my question, it was great to hear both yours and Rons take on the scenario.
BG Peter –
I was at an MCI drill the other day helping them manage the parking of emergency vehicles. Their were many EMT’s and firefighters who had no issue listening to my parking instructions but the feds and the bomb squad were giving me lip and disobeyed what I was saying and some of them just ended going around the parking lot looking like morons . long story short, how do you deal with other agency that disobey what you are telling them what to do. Get complete information on the The Confessions of an EMS Newbie Podcast.
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Ep 40 – HazMat Mar 30, 2011

(38:41) This week we talk about the time Kelly stripped down in class. Ron’s trauma test and scenario. Learn how chest decompression really works. Handling belligerent bystanders, and HazMat. After the Harris County HazMat team talked to Ron’s class, he learned how a thumb has been replaced with a pinkie. Kelly informs us of the rule of donut.

Listener Questions

BG from NY –

Great show guys. Been an EMT -B for 5 years in NYS and worked for several volunteer squads and just signed on for a squad in NJ now. I was wondering if you have watched the show Trauma on NBC and in the last episode one of the paramedics who is trained as an MD did a few procedures in the field and saved the pts lives but in one instance gets caught and the pt although alive ends up being paralyzed from the neck down. Long story short, she gets her license suspended and possibly faces jail time. Although an unlikely scenario I wanted your thoughts in today world with malpractice rampant etc as a paramedic would you do procedures not allowed for example in your county but perhaps allowed in another state in order to save a patients live but lose your license. When you always taught that pt comes first, at what point do you put yourself and your interest ahead of them. If you did happen to save their life but left a debilitating disease or injury worthy of a lawsuit is it worth it. Rather than following the rules and if the patient doesn’t make it that’s just the nature of the job and situation. Reason I ask this is I had a recent call with a4th year medical student who refused to use his skills to because he was only a certified EMT-B but was ACLS certified but due to not being a paramedic or an EMT -I could not use any of his skills which related in the pt from an MVA ending up braindead. Let me know your thoughts guys. Great show again, even thought I am only an EMT-B i learn a LOT from the podcast and enjoy hearing about your journey through paramedic school. Keep up the GOOD WORK

Hey Ron,

I am an EMT-B and paramedic student in San Antonio. I had a patient a few days ago with contractures to all four extremities secondary to a stroke he had several years ago. The call was for HTN, so getting a blood pressure was a priority, but when I tried to put the cuff on the patient’s arm I found it to be nearly impossible. Even if I had been able to get it around the arm there would have been no way to listen to the artery due to the arm’s bent position. I was wondering are there any other places to listen to blood pressures of patients like this or with other similar difficulties? I ended up palpating the BP with the pediatric cuff around the patients forearm but I was not sure how accurate that method was.

Thanks!
Seth Bruton

Mentions:

Ep 20 – Maintaining Control Kelly’s hazmat exposure.

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SP05 Organ Donation as a Career Path for Paramedics Mar 23, 2011

(55:55) While Ron is on Spring Break we bring you a special episode of the EMS Educast on Organ Procurement.

The EMSEducast Episode.

Mentions:

Buck Feris – http://gomerville.com/
Greg Friese – connect at Blog.CentreLearn.com and EverydayEMSTips.com
Rob Theriault – connect at Paramedic Tutor, EMS Connect and JEMSConnect
Bill Toon – connect on Twitter, @wftoon and www.facebook.com/EMSEduCast

Get complete information on the The Confessions of an EMS Newbie Podcast.

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**39 Head Trauma** Mar 16, 2011
(30:04) Ron did PHTLS this week and covered head trauma. We talk about the Hatchet manuver for intubation, the Parkland forumula, doing a Head to toe in the vehicle, and the Tickles test for pedi trauma.
The Brains of My Trauma Class, Ms O'Connor, my laptop, the screen of notes.

Listener Questions
Elias –
Our system received a grant from the state for a new AED/Cardiac Monitor and have a couple choices. Do you have any preference of brands? i know we’re looking at a Zoll device and a Lifepack device and they both seem very similar, though the lifepack seems more rugged. Have you had experience with either?
Also, what’s your thought of pre-hospital autopulse cpr devices? The zoll monitor comes with one and i’m not sure if that’s a boon or a curse.

Mentions:

TICLS – Tone, Interactibility, Consolability/color, Look and gaze, Speech/Cry.
Get complete information on the The Confessions of an EMS Newbie Podcast.
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38 Burns Mar 09, 2011

(38:54) This week we talk about burns, intubation, vassopressors infiltrating from peripheral IVs and much more. Kelly is calling in live from the road returning from EMS Today, and Ron is in some of his hospital pajamas pre-clinical.

Remember all that discussion about what you should or would do if you were on scene for an emergency event, but not on duty? Well we get the answer today because Kelly and TOTWTYTR were at a diner when a women went into cardiac arrest. Find out what Kelly did by listening this week.

Listener Questions

Rachel:
I discovered your podcast last February and even though I’m not in EMS (I’m a nursing student) I’ve been fascinated with your podcast and have binged through the entire series during my workouts and trips on the train.

My question for you is if EMS ever has to do any type of genital exam, like in the case of vaginal bleeding? And what do you guys do to protect yourselves from patient allegations of misconduct?

Mike:
I might be getting annoying with all the questions that I’m asking, but…..

If an NPA or an OPA is inserted into a patient, is a head tilt chin lift or a jaw thrust still neccessary? It’s one of those questions that has been nagging around in my head, and I’m curious about it.

Alex
As an EMS newbie myself (an EMT halfway through precepting) I’m having a hard time figuring out how to respond to the typical “new guy” crap. I seem to be held to a higher standard than the others, while at the same time being treated like I’m incompetent. I know it wouldn’t be wise to overreact and respond in a mean way… it would only vindicate those who are giving me a hard time. But I also don’t want to cave in and appear weak every time someone dishes it out at me. I want to earn the respect of those I work with, but I’m still trying to figure out exactly how that’s done in EMS. Any suggestions?

Mentions:

CPR for 90 min link
Hand washing. Talked about in basic episode.

Kelly’s excellently written account of his save is on his blog.

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

37 Soft Tissues Mar 03, 2011

(46:32) You get a story from after the show last week about German paramedic Niels first Louisiana field delivery to start the show. Then we talk about Ron’s test and how he didn’t do as bad as he thought.

Soft tissue injuries was the subject of the week. Kelly tells how to deal with crush injuries and a discussion of rhabdomyolysis or rambo or radbo to how ever it is pronounced. Ron had never heard of injection injuries before this week, and he now has two new drugs to memorize.

Ron did his first 24 hour shift and he talks about how it was and how he’s thinking about preceptors differently.

Listener Questions

Simon:
3. Finding veins. Do you prefer to find a vein visually, or by palpation?

4. After a recent trauma call on a very busy highway, we were left with a grossly disfigured body, a lot of distressed people standing around, and a huge procession of traffic all rubber-necking at the pool of blood spreading from the white sheet. How do you deal with those who are emotionally distressed in these situations? Apart from a brief few gentle words and a phone number for a counselling line to the bystanders, and letting the police divert traffic, I was all out of ideas.

Elias:
New EMT-B here, had my patch since the beginning of january, and am working for a paid volunteer rural service (very rural, frontier even) in a town of around 1000 people, with another 5k within the county lines. A part-time firefighters job has opened up in a town about 30 miles away and they run their ambulance through their fire service, so there’s a very good chance of getting a paid, part time ems position with this fire department. My question is: would it be considered “bad form” to work for two different services? I don’t really want to be a firefighter, but if it’d get me some consistent time in an ambulance rig before paramedic school starts in September, it’d be a good thing, right?

What book would you recommend for a person with no AandP experience to begin study for medic school, so as not to be totally lost?

Shawn in KS:
In regards to proper documentation of your scene reports, would using a digital voice recorder while on scene w/ a lapel mic for hands free operation be professional and reasonable? The idea would be to speak your notes out as you progress such as pt assessment, VS, and so on. You are intending to record yourself for your own use, so I don’t see a legal issue. Recordings would be deleted after their use. And shy of your partner, no one would likely notice you are even mic’d up.

Mentions:

A&P for Emergency Care

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36 ABC or CAB Feb 23, 2011

(36:10) “Which will kill you faster? And which should you treat first?” Ron had his first test of the semester in trauma and we talk about a couple of questions that annoyed him. One involved and airway problem and a lacerated femoral artery. Was this a case of the book vs the street?

Speaking of the real world, we also talk about taking off helmets, using a PASG, and one of the alternative uses of a KED – pelvis fractures.

Listener Questions

Answers about Boston EMT from Ep 32 from Matt: “NREMT-B vs. MA EMT-B…
a bit of a difference. NR generally comes with Epi and Glucometry skills. MA EMT-B must be tested and individually get permission from the service for such skills. MA EMT-B per diem runs $9.50 – $12.00”

Stomach inflation when using BVM from the video. from Timothy

Simon –
More questions, sorry if there are too many for the show, feel free to make them more succinct, and dont feel you need to use them all:
1. The dreaded BP. Lately I do a BP on a patient either by auscultation and/or palpation (no machines ever), I instantly do it again to confirm it, I get repeatable results all the way to hospital…and the hospital gets something way different to me with the machine. Like 50mmHg higher different. And they confirm it with auscultation. Someone told me I might be aligning the cuff in the wrong spot or on the wrong way, but changing its position doesnt seem to help. Any ideas?
2. Another BP question. I remember reading that if you let the cuff deflate too slowly, you are creating a back pressure of blood that will give you an artificially high reading. This makes some sense to me, is it correct?

Mentions:

Videos on airways, and tourniquets. In the tourniquets video at 20 min what femoral artery bleed looks like (animal). At 23:15 what radial arterial bleed looks like and a tourniquet stopping the bleeding (human).

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Ep 35 Shock, Air Medical And NIMS Feb 16, 2011

(33:34) Trauma seems to come down to shock, and that’s what Ron has been focused on. So we talk shock and patient assessment.

Everyone loves the helicopters. This week Ron also studied aeromedical and we talk about they can and can’t do.

And lastly NIMS – the National Incident Management System. The course work of which is enough to make you want to cause a MCI.

Listener Questions

Harry Ford – Australian born and am moving to Houston to begin my degree in EMT (same as you) in august. and i am so pumped. Last year my Girlfriend and I were in Houston and we were robbed. Long story short, an ambulance was called (no one was hurt) but My GF had previous Asthma and i thought having her in a safe Ambo might help her calm down. as well as obviously being the safest place if she did have an attack. when the Ambo turned up i can remember three things the paramedic said to her or me, “whats wrong?” .”Are you having an attack?” and “Sign here” he showed all the emotion of a rock. i was furious and had there not been police around the area, i could have easily given him a knuckle or two of my thoughts. In all of my training and testing even at a basic level, i was taught that bed side manner, was key, you don’t want your patient to feel like they should be ashamed or guilty for calling you out. even if its non- life-threatening. in our exams, if we missed one or two minor points but had a good relationship with the patient, the examiner would over look it. Are you taught patient care and service or some kind of customer service in your course? do you feel it needs to be taught more or is it a sad standard across Houston/Texas I’m hoping you will tell me it was just a one off and i know there are people in every country in every company or service that has th same poor attitude, it just concerns me that he is a full paramedic as was his partner which was equally as quiet. and no one else around seemed put off by his poor attitude. a few re-assuring words would have gone a long way to calming down my partner but all she got was a cold stethoscope (figuratively and physically)

Mentions:

4 Simple Questions Every Preceptor Should Ask
NIMS

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Ep 34 – Blunt and Penetrating Feb 09, 2011

(1:00:32) Kelly and Ron braved the horrible winter weather here in the south to bring you this week’s episode, so don’t miss it. We talk about what makes a good medic both personality-wise and medically. Kelly gives a really good football based metaphor for where EMS fits into the overall field of medicine.

We talk about assessment at MVCs. Whether we’ve become too focused on the terrorist threat in EMS, and you get an everything you always wanted to know about firearms discussion as well. Finally we discuss flight medics and nurses.

Listener Questions

Alex – We ran a call the other day with a combative patient. He had to be physically restrained by several firefighters just to keep him from attacking us. He was diabetic and gave every impression of having low blood sugar, but when we checked his sugar it came back around 250-ish. The medic hit him with some versed and he almost immediately became the friendliest guy in the world. We were never able to determine why he was acting the way he was. There wasn’t alcohol on his breath. Any speculation as to what might have been going on?

just some kid – know your system’s rules will be different from those in this country, but i am wondering what would happen if you were called to a family member or a friend, or someone you are close to came into the ER, would you treat them yourself, or would you step back and (if it’s possible) let your partner or someone else treat them. i know it is not always going to be possible with most crews, but if you had the choice. i would like to know your personal opinion more than what your guidelines say

Mentions:

Family Matters
Educast – Tactical EMS Training
Point Blank by Gary Kleck
Surviving in Argentina’s Gun Myth’s Post.
Dr. Martin Fackler – Wound Ballistics
Glasgow Coma Scale Desktop Images

Colonel Cooper’s 4 Rules of Firearm Safety

All guns are always loaded.
Never let the muzzle cover anything you are not willing to destroy.
Keep your finger off the trigger until your sights are on the target.
Be sure of your target and what is beyond it.

Wikipedia Overview of Gun Safety
—Jeff Cooper

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SP 04 Bob Page Feb 04, 2011

(1:00:58) From Boy Scout to CCEMT-P and nationally known EMS educator Bob Page shares a lot of cool info for the newbie. Learn which part of your stethoscope to use for a BP. What the ATLS says about the relationship between radial pulse and BP is. A cool gadget you can get to help you learn breath and heart sounds.

In 1993, years before EMS services carried 12 Lead ECGs, Dr Zalenski wrote a paper about how 15 Lead was 23% more sensitive than at 12 Lead, which was only 50% sensitive. Bob literally wrote the book on 12-Lead ECG for Acute and Critical Care Providers and we talk about 15 lead alot in very powerful ways.

Our podcast teaches you interesting and useful stuff on a regular basis, but in this episode you can literally learn something that can save someone’s life.

Listener Questions

Timothy Clemans: What would you change to EMS education?

Dandude: What are some “must knows” for EMS about stethoscopy? What the hell is a 15 lead EKG? How do you feel about EMS reading and interpitating 12 leads, (or 15)?

Gerald Byrnes: Got a EMT-B in New Mexico over the summer, then moved to Tempe, Arizona. In addition to learning a slightly wider SOP in NM than National Registry standard he also started learning to read 12-lead. people in AZ seem startled when they learn he’s learning to read 12-leads. Am I going a bit overboard and becoming “that guy” or is it just a bit of an attitude difference between states with different Basic Scopes of Practice? What are good resources for practice assements,12-lead and stethoscopy since I have no patients?

Christine:
Concerning stethoscopes:
1. For the listeners who may have suffered some hearing damage in past years from things like roof-mounted sirens, firing rifles without hearing protection, helicopter rotor blades and such, is any particular scope better than another?
2. Are expensive scopes always the best?
3. What are the benefits/drawbacks to a pressure sensitive stethoscope head versus a dual-headed scope?
4. Short of attending one of your “Stethoscopy for Dummies” courses, are there any resources we can use in the meantime to brush up on our skills? The seminar handout on your site looks like a good place to start…

Mentions:

Bob’s Website, Multi-lead Medics
Pinnacle Medical Technology
The Sounds and Arrythmia TUTOR for educators.
The Guardian
Littmann Cardiology III
Flip Cam
12-Lead ECG for Acute and Critical Care Providers
Littmann’s Lesson’s in Auscultation
Zalenski RS, Cooke D, Rydman R, Sloan EP, Murphy DG. Assessing the diagnostic value of an ECG containing leads V4R, V8 and V9: the 15-lead ECG. Ann Emerg Med. 1993;22:786-793.

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Ep 33 Trauma Centers Feb 02, 2011

[audio:33_TraumaCenters.mp3] (43:43) School is in full swing and Ron has a bunch of questions. This week we talk about the use and over use of lights and sirens, why picking the right hospital is critical in trauma, and photography in the field. The newbie also asks flight nurse/flight medic, why do we need both?

Listener Questions

Crystal asks I’m a EMT-Basic student in SC, I will be graduating soon and I’m worried about finding a job. Is there any advice you can give on job hunting?

Mentions:

The Cult of Mechanism

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Ep 32 Trauma and EMS Ops Jan 26, 2011

[audio:32_TraumaAndEMSOps.mp3] (34:27) Back in school again. We go over Ron’s schedule for this semester, talking about Trauma, EMS Operations, Methods of Teaching EMS, and Paramedic Clinicals. Talking about working in the ICU Kelly tells a story where he was creeped out on a transport.

Along the way we discuss, NIMS, PHTLS, PASG/MAST and permissive hypotension. We also answer a number of questions and Kelly says he’s going to be politically incorrect.

Listener Questions

Mike:
How much of a difference isthere in scope of practice between NREMT-B and MA-EMT-B?
Any idea of a general starting wage for a per-diem EMT-B?
In your opinions, what works better on an unresponsive patient: NPA or OPA?

Hi Ron and Kelly, I am a listener from Switzerland, Europe, and have a question. Me and my EMS colleagues here are discussing the usage of the Trendelenburg position for patients with (possible) shock. Although it seems the position does not do any good, http://www.cjem-online.ca/v6/n1/p48I just learned in an EMT-Basic class in California to use it and it is still in the newest (10th edition) EMT book of the AAOS. Dou you guys have anything usefull to say about whether or not to use the Trendeleburg or modified Trendelenburg?
-Menno

Mentions:

NIMS
PHTLS
Ken Maddox paper, “Mattox KL, Bickell W, Pepe PE, et al: Prospective MAST study in 911 patients. J Trauma 1989;29:1104-1112.”
Too Old To Young To Retire
PASG White Paper

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Ep 31 Listener Questions Jan 19, 2011

[audio:31_ListenerQuestions.mp3] (57:24) Since Ron isn’t in school we took listener questions and there were a lot of them.

Listener Questions
I passed my NREMT-B exam – yay!!- but am curious to know why the CAT will ask one question a couple of times? It seemed a little odd, as if it was testing to see if I was guessing. Love the podcast! Kim

Something Ive wondered about was when we pinch off the IV tubing to administer a slow IVP, then unclamp the tubing… What’s the difference in giving that Fast IVP then? Just a random question.
Another is any advice for a student who’s about to start medic school in 3 weeks or so? It’s not my first time through but I want to do better this time than I did a couple years ago. suggestions on how to handle people at a service that decide to give me hell because I’m not satisfied with just obtaining the minimum. I plan on getting my LP here in TX which requires an AAS in EMS at a minimum and I’m catching hell for that idea here at my service in BFE.
-Transport Jocky

I feel like you failed to address what I think was Ron’s main point of frustration, or at least mine: WHY is it that the game somehow changes just because you’re a bystander versus when you’re on duty? I mean, taking Ron’s car accident example, really the only difference in the situation is that Ron happened to have been off-duty and witnessed the accident instead of being dispatched to it in an ambulance. One might think that this person is lucky to have had Ron, an EMT, witness his accident rather than a lay person because Ron is trained to deal with these situations. But you’re saying that because Ron is off-duty, even though he has special training and equipment handy, that he is just as powerless as any other “John Q Citizen” who may have witness this accident instead. WHY is it that Ron couldn’t pull out his OPA in order to open this person’s airway and potentially help them? It’s exactly what the EMTs who pull up in the ambulance are gonna do when they get there–why can’t Ron just do it sooner since it could potentially help? I understand what you were saying about how it MIGHT not help, and it fact might be harmful, but again, it’s exactly the same thing that the EMTs who show up are gonna do and exactly the same thing that Ron would do were he on duty, so I guess I just don’t get what the difference is.WHY does scope of practice suddenly change just because you’re off-duty? Are you only an EMT when you’re in uniform and on-duty then?……I’m sorry, I’m not trying to be difficult….but I’ve listened to that section of the podcast twice and I’m still confused. Any chance you can explain it even more and maybe give more examples?
…also heard you say somewhere in this episode that Ron, as an off-duty EMT, does NOT have a duty to act. (Please correct me if you didn’t say that.) Again, this completely flips my world upside down because it is completely opposite of what I understood from First Responder training. I thought we DO have a legal duty to act.

#2 what’s the value of a college degree in EMS. She’s a liberal arts psych major and wants to be an EMT, which people think is a step down.
-Katie B

I wanted to say thank you for all the great podcast and advice. I really just started listening a few days ago and have all ready gone though most of the them. It is really easy for me to relate to Ron since we both live in Texas, we are both entering the EMT/Paramedic field, and we both are model photographers. Lol.. Are you the future me? hmmmm..
My very first day of EMT-Basic will be on the 18th and I’m pretty much having panic attacks. My school, although is a community college (Weatherford College), is militarized in it’s teachings and rules and will be REQUIRED to maintain an A average throughout the course. We cannot even wear a jacket to class unless it is pre-approved by the EMT program coordinator. If we show up even a minute late to class we have to sit the class out until the next brake and will have to work out, jog, or push-ups as punishment for this. lol. We even have to have our hair short with no facial hair that is trimmed all the way to the top of the ears. Is this what you had to go through in your school Ron and Kelly? I am studying and obsessing about EMT and reading the book trying to get ahead of the curve and not get so over whelmed after school starts up. I will keep you posted again on how things go after school starts.
Anyway, Can an EMT or Paramedic be colorblind? Do you think it can affect with your ability in providing emergency medical care or cause problems? I have a red/green color deficiency and I would really like to know if this can affect me.
Another fun question and ultimately pointless is; If you could have one super power while being an EMT, besides healing powers, what would you choose to have that is most useful? – Listeners answer this one in the comments.
Thanks again guys and look forward to new podcasts!
Wish me luck,
-Aaron H.

What’s the best way to study for an EMT-B class? Notecards? Cramming? Just reading the book for hours on end?
What’s the Glascow Coma Scale? I’ve heard of it, but have yet to fully understand it.
How much anatomy am I going to be expected to know? Am I going to be asked bone – muscle attachment points, what muscle is where and performs what, etc.
I’ve got a bunch more in the back of my head, but I can’t really seem to word them right (not gonna lie, I’m a little tired, it’s 11:50 PM local time.) I’ll post them when they come to me.
-Mike

Any tips for trying to save a (likely) blown vein when cannulating? Some people aspirate while pushing in/pulling out with varying results, any more tips?
– Simon

I am a 55 year old Intermediate. Got into EMS late in life. Was a Cop. Started as First Responder. Basic in 08. Intermediate in 09. Taking A&P this spring online. Thinking Paramedic in the Fall. Am I crazy?
I still suck at Iv’s. Any tips? I look forward to your stuff. Thanks!
-EMT32

I know you’re in a 2 year paramedic program, I’m in a 1yr compressed course. What are your opinions on the 2year v. the 1yr crash course?
-Nick Shaw

Any tips for taking a pulse easier?
Is the bouncing on the BP Cuff’s needle accurate for a Blood Pressure? I personally doubt it but friends who are EMTs & Paramedics tell me otherwise.
-Mike

What’s the benefit of field experience for EMS number crunchers?
People who on QA projects like coordinating the cardiac arrest registry.
-Timothy Clemens

Is it better to take an EMT course durning HS or wait until you graduate? I’m dertimed and plan to succede at this however it may be. I would just like a proffesional opinon.
-Cat

I’m a student paramedic in the UK, in year two of three, and I was wondering what your situation in the US/ your particular area is with regard to elderly patients and futile resuscitations?
This is mainly prompted by a cardiac arrest call I went to a while ago to a 90-year old lady in a care home; a carer had been doing ‘compressions’ mainly over her stomach and so as it was presented as case of CPR in progress we were obligated to continue, although if this hadn’t been started it would have been more than 15 minutes from arrest to onset of CPR so we could have just carried out our ROLE (recognition of life extinct) procedures. On the first proper compression carried out by my crewmate the whole side of her chest caved in; we’d felt it was futile anyway and this only served to make us feel more like all we were doing was inflicting indignity on her corpse for 20 minutes of required ALS.
Do you have an option to refuse to start? On this particular occasion I’d have given a lot to be able to turn around to the carer and say, ‘look you might think you’ve been doing CPR but you haven’t , she’s been down 15 minutes, she’s gone and probably was the second she collapsed, I’m sorry.’
-Helen

Has anything totally freaked you out on your shift? How did you handle it and were you surprised by your reaction?
-Linda G

Mentions:

Study Hacks
Keys to Student Mastery of EMT Training

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SP 03 Dr Bill Drees Jan 05, 2011

[audio:SP3_BillDreesInterview.mp3] (1:08:22) This week we have another special episode where Ron interviews the head of his paramedic program Dr. Bill Drees. They talk specifically about the program Ron is in and why it is structured the way it is. What impact will the NREMT accreditation requirement have on paramedic programs and The Street vs The School.

Dr Drees also answers listener questions.

Listener Questions:

Jamie Davis, podmedic: I’d like to find out what his views are on expanding the amount of distance learning allowed for re-certification of providers? Many EMS providers are working two jobs to make ends meet. Having a cost-effective and time-saving way to gain continuing education credits is imperative in retention of our existing providers.

Timothy Clemans: What would you change to BLS training?
Simon: What curriculum changes does he think are necessary to form a good base for increased pay for medics?

Mention:
How to Hack the Psychology of Student Motivation

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Ep 30 Best of Paramedic School Semester One Dec 29, 2010

[audio: 30_BestOfPSchoolFirstSemester.mp3] (50:00) While Ron and Kelly take a break over Christmas, here is another best of episode. Some of the funniest and most useful stuff from the last 4 months.

A never before heard piece of feedback about our show’s opening. And Kelly lays down a fat beat under another version of our opening.

Also includes clips from Dr. Bryan Bledsoe and Mark Glencorse.

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Ep 29 One Done Dec 22, 2010

[audio:29_OneDone.mp3] (32:55) Finals week is over and Ron went on his first shift as a volunteer. We talk about finals and having high standards. We also talk about testing and how it is done in colleges now and what that means for the student. Ron got to meet his medical director where he is volunteering and we talk a little about medical direction in EMS. Ron’s medical director actually pulled the ambulance crew while he was working and gave them some intubation tips, which he shares on the podcast.

Listener Questions

Kelly and Ron, I’m going to be starting classes for my EMT basic in a few months and I’m pretty nervous. I know I’m smart and capable but I’m only 5 feet tall. Do you think this will be a problem on the job? Or will I not be taken
seriously because of my size? Thanks….JJ

Mentions:

Fentanyl
Study Hacks
Four Hour Work
Week by Tim Ferris
Street Medicine Society
Univ of Pittsburgh EMS Fellowship
Scary EMS story for the smallest medic.(Looking Through A Pair Of Pink Handled Trauma Shears)
Stryker
Stretchers (They call them emergency cots)
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Ep 28 Acid Base Dec 15, 2010

[audio:28_AcidBase.mp3] (43:20) This week Ron did his practical testing – ET, Combitube, IV, Patient Assessment Medical and we talk about that, including answering some listener questions about testing. Ron asks Kelly, “What are vitals?” and the answer is an interesting discussion. Ron’s medical scenarios was something he hadn’t studied since Basic. He could remember what it meant and how to treat it but not the name. And he got a little creative in the treatment.

Acid/Base lecture was the last lecture Ron had and the hosts talk about how Acid/Base works.

ROME = Respiratory Opposite Metabolic Equal

Memorize the normals:
pH 7.35 – 7.45
PaCO3 35-45 mmHg
HCO3 22 – 26 mEq/mL

Remember the 3 question algorithm:
1. Is the pH acidosis or alkalosis?
2. If PaCO3 is high it is respiratory acidosis, if it is low it is respiratory alkalosis, if normal it isn’t respiratory.
3. If it isn’t respiratory from step 2, its metabolic. If HCO3 is low, it is metabolic acidosis, if HCO3 is high it is metabolic alkalosis.

If the opposite one (PaCO3 vs HCO3) is in the other direction, then it is compensated.

Mean Arterial Pressure

MAP = Diastolic Pressure + ( 1/3 Pulse Pressure )

Listener Questions
Flo sent us 3 questions related to ep 26
– Why is an accurate BP so important? It smore of a trend thing I though, and generally “is the patient normo, hypo or hypertensive.”. Does it really matter if the patient has a BP of 130/90 or ?2140/8?

– When is a pre-hospital IV indicated? Some parameds here are just plain lazy, and never do one. I had a phase where I cannulated nearly everything that moved. I know there are pros and cons in both directions, but what would you say is best practice?

– last but not least – do you have any links to the studies about paramedics leaving patients at home, that would be interesting to read up, and to present to some colleagues who really like to indulge in such practices. Always good to back up your statements with hard facts… – Flo

Also found out last night(12/9) that I will be taking the practical portion of the nation registry exam next thursday (12/16) when I come to lab. I have been watching on youtube various vids of the stations. Is there any other advise you or Kelly can give me that could help me out next thursday?? – KJ Reed

Mentions
Rogue Medic – purveyor of fine EMS research.
The Missing Protocol by Denise H Graham – out of print book.
House of God – book

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Ep 27 Let the Testing Begin Dec 08, 2010

[audio:27_LetTestingBegin.mp3] (46:53) Ron had two tests and his last clinical this week. Pretty much nothing but testing from here on out. We talk a little about EMT Intermediate 85/99.

Learn at what point Ron’s last patient asked, “Did I get a student?” And all about his injury prevention program he’s working on.

We follow up on the Tazer vs. GSW discussion with feed back from someone who’s experienced both. This leads to how much does and IO really hurt? And a discussion of the various IO devices.

Listener Questions
I was wondering if, on the show, Kelly could give any info or opinions about specialty EMT professions. Things like Tactical EMTs, Wilderness EMTs, etc..– Don

Mentions:
National Safe Kids Campaign
National Registry of EMT – EMT-I 85 and 99
SOLO Wilderness EMT course
George Washington University Paramedic ER course
CONTOMS Tactical Medic Course
CCEMT-P Course from University of Maryland Baltimore County
International Flight Paramedic Association

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**Ep 26 More Conference** Dec 01, 2010
[audio:26_MoreConference.mp3] (55:54) We talk some more about things Ron learned at the Texas EMS conference. He asks, “Doesn’t anyone know how to take a BP?” Find out what Ron’s favorite condition is, and everything you wanted to know about it.

We also discuss drawing blood on the ambulance and how hospitals feel about it. And to stir up some controversy and reflect on another EMS conference panel, we talk about paramedic initiated refusals.

**Listener Questions**

I’m in training to be a paramedic in Perth, Wsestern Australia, with St Johns Ambulance. Our program seems to run very differently from yours, in that we have 6 months and 4 rounds of interviews and fitness tests to get into the program. On top of that, you cant study to be a paramedic outside of the program. The benefit is that once you are accepted, you have one year of full time university study, then you have a mixture of practical and theoretical studies over years two and three, while working full time in an ambulance as an ambulance officer, working under a paramedic. We dont have levels of EMT here, you are either a paramedic, or you arent. Technically we do have patient transport (a touch lower than EMT-B), and critical care paramedic, a fairly standard role. So at the moment I am at the end of my first year on the road, I have 18 months of university left, then a year of internship, then I will (hopefully) be a paramedic with a Bachelor’s Degree in Paramedical Sciences.
Anyway, enough blathering, my question is probably not isolated to our fair city, and it is about the handover. We supposedly follow the DeMIST procedure, which is patient details , mechanism of injury, injuries sustained, and treatment given. My problem is that I usually get about halfway through it when the triage nurse cuts me off, with a 50/50 chance of them making a bored/sarcastic comment about . What is the key to giving a good handover? How do you keep the other people interested enough to listen to the whole thing? And how the hell do you remember everything and not get lost halfway through? Have fun at the EMS conference, cant wait to hear the next update.
Simon from Australia

**Mentions:**

EMSCat.com
JBLearning.com
NREMT
EMT Achieve for both Basic and Paramedic.
Happy Medic

Excited Delirium EMSEduCast episode

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Ep 25 Live from Texas EMS Conference 2010 Nov 25, 2010

[audio:25_TexasEMSConf2010.mp3] (34:28) One day in and we are both already tired. We talk about the different classes and workshops Ron went to, including Kelly’s PediALS workshop.

Learning all about tourniquets and hemostatic (clotting) agents including recommendations for what works, and a history of tourniquet use from Larry Torrey’s “All bleeding stops eventually”.

Why do we design things in EMS for the rare cases? How often do we need Pedi ALS? Of the calls we get how many are pedi, and of those how many involve ALS, IV or ET? Kelly knows. And Ron gets excited over using an EZ-IO for the first time.

More ways animals make the ultimate sacrifice for medicine.

What if your program required you to be able identify breath sounds and heart sounds in a noisy distracting environment before they’d let you wear a stethoscope? Well Bob Page’s student have to do that, and Ron learned a lot in his Stethoscopy for Dummies lecture. Would it be a consolation if he gave you a Littmann stethoscope when you passed?

How do you clean your laryngoscope? Or do you? Learn about the cool stuff the audience saw and that Kelly liked.

Learn a tip on balancing a show like this one. This episode was recorded live at the Texas EMS Conference in Austin Texas November 22, 2010.

Mentions:
The active ingredients in the three main hemostatic agents.
Kaolin -> a clay (QuikClot)
Zeolite -> lava rock (QuikClot)
Chitosan -> protein from crustacean shells (Celox)

C.A.T – Combat Application Tourniquet Get it in Orange because you are an EMT and not a tactical wannabe.
EZ-IO
Littmann Master Stethoscope
Ron’s DRG Stethoscope
SafeSeal Stethoscope Diaphragms.
The R.A.L.E Repository
Auscultation Repository
Jules Scadden
Bob Page
Larry Torrey
Stylite, maybe Surch-Lite
Veinlite
PHI
JBLearning

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Ep 24 – Crics and Foley Catheters Nov 17, 2010

[audio:24_CricAndFoley.mp3] (55:38) This week we talk about Folly catheters and how it is different on a real woman than the mannequin. Also about getting the smell out of your nose. Ron had a big extrication day where he learn all about cricotomy, alternative airways, digital intubation and blind nasaul intubation. In pharmacology we learned about HTN drugs.

For the first time one of my teachers told me the exact opposite of something Kelly said was airway fu last week. Listen to us discuss why each of them felt the way they do. And while we’re having disagreements the newbie ain’t so sure about other things Kelly said, or maybe it is the other way around.

Listener Questions

Kelly, I am having a real problem being able to hold manual c-spine on on a supine patient who is face down as we log roll the patient on to a long backboard. Try as I might, I can’t seem to hold on thru the whole rolling process without falling on my face or breaking c-spine. I have to stop the roll midway thru & have someone temporary take over c-spine while I get my hands reset, then I take over the c-spine & finish the roll on to the board. My instructors are getting fustrated with my not doing the roll without stopping. My other classmates have no trouble being able to do this. Now I realize that I’m alot older than 99% of my classmates (I’m 42) & I’m not as flexable as I use to be. Is it ok that I stop & reset my hands?? Is this going to be a issue when I do my national registry practicals?? I understand the concept & I believe that I have my hands in the correct positions, it’s just can’t seem to flex enough to continue the roll. I will keep trying to figure this out. It is very discouraging to me. – Kenneth

I’m wondering if you (Kelly) have any advice for someone about to start their paramedic internship. – Matt
Mentions:

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Ep 23 Grey Clouds and Amiodarone Nov 10, 2010

[audio:23_GreyCloudsAndAmiodarone.mp3] (53:00) Is Ron still a white cloud if he visited both level 1 trauma centers in one ambulance shift? Find out about Halloween in the hood.

Cardiac drugs, new ACLS guidelines and the Noah’s Ark drug. Video laryngoscope and a description of your vocal cords that a fireman can remember. Learn what kind of patients don’t respond to atropine.
Listener Questions

When will I feel comfortable? When will I feel like I know what I’m doing? – Sabrina

I am a teen in Arizona. Do you have any suggestions for me to sort of jump start my education with medicine and EMS? – Amy

My question is if Kelly would comment on a few cases which have come up over at ems1.com between here and the UK about medics ignoring someone who asks for their help during break. I think doctors are required by law in some places to respond if someone asks if there’s a doctor in the room. How does that work with Paramedics/EMTs? What’s the balance between catching your breath and getting someone the help they need? – Chris

Mentions:
Emergency Cardiac Care 2010 Update Interview on Mediccast.
http://www.mediccast.com/blog/2010/10/18/ecc-2010-update-interview/

stileproject.com look it up yourself cuz this is a hardcore porn site with gory trauma video.

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Ep 22 Intubation Baby Nov 03, 2010

[audio:22_IntubationBaby.mp3] (59:47) Maybe we should have called it “everything you wanted to know about intubation but were afraid to ask”. Kelly is the Jedi Master and Ron started intubation this week. Had lots of questions to ask Kelly, so this is a long one.

Here’s some of the questions asked.
Blade Preference: Miler/Mac
Pedi Bougie
Do you have a backup device?
How do you secure the tube to the mouth/in place?
Vomit and other stuff coming out of the tube.
When do you start intubating?
Burned airway gets the most experienced medic.
Do you hold your breath while intubating?
How do you know you are in?
What drugs do you use for PAI?
What is you method for PAI?
RSI is now PAI
Do you always paralyze?
How do you pick a tube size?

Listener Questions

Christine Springfield: Intubation on a concious, non-sedated patient. Experienced that this week during clinicals and it was VERY interesting. I can see that this might be necessary in the field at some point… what are your thoughts and experiences?

Christopher
How as a relatively new medic how can I get senior “It’s always been done this way” medic to change some of their modalities of treatment?

Mentions:
Dr Michael Bailin intubating himself.
Ron’s EMS Youtube Channel.
Kelly’s Medic Math post.
Kelly’s Airway Continuum

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SP 02 The Mark Glencorse Interview Oct 29, 2010

[audio:SP2_MarkGlencorseInterview.mp3] (50:51) In this special episode Ron interviews UK paramedic Mark Glencorse, aka UKMedic999. He tries to ask everything you ever wanted to know about EMS – or Ambulance Service – in the UK but were afraid to ask.

How are medic’s trained? What are the levels of medic? How does medical direction work? Is ambulance service uniform through out the UK? What are transport times like? How do nurses and medics get along?

Along the way we talk about how changes in the UK system mean paramedics have to take on more responsibility. It is something we in the states need to listen to because some of the same problems that caused these changes are also at work in the US medical system.

Also Mark did some research and tells you how to become a medic in the UK for a limited time.

Listener Questions

What made him decide to make EMS a career? Is he familiar with a fire-station/dispatch center near Throckly? As I got to visit there when I was over visiting some friends in Newcastle. – Ctroberts01

Chris:
– What do you think works better in the UK system that we need in the US systems?
– What protocols/treatments were you suprised at when you visited the US, be it rudimentary, advanced, or just strange?

I have some interest in working as a paramedic outside of the United States in the future. I am thinking canada or the UK; What would that process look like?
> Ben Wolcott W – EMT-B, Registered Maine Guide

An ever pressing issue here….pay differences. Is the respect that a Paramedic gets in the UK equal to or less than that an RN gets. And by the same token, what is the pay grade difference – First Due Medic

What laws or regulations control your ability to route people away from the A&E? – Happy Medic
Timothy Clemans – With what you know now what would you have done differently as a student?

Mentions:

EMS Garage Liability Episode
UK Health Professions Council
Chronicles of EMS
Why Mark became a medic post.
UK EMS TV program – Casualty
Hot Fuzz

Where To Find Mark
Blog: 999Medic
Twitter: @UKMedic999
Podcast: Ambulance Matters

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Ep 21 A Stable Rhythm Oct 27, 2010

[audio:21_StableRhythm.mp3] (35:08) This week Ron experiences his first dead patient and CPR on them. We talk about capnography, and symptomatic bradycardia. Newbie asks about clearing C-spine and moving the head to a neutral position. And Kelly tells how to give informed consent to spinal immobilization. We also answer a number of listener questions.

Mentions:
Mediccast Ep 240 on EMS Clinical Precepting, and Education.

Nexus Protocol for Clearing C-Spine

Listener Questions
Shaun:
As a new EMT-B I am about to start IV Therapy class. Any hints or tips for me? Other than the obvious humility that I am about to learn. lol

Matthew:
In a recent episode, treatment for drunk patients was brought up and Kelly stated that dehydration was the biggest problem (and the primary cause of hangover headaches). He then went on to say that he would personally take 1000 mgs of Tylenol and drink a bottle of Gatorade to avoid this.
I was surprised to hear him mention Tylenol since it’s been my understanding that taking acetaminophen before or after consuming alcohol can put a strain on the liver and possibly even cause damage to it. Is this true or have I been misinformed?

Christine Springfield:
Prilosec for anaphalaxis. Going along with your discussion on drugs and how/why they work, in the ER, we had a patient come in with a severe reaction to an unknown substance and the protocol was Epi 1:1,000, Benadryl and Prilosec, all IV. The doc told me that the Prilosec is also a histamine blocker that addresses the receptors that Benadryl doesn’t affect. Do y’all have any experience with this and is this something we can expect to be rolled out to EMS at some point?

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Teaser: Coming Very Soon MVC not MVA Oct 25, 2010

It is not really 2 hours long, really only 23 seconds, but Blip is having issues with it.

The mp4

Ep 20 Maintaining Control Oct 20, 2010

[audio:20_MaintainControl.mp3] (38:52) Is the scene safe, Kelly?

This week Ron and Kelly talk about maintaining your own pulse when dealing with a crazy call, what’s the reason to give pain meds, and the difference between the parasympathetic and sympathetic nervous systems. You’ll learn a new way to remember what part the parasympathetic system has on breeding.

This week Ron started giving IVs to the public at large and got to see a cath lab procedure.

UPDATE: After listening to the show and checking my pharmacology book I’m pretty sure the STEMI patient was not given Haldol. He was given Heprin. Haldol is an antipsychotic. Heprin is an anticoagulant which makes way more sense.

Listener Questions

I am wondering if there are personality types that are more successful than others in EMS? The reason I am asking this is because I have often been told that people can’t see me working on an ambulance or in an emergency department and have often been told that I should be a case worker. – Kim in Colorado

How familiar are EMTs/Paramedics with the Road ID wrist/ankle identification tags? Also, what information would you suggest to have on the tag? Typically it is name, city/state, 2-3 contact numbers, and any medical conditions or allergies. Eric – Las Vegas

Mentions:
House of God
Rogue Medic
Anatomy & Physiology for Emergency Care
Veinlite

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pigheart — **Ep 19 Thank God For Pigs** Oct 13, 2010
[audio:19_Pigs.mp3] (43:24) This week we talk about giving narcan, should you give nitro before or after getting an IV. Can an IV of Lactate’s Ringer cure a hangover?
What the inside of a heart looks like

We talk about doing patient assessment the same way every time and and getting your reports done quickly. Can an experienced paramedic get a pulse without a watch? Well you newbies can’t, so wear your watch. Looking for patients on scene and finding ones that weren’t there before.

Mentions
Aimee Binning from NAEMT talks about the TACOS acronym

TOTWTYTR

Naloxone: The Most Abused Drug in EMS

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Ep 18 Busy Busy Oct 06, 2010

[audio:18_BusyBusy.mp3] (31:43) It’s been a crazy week for the newbie. 3 tests, first IV lab and first hospital clinical. We talk all about those tests, the ones that made him feel like a starfish and the ones that made him feel like Hank Arron. Kelly gives some tips on IVs and we answer a number of listener questions.

Questions:

How do you keep your skills up when you aren’t in the field? Advice for a teenager who wants to be an EMT. What’s the best way to do IV pass-off.

Mentions:
Kelly’s post on medical math.

EMS Educast and the episode about EMS education for high school students.

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SP01 Interview Dr Bryan Bledsoe Sep 30, 2010

[audio:SP1_DrBledsoeInterview.mp3] (53:17) This is a special episode where the EMS Newbie, Ron Davis, interviews Dr Bryan Bledsoe. As Kelly puts it, Dr. Bledsoe is a rock star in EMS. He speaks at numerous EMS conferences, teaches Emergency Medicine at the UNLV Medical School, and literally wrote the book on Paramedic Care. The 5 volume set Paramedic Care Principles and Practices is the text book for Ron and many paramedic’s training to get his EMT-P. He also wrote another of Ron’s textbook, Prehospital Emergency Pharmacology (6th Edition). He co-wrote with Kelly the SUCCESS! for the Critical Care Paramedic book, to prepare paramedics to get their Critical Care certification.

In this interview Ron talks with Dr. Bledsoe about why he is so involved in EMS. What changes he’s seen over the years and where he sees EMS going in the future. He answers listener questions, including what makes a good paramedic, what’s up with O2 administration being a bad thing, and are standing orders enough. There is also a little talk about how patient assessment taught in his book for paramedics is like that taught to medical students and if paramedics make better med students.

Lot’s of interesting stuff so give it a listen.

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Ep 17 What If They Need To Pee Sep 28, 2010

[audio:17_NeedToPee.mp3] (50:49) This week we talk about learning the 12 Cranial Nerves, in depth patient assessment, keeping fluids and drugs at the right temperature in the ambulance. Kelly tells you the secrets of peeing on long transports, both for the patient and the paramedic. Since Ron is learning IVs next week we talk about dealing with pediatric patients and needles, with Kelly the Pedi Stick King. Also what is a Critical Care Paramedic, does anyone really know? Apparently the Flight Medics do.

Kelly will be in Dallas this week at the EMS Expo starting on Wednesday and will be podcasting with EMS Educast, EMS Garage, and others as well as handing on EMS Newbie CDs.

On Thursday night, both Ron and Kelly will be on the Dr Anonymous show live on Blog Talk Radio.

Mentions:

Bevel Down IV for Pedis

Wenckebach Phenomenon, aka the Heart Block

Keys to Student Mastery of EMT Training

SEX, RELATIONSHIPS AND THE CARDIAC CONDUCTION SYSTEM

International Association of Flight Paramedics

University of Maryland Baltimore Department of Emergency Health Services

George Washington University EMS Degree

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Ep 16 – Shooting Your Face Off Sep 22, 2010

[audio:16_ShootingFaceOff.mp3] (29:43) This week we talk about an EMS guide to suicide, and how to start an tube on someone without a face. Ron’s finally offical, having passed his National Registry test and be certified by Texas as and EMT.

From class we talk about taking a patient history from a hypoglycemic diabetic is a waste of time, and how to establish and maintain a relationship with other healthcare professionals.

Kelly will be at the EMS Expo in Dallas September 27-OCt 1 and will have CDs with the first 13 episodes of Confessions to hand out and autograph.

We’ll both be on the Dr Anonymous show Thursday Sept 30 at 8PM Central Time.

Mentions:
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Ep 15 Agenda for the Future and Drugs Sep 15, 2010

[audio:15_Agenda_Drugs.mp3] (41:16) In this episode Kelly and Ron talk about the 1996 EMS Agenda for the Future, EMS 2.0, the community paramedic. Studying for the NREMT and learning to learn after 18 years out of school. Narcotic tracking and security. Hypothermal treatment and the Morgan Lens.

Mentioned:

Study Hacks blog

How to Become a Straight-A Student by Cal Newport

Livescribe Pen

Keys to Student Mastery of EMT Training by Smith, Post and Jacobus

Kelly will be at the National EMS Expo in Dallas Sept 27-Oct1 and will be passing out CDs of the first 13 episodes of Confessions on an EMS Newbie.

Kelly and Ron will be on the Dr Anonymous show Sept 30 at 8:00 PM CT.

Kelly and Ron will be at the Texas EMS Conference in Austin Texas Nov 21-24 and will be doing a live episode.

And we are still taking questions for Ron’s interview with Dr. Bryan Bledsoe this month.

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Ep 14 Beginning Paramedic School Sep 08, 2010

[audio:14_BeginPSchool.mp3] (29:43) This week we talk about how many EMS schools there are in Texas and how many of them are accredited. Ron started the Lone Star College North Harris two year paramedic program, which is accredited, this week.

We talk a lot about that program and how it is structured. Ron asked the head of his program, Dr. Bill Drees about different rules they have like not requiring Anatomy and Physiology as a prerequisite and the no visible tattoo rule.

We also announced a few things that we will be doing. On September 23 we’ll be on the Dr Anonymous Show live on BlogTalk Radio. At that same time Kelly will be at the National EMS Expo in Dallas, Texas and wants you to meet him and buy him an adult beverage. In November we’ll be doing a live shot at the Texas EMS Expo in Austin, where you can meet both of us, ask your own newbie questions get autographs.

We also answer a listener question about going straight to P-school from basic.

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Ep 13 The Best of Basic Sep 01, 2010

[audio:13_BestOfBasic.mp3] (53:40) Special best of episode. Ron was off on Vacation between Basic and starting P-school, so our audio wizard Marc put together this best of episode. Some of the funniest, most touching and most practical stuff. New to the show and want to know what it is like? This is the episode to listen to.

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Ep 12 Finally Aug 25, 2010

[audio:12_Finally.mp3] (29:43) Ron goes through his final skills tests and the Final Exam. In the process almost failed out on traction splint. Kelly tells us how to auscultate a fracture. We discuss “Getting Your Patch” and what comes next. Registering with the State. Registering with National Registry. Waiting for my school work to be certified by our medical director and sent to NR. Taking the Test. Waiting for the state to send me my certification/patch.

Live Listener Question

Matt – Palpating a diastolic BP.

Mentions:
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Ep 11 – Patient Assessment Failure Aug 18, 2010

[audio:11_PatientAssFail.mp3] (43:43) Learn how Ron failed and then passed Patient Assessment Medical and how that could be a good thing.

Ron also retook his CPR for heathcare provider this weekend, find out why and how that’s important to the newbie.

It is coming down to the final week of class and Ron could be an EMT Basic before the end of the month.

How long should you do CPR? An hour? Listen to find out.

Listener Questions

Lisa O’Connor
Ron – Do any of the students in your class have tattoos?
Kelly – How are tattoos responded to in EMS?
I have been told that I will not ever be hired since I have a small cherry tattoo on each forearm. I have 9 total, but those are the two that “show”. Some have said its no problem, wear a long sleeve under shirt, while others say patients are offended and it makes companies look dirty.
I start school in January, and honestly, am a little nervous about my ink. I just want to know if I should be?

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Ep 10 I Don’t Know Nothing Bout Birth’n No Babies Aug 11, 2010

[audio:10_Babies.mp3] (42:41)
This week Ron covered behavioral Emergencies and started talking about delivering babies in class. How many do you think Kelly has delivered? Find out on this episode.

Ron also passed my Patient Assessment Trauma skill on Wednesday and will attempt Patient Assessment Medical on Monday. So he asks Kelly for tips on doing that exam.

You’ll also get a complete list of books a paramedic student should be reading.

Listener Questions:

This is Cameron from Colorado. I was wondering what Kelly thinks is the best way to prepare for paramedic school? Do you think you should ready ahead as much as possible? Such as, ACLS protocol, and drug memorization or do you think there is adequate time in the class to learn this material? Also, how much experience do you think an EMT-B needs before attempting P school?

Ken – besides reading Kelly’s book (which is very expensive on amazon), is there anything I can read / watch that can help me start my learning – getting ahead of the curve??

Kelly’s Book List

Anatomy & Physiology for Emergency Care by Bryan E. Bledsoe, Frederic H. Martini, Edwin F. Bartholomew, William C Ober, Claire W. Garrison

Emergency Medicine: A Comprehensive Study Guide 6th edition by Judith E Tintinalli

Rapid Interpretation of EKG’s, Sixth Edition by Dale Dubin

Taigman’s Advanced Cardiology (In Plain English) by Syd Canan, Charly D. Miller, Mike Taigman

The 12-Lead ECG: In Acute Myocardial Infarction by Tim Phalen

12-Lead ECG for Acute and Critical Care Providers by Bob Page

Goldfrank’s Toxicologic Emergencies, by Neal Flomenbaum, Lewis Goldfrank, Robert Hoffman, Mary Ann Howland, Neal Lewin, Lewis Nelson

Paramedic: On the Front Lines of Medicine by Peter Canning

Rescue 471: A Paramedic’s Stories by Peter Canning

Rescuing Providence by Michael Morris

Street Dancer by Keith Neely

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Ep 9 I Am A White Cloud Aug 04, 2010

[audio:09_IAmAWhiteCloud.mp3] (43:05) Show Notes

This week we talk about Ron’s super power, being a white cloud. Another ambulance shift with almost no calls again. We talk about 24 hour shifts and last minute calls. Lots of questions answered in this episode as well.

Is a Basic just a paramedic assistant? National and State EMS organizations, are they worth joining and do they do anything? Advanced airways, Good Bad or Indifferent? When should you call a helicopter? And where can we find the last chapter of Kelly’s book online?

Mentions:
Grief Sponge

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**Ep 8 Boring Ambulance and Stupid Skills** Jul 28, 2010
[audio:08_BoringAmbulance.mp3] (49:38) Well Ron lost is ambulance virginity on a Friday night and was basically bored. Everybody built it up, but his shift wasn’t that exciting. But after being up all night he got on Skype with Kelly and that is always interesting. They talked about his shift, and about the skills he is learning to be tested on and how a couple of them are just stupid. At least in Ron’s opinion. And learn the truth about activated charcoal.

There was a discussion of practicing in different states and how that is a mess. The upcoming accreditation standard for paramedic schools won’t make it any better, but it should help in the National Registry states. Didn’t understand that sentence? It is all explained in the podcast.

What do you say to someone who just lost a loved one? Kelly’s post, Seeking Words of Balm is the topic of discussion this week. And on gear, Ron takes issue with Kelly swiss army knife of trauma shears.

We also answer a question about how much time Ron is spending studying and Kelly gives his take on how long you should take.

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Ep 7 Shock & Scenarios Jul 21, 2010

[audio:07_ShockScenarios.mp3] (47:35) This week Ron confesses to making his wife an EMS widow already but at least he got out of doing P90X. Hear the story about how half of Ron’s team got killed during his extraction day scenarios. His scenarios included sucking chest wounds, ejected infants, and belligerent drunk drivers distracting Ron. Kelly also tells us a lot about various kinds of shock including one that makes people faint at the toilet.

We answer two listener questions: “Does the Trendelenburg position help hypotensive patients?” from Vince DiGiulio and “What malpractice insurance would an EMT need?” from Dan Pelzel.

Since we finished talking about Kelly’s book last week we talk about his post “Why y’all looking at me like I’m the douchebag?”

During the gear section Kelly answers “What gear do you carry on the ambulance that you don’t use in the hospital?”

Mentions:
HPSO Insurance

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Ep 6 The Beginnings of Trauma Jul 14, 2010

[audio:06_BeginningsOfTrauma.mp3] (48:03)

In this episode we talk about Trauma, or at least we start talking about it because that’s what Ron is studying. There is a discussion of learning the kinematics of trauma and then bleeding. Kelly gives a discussion on Tourniquets and not cringing at the trauma pictures.

Ron spent more time in the hospital, still with a white cloud. Learn what he learned from his preceptor this time and more discussion of 12 lead EKG.

This is the last discussion of Kelly’s book with the last chapter. Then we talk Blood Pressure machines.

Mentioned:

Report on how people come to the hospital.

The Rale Respository of breath sounds.

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mjsMovie — **Ep 5 – First Hospital Clinical** Jul 07, 2010
[audio:05_FirstHospitalClinical.mp3] (53:18)

This week we talk about Ron’s first hospital clinical. His fears going in and some of the cool stuff he got to do. We also talk about the fact a 12 line EKG has 10 lines. How Ron got blood on his gloves, but Kelly didn’t like his BSI. And what paramedics do in the ER and why nurses don’t like it.

If you are new to EMS and EKGs, Kelly will tell you about the modified scrotal lead. You’ll also learn the GMFYOYO radio call.

Lastly every new EMT wants cool gear with him all the time. Find out what Kelly carries in his truck.

We answer a listener question from Timothy in Seattle about how to be the best you can be.

Mentions
Mother, Juggs, and Speed

Too Old To Work, Too Young To Retire

The Thomas ALS Pack

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nasalcannula-thumb — **Ep 4 – Airways and Reports** Jun 30, 2010
[audio:04_AirwaysAndReports.mp3] (1:05:24)
This week we cover Airways and Reports on Confessions of an EMS Newbie. Ron’s class is doing skills labs in securing a patient to a backboard, airway management, oxygen and we discuss them all.

Some of Ron’s questions include, “Do paramedics use OPAs and NPAs? Or is intubation just the silver hammer of airways?”

Then we move onto writing reports, which Ron will have to do for his clinicals and he’s paranoid about. Kelly answers the question, “How do you remember everything that happens on a call for the report?”

We have a couple of listener questions. Katie asks how to make the most of a EMS ride along and Kelly’s answers will help anyone who is preparing to work on an ambulance, whether a ride along, for clinicals, or as the new guy on the truck.

And did you wonder what happen to the guy from the chicken gut truck? We’ll find out today.

In the book section we’ll talk about a very airway related story and what it is like to be sued as a paramedic.

In gear we talk EMS Pocket guides and how they can improve your reports.
**Gear:**
iPhone Apps:
NREMT Paramedic Medications pocket guide
Epocrates
EMS Field Guide

**Vocabulary in this episode:**
CHF – congestive hear failure

Nasal canulla

BVM – Bag Value Mask

Non-rebreather mask

Link for explanation and pictures of oxygen masks.
Backboard

**Mentioned**
EMS Garage – C-spine episode

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sa706 — **Ep 4 – Airways and Reports** Jun 30, 2010
[audio:04_AirwaysAndReports.mp3] (1:05:24)
This week we cover Airways and Reports on Confessions of an EMS Newbie. Ron’s class is doing skills labs in securing a patient to a backboard, airway management, oxygen and we discuss them all.

Some of Ron’s questions include, “Do paramedics use OPAs and NPAs? Or is intubation just the silver hammer of airways?”

Then we move onto writing reports, which Ron will have to do for his clinicals and he’s paranoid about. Kelly answers the question, “How do you remember everything that happens on a call for the report?”

We have a couple of listener questions. Katie asks how to make the most of a EMS ride along and Kelly’s answers will help anyone who is preparing to work on an ambulance, whether a ride along, for clinicals, or as the new guy on the truck.

And did you wonder what happen to the guy from the chicken gut truck? We’ll find out today.

In the book section we’ll talk about a very airway related story and what it is like to be sued as a paramedic.

In gear we talk EMS Pocket guides and how they can improve your reports.
**Gear:**
iPhone Apps:
NREMT Paramedic Medications pocket guide
Epocrates
EMS Field Guide

**Vocabulary in this episode:**
CHF – congestive hear failure

Nasal canulla

BVM – Bag Value Mask

Non-rebreather mask

Link for explanation and pictures of oxygen masks.
Backboard

**Mentioned**
EMS Garage – C-spine episode

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Ep 3 – DNR, Palpation and Medical Control Jun 22, 2010

[audio:03_DNRPalpationMedicalControl.mp3] (39:18)

This week we talk about Ron’s first test and getting his shots finished up. Kelly gives some insight into what the National Registry test questions are like as well.

Then we go into taking vitals and Kelly gives a really great tip on palpating a pulse. We talk about medical control. How Kelly contacts them and when he does.

In the gear section we discuss blood pressure cuffs. And from he book and class we talk about DNRs and how Kelly deals with that one family member who wants you to do the resuscitation anyway.

Update:

There is a DNR Bracelet in Texas as well.
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The Pen Light Ron ordered.

Ep 2 – Sex And EMT Pants Jun 15, 2010

[audio:02_Sex_and_EMT_Pants.mp3] (48:35)
This is episode 2 of Confessions of an EMS Newbie where we talk about Love, Sex, Relationships, and the EMT as well as Anatomy, Physiology, and those cool EMT Pants. The show begins with a discussion of Ron getting ready for clinicals and the trials of getting all his shots. We learn how Kelly does 200 mile, one way critical care transports, and why Hurricane Katrina is to blame.

Through number of comments Ron gets the idea is is easier to get laid in EMS. Kelly gives him the real scoop. And while EMS may get you married, it is hard being married to someone else in medicine and it hard being married to someone outside of it. Ron is already beginning to see a separation where he doesn’t want to tell his wife stories from EMS to protect her.

Talking from his book, Kelly explains how ambulances are staged, or positioned and what an ambulance station is like. And don’t get him started on System Status Management, but Ron did.

In the gear you really need, it is time for Ron to get his uniform, so we talk boots and pants. Do EMT’s really use those cool trauma shear straps? What is the biggest give away of a sparky new EMT? And what is in Kelly’s pockets?

Mentioned:
Lucy Hornstein, Declarations of a Dinosaur: 10 Laws I’ve Learned as a Family Doctor

Boot makers: Magnum, High Tech, Bates, and Rocky.
Kelly’s review of Magnum boots

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Ep 1 – Newbie EMT Fears Jun 10, 2010

[audio:01_EMT_Newbie_Fears.mp3] (49:05)
Our first episode, recorded the morning before Ron’s first EMT-Basic class. We talk about the fears he has before he ever gets started and Kelly – his Jedi master paramedic – calms those fears with ease.

Those fears are:
#1 I’ll have too weak a stomach to be an EMT.
#2 I’m not emotionally strong enough for it.
#3 I won’t be smart enough.

Other things we cover:
What are good and bad motivations for becoming an EMT? Stories including chicken and horse guts. We get Kelly’s opinion on CISM and the calls that haunt him. As well as how he think you should for studying for class.

Every episode we will also talk about Kelly’s book. This week you’ll learn everything about it and some of the hardcore paramedic stuff the editors thought to dangerous to include.

Lastly we start our section on the Gear a Newbie Really needs. Kelly brings it down to 3 things

A Pen
A Watch
A Stethoscope

Mentioned:
Ron’s Photography site and podcast, Photographer And Model
Kelly’s book En Route

Correction
Ron’s class is actually 12 weeks long and also has 2 5 hour extrication labs.

Definitions:
Critical Care Paramedic – Primarily deals with high acuity patient transfer.
Acuity – from acute; how sick the patient is. The higher the acuity the worst sick they are.
CISM – Critical Incident Stress Management.

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Medical Emergencies

Special Populations

Clinicals

Mentions:

Listener Questions

Mentions:

Listener Questions

Listener Questions