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Confessions of an EMS Newbie
By Ron Davis and Kelly GraysonMedicine
Confessions of an EMS Newbie episodes
- 83 Newbie JD Meyerdirk
(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 TexasLivestrongProstate Cancer FoundationBlueCureAlt KiltKilt ThisBlinn CollegeGet complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.24 min - 82 NREMT-P
(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 WeekOn 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
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.25 min - 81 NREMT Skills Testing
(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 QuestionsMatt 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 FREAKWhat 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.
Subscribe or review on iTunes.35 min - 80 Not So Done
(22:48) Well I thought I was done, but it turns out I was living an illusion.
What I Did This WeekI did not pass my orals, as a matter of fact I failed them miserably.
12 Lead and ECG interpretationDrug DosesHit the stress wall and flamed out during PALS.
Failed PALSDoses are my nemesis
Mentions:MedicTests.com
Listener QuestionsI 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?– SachaReally 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-PED-EKG LiaisonIntermountain Heart Institute EKGIntermountain Medical CenterGet complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.23 min - SP09 My Clinical Preceptor – Sarah Francis McClure
(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?
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.0 min - 79 Finished Paramedic School
(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 WeekAssessment Based ManagementOrals
FinalClinicalsFinished 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?BirthDKA – KussmaulsIf you are a newbie and interested in being on the show, contact us. [email protected].
Mentions:HHNK
DKAZofran – contraindicated with wide QT intervalPhenergan – give with fluidQuicktrachEMS Pocket GuideVagus Nerve StimulatorListener QuestionsChristopher asksHave 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.
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.0 min - 78 Plug The Holes
(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 WeekAssessment Based ManagementLearned 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.ClinicalsPlugged 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 QuestionsRyanHave 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 hereRob 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.
Subscribe or review on iTunes.19 min - 77 Breakdown
(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 WeekAssessment Based ManagementMore scenarios and I’m wondering a little how much it is helping.
ClinicalsYou 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”
AndrewQuestion 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!RyanLearned 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?
Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.39 min - SP08 – National Test Prep
(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 BlogBrain Rules Book.Get complete information on the The Confessions of an EMS Newbie Podcast.
Subscribe or review on iTunes.27 min - 76 Calling In Reports
(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 WeekAssessment Based ManagementTested all our paramedic skills.
The one that got the most people was Static Cardiology.I got all the rhythms, but mess-up 2 drug dosesAlso you have to treat the patient, meaning if they have a bee sting and no cardiac issue treat an allergic reactionClinicalsFirst time to call in reports to hospitals.
On the phone.Wrote it down firstMentions:6 Second ECG
No Guts No Glory Blog PostListener QuestionspeterHello 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 SoxfanHey 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…JasonCatching 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!,NateMikeI’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?shannonDear 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.
Subscribe or review on iTunes.33 min
About Confessions of an EMS Newbie
From the publisher's feed
Confessions of an EMS Newbie is a weekly podcast for beginning EMS providers. As Ron goes through paramedic school he'll sit down and discuss what he's learning with experienced Paramedic and writer…
Kelly Grayson. Anyone new to being an EMT will enjoy getting the strait scoop and accurate information from someone who has been there over and over. Ron's perspective as knowing next to nothing means we'll keep it understandable and practical.