[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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[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.

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

Fentanyl

[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:

Remember the 3 question algorithm:

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

– 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

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[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

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[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.

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EMSCat.com

Excited Delirium EMSEduCast episode

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[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.

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C.A.T – Combat Application Tourniquet Get it in Orange because you are an EMT and not a tactical wannabe.

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[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

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[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.

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

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

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[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.

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

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[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:

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?

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

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EMS Garage Liability Episode

Where To Find Mark

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