Constant reader, my apologies. I feel simply awful that I’ve neglected you and all of my other my blog readers for the past few weeks.
However, I do have an excuse.
It’s the final couple of weeks of the first quarter of Medic School. That means I’m cramming clinical and ride time in, studying all of the material we’ve covered for the past 3 months and trying to have a little bit of life on the side. It’s tough.
So, I’m sure you’d love to read about what’s been going on… here’s a little recap of the past few weeks.
I’ve shown some marked improvement in my IV skills. It’s simply a Jedi Mind trick. If I visualize the catheter advancing in my mind, it will happen when I do the skill. I also met some great nurses and other medics during my ER rotations that are helping to hone my skills.
The ER rotations are fun for me. I know some of the other guys look at them as a waste of time. “Let me get my sticks and get outta there!” I like talking to the Docs and learning more about how THEY evaluate the patients and what happens after we bring ‘em in. It’s really a great learning experience. I do my last ER shift of the quarter tomorrow morning.
My ride time has been strange, to say the least. I’m riding with a department that has 4 platoons and medics that float from station to station depending on debt days and staffing needs, so I never have the same preceptor. That’s something I’m not really happy about. Although, I guess at this point in my education, it’s more about me learning how they work in the field.
My first 24 was pretty laid back. 2 ALS calls, both very minor. My preceptor told me, “Just do it. If you’re gonna kill someone I’ll stop you.” Not exactly the learning environment I was hoping for. But, all went okay, and I didn’t kill anyone.
I just finished a 24 this morning and it was another strange one. The first medic I was assigned to was very cool and seemed really interested in training and teaching. We really clicked. However, he was only working a couple of hours on a fill, so he left at noon. The senior medic who came in to cover the rest of the shift wanted nothing to do with a student. The third guy on the truck was a precepting medic and he was running all of the calls. It was confusing and a little messy and I just tried to stay out of the way and do what I could. The Captain on the shift said he could send me to another station if I wanted to work with just another medic. By that time it was mid afternoon and I figured I’d just stick it out.
Three ALS calls for the day. A possible CVA, a cardiac arrest and a fall/fracture that was ALS due to pain meds.
The CVA was really a marginal ALS call. The PT had some slurred speech and left arm drift. We did run a 12 lead as she had a history of Afib, got a dexi and we tried to get a line. No success. The transport time was short (under 5 minutes) so I suggested that we just load and go. Nobody disagreed, and off we went, code to the ER.
Shortly after that we responded to an Extended Stay motel for a “Citizen CPR”. Young adult male, unknown down time. Best guess? “Awhile.” The guy was at least 300 pounds and gray when we arrived. He was asystolic on the monitor and that never changed through 40 minutes of ACLS. I did attempt to get the tube, but no dice. The guy was huge. A Mallampati Class 4, no neck and his jaw was pretty rigid from the extended down time. But, I figured I should give it a go. The medic handed me a Mac4. (not my choice. I wanted a Mac3, due to the size of his mouth.) I grabbed a pillow off the bed and crammed it under his shoulders, stuck in the laryngoscope to take a look and couldn’t see the cords. I mean, I couldn’t see nuttin’! He had very little jaw excursion and it was tough even getting a look. One of the other medics switched places with me and just shoved the tube in while I gave some cricoid pressure. He told me he didn’t see the cords either and just went for it, hoping he’d hit the trachea. Good bilat breath sounds and the capnography was showing a good wave form with ventilation. Luck? Experience? Maybe some of both. I wasn’t comfortable enough to just try and jam a tube in blindly. The guy also had no veins and he wound up getting an IO drilled in each tibia and we pushed drugs that way. We worked him for 40 minutes and after we called it, the story we got from the cops was that he had a history of sleep apnea and took a bunch of Percocet with his buddies … and that was that. Lots of help on this one. There were 4 guys on my Medic Unit and we had an additional Medic Unit and an Engine Company. So aside from the firefighters and cops, there were LOTS of medics on scene. At least four, plus me (the 1/3 medic.)
Later in the afternoon we rolled to a call for a mid 50’s female that fell and dislocated or fractured her ankle. It was on the verge of becoming an open fracture, so we did a pillow splint and got her in the truck. It took a long time to find IV access, as she had no veins. She eventually got a 20 in her hand, some fluid and 10mg of MS that really took the edge off by the time we arrived at the ER. Personally, I think I would have lingered a little longer on scene to get the IV and some pain meds (and maybe some Diazepam) on board before we took that long, bumpy ride to the ER. But that’s a personal preference thing.
The rest of the night was quiet. Pizza for dinner, got a lot of studying in. However, I don’t know if I’ll go back for a ride with that shift again. I guess I just have to take what I can get.
I’ll admit, spending long shifts in a fire station is a little awkward at first. I have a history with Fire, so I know the rules. But, it seems that some of the other students didn’t and that makes it rough for all of us. When you’re a student doing ride time at a fire station, you need to remember you’re a guest in someone else’s house. I’ll write a full blog post on “how to behave during field shifts” in the next day or so. I think it’ll be valuable to anyone who is nervous or unsure about what to expect and how to act. The EMS part is easy… it’s what you do for the other 22 hours that you need to think about. Here’s a couple of big tips; don’t argure with your preceptor and always do the dishes!
Okay then… Today is Sunday so that means some football, some studying and early bedtime to get up and ready for my final ER shift in the morning.
It’s YOUR tube. You want a 3, ask for a 3!
Yeah, I did ask for a 3. The reply, “You’ve got a Mac 4. Go for it.” Afterward, the medic agreed that a 3 might have been a better choice.
I’m still just learning. The next one will be will be better.
I am curious on some of your terminology and wouldn’t mind a quick discussion on it. You use two phrases I find interesting, and perhaps it is just a regional thing.
First “No dice.” Seems straight forward enough, but brings to mind playing craps and trying with multiple outcomes to reach a narrow goal. It sounds as though you relied on luck instead of your training. “I couldn’t find a vein” is what I use, but it is far less interesting. But the phrase makes sense in this context, I’m just wondering if you think “no dice” or just type it.
Second “Had no veins.” Again a straight forward phrase but one I hear a lot from folks unclear on starting lines. I hear that phrase all the time or people saying, “it rolled” or “They’re deep” All excuses. We all miss and some patients do present with unique vasculature but the phrase “had no veins” will get you dirty looks from hospital staff who have the luxury of sitting still with bright lights to get the access you tried. But again, I get what you meant and the phrase works on a blog, just not on your PCR.
GREAT post and I think almost as therapeutic as informational. The description of the second preceptor who wanted nothing to do with you is a classic and there are those in every service for sure.
Keep posting, fun to follow along.
Honestly, the “no dice” expression wasn’t intentional… and after I reread it, I agree, it sounded like I was rolling the dice and hoping to hit something big. Your comment brings up an interesting point. As I grow in this profession, I really must be clear and concise as to how I describe situations. It would have been much cleaner if I had written, “I attempted to visualize the cords, but had difficulty due to the patient’s anatomy and rather than traumatize the airway further, I deferred to a senior medic to attempt to place the tube.” That’s what I was thinking, but “no dice” was quick and easy. And as you mentioned, it kind of works on the blog. And the blog is ‘info-tainment’.
As for the “no veins”, I know that’s a cop out. I mean, really… EVERYBODY has veins. It’s up to us to find ‘em and cannulate them. I also will never use the “it was deep” or “it rolled on me” excuses. if I miss, or can’t find a vein, I own it. And, I usually don’t go sticking blindly. (It’s just poor form, don’t ya think?) I’ll admit I am new at the starting an IV in the back of a moving truck game. But, when it’s me, and two other medics hunting for something, ANYTHING… it’s pretty fair to say “she had no veins.” It took a heat pack and 15 minutes of looking just to get that 20 in the hand.
And yeah, this post really was a “get it off my chest” kind of post. I had a not so great day on the medic unit. I felt like a complete F@#$ Up for a good portion of the day and I needed to vent a little. But that’s what being a medic student is all about.
HM, thanks for taking the time to read and comment on my blog. I truly appreciate the feedback.
I laughed out loud at your first paragraph! I get what you mean, I was just curious as to the thought behind it. Clearly the blogs are different than the PCRs and the “tainment” portion of info-tainment, as you said, comes first most times. That is the joy of blogging.
Keep venting!
Visualization. Great reminder. Also visualize where the veins should be. So you are palpating in the right places.
As an occasional preceptor your post is a great reminder that my attitude and interest in the student’s learning experience can make the difference between a so-so day and great day.
“I felt like a complete F@#$ Up for a good portion of the day and I needed to vent a little. But that’s what being a medic student is all about.”
I have been a medic in the field for 2 1/2 yrs now (and been at my current job for a year) and there are still days I feel “like a complete F@#$ Up”
We all have good days and bad days, just have to hope the good outweighs the bad, and remember to come away from everyday learning a new lesson.
Keep your chin up, and thanks for blogging for “info-tainment”
thanks for the replies. Greg, I usually find those veins ‘by feel”. A nurse told me to “close my eyes and let my fingers see the veins.” She also said don’t just stick what you can see… always feel for ‘em. i know the anatomy, and most of the time I’m pretty good. Some days though… whew. It’s difficult to the Nth degree.
And that’s why this blog is good… it’s a great way to share my thoughts and feelings with others. as HM mentioned, it’s rather therapeutic.
Glad to hear you’re surviving school.
“if you’re going to kill someone, I’ll stop you.” Shesh!!