Still Around!

Man I'm awful at this.

I put my thumb through a bandsaw (ironically while working on a wooden replica of the Star of Life) so I've got an excuse. Somewhat. Not really. I'm just lazy.

I really love Megacodes. I think they're fascinating. I love having an algorithm that I follow and that's that.

For example (aren't you excited? I'm back to sharing knowledge!).

Pulseless V-tach/V-fib

• First...well...make sure you have that rhythm
• Witnessed: Defibrillate immediately at 200J (biphasic) or 360J (monophasic)
• Unwitnessed: 2min of CPR followed by defibrillation.
• 2min CPR while pushing EPI
• Shock
• 2min CPR while pushing either EPI or VASOPRESSIN
• Shock
• 2min CPR while pushing Amiodarone
• Shock
• 2min CPR while checking for underlying causes
• Continue until a regular rhythm resumes. However always finish a full 2min cycle of CPR even if there's a normal rhythm so the heart has extra friction to keep going normally.

There. I've shared.

I've also covered fun stuff like psychiatric emergencies (don't let them get between you and the exit), childbirth (they will be slippery, dropping a newborn is really bad PR), abdominal emergencies, diabetic emergencies (D50 for hypo, lots of fluids for hyper).

Only 16 more classes until the end. Wow. I can't believe that.

Interesting information for Colorado EMTs: You can send in a name-based record check for all of your previous residencies and they will issue a 90-day provisional license while awaiting your CBI/FBI fingerprints! This awesome allowance was enacted January 2010, I found out about it at the EMS Symposium in my area.

That's it. All I have for now. I'm exhausted. Pain medication is nice.

For the Record

A quick run-down of things:

• I got my NREMT certification, huzzah. I really, really thought I was going to fail that test. I had a horrible headache, and I nearly cried while I was going "ohmigod I don't know what this IS. Or THIS. Or THIS OR THIS OH MY GOD HOW DID I EVER GET OUT OF MY EMT CLASS?!??!" However, an hour after I took the test I got an email all huzzah, you are not going to kill someone today sucka, welcome to being an EMT! For those curious, I got to question 86.
  
• Still in my EMT-I class. I was SURE I was going to fail out of it. Positive. Panicked. I don't know why but I had these fierce mental blocks going on or something and I kept doing very badly on tests. You have to get a 75+ on tests in the EMT-I class, and you only have 3 failure/retakes allowed before you're screwed and failed. I used all three of my retakes before the final test and I was FREAKING OUT. I took that final test and got a 76. I was actually a little angry, since I had really, honestly, been studying my ass off for that test for days.
  
• I have exactly one semester of EMT-I left before I am officially an Intermediate. Once I get my certification from the state in, I'll be able to actually do my 100+ hours of clinicals and the people will rejoice. Especially the people I'm going to stick with IVs. Yay fieldsticks!

So that's all that's going on for me. I will try to keep things updated for my EMT-I class. Maybe when I get really extra bored I'll write up some blogs about reading 3-lead EKGs and megacodes. Yay megacodes. That was so much fun for me. I danced around in socks!

Around

Still technically around. I got soooo swept up in my EMT class that I completely forgot to keep posting! I was constantly exhausted.

I finished the class with an A. I haven't taken my NREMT because... frankly I keep forgetting to get my fingerprints. Cough. I need it soon, however, because I have to get started on the next clinicals. Why's that? Because I chose to start my EMT-I!

I finished my IV class last night which was very painful. See, in an IV class, you have to GIVE two successful IVs and take them.

I was the only one in the class who managed to stick two IVs without any redos, so my partner only got two sticks. Me, I got three. The first one went through the vein out the other side and WOW does that hurt! The second went in and she got it going and all was well, and then she accidentally turned it back on (he had turned it off and she didn't realize it) while DCing and bumped it and the damn thing infiltrated. Which sort of felt like a rush of cold water being thrown on my arm. It was weeeird. Also, hurt hurt hurt. The third one was someone else who had just stuck his partner for the fourth time and didn't get it in, and I felt bad for her so I let him stick me and he dug around for five minutes before giving up. Ow. Ow ow ow.

I have no bruising. Joy. Just three huge holes because I'm a tiny person and an 18g needle is freaking gigantic.

I took pictures of my two successful IVs, I will post them for my own amusement at some point.

I really love EMT.

During my clinicals I got to deal with a broken pelvis, which was fascinating. I got a broken wrist which was moreso "shattered" and woooow was it broken visibly. A Schitzophrenic off her meds who kept talking about someone who we're pretty sure didn't exist. A guy with a BAC of .412 who had to be arrested 'cause he had a restraining order and he isn't allowed to drink (it's a clause in restraining orders now, weird huh?). We had a cluster migraine who was basically incapacitated; we thought she had a stroke at first but it turns out she was just having a really bad migraine. After some meds she was able to sit up and talk which was good.

I only actually RODE the ambulance twice. Woe. =( Once for a little boy who'd taken a fall from a cart at Walmart (he was fine), and once for an older woman with AMS who I still don't know what was wrong with (who BIT ME).

And...that's it.

Off to take my first EMT-I test.

Night Nine

We got to cram airways into throats! It was awesome! I like it. I'd be terrified of trying that on a real person, but on a mannequin it's super fun. Technically you aren't supposed to be gentle with a real patient either seeing as you're trying to give them air, not be delicate. So as long as you don't cause real damage...go for it, apparently. I like this edict. Hehehe.

So we got to insert Combi-tube and King airways, which was a bit easier than I expected. So much so that I accidentally intubated my dummy the first time. -cough- But the second and third times I did it right.

ALSO. Guess what this is?

That's right.

That's my grade on the first test.

90% ^^

And we got two extra "gimme" questions because his explanations in class didn't coincide with the questions on the test (Cap refill, most of us chose 3sec and it's supposed to be 2sec - Pupil Reactivity, we were told we could use a light, have them open and close their eyes, or look up at the lights above if we didn't have a light so we chose all of the above which was wrong in the book), so "technically" I only missed 9. So I got 101/110 which divides to a 92%

SWEET.

I have another test tonight, on respiratory stuff and airways. I'm really confident about that.

Today's Lesson
Respiratory System

So what's in a respiratory system? Well, a few things. Let's take a look. All aboard the magic school bus.


We have the Nasopharynx - the nose
The Oralpharynx - the mouth
The Epiglottis - The flap of skin that covers the larynx to keep food from entering
The Larynx, which I misspelled on the picture and don't care enough to fix, which you breathe through.
The Trachea - Those hard Cs in the front of your throat. They keep your throat from being crushed by a bit of pressure. This is good. They also move if you swallow, also good.
Esophagus - The thing you swallow food through
Bronchi - The tubes that diverge and split into the lungs.
Lungs - Two of these, too.
Alveoli - The teeny tiny things at the end of the bronchioles. What do they do? Hell if I know. I'll look in a moment, I'm busy.
Diaphragm - the muscle under the lungs. It's used mostly for singing, it moves down as you breathe in and up as you breathe out. It's also known as your solar plexus. While checking to see where it is, don't smack yourself. It hurts.

OH RIGHT. The Alveoli are teensy tinsy sacs that do the air transfer - oxygen for carbon dioxide.

So now you know. I've also listed them in the order that air technically moves. The air goes down to the Alveolis and then is transferred and goes about oxygenating blood and all while the carbon dioxide heads back out.

Also, all oxygen tanks have between 2000 and 2200 PSI. And if they get down to 500 you're supposed to switch to a new tank. You can get about 23min out of a fully active 15Liter-flow tank. Or something like that.

Adequate breathing means your chest is rising evenly and you aren't blue. Inadequate is usually fairly obvious.

Only perform a jaw-thrust on a patient you believe has a compromised cervical spine (the first 7 vertebrae in the neck).

Room air is 21% oxygen.

No air = You die. Probably because your heart stops. We don't like that.


Side note, a kid in a football camp today totally broke his leg. I really wanted to go over but seeing as I ... well, don't know how to splint and don't have a cert I couldn't do anything. But I still totally wanted in on the action. I sat sadly at the window at work and gazed at the ambulance.

I cannot wait for clinicals.

Night Eight

Oh dude last night was so sweet.

I had my first test, which I felt really good about - so either I kicked some test arse, or I failed. I'll let you know.

I KNOW I rocked out on the bones and the body positions but I may have gotten Coccyx mixed up with Sacrum so I guess we'll see. And I know I did well on the blood pressure questions because I went with "Sys/Di" and...well, that's right so yay lol.

I had a few where I went "HUH!?" but mostly it was "Bam. Bam. Bam. Bam. REALLY? BamBambambam." I even had time to go get dinner and eat it before everyone else finished. O-o;

And then we did airways and it was thoroughly awesome.

Seriously.

Okay.

There are several awesome ways we can do this.

You do airways with the nose and/or mouth.

There are several different types.

Conscious
Nasal-Pharyngeal airway, a super comfy rubber tube that one shoves down the nose of the patient. This is not pleasant but can be used for a patient that may be having trouble with maintaining the airway. See that right there? Yeah that's the thing they shove in your nose. The beveled edge goes in against the septum (the thingy in the middle) and they just go "swoop!" down the nose.

I suspect it's highly uncomfortable.

I'm not going to test it and try it. It can also be used on unconscious patients.


The Nasal Cannula is something you've probably seen your gramma or some other random person in at some point. It's relatively non-invasive and low-flow which means you only give it about 1-6liters per minute (by comparison high flow is 15LPM). It's sort of... supplemental.

Generally the Cannula isn't used too much, especially not by an EMT-B. We're supposed to use "Non-Rebreather Masks" but sometimes they can give patients a very nasty feeling of claustrophobia so the Cannula gives oxygen without them feeling the need to panic.

This is applied by inserting the ends into the nostrils and hooking the edges of it over the ears before tightening the bottom piece somewhat like wearing earphones. Not too bad.

Non-Rebreather masks are sweet. They're for high-flow, 8-15LPM. Usually you should just go to 15. This is because it has a bag on it, which will fill with oxygen and the patient gets their air from that bag. Therefore no matter how fast the air is going, the patient is getting a nice regulated flow. This is applied by slipping the cord around the head and positioning the mask over the mouth and nose. It's only applied after you have put your thumb over the bag flap and held it for the bag to fill. Be sure to remove it before it pops. Because it will, if there's no way for the air to escape.


Unconscious
Oral-Pharyngeal Airway... please don't ever try to stick one of these in the mouth of a conscious patient. It will freak them the hell out. Also it looks like it hurts like hell. You put it in with the curve pressing down on the tongue until you meet pressure, and then you twist and push down, which then makes the curve follow your tongue and push it forward, keeping it from relaxing into the airway. Also? It keeps your panicked patient from biting your damn fingers off and choking to death on them. This happens more than I care to realize.

There are sizes for everyone. The Oral and Nasal Pharyngeal airways need to be checked before being crammed in or guess what? You find out what Patient X had for dinner. So, for the oral you measure from the corner of the mouth to the ear and for nasal from the corner of the nostril to the ear. These can be used in children and the iiiiiitty bitty ones are just too cute for words.

Combi-Tube airways are really cool. They involve taking a tube, cramming it down your throat, and then giving you oxygen through them. You don't want this, because I doubt it feels good. You do want this, because by the time the situation calls for this, you're likely to be quite hungry for some air. It isolates the Trachea, pushes air into the lungs and if you vomit has a neat little tube just for that, so you don't aspirate it. Aspirating that means you will choke on it. And guess what? Hydrochloric acid in your lungs means you may suddenly be down a lobe or two.

King Airway is basically the same as Combi-tube but has a lot mor give to it. It's also shorter, sitting above the Epiglottis. It's sized for people 4-5ft, 5-6ft, and 6+ft tall.

Neither of these airways can be used on children under 4ft tall, by the way.

That picture is of the King airway. The comments are mine.

I could picture the combitube but it's pretty much the same damn thing so I'm not going to bother.






Official favourite quote from the night:
"The more things I can stick in you, the more fun I have."

Guess how long you'll live without oxygen? As an adult, 6min. Yes. That's it. After 6min you start to go into respiratory failure.

So what did we learn?

We don't want to stop breathing, because not breathing means our heart stops. Also it means some crazy EMT is going to grab me by the jaw, yank my mouth open, and jam a long plastic tube down my throat before attaching a Bag-Valve and forcing oxygen into my lungs.

However, if this sounds like a fun night for you, I can see about renting some equipment and practicing on you. That'd be great! ^^

Fun Fact: Blowing oxygen into a baby's eyes will blind them. Stevie Wonder? Yeah, a nurse did that.

Also. Petroleum Jelly + Oxygen = Boom. No, they didn't let us test that. Dammit.

Night Seven

Yes, two posts in one day. It's true. I know.

Last night we learned some really fun stuff. Really. Yes.

Did you know: If you're walking down the street and an ambulance needs a driver, as long as you're over 18 with a valid license you can be COMMANDEERED and essentially kidnapped to drive the ambulance? LEGALLY?

So cool.

Also, between 5 and 7am is "heart attack and chest pain" time.

If you have someone on drugs and push Narcan, never ever push it all at once. They'll wake up super pissed.

We also got to...well, eye the backboards, but we didn't get to play with them yet. However, we will soon get to strap each other into the backboards... and come in and be informed "you and you are hurt, you and you are team leads go" lol. THAT will be super fun. Getting to do all the assessments and stuff. I'm excited to start doing scenarios!

Also there's a spiffy thing called The Black Bag, which contains all sorts of IVs and drugs and other goodies. Only an Intermediate or above can replace stuff in the Black Bag since it contains drugs which Basic cannot touch.

Doctors suck in the field. Just so you know. You don't want a doctor in the field if you can avoid it. They tend to get all flustered and pushy and generally just...suck. So if you're a doctor and you see an accident scene that has EMTs on scene, JUST KEEP DRIVING.

If you have a big accident scene and a small service, you should perform triage (meaning assess patients and start laying out equipment) while waiting for backup to arrive. This is because once you start the care of a patient, you cannot give it up unless it's to someone with the same or higher level as you (B to B, I, P, RN, Dr and I to I, P, RN, Dr and P to P, RN, Dr) and that can just cause problems. So if the care can wait, wait.

And there's what I learned.

Sorry it's actually informative instead of snarky, I'm exhausted.

Night Six

I am officially CPR certified. So if I see you choking and I blink and walk away, technically I can be held liable. Fun, huh?

I got to class and we immediately began to cover what rhythms an AED will shock (V-tac and V-fib which are ...well only way I can remember is "top line and bottom line" which may or may not make sense to anyone else. But I remember this because a flatline or acystole. Which I just spelled completely phonetically, by the way). Then we discussed the stuff we already knew (30 compressions, 2 breaths, rate of 100pm) and then we got to stare at creepy child dolls.

They were all...gaping mouths and striped onesies and it was generally freaky. However, using a BVM on an infant sized mannequin was way easier than using one on an adult so I rocked that. Actually it was funny - after just one night of working on the adults when it came to the infants I was a lot more confident as to where to compress and how.

Generally the chest won't LET you compress any deeper than you need to so that's good.

With an infant you can use two fingers to press down on the chest, or you can wrap your hands around the sides and use your thumbs. I found that way easier for the throat not closing again but it shouldn't be used without help for breaths because then you have to put them down for breaths and that defeats the purpose since the airway closes. So it's a good idea to put a facecloth or similar between the shoulder blades to help keep the throat open.

And then came testing time.

I was all geared up, asking to hit some dummies before we actually got tested on it - and was informed "oh, you all passed the practical part of it Thursday." And then they handed up a twenty-question test.

Yes.

Really.

The American Heart Association CPR certification test is TWENTY QUESTIONS LONG.

Multiple choice, too.

I missed one, and that's because I didn't read all of the possible answers.

Busy and Holes both failed it the first time - if you miss more than three you don't pass. Notice how I said first? Apparently you can re-take the test just as many times as you feel you need to.

Yes, really.

No, I'm not kidding.

They both passed it the second time but if they hadn't, they could have just...kept taking it.

These are the people who might stumble upon you after your heart stops. Yes. Really.

So there we go. I'm now a Certified CPR provider.