Ask a Paramedic anything at all...
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Crossflow Kid said:
Have a quick search on YouTube for "EZ-IO".
When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Handy indeed when the brown stuff hits the swirly thing. I've done both tibial and humeral IO in cardiac arrest and big trauma jobs.When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Edited by Crossflow Kid on Thursday 18th January 22:03
Crossflow Kid said:
Have a quick search on YouTube for "EZ-IO".
When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Did one recently as it happens. Professionally I recognise that it is a useful tool we have to administer life-saving treatment to a patient - however I can't help admitting that whilst I am drilling into someone's bones, I often think to myself 'I can't believe I am allowed to do this..!' When IV access is compromised the alternative is to go for Intra-osseous access.
It involves essentially drilling in to a major bone to administer drugs via the marrow.
Edited by Crossflow Kid on Thursday 18th January 22:03
What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
Ray Luxury-Yacht said:
Did one recently as it happens. Professionally I recognise that it is a useful tool we have to administer life-saving treatment to a patient - however I can't help admitting that whilst I am drilling into someone's bones, I often think to myself 'I can't believe I am allowed to do this..!'
What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
Done it a few times on GCS 14-15. Again the actual insertion isn't too bad, putting anything through is unpleasant. Has to be weighed up carefully on actual clinical need rather than being gung ho. What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
I've encountered a few RTC's, people falling etc outside of work, doesn't bother me as I'm glad to help.
Fattyfat said:
Ray Luxury-Yacht said:
Did one recently as it happens. Professionally I recognise that it is a useful tool we have to administer life-saving treatment to a patient - however I can't help admitting that whilst I am drilling into someone's bones, I often think to myself 'I can't believe I am allowed to do this..!'
What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
Done it a few times on GCS 14-15. Again the actual insertion isn't too bad, putting anything through is unpleasant. Has to be weighed up carefully on actual clinical need rather than being gung ho. What's your Trust's guidelines on GCS score for usage? Ours is 8 or below. My patient yesterday was just about 8 - ex drug-user with many co-morbidities, suffering a hypo, with a BM of 0.9. Tried to cannulate 3 or 4 times but couldn't due to hypotension and a lack of vessels from years of IV drug use.
She didn't stir when I drilled, but did moan a bit when I flushed with 10ml of saline. The flush seems to be the thing which would cause the most pain, strangely.
Got IV glucose into her, until she suddenly sat up with a start and returned to GCS 15 with a BM of 8.0 like nothing had happened on the way to hospital. She laughed when I told her what I had done, like I was joking, Until I lifted the blanket and showed her. She nearly passed out again
I've encountered a few RTC's, people falling etc outside of work, doesn't bother me as I'm glad to help.
Ray Luxury-Yacht said:
jet_noise said:
Do you have a protocol for an Addisons Disease patient in crisis?
No cheating, put the portable 'phone away!
Yes I have that rare condition
We do, although I have never come across a patient with it yet. We carry Hydrocortisone, and fluids if needed too. I understand that it can however flare-up to be pretty nasty, and even life threatening. So following that treatment it would then just be a case of pre-alerting the hospital and blue-lighting you in.No cheating, put the portable 'phone away!
Yes I have that rare condition
One thing I might note regarding some of these rarer conditions that ambulance staff rarely come across, is that I usually find that the patient is very well-versed and knowledgeable about their condition. In these cases I am happy to be guided by the patient and treat accordingly, within reason. So if the patient tells me that this / that helps them specifically, then I'll go with that.
I suppose that does generate another question: do you look for these sort of things? and which is a better tag: medic alert card or a bracelet/tag-on-a-chain?
Crossflow Kid said:
Ruskie said:
Crossflow Kid said:
Ray Luxury-Yacht said:
Seriously though, I don't know how you hack working in London doing this job - I know I couldn't.
Shift-swap some time? London is pretty special for all the ES.
In one shift I've gone from treating a stinky homeless alcoholic in a bus shelter, to the spouse of a leading MP in their Pimlico apartment, to an intoxicated minor in a well known night club, to a 6 week-old baby in a council high-rise.
We stopped a performance of Les Miserables once too.
It's what keeps it interesting.
Unfortunately, LAS training is so haphazard and poorly administered I simply don't trust them to deliver decent paramedic training, plus they're the only Trust without university affiliation so the end product is non-graduate paramedic registration as opposed to the full degree.
Pompeymedic said:
Crossflow Kid said:
Ruskie said:
Crossflow Kid said:
Ray Luxury-Yacht said:
Seriously though, I don't know how you hack working in London doing this job - I know I couldn't.
Shift-swap some time? London is pretty special for all the ES.
In one shift I've gone from treating a stinky homeless alcoholic in a bus shelter, to the spouse of a leading MP in their Pimlico apartment, to an intoxicated minor in a well known night club, to a 6 week-old baby in a council high-rise.
We stopped a performance of Les Miserables once too.
It's what keeps it interesting.
Unfortunately, LAS training is so haphazard and poorly administered I simply don't trust them to deliver decent paramedic training, plus they're the only Trust without university affiliation so the end product is non-graduate paramedic registration as opposed to the full degree.
I'm in a slightly grey area at the moment to be honest in that I'm awaiting formal qualification as an Associate Ambulance Practitioner. The LAS training fraternity haven't got a clue about how the course is meant to be run or what our overall aims are, and have simply taken their old band 3 EMT ten week course and rebadged it as the year-long band 4 AAP course and just assume it'll work - they're utterly useless and are only interested in getting students to sign the dotted line to say they're happy with the tuition.
To give you an idea I'm two years in to a one-year course and am still effectively classed as a trainee, as are countless other people. Ops don't really mind as it has little impact on crew numbers on the street and ultimately it's a bum on a seat driving a truck
It's now with the union and a couple of guys who started with me are also talking about dragging in a solicitor. We've got CQC coming to play in a couple of week too. Could be interesting.
That said, I'm confident in my own abilities and skill level and there's nothing that would jeopardise patient safety, and I absolutely love the day to day of the job itself, it's just from a career point of view it's all a bit......foggy, and on top of all this, the one thing the LAS doesn't tolerate for a millisecond is criticism or poor feedback.
I did have an interview with SCAS but, understandably, they were highly suspicious of my reasons for wanting to transfer before appearing to fully complete the course, even though I explained part of my reason for wanting to transfer was to start the course all over again with a organisation that knows what it's doing.
And where as SCAS seem to break the course down in to modules, (so assessment is a continual process with ongoing improvement) LAS just chucked a year's worth of theoretical objectives at us and said "Bring that back in a year" so I wasn't able to give any indication of my level of success thus far.
mil has dementia, still recognises us, in a care home, but she has had constant black outs, her eyes roll back, she is still breathing ok, but can have 5 or 6 instances in hour, usually when we are sitting next to her, she has been in hospital, blood pressure, blood tests etc, and next she will be tested for epilepsy, she is quite tiny, last weight was under 6stone, but the hospital and doctors cant find the reason why, any thoughts gratefully received ta
Mexican cuties said:
mil has dementia, still recognises us, in a care home, but she has had constant black outs, her eyes roll back, she is still breathing ok, but can have 5 or 6 instances in hour, usually when we are sitting next to her, she has been in hospital, blood pressure, blood tests etc, and next she will be tested for epilepsy, she is quite tiny, last weight was under 6stone, but the hospital and doctors cant find the reason why, any thoughts gratefully received ta
Without knowing you MiL's history and without actually assessing her it's near impossible to say I'm afraid.I'd let the neurology tests run for now.
Are there many incidents of cocksockets such as the one referred to in the news recently hurling abuse at you whilst you work?
https://uk.news.yahoo.com/angry-paramedic-blasts-m...
https://uk.news.yahoo.com/angry-paramedic-blasts-m...
JPJPJP said:
Are there many incidents of cocksockets such as the one referred to in the news recently hurling abuse at you whilst you work?
https://uk.news.yahoo.com/angry-paramedic-blasts-m...
Fortunately for me, very few and far between. The London boys might say different though! https://uk.news.yahoo.com/angry-paramedic-blasts-m...
I have had a handful of occasions when someone might approach me and ask if I can move the ambulance so they can get out, and for the most part, they have been quite polite. I'm never obstructive on purpose either - I'm not on a power-trip - and if I can move the ambulance, then I will. If I can't, then I politely explain why not, and most people accept this. Funnily enough, the only few people who have tutted and huffed at me were women, which I was surprised at. One recently went off and sulked in her car, and when I moved the ambulance once I had the patient on board, she drove past and gave me the shaking of the head treatment.
I never get annoyed though, in the same way that I never get annoyed at any 'challenging driving' I come across when I am driving on blue lights. I think some emergency service staff forget that whilst we are at work, we are doing a difficult job with sometimes life-threatening incidents, and running on adrenaline. However, outside of our little bubble, the rest of the public around us are all just trying to live their lives, go to work, deal with their own problems, or whatever - and so, can't really be expected to understand the thing that WE are dealing with at that particular moment. It's unrealistic to expect otherwise.They're also just ordinary drivers, with no advanced and blue-light training that we are privileged to enjoy.
Hence, I just let it go with good humour, and if I feel like uttering a comment to my crew-mate, I usually say something along the lines of 'forgive them, for they know not what they do!'
Had the "You can't park there" thing a couple of times. Thing is, in London parking is so bad, people are fairly used to vehicles being abandoned in stupid places. So abandoning ours in really quite workable places goes unnoticed.
Public driving standards in town are woeful. Unsurprisingly, foreign minicab drivers are the absolute worst with little clue about UK traffic law and the distraction of trying to follow an Uber app to their next fare. I've approached St Mary's A&E on blues, found the road blocked by an Uber cab, given it some siren and the silly arse simply waved his phoned out the window, pointing at the Uber map as if to say "But I'm picking up a fare!".
They just don't get it, but then a lot of drivers in London are from countries where they just don't have emergency medical care so ambulances are something of an unknown to them.
The safest assumption is the one where you haven't been seen or heard.
The yellow button helps.....
Public driving standards in town are woeful. Unsurprisingly, foreign minicab drivers are the absolute worst with little clue about UK traffic law and the distraction of trying to follow an Uber app to their next fare. I've approached St Mary's A&E on blues, found the road blocked by an Uber cab, given it some siren and the silly arse simply waved his phoned out the window, pointing at the Uber map as if to say "But I'm picking up a fare!".
They just don't get it, but then a lot of drivers in London are from countries where they just don't have emergency medical care so ambulances are something of an unknown to them.
The safest assumption is the one where you haven't been seen or heard.
The yellow button helps.....
Edited by anonymous-user on Thursday 25th January 15:24
How come ambulances often just run with blue lights & no siren? Is it to keep the NIMBY "I dont like noise in my street" types happy? (If so, sod 'em!)
Surely no one can object about emergency vehicles at full chat, after all it might be them one day. Personally I love the sound,especially the Yank ones. I would have thought sirens may help the unobservant twunts that litter the roads
Surely no one can object about emergency vehicles at full chat, after all it might be them one day. Personally I love the sound,especially the Yank ones. I would have thought sirens may help the unobservant twunts that litter the roads
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