Confessions of an EMS Newbie
By Ron Davis and Kelly Grayson
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Podcast Description
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.
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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 Week I did not pass my orals, as a matter of fact I failed them miserably. 12 Lead and ECG interpretation Drug Doses Hit the stress wall and flamed out during PALS. Failed PALS Doses are my nemesis Mentions: MedicTests.com Listener Questions I 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? - Sacha Really 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-P ED-EKG Liaison Intermountain Heart Institute EKG Intermountain Medical Center Get complete information on the The Confessions of an EMS Newbie Podcast.Subscribe or review on iTunes. | 4/13/12 | Free | View In iTunes |
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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. | 3/26/12 | Free | View In iTunes |
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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 Week Assessment Based Management Orals Final Clinicals Finished 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? Birth DKA - Kussmauls If you are a newbie and interested in being on the show, contact us. contact@emsnewbie.com. Mentions: HHNK DKA Zofran - contraindicated with wide QT interval Phenergan - give with fluid Quicktrach EMS Pocket Guide Vagus Nerve Stimulator Listener Questions Christopher asks Have 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. | 3/20/12 | Free | View In iTunes |
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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 Week Assessment Based Management Learned 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. Clinicals Plugged 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 Questions Ryan Have 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 here Rob 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. | 3/3/12 | Free | View In iTunes |
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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 Week Assessment Based Management More scenarios and I'm wondering a little how much it is helping. Clinicals You 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" Andrew Question 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! Ryan Learned 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. | 2/15/12 | Free | View In iTunes |
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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 Blog Brain Rules Book. Get complete information on the The Confessions of an EMS Newbie Podcast.Subscribe or review on iTunes. | 2/11/12 | Free | View In iTunes |
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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 Week Assessment Based Management Tested all our paramedic skills. The one that got the most people was Static Card... | 1/30/12 | Free | View In iTunes |
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75 Real Medic Stuff Now | (45:44) We're back from a long break and the Newbie has been busy. Ron started his clinical internship and have now done 4 24 hour shifts with one crew at the Harris County Emergency Corps. He's learning a lot, here's some of the thing Ron and Kelly talk about: How to use the IV cath right How to do CHART. I now understand it and even take notes in it. Running calls. Lasted about 30 seconds in my first call. Turns out it was likely a AAA( Or was it? Listen to Kelly's comment), but it was seizures with a fall to start and I just didn't know what to do. Vs ran my first MVC yesterday and did pretty good. A little too much scene time. Not enough delegation. My preceptor is really good. She reviews calls after I run them, gives good feedback. Let's me beat myself up only so much. Also gives me homework. Quizzing me on my ALS. Calls: 1/6 = 6 1/12= 3 12/29 = 6 1/4 = 6 Started my new job. Service is really different. Big difference between a 2 paramedic truck and a Paramedic/Basic truck. Kelly do you do truck chores? Or is that all on the other guy? New experiences there: System status management. Working 12 instead of 24. Going to prison. Not having 2 level 1 trauma hospitals at your beck and call. Sorry for not keeping up with the show, but as you see Ron and been doing something every day. Now we're both on weird EMS schedules, so expect Newbie will be on a weird schedule too. Not more releasing on a particular day, because we may not be able to record on a regular one. Get complete information on the The Confessions of an EMS Newbie Podcast.Subscribe or review on iTunes. | 1/17/12 | Free | View In iTunes |
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74 The Final Final | (21:58) Ron goes through his final final and some skills testing. No more lectures, no more teacher's dirty looks. What I Did This Week Clinicals Paper work. What a pain. Mentions: Bob Page on Stethoscopes Listener Questions I had originally planned to contact Kelly directly, but then realized his answer would probably be useful for EMS Newbie fans as well. Hey Kelly, I know that you've blogged on this topic many times and I've got a quick question for you. Since you're apt to transport some rather sick (yet not entirely time sensitive) patients without lights, sirens, and guns a blazin', do you sometimes still describe your transport as "emergent" when giving radio report to ensure the receiving staff understands that the patient is sick? It would sure be nice to trust that painting a clinical picture would be enough to alert the nurses that they should plan on placing the patient a corner or hallway, but having spent a lot of time working in the department, I fear the staff would sometimes be too busy and distracted to pick up on less overt signals. Even with a fairly obvious description, our nurses are often multi-tasking while taking radio report, and it would be very easy to assume: "The patient can't be that sick, I didn't hear any sirens and they're non-emergent." As always, thanks for the podcast, - Vince Hi Ron, hope you are well. I was just wondering if either you or kelly had heard of the 'lethal triad' with regards to trauma and whether this was something that you guys were being taught about on your course or whether you thought it should be? Warm regards from a cold england Jamie On the GI symptoms relating to anaphalaxis, I had heard that people with a new food allergy will often go through a progression of allergy symptoms to a certain stimulus before reaching full-blown anaphalaxis, often starting with GI symptoms. My understanding was that they would consume the food and have nausea, vomiting and/or diarrhea but not necessarily an airway issue, so it might be written off as "bad food" or stomach bug or something similar. Next time they ate that food, maybe they had worse GI symptoms but still did not connect the issue. Eventually it progresses up to true anaphalaxis with airway issues. Have y'all heard anything similar? Andaew - Hey, In regards to stethoscope is there really a difference from a low end stethoscope and a high end stethoscope? If there is a difference how much of a difference is it and would it be worthwhile purchasing a higher quality stethoscope? Get complete information on the The Confessions of an EMS Newbie Podcast.Subscribe or review on iTunes. | 12/18/11 | Free | View In iTunes |
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73 Environmental Emergencies | (29:40) Ron has his last lecture of paramedic school and it is about Environmental Emergencies. What I Did This Week Medical Emergencies Environmental Emergencies Heat Cold Do you have a low temperature thermometer? We'll see hypothermia in Houston because there are lots of ways to have it happen, but she said not going to see frostbite. Then my wife posted to FB it was snowing in Abilene. Drowning Fresh vs saltwater Fresh washes away surfactant. Since salt water is osmotic, do you risk hypovolemia? Special Populations Final review Clinicals Final paperwork Mentions: ALTE University of Chicago Listener Questions Hey Kelly and Ron. Or is it Ron and Kelly? I've been following he podcast since the beginning as I was starting EMT B right after Ron. It was a cool experience to go through the class while listening to Ron's show at the same time. Now I am half way through P school. My school is segregated in to thirds. Didactic-Clincals-Externship (intern). Unfortunately I have become extremely unmotivated during my clinicals. I know this is an important part of the learning process but it's really dragging me down. I know the general answer to many issues is to "man up", but I was wondering if this is common and if you have any advice on making it through this phase. In my EMS experience there is nothing I dislike more than working in an ER. I really appreciate the folks who can spend a career in there. Russell Could y'all talk about ALTE's? It relates to the blue baby that resolves prior to EMS arrival. After having one of these, I did research on it and it apparently can be a precursor to SIDS. Our protocol mandates that we always, always, always transport these kids due to that risk. Is this related to the cardiac conditions Kelly discussed, or is it different? We discuss airway obstruction beyond the vocal cords. What was your first Oh $#!T moment as a EMT and as a paramedic What did you learn from it? - Andaew Michael wrote: Kelly, Are you one hundred percent positive that 250 mLs of D5W has the same of amount of dextrose and D50. My math shows that 250 mLs of D5W would have 12.5 g of dextrose (glucose). Just curious. Get complete information on the The Confessions of an EMS Newbie Podcast.Subscribe or review on iTunes. | 12/11/11 | Free | View In iTunes |
| Total: 10 Episodes |
Customer Reviews
Great Podcasts
This is the way a podcasts should be.. Fun, informative, funny, interesting, educational, and never dull or dead air. Ron Davis is a fun, interesting and even a little bit "sparky" of a EMS student who goes through the program while sharing his progress with Kelly Grayson who has been a Paramedic for decades, writer, and teacher in the EMS system. Along the way, they share both their stories and the knowledge they have gained from EMS for the audience as well as answer listener questions. Love the show and look forward to every podcast. Thanks Ron & Kelly! Ya'll keep saving lives and stamping out disease! -Aaron H.
Thanks!
Awesome!
Fantastic podcast even beter medic
Started listening at begining of my class. Very awsome!!! I love the medic who does this. He has a awsome book that i just finished !!!
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