I love posting articles controversial enough to warrant a disclaimer. Today I have the pleasure of bringing you another post by guest author Sean Fontaine. Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel.
Today, Sean throws down the gauntlet on an issue that must be addressed by every emergency caregiver; the delicate balance between delivering objective, impartial medical care and the urge to interject our emotions into the often emotional drama that is emergency medicine. Can you make real emotional connections in the process of administering medical care, or does the emotional aspect of the job directly impact the effectiveness of your care? Some of us may address this dilemma only in our own private thoughts. Others may wish to publicly declare their position. To that end, here’s Sean…
Let me preface this post with the explanation that this topic comes straight from my discussions with paramedic school students and co-workers and the differing/agreeing viewpoints that resulted from those discussions. These are my opinions (not Steve’s) and I know full well that there are many of you out there that will disagree and some that will think I’m an insensitive ass. So be it, we’re here to listen to different viewpoints and think through them for ourselves, deciding in the process what our own thoughts truly are on a given subject.
The Argument: Your level of objectivity effects the quality of your patient care.
I contend that when we emotionally care about our patients we become subjective caregivers and as such render subjective care, transitioning to reactive rather than proactive medicine.
Here’s a (fairly) simple calculation that you can use to figure out just how much fluid you should be giving to your burn patient. The Parkland formula is both simple and useful. It not only gives us a good general idea how fast we should administer that first bag of saline enroute to the E.R., it’s also a great reminder of an important fact of burn care:
Burn patient’s need lots of fluid. …How much?
Let’s review the Parkland Formula and figure it out.
The Parkland Formula was born in 1968 when emergency room physician Charles Baxter realized that his critical burn patients needed massive amounts of fluid in the first 24 hours of treatment to remain hemodynamically stable. Working out of Parkland Memorial Hospital in Dallas, Texas, he and his fellow physicians began experimenting to figure out a fast way to know just how much fluid was enough.
The result was the Parkland Formula. Used today almost universally, in burn centers across America and around the world, it has become a standard of critical burn care. And, yes, you can do it too. Don’t get nervous about your protocols, your local E.R. physician knows the formula.
The Parkland formula begins with a rough calculation of the patients total body surface area burned. That is to say, what percentage of the patients total body surface area is involved in the burn? To come up with that number we can use a few techniques. There’s the palm rule (or palmar rule) and the rule of nines. Feel free to brush up on both. We’ll wait.
OK, now that we know the total body surface area burned (TBSA) we also need to estimate the patient’s body weight in kilos. This is a relatively simple matter for just about everyone in the entire industrialized world…except within the United States. Here in the states we insist on teaching, learning and using the English standard system of measurement, which gives all of us in the medical field fits. There are a few good techniques for learning to estimate body weight in kilograms. You may want to review those too.
My latest Remember Two Things video is up over at EMS1. At EMS World last year I gave a 90 minute presentation about sepsis for EMS providers. This video answers the most essential question from that lecture in about four minutes.
The question: What can EMS providers really do to reduce mortality rates in sepsis patients?
Chances are, you’ve probably heard about the new trend in synthetic cannabis products either from your local news media or from your ongoing EMS education. Over the past few years, these products have been increasing in prevalence around the US and in Europe. But what are these products anyway? Are they cannabis or not? Are they legal to posses? Are the effects similar to traditional marijuana?
Here’s a quick rundown of what EMS folks should know about this new and growing trend in street pharmacology.
Synthetic cannabis products have a variety of street names including Spice, K2, Herbal Incense, Potpourri, Barely Legal and Kronic. It is frequently sold under the classification of an “herbal smoking blend” and some head shops and online retailers have attempted to skirt the ongoing tide of new regulations by selling the products as legitimate potpourri or plant food with the warning, “Not for human consumption.”
What is it really?
These products are all various dried organic (plant) compounds that are laced with a synthetic cannabinoid chemical that is designed to mimic the effects of cannabis in the body. Many of the products claim that they are a natural blend of legal herbs and spices that combine to give the user a legal and cannabis free high. Investigations into the contents of the products reveal that most of the herbs listed on the product packaging are not truly present in the product and that the often unidentified organic material in the product is laced with one of five common synthetic cannabinoids. (While there are over a hundred known synthetic chemical cannabinoids, these products tend to contain cannabicyclohexanol, JWH-018, JWH-073, CP-47,497 or HU-210.)
Yeah, It’s been a ride…
I guess I had to go to that place to get to this one
Now some of you might still be in that place
If you’re trying to get out, just follow me
I’ll get you there
- Rapper Eminem, I’m Not Afraid, Recovery
I’ve been there.
Sure, I’d like to say that I was always a positive, proactive and optimistic EMS employee but that isn’t the case. I’ve been through periods of burnout. More than once to tell you the truth.
I know what it’s like to dread getting up in the morning and going to work. I also know what it’s like to feel like you aren’t valued by your employer. I’ve been through phases where I just didn’t care about the service that I worked for or the quality of the care that I provided. If they don’t care, why should I…right? I know what it feels like to be a cog in the machine, replaceable and unimportant.
I’ve been to those places and I’ve come back. I’ve come back stronger than I was before.
If you’re in that place right now, first let me say a heartfelt, “I’m sorry.” I know where you’re at. I’ve felt the disillusionment and frustration. Hang in there. EMS still needs you. You still have something meaningful to contribute.
Now let me give you a few ideas for how you might get back to where you need to me.
I’ve been bugging Sean to write a guest post for the blog for a few years now. I don’t usually harass my friends about writing content, but Sean is so enthusiast about his work that I just couldn’t help myself. As a first year paramedic, Sean has a unique perspective on what it takes to make the transition from EMT certification to paramedic. In this post, he shares with you five things that can make the difference between success and failure.
Sean is a graduate of Regis University and a Firefighter / Paramedic for The South Metro Fire Rescue Authority. He lives in Denver, Colorado with his lovely wife Oz and their two sons Jonas and Axel. If you’re considering making the jump from EMT certification to paramedic practice, you won’t find better advice anywhere.
Steve and I have been discussing the possibility of my writing a guest post for The EMT Spot for a couple years now. So, after paramedic school and clearing as a new paramedic were done, he proposed that now was a great time to stop backpedaling and get on it. I’ve been accused of dragging my feet on getting this done. Shooting topics back and forth, we came to the obvious conclusion that an article discussing five tips for new or perspective students would be far more uplifting than the pediatric death and dying discussions that I’ve been having with the current paramedic school students.
With that said, here are my top five tips for fledgling paramedic school students.
Tip #1: Get Ready for Paramedic School
Let’s start with the question I’ve heard prospective and new paramedic school students ask over and over again, “What do I need to read to ensure that I’m ready for paramedic school?”
Don’t worry, everything you need to read to be ready for paramedic school is in your EMT-Basic book. There’s a reason every EMS class and every EMS book you’ll come across stresses the ABCs; these are the basic essentials that we use to evaluate and treat every patient. These are the basics we need to be prepared to treat and have within normal limits before we move forward with our patient assessment. These are also what you should fall back on when your advanced interventions aren’t working or cannot be performed for any reason.
There’s something about the patient in labor that makes my palms sweat. I’m not alone. Most of us EMS folks get a little anxious at the idea of delivering a baby. Obstetrical calls can go very right and they can go very wrong. The stakes are high.
Here are a few things to consider before you run your next obstetrical call.
1) At full term, pregnant females have a heart rate 10-15 beats per minute faster than when they were prepartum. (Psst…Before they were pregnant.) They also have 25%-30% higher stroke volume and 30%-50% higher cardiac output.
2) Pregnant females will tolerate significant blood loss before they become symptomatic. Once they are symptomatic, they will decompensate rapidly.
“It’s the space between the bars that holds the tiger.”
-Zen Koan
How does anyone become really good at what they do? Is there a magic recipe?
From the opposite side of the bars, an adult Bengal tiger studied me from his resting spot. He was big, topping out just over five-hundred pounds. He was also strong. Pound for pound a tiger is four times stronger than a man. Our guide explained this to me while she pointed out some of the finer elements of the great cats stalking behaviors.
The Feline Conservation Center in Rosamond, California, isn’t like a typical zoo. There are few barriers that prevent guest from reaching inside the cages if they chose to be so foolish. Hence our watchful guide. At the observation end of the enclosure, thirteen bars kept me from becoming tiger lunch. Once the great cat fixed on me, they seemed hardly adequate.
I rarely create posts that point directly to another post, but I’m making an exception. Every once in a while I come across a post so phenomenally useful that I just have to point it out and share it. Recently Kevin Pho, M.D. of the KevinMD blog (pictured left) posted just that type of post on his blog. The post, written by Carolyn Thomas, shares the first person descriptions of dozens of women who have had heart attacks.
Why is this so useful to my EMT and paramedic readership? Right now, 43% of your female patients who are experiencing heart attacks will present with no chest pain. Chest pain may be the “classic sign” of a heart attack in men, but women are a different story. Female patients are twice as likely to have their heart attacks misdiagnosed by a physician. How many will slip by your assessment skills undiagnosed?
Here’s my suggestion. Check out this post, “Heart Attack Symptoms in Women, In Their Own Words” over at KevinMD.com. Read these excerpts from real female heart attack patients, describing what their heart attack felt like to them. I think you’ll find it a surprising, interesting and informative exercise.
Posted 1 year, 1 month ago at 11:58 am. 2 comments
Don’t feel bad if you don’t have a really good answer. Most of us don’t. Before I started researching the question two years ago, I didn’t have much of an answer either. People get sick. Some get better. Some get worse. If they get really sick they transition into septic shock. End of story.
As an EMS educator, I didn’t go into too much more detail than that, so my own lack of knowledge was carried forward by my EMT students and the cycle continued. Sure, I could turn around and blame my instructor, but here’s a better idea, let’s end the cycle right now.
Here is your one stop shopping guide to the pathophysiology of sepsis. Give me a few minutes of your time and I’ll give you a more complete understanding of the etiology that we call sepsis than most of the prehospital folks you’re working alongside. Put your thinking cap on. Here is sepsis in a nutshell.
