How did I do?

Share a survival experience with us and explain what you learned from it. You might help someone.

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pstash
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How did I do?

Post by pstash » Thu Feb 25, 2010 3:08 pm

Im a volunteer Firefighter for our small town. We got called out to what was said to be a case of alcohol poisoning. It actually turned out to be a cocktail of meds and alcohol that lowered his blood pressure to extreme levels.

This is the first medical call I made alone. Usually we have about 3 people make these types of calls, but i guess everyone was being lazy. I am about a quarter of the way into my EMT-B class and have had some BASIC medical training at the fire station.

When I arrived, the patient was being held up in a sitting position by a family member. He was semi-conscious with rapid, shallow, labored breathing. He was pretty much "Gasping" for air. First, I asked the family member to lay the patient in the recovery position and assisted them in doing so. As we did this it occured to me that there wasn't any vomit anywhere in the vicinity. I am nowhere near experienced enough to start diagnosing patients, but I would think that alcohol poisoning would be accompanied by vomit. This was my first clue that it may not be alcohol poisoning.

I then administered oxygen via non-rebreather @15LPM. This helped drastically stabalize his respirations, although they still were not normal. He also started to become more alert, such as his eyes looking around the room, but still unresponsive to verbal stimuli. At this point I started to take vitals. I got the blood pressure cuff on him just as the Ambulance got there, so i stopped and let them take over.

I had asked all the questions like, past medical history, current meds, allergies (medical and food), history of diabetes etc. while i was administering the oxygen.

Anyone see anything that I did wrong?

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bigmattdaddywack
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Re: How did I do?

Post by bigmattdaddywack » Fri Feb 26, 2010 8:36 pm

Fuck if I know.
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Re: How did I do?

Post by jeepgunman » Fri Feb 26, 2010 8:41 pm

Ya did good. Keeping them calm and on o2 is a good route. I ve done the same. Its always nice when theres a bus close by.
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Re: How did I do?

Post by Bubba Enfield » Fri Feb 26, 2010 9:46 pm

I'm a former volunteer firefighter myself, and work as a paramedic. I say you did it right. Positioning is one of the most basic skills, one you can perform anywhere without equipment. It's also one of the first things people forget to do, once they start adding more advanced skills. Then right on to the O2; it's the reason Fire goes on medical responses IMO. You improved his breathing AND his mental status. Top marks.

Not getting a BP before the transporting crew arrived? No worries, they'll get their own. You were busy actually making a difference with the patient.

I'm glad it went well, your first solo. Best of luck on your EMT. There's a thread in First Aid where folks are keeping us updated on how their course is going. Drop in and say hi.
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Re: How did I do?

Post by Noven » Tue Mar 02, 2010 1:30 pm

I really sounds like you did not have enough time to do anything really wrong if you were taking their vitals and the ambulance showed up.
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Re: How did I do?

Post by dog_killer » Tue Mar 02, 2010 2:32 pm

your good enough, your smart enough and doggonnit, people like you..............lol

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Re: How did I do?

Post by arrowolf » Tue Mar 02, 2010 2:42 pm

15 LPM on the O2 seems a like a lot to me but I haven't been a medic in a very long time.
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Re: How did I do?

Post by dog_killer » Tue Mar 02, 2010 2:48 pm

Why dont you ask the ambulance guys, I'm thinking they could probably tell you a bit better, and are a bit more reliable than folks here......

I can see it now...."sorry about your husband maam, but the guys on the zombie forum told me to do it that way".......

sorry, not trying to crack your stones or anything, but seriously.....

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Bubba Enfield
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Re: How did I do?

Post by Bubba Enfield » Tue Mar 02, 2010 4:01 pm

dog_killer wrote:Why dont you ask the ambulance guys, I'm thinking they could probably tell you a bit better, and are a bit more reliable than folks here......sorry, not trying to crack your stones or anything, but seriously.....
I thought he was asking the ambulance guys, which is why I answered. Really, a firefighter asking the responding ambulance crew for feedback? I don't see that going well. Better to discuss it at his next class, as I'm sure he will. Also, if he posts on any web forums where firefighters and EMTs hang out, he could ask what they think. :roll:

OP, you could put something like this in the First Aid forum; it will be seen by more of the medics/nurses/docs. It's also more likely to start some kind of petty "we do it this way and we are right" kind of thing. Those tiffs are almost always infotaining.
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Re: How did I do?

Post by DannusMaximus » Tue Mar 02, 2010 4:52 pm

arrowolf wrote:15 LPM on the O2 seems a like a lot to me but I haven't been a medic in a very long time.
That's the amount we administer per SOG for nonrebreathers. It DOES seem like a lot. I guess the thinking is that O2 is cheap and it's pretty much impossible to OD on it, so let 'er rip... :wink:
Bubba Enfield wrote:
dog_killer wrote:Why dont you ask the ambulance guys, I'm thinking they could probably tell you a bit better, and are a bit more reliable than folks here......sorry, not trying to crack your stones or anything, but seriously.....
I thought he was asking the ambulance guys, which is why I answered. Really, a firefighter asking the responding ambulance crew for feedback? I don't see that going well. Better to discuss it at his next class, as I'm sure he will. Also, if he posts on any web forums where firefighters and EMTs hang out, he could ask what they think. :roll:
Bubba, I ask our ambulance crews for feedback pretty frequently (I'm a career FF/EMT, FF for 10 years, EMT for 15), and have never gotten any flak about it - - at least to my face. In particular if it's an incident which is new to me or we don't respond too that often, I figure it's good to get input from the folks who do EMS full time and may be more up on their EMS journals, etc. Most of the amublance guys/gals seem happy to give their input. Why don't you think that would go well?

OP, sounds like you did fine. Get a quick patient history, perform a quick medical and physical assessment, apply O2, take vitals, keep everybody chilled out. We do some combination of those things on pretty much every medical run we make, from the mundane to the spectacular. Given your timeframe, training, and supplies on hand, that's exactly what I would have done.
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Bubba Enfield
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Re: How did I do?

Post by Bubba Enfield » Tue Mar 02, 2010 5:54 pm

DannusMaximus wrote:Bubba, I ask our ambulance crews for feedback pretty frequently (I'm a career FF/EMT, FF for 10 years, EMT for 15), and have never gotten any flak about it - - at least to my face. In particular if it's an incident which is new to me or we don't respond too that often, I figure it's good to get input from the folks who do EMS full time and may be more up on their EMS journals, etc. Most of the amublance guys/gals seem happy to give their input. Why don't you think that would go well?
I guess it depends on the relationship. There's fire guys around here that know me, whether from teaching, or when I was on the local department, who would ask me about certain things. And I will always share what I know or have seen, if someone is interested (professionally, I mean). Lots of places around here, though, medics have a real sense of ownership about medical calls, and get pretentious around firefighters. I guess I was thinking he meant asking the crew during the call; lots of medics I know would be insulting in response. After the fact might be different. It varies from mutual respect, to getting along, to merely civil, and there's a few places where the medics and firefighters hate each other. I mean "want to fight" kind of hate. It's sad and shameful, but it exists.

My point is, be relatively sure who you're dealing with when you ask for feedback. A dismissive put-down can really kick the crap out of your confidence, especially when you're learning the ropes. I don't think anyone deserves that.

Just to be perfectly clear, let me restate that I agree completely with Dannus; what the OP did is what I would have done.
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Re: How did I do?

Post by DannusMaximus » Tue Mar 02, 2010 7:00 pm

Bubba Enfield wrote:I guess it depends on the relationship. There's fire guys around here that know me, whether from teaching, or when I was on the local department, who would ask me about certain things. And I will always share what I know or have seen, if someone is interested (professionally, I mean). Lots of places around here, though, medics have a real sense of ownership about medical calls, and get pretentious around firefighters. I guess I was thinking he meant asking the crew during the call; lots of medics I know would be insulting in response. After the fact might be different. It varies from mutual respect, to getting along, to merely civil, and there's a few places where the medics and firefighters hate each other. I mean "want to fight" kind of hate. It's sad and shameful, but it exists.
Gotcha. I'm sure it does depend on where you're at. Fire/Police/EMS around here (my hometown is around 120,000 people) is a fairly small club, we do quite a bit of interagency training, and we all get along pretty well minus some good natured rivalry. There are exceptions, of course, but things overall run smoothly. It is VERY rare to get into a pissing match during a run. I have spoken to EMS crews after runs before if I think things didn't go well (for whatever reason), and usually nobody goes away too butt hurt. We're lucky to have good medics in our area.

Honestly, it behooves us all to get along, because...

The hoseheads and ambulance jockeys might need the cops to show up with their guns and body armor... :shock:

The medics need the hoseheads to help lift the 450 pounds patients onto their tiny cot...

The cops need the hoseheads and ambulance jockeys for medical runs because they all develop an acute allergy to giving first aid at the police academy - - must be something in the water?
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Bubba Enfield
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Re: How did I do?

Post by Bubba Enfield » Tue Mar 02, 2010 10:45 pm

DannusMaximus wrote:Honestly, it behooves us all to get along, because...

The hoseheads and ambulance jockeys might need the cops to show up with their guns and body armor... :shock:

The medics need the hoseheads to help lift the 450 pounds patients onto their tiny cot...

The cops need the hoseheads and ambulance jockeys for medical runs because they all develop an acute allergy to giving first aid at the police academy - - must be something in the water?
I'm grinnin from ear to ear reading that, because every word is true. :lol:
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Re: How did I do?

Post by NoSt8mnt » Tue Mar 02, 2010 11:03 pm

id have to say pretty good. did you notice any empty pill bottles or other medication containers nearby? reminds me of a call i went on not too long ago. except when we showed up it wasn't alcohol poisoning. the guy had a blood sugar of 16. so started an iv and pushed dextrose.

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Re: How did I do?

Post by TxMedic645 » Tue Mar 02, 2010 11:45 pm

It really sounds to me like you did everything correct.

+1 on finding the pill bottles, or at least getting some kind of feedback from witnesses/family members on what the patient might have actually taken.

As for discontent between FD/EMS it's pretty common here. Since the emergency medical services are contracted out, and at any time the city can pull that contact and put ambulances in the fire stations I think a lot of medics fear for their jobs.

Just my two cents, from my neck of the woods.
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Re: How did I do?

Post by yale » Wed Mar 03, 2010 3:41 am

Sounds like you did well enough for the time you had and you skill level. Got the pt in a good position, administered O2, got pt history and started vitals. Damn fine job. But I'm a EMT-B and former volly and then paid city firefighter/emt. What do I know? :wink:
As for asking the ambulance crew, I don't see a problem with that. I commonly assisted packaging the patient and once they were on the ambulance asked the medic "What would you have like me to have done or done differently before your arrival?". Most of the time the medic would reply that we had done pretty much everything necessary and to keep up the good work.
As a EMT working at industrial sites I sometimes transported pts to the hospital and would stay with them until the Doctor triaged them. I always found a moment to ask the Doc "What would you have liked us to do for the patient before you saw him/her?" The Doc would often say something like "Well, you got him boarded, got his c-collar on and protected his neck. You splinted his obviously broken arm and gave him O2 then brought him here to the hospital. I can't think of much else. Good job and have a good rest of the shift."
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You done good, sir.
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