AlmostJesus 593 Views
Joined: Feb 3, '10;
Posts: 9 (11% Liked)
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Stethoscope in my left cargo pocket (I hate carrying it around my neck)
Watch (again, oddly enough I hate having a watch on my hand and rarely need it), pen light, carpuject, tape, IV tourniquet, trauma shears, alcohol preps and sometimes a nitro gtt table in my right cargo pocket.
I also carry my iPod touch with me which is full of reference materials, I use epocrates and micromedex the most.
I have noticed that if I start thinking that damn this guy has amazing veins that I end up becoming over confident on them and this leads to me preparing poorly for the IV and I am more likely to miss on easy IVs. Thus, I started to treat all IVs like when I am preparing for what I think will be a tough IV (spending more time looking for the best vein, preparing/anchoring the vein better, using my tough IV tricks) and I have found more success.
On my internship for paramedic, we used the protectivs and we use the insyte autoguards at the hospital I am at right now. I definitely like the protectivs more in the prehospital environment because you can lock them back and keep the needle on the hub until you are good and ready to switch over leading to fewer bloody messes. It takes a learning curve to switch from one to the other.
Hope that helps
I actually have one that I have yet to use, I might take that to work next time and see how it goes. Id imagine that it wouldnt yield that great of results due to the inability to get it as tight as a nitrile/latex tourniquet but I could be wrong
I did appx 120 IV sticks in paramedic school between internship and clinicals (about a year long part time) which put me with a good basis. Now that I have started as a paramedic I feel like I am pretty confident with my IV sticks and I am getting good at tough ones. I have found the #1 trick to getting the IV is preparation. If they are obese, go grab a BP cuff and use that as your tourniquet (inflate to somewhere between their sys and diastolic) and then hang their arms down for awhile to use gravity as your friend. You will then have a LOT easier time with finding a decent vein. With many bariatric patients much of the problem with IVs in them is due to the tourniquet not being able to provide enough pressure (It makes sense) When I dont have a cuff, I have had good success with 2 tourniquets spaced 6 inches apart.
Marking your spot with an indent in the skin with a closed pen before you disinfect works well to mark your spot.
With AC IVs in tough patients take the IV needle and bend it slightly to put the needle at a better angle to get the vein
Always use confidence or even if it crosses the line to cockiness, it puts the patient at ease when you come in saying you WILL start the IV on them and if they ask if you are good at IV sticks say yes. If you miss dont give excuses.
Before long nothing will amp you up more than when you get a tough stick first try. I had a patient on Sunday that insisted that there was only one person - a doctor - who has ever gotten an IV on her first try. I took it as a challenge and used the tricks I have learned from here and while she was mentally prepared for multiple sticks I got it in first time which she was extremely surprised about. - I was pumped.
Hope that helps.
When I was on my internship for my paramedic certification we were paged out code 3 (lights and sirens) for a guy who had cut his pinky finger (about the size of a paper cut) and he told the dispatchers it was still bleeding. The EMR system required it to be an automatic page out for the ambulance and fire department to drive across the city lights and sirens. When we got there the patient said it wouldnt stop bleeding while he was just dabbing off the blood not holding pressure. Needless to say we handed him a 4x4, told him to actually hold pressure on it, and ended up leaving.
and people wonder why ambulance accidents happen?
Soooooo in an attempt to get back on topic
I work in Iowa right now and I did my internship in South Dakota.
In South Dakota with the service I was at - ACLS drugs, RSI, Morphine(no need to call for orders for up to 10), Ativan (have to call for orders if it is for sedation), still carried lasix and used routinely, 12 leads
In Iowa - Morphine/Fentanyl/Toradol (8mg/100mcg/30mg without orders) along with Versed or Valium if they are in severe pain (no orders), Versed or valium for sedation, CPAP with more aggressive NTG and lasix, first line ACLS drugs (we have to transport codes), no need to call for orders on anything unless you question giving it
The thing that they have done right at the hospital I work at is they have the medics work in ER essentially as nurses, thus we get a ton of experience working with patients and understanding the ER course for these patients. It isnt uncommon that we are the main caretaker in ER and then work as the medic when we transfer them (continuity of care ftw) This is an excellent way for the hospital and the ambulance to gain trust and for the medical director to continue to be comfortable with the scope he gives us. It also gives us a better idea at how the doctors order things, this is good when you know the doctor doesn't like to give pain meds, you can get them loaded up before they get to the hospital.
I work as a paramedic in a small town ED, we have 5 beds 2 which are in a trauma bay. Generally we staff one RN in the ED and the paramedic is available to help, generally, when it hits the fan, we have the floor charge come up and assist us, especially if the paramedic (me) gets sent out on a call. If it is a trauma that come in by POV, the nurse and paramedic will share the patient. We are unique here in that we are allowed to take patient assignments in the ED, so the paramedic might take lead on the patient, especially if they are going to be transferred out for continuity of care.
The other smaller hospital hospital I work at has 3 rooms 1 which is a trauma bay. The floor charge is the ER nurse and when we get something more serious in, nursing administration will help during the day or on call at night, many times the floor nurse will go to assist while the ward clerk watches the floor. (Our normal staffing is 2 nurses, 1 ward clerk, and 1 on call nurse... I'd like to see that changed to add a medic)
Right now, I am a first year student in a BSN nursing program and I will be starting a part time paramedic course while I am working on my prereqs for my BSN. The way I see it, if I become a paramedic, that will be a TON of experience for my nursing program, and it will give me a ton of hospital clinical hours before I start my nursing program. I will also be able to work for more and in a more pertinent job while I am in nursing school. I would like to specialize as a nurse in Emergency Medicine/Flight, and I figure with paramedic experience, I will be able to get in that area a lot faster. Now, I would prefer to be a paramedic and work pre-hospital, which I may do for awhile, but I just can't see myself doing it my entire life, and then I am stuck with a cert I can't do a ton with, as opposed to a nursing degree, which I can go from ER to Med-surg to clinic to ICU, etc if I burn out at one area.
So my advice to you, do both
Unfortunately, as stated it is a touchy subject with really no correct answer.
Personally, I work as an EMT-B with our ambulance and as a Ward Clerk/Nurse Aide (not certified) at our local hospital. Our hospital is in a small town, so more often than not, we know our patients at least in some capacity. I am the first male to ever be employed on our nursing staff, which has made for a few complications. Generally, patients are receptive to having a male caregiver. Although, I have noticed that generally women prefer to have personal cares done by a female nurse. I will take a female patient to the bathroom and provide help or put them on the commode, but usually, I leave any wiping up to the patient and I usually step out for privacy. I will help them pull up their pants and such, but I generally don't get involved with anything more than that including bedpans. If the patient is confused, doesn't care for men, or is close in age to me, the female nurse will do it, or she will be in there too with me just helping.
As far as bathing goes, I generally get assigned to help the men in the shower and bath and generally, the nurses will bathe the females. There has been one exception, we were very busy one day and we had been putting the female patient's bath off because of it, and I was the only one available, and her daughter was there, so she agreed to stay with her and help her, and I just had to lift her in and out of the tub. The daughter and patient were both content with that. I felt more comfortable with that too, I, like many others, am afraid of accusations.
When I am doing 12-lead EKGs in the clinic, I will have the patient put a gown on and I can put the leads above and below the gown with no exposure of the breast, which most patients prefer.
Generally, I have found that the patients that have had to have the most hospital care are the most receptive to having a male care for them.
Just my two cents
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