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Medic09 BSN, RN, EMT-P

ED, Flight
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Medic09 has 10 years experience as a BSN, RN, EMT-P and specializes in ED, Flight.

Israeli/American, Combat Medic, Paramedic, Board Certified Flight Paramedic, RN. Is that enough?

Medic09's Latest Activity

  1. Medic09

    ICU or ER?...Dec 2012 Grad

    I recently had an interesting conversation with my Chief Flight Nurse regarding who we ought to hire, and why. The CFN is an NP who works in Neuro ICU. She has worked rotor wing and fixed wing flight jobs, and in house critical care nursing. She contended, and pretty well convinced me, that nowadays an ICU nurse is going to develop a lot more medical understanding and critical thinking than the average ER nurse. Especially if the ICU nurse works nights. Today's ERs are full of patients who aren't all that sick, and don't have emergencies. We spend a lot of time just rushing to keep up with the amount of patients. As a result, the new ER nurse will have to look more for opportunities to learn and understand complicated patho-phys and how to make decisions and implement treatments. My shift today was a good example of that. Within a four hour block I had two drunks with rule-outs, a bug bite, two simple fractures, a cardiac rule-out who was stable before I got him, and new onset CHF. That last one could be an interesting and mildly challenging patient - but I didn't have that much time for him after the initial assessment. The busy ER environment doesn't allow much for taking advantage of the chance to get really involved in the patho-phys, differential Dx, and Tx decisions and modalities. An ICU nurse is going to be seeing genuinely sick patients. There will be much more opportunity to hone knowledge and thinking skills. The nurse spends a lot more time with each patient. The ICU will confront you with educational and cognitive challenge; the ER might not give you the time to pursue similar learning.
  2. Medic09

    Do Other Professionals Skip Restroom Breaks And Meals?

    Soldiers. Police. Firefighters. EMS crews. Flight Medical crews. Physicians. Shall I continue? I don't think skipping lunches or pee breaks should be a regular thing. If it is, then the unit must be sorely understaffed. But there are occasions in several professions where the professional is called upon to put up with some discomfort and forgo their own needs. I think our noble and demanding professions sometimes require this of us. For the record: I have been a soldier, paramedic, flight nurse/medic, ER nurse, SAR medic. I am married to a physician. There have been quite a few times for both of us when the job simply demanded we do or give more. Including missing a meal break or bathroom break or sleep. We chose these jobs, and that comes with the territory; though it shouldn't be a constant.
  3. Medic09

    Looks for a job in Flight Nursing

    'Medical escort' and Flight Nursing aren't the same in many/most people's minds. I suggest you visit FlightWeb. It isn't so busy these days; but still is the best online place for Flight Crew Members. Also check out ASTNA. Good luck.
  4. It is interesting how people's experiences vary. Maybe the difference for me was being an older student with previous degrees. I was in a BSN program at a state university. For me, and some of my classmates, it wasn't rocket science. A person with reasonable intelligence could get through it in good shape with a modicum of effort. I hardly cracked a book, and still made Dean's List all but one semester. I actually wish I had studied more for the information I would have learned; but getting good grades and passing the NCLEX wasn't all that scary. I think many people blow it all out of proportion.
  5. Medic09

    Need advice on online schools RN-BSN

    Your best bet is to contact a counselor at whatever school interests you, and get direct guidance from them. Many of the universities require that you submit your foreign transcripts to a professional evaluation service to assign academic status, but I would ask the counselor at the school you are interested in.
  6. Hey Doc, thank you for your service. There are schools that will give you more credit for what you've done and studied in the Navy. Some folks have found the distance learning route with Excelsior to work for them. Others have gotten a leg up with Touro (which has a lot of active duty students, or did in my time there). So look around for who will give you maximum credit as you come out of the Navy. You may be closer to a BSc or BSN than you think. The community college route makes good sense for a lot of people. Not too long, close to home, and you can do an RN-to-BSN transition program on line after that while already working. Take a look over on FlightWeb and see if there is some relevant discussion there.
  7. Medic09

    Shoes. Yes. Shoes.

    I've been tempted to wear my combat jump boots that I wear working outside the hospital, but... I wear low, lightweight hiking shoes. A number of our people seem to like these 'approach shoes' (so called because they were first popular for the approach hike to a climbing route) or something similar. As JBudd (my colleague) mentioned, they can be a bit hard to clean. Whatever you choose, DON'T wear white. And the key thing is to check that the soles won't be slippery on wet stuff. I had a pair of shoes that I tossed because of that.
  8. Medic09

    IV bolus to CHF patient. Need your opinions please

    I would just like to point out that calling an edematous CHFer 'fluid overloaded' simply may not be correct. The problem isn't 'too much fluid' in the body. The problem is 'fluid in the wrong place'. That's why there is some movement away from giving Lasix, for instance. There are other ways to pull fluid out of the lungs, without diuresing it completely out of the body. Of course, ultimately the two docs should talk to each other. For the sake of the discussion here, the people who want more data are right. Labs and meds. Along with clinical findings, we need some idea about real fluid status. Is the pt. really overloaded, or maybe actually running dry with what fluid there is in the wrong place (the lungs and interstitial spaces). This may require more nuanced Tx than simple 'fluid-yes or no'. Also, is the pt. on ventilatory support such as BiPAP? For many pts. in the ER and ICU, positive pressure support (at least at night) helps move fluid out of the lungs and improves oxygenation without mucking around with chemistry. CPAP and BiPAP have become more common and affordable outside the hospital.
  9. Medic09

    Christus St Vincent, Santa Fe NM ER contract

    I work at C/SVRMC, and live in Santa Fe. The staff is fine with travelers. Typically, they just want the patients to get good care. The hospital's recent staffing history is weird, and we almost went out on strike last summer - but none of that will be your problem. There are a number of travelers who come back every couple of years just because they like the locale, and there are some who have signed on as staff. You shouldn't have any problem as far as work relations with other staff goes. Whether or not you like management - well, you'll figure that out after you've been here for a while. For now, it's just good you have a job!
  10. Medic09

    Where are the jobs at?

    Mark, I hate to say it - but Google just might be the best way to go. I googled 'flight nurse jobs' and 'flight paramedic jobs' and got directed to concentrated sites like Indeed and other similar lists; as well as some newspaper ads. ASTNA has job listings; but like FlightWeb it isn't comprehensive. IAFP doesn't list jobs. I think that's about it.
  11. Medic09

    Fluid Warming

    Induced hypothermia is only for specific, controlled cases. Mostly post arrest. Traumas should NOT be cold. As little as .5 C drop can begin coagulopathies. The cheap and easy way to keep fluids warm is to have them on an electric warming pad. Definitely better than nothing. Or keep them warm in the base, and put them in a small soft cooler for flight.
  12. Medic09

    ED nurses what are your protocols/orders for IV?

    Mostly it's 'start it if you need it'. Just have to use good judgement. Might I reasonably need a route for fluids or meds? We do have standing order sets for certain patients like CP, stroke, trauma, suspected sepsis, etc. All those are getting IVs in any case.
  13. In most places, a flight nurse with ACNP won't make any more money and won't be allowed to do much more. On the other hand, I worked with a Chief Flight Nurse who was an ACNP and I really appreciated having someone available with the extra education and insight. Personally, I like the idea of having an ACNP for the really critical and long transports. The only NPs I've seen over the years who consistently operate as NPs in the flight environment are Neonatal NPs.
  14. I didn't read all the responses, but I will verify that-yes, in many areas paramedics carry and may administer Haldol, lorazepam, diazepam, and possibly some other 'behavioral drugs'. Since we work with protocols/standing orders/guidelines (depends on what the medical director calls them, and there are some legal differences), we don't usually need a direct verbal order. Even so, the only time I gave Haldol as a rural paramedic - I called first. It was a good choice for a violent psych patient and looking at nearly an hour long transport over rough roads. Most medics are more familiar and comfortable using benzos in various situations.
  15. Congratulations. ICU may even be a better start for your eventual goal. ED nurses need a lot of ICU skills, but not all the time. We tend to get rusty with ICU setups, then find ourselves needing those very skills with a patient who will be boarding with us for lack of ICU beds. You will never regret having good ICU skills, even if you do move to ED later on.
  16. Medic09

    An open letter to the ER triage nurse

    There is no excuse for rude or negligent. None. Send that letter to the CNO of the hospital, with a request to be informed how they intend to address such a problem. I've done occasional triage. I haven't always been the most helpful or efficient; but I have always been careful to show some sympathy and respect. That is the very least we can do for every one who comes to triage. That nurse owes you an apology, and a promise to change for future patients. BTW, if the letter goes public, don't be surprised if the EMS crew don't like it. They are not 'ambulance attendants', and haven't been since the 60s. EMS is a profession, like nursing. Even the volunteer services have to use trained crews. They are EMTs. Just a side note, there.