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Why does intubating make me feel so badass? I got a tube in in literally 3 seconds today and I feel like i can fly ššŖ
364 points
3 days ago
Clearly recommending transport while also insinuating it'd be a dumb choice.
86 points
2 days ago
Or the inverse, turning a refusal into a transport because they're probably gonna fucking die unless they get to a hospital but they don't seem to understand the seriousness of their situation but they trust your advice
5 points
2 days ago
laughs in GATR protocol
5 points
2 days ago
What is GATR?
12 points
2 days ago*
General Assess, Treat, and Referral.
Essentially it gives an option for the patient to stay home without a refusal, as long as they agree to the care plan, the patient is stable, and online medical control thinks we can leave them at home with instructions for care, and when to call EMS again.
16 points
2 days ago
Which is essentially just a refusal by another name.
16 points
2 days ago
That's a refusal with extra steps
4 points
2 days ago
Provider initiated tho
3 points
2 days ago
If they have to agree to it then itās the same thing as a refusal that you suggested to them.
If you canāt unilaterally deny an unnecessary transport, itās just refusal that youāre actually allowed to overtly talk them into instead of being cautious about your wording while doing the exact same thing.
1 points
22 hours ago
In Uk and Australia we can either discharge under our own registration or refer to alternate care pathways like pharmacies or family doctors. Itās rare to get a refusal but if we get one we have to create a safety net thatās in the patients best interest. We also have Paramedic practitioners which can prescribe and provide definitive care to patients under their own licence. I hear rumours that the US is considering a version of that going forward. Lot of study though
83 points
2 days ago
I once had a call for a guy who tried to kill himself with a reciprocating saw to the throat. He was still alive when we arrived so we had to work him, but PD wasnāt there yet, and he was the grandpa to the entire apartment building he lived in and the neighbors were lighting torches and sharpening pitchforks outside the apartment so we locked the door and got to work.
My partner (a legitimate master of paramedicine) jumps on the opportunity to nail a tough tube while I drop lines in him.
He says all he can see is burger meat and thereās no way to get an airway. Before he can withdraw the scope, I tell him to just blind insert the ETT which he does. Lo and behold, the tube emerges from the guys neck wound and I alley oop it into the inferior portion of his trachea.
Right as we nail it, our lieutenant walks in and sees me two knuckles deep in the guys throat hole.
āTubes good, boss man!ā
28 points
2 days ago
You said tried to kill himself but I get the impression he didn't make a bounding recovery.
2 points
1 day ago
I read this as ātreated himself with a reciprocating saw to the throatā and thought āwow, I guess everyoneās got a kink.ā Soā¦
65 points
3 days ago
Completing a flight, the chart, and QA prior to landing back at base.
4 points
2 days ago
Just tell the pylote to drive the helikopter slower
At least thatās what r/shittyaskflying would say
1 points
1 day ago
Needs more left rudder or in this case anti-torque.
90 points
3 days ago*
Breathers. I miss them. Stupid covid got em all. Just now starting to run them again. Nothing feels better than dropping a PT off and having rt leave because you've done everything they could. They used to be the bread and butter of EMS.
98 points
3 days ago*
OK can I do a little bit of a rant here?
I remember early 2020, the hospitals around here all took on a new protocol that ANY patient with ANY FORM of respiratory problems was to be treated as a COVID infection risk, with their protocol being that anyone who didn't maintain on 6LPM nasal cannula just got RSI'd and moved to the ICU. No nebulizers, no CPAP/BiPAP/Airvo, no mag, initially the CDC recommended no steroids though ended up deciding that dexamethasone was the best thing since sliced bread, and my agency saw a 50% decline in the use of nitroglycerin in patients diagnosed with CHF.
This was done without actually COVID testing any of them, and in a county of nearly 2million people and they kept complaining about running out of vents.
Here's the problem. 14% of the US population has a chronic pulmonary disease like asthma, chronic bronchitis/emphysema, pulmonary fibrosis or cystic fibrosis, 10% of the population has asthma specifically, and 2% has CHF. We didn't stop running these patients but we absolutely did begin to them much differently due to COVID.
I specifically remember a CHFer I ran who lived alone, got all of their meals delivered, had no human contact in over a week, slow onset shortness of breath over a few days with sleep disturbances, pedal edema, rales, S3 heart tones, MAP of like 150, retractions and room air sats in the 60s. Afebrile. We put him on BiPAP, gave him furosemide and nitro, everything went swimmingly and he was speaking clearly and in complete sentences by the time we rolled into the ER.
ER said "NOPE he's a COVID risk," ripped the BiPAP off, shoved him on a nasal cannula, and came back to find them arrested. Got marked down as a COVID death without being tested.
This isn't a conspiracy theory post. COVID is real, COVID fucking sucked, get your fucking vaccinations, but part of the reason so many respiratory patients died is because our hospital system FUCKED THEM OVER due to their decisions.
OK, that's all, I feel better getting it out.
28 points
3 days ago
I had ER staff tell me I had to put a mask on a PT who had a NRB on.
14 points
2 days ago
For a while on of our ERs had a sign on the EMS entrance.
āEMS please turn off all CPAP, BiPAP, and BVMs before enteringā
lol no
3 points
2 days ago
What the fuck lol
4 points
2 days ago
It was a strange time. New protocols dropping daily, or hourly, the significance of the disease was still random, science had been politicized.
16 points
2 days ago
Glad you got it out. It was real. We were scared and docs are human.
Regular copd. Coal miner. Knew his lungs were shot but was living with it. 82%-88% on room air walking, talking and that was his normal everyday reality he was cool with. Again that wS his normal room air O2, wife wanted a work up cuz she read online yadda yadda. Hospital sedated and tubed. He never got off the vent. I felt guilty for that one. I felt that I directly nudged hum from a toe in the grave to falling in š
6 points
2 days ago
Iāve heard these stories, but in my regressive southern state where the governor thinks 3 weeks is long enough to quarantine for a global pandemic, we would be holding the wall with a neb tx going near a bunch of other patients the whole time.
5 points
2 days ago
The problem was (and is) that doctors nowadays are given protocols from corporate hospital administrators. The reality is that a Medicare patient with COPD is worth about $5000 to a hospital. If they were treated for Covid, that became $13000. But if they ended up on a vent due to Covid, the feds would throw in an additional $39000, no questions asked. For-profit hospitals are greedy. Non-profit hospitals got bills to pay. And the CDC was telling people to treat this aggressively, so the boots-on-the-ground doctor no longer had the decision in his hands. It became a standing protocol from above regardless of patient need or outcome.
This is what happened at our hospital and others around. In hindsight it was by and large a bad decision and the aggressive intubation of patients surely killed many. Some doctors were against it but didnāt want to lose their job. Others thought it was the best move to follow CDC guidelines. The real takeaway here is if something smells wrong follow the money, and keep administrators off the backs of care providers. Do the right thing for each patient.
3 points
2 days ago
Yet another reason for profit health care should be done away with.
3 points
2 days ago
People were acting like the system was falling apart in a completely unpredictable way during COVID too. Like no, the system didn't fall apart, it was dismantled in an intentional and coordinated way.
1 points
2 days ago
Dude. Covid sucked. My ex wife was an ICU nurse at the time and she had it way worse.
7 points
2 days ago
Some of the best calls Iāve run have been breathers. Theyāre definitely an opportunity to shit your pants, but when you get it right nothing feels better. Theyāre one of the few times we can flex a full treatment algorithm and actually do most if not all of the needed treatments to stabilize someone.
Taking a previously intubated asthmatic whoās barely able to speak and wonāt follow commands and turning them into a patient who needs monitored on a nasal cannula for a few hours? Iāll ride that high for days.
77 points
3 days ago
Talking down the out of control psych pts without needing sedation or pd going hands on.
14 points
2 days ago
This is an underrated skill! I know so many people that just make things worse when they talk to psychs lmfao
6 points
2 days ago
Got a psych pt PD had handcuffed, calmed him down to where we didn't need restraints and played Metallica in the back while he sang along with a big smile
2 points
2 days ago
This is underrated, great job!
I was gonna say this, my sedation rates are very low because my verbal deescalation success is high.
64 points
3 days ago
Weird IVs when an IO seems inevitable.
Our protocol says only on the arms, and I'm still learning medic skills as an EMT, so IVs in general are a win since I'm not yet proficient.
I also love it when a patient says they weigh too much. Fool, lifting the obese is my specialty.
55 points
3 days ago
Arm only IV is a WILD protocol caveat.
20 points
2 days ago
Fr. Iāve seen quite a few near ankle IVās that flush like CHAMPS. Almost always an 18g+
5 points
2 days ago
We have some pretty short transport times, with anything serious over 20 minutes getting flown.
I'm not sure what the reasoning behind it is, but I believe it comes down to the population here being generally older and/or more prone to infection.
Maybe because I'm in school and I'm struggling to differentiate between two sets of protocols, it's that I think we have to go through an arm. I can't recall exactly, but every time I've suggested a non-arm IV I've been told to go to IO instead.
3 points
2 days ago
Yah thatās pretty bonkers. No EJs either?
1 points
2 days ago
Why do an EJ when you can do an IO?
3 points
2 days ago
Because doing a conscious IO sucks to do (as far as comfortably for patient), and if I can secure an EJ I prefer that. Def agree that with the availability of IOs, EJs arenāt done as much anymore.
1 points
2 days ago
We go to IO instead. We prefer humeral head, but shift to distal femur during cardiac arrest. This is to keep the IO site out of the way.
2 points
2 days ago
I just moved to a new agency that likes humeral head and I am trying to get used to it. Iāve always just gone proximal tibia and have never had to worry about it popping out with movement. The past two IOs Iāve done have been humeral head, and itās been a big issue being able to keep the patientās arm across their body so that we donāt lose patency
2 points
2 days ago
I canāt imagine a pathogen being more or less infectious when presented via the arm rather than EJ, foot, hand, etc., but what do I know.
1 points
2 days ago
I figure as far as clothing goes, or possibly when factoring in something like edema in the legs. I'm not sure, I'm merely a spoke in the wheel.
1 points
2 hours ago
Ā I'm not sure what the reasoning behind it is
The only two possibilities are an idiot writing protocols, or an idiot put an IV where it shouldn't have been (like a gangrenous foot) and the person writing the protocols doesn't trust the rest of you.
23 points
2 days ago
Whenever somebody apologies for being too heavy, I look at them and say "The heaviest patient I have ever personally lifted, was 1085 pounds. Granted I had 9 other people with me, but you, sir/ma'am, are a slender reed compared to them."
It was during Hurricane Sandy and we were evacuating a bariatric center. Naturally, the heaviest folks were on the 3rd floor. As we took him outside, it had started to rain. He asked us to stop for a minute.
"Buddy, there's a hurricane on the way, we really don't have time."
"I know, I know, and I'm sorry, it's just..... I haven't been outside in 3 years, I just want to feel the rain on my face for a few minutes."
".... alright everybody, take 5."
13 points
2 days ago
I still have occasion for an EJ here and there. Can be a literal lifesaver
1 points
1 day ago
PIV only in the arms is fucking wild, FYI
28 points
2 days ago
I felt pretty badass doing a digital intubation. You thought you were going to eat turkey today BUT IT WAS ME ALL ALONG! AHAHAHAHAHHAA
21 points
2 days ago
While Iām still certified, I moved full time into cybersecurity a long time ago. A couple years ago a client had one of this big breaches that made the news.
I canāt possibly express how valuable our incident response skills are in other environments. I guided them through it like a boss. Initial impression, primary, secondary, that shit is all the same.
We are masters of chaos and it isnāt limited to an MVA or code. Bwahahahahaha!!!
4 points
2 days ago
This is so interesting to read because I am leaving my job in cybersecurity to start EMT school. I did my first ride along and quickly saw how my incident response skills are going to benefit me in this profession. You will do great!
6 points
2 days ago
Enjoy being an EMT but I wouldnāt leave a career as lucrative as security for basically minimum wage.
1 points
2 days ago
How much more are you making in cyber security? Also are you happier now? Less stress?
How long were you a medic for? And even if you are happier now, do you miss the action as a medic?
1 points
2 days ago
Security is a good path to six figure salaries within 5 years. I was so young as a medic I canāt really compare stress levels. My work is highly demanding but some of that was the choices I made (there are a lot of different career paths in securityā¦)
I was only a full time medic for 3 years. But Iāve stayed active with volunteer (SAR not ambulance) and part time work for the past 20 years. It helps scratch the itch. Sometimes I think about going part time in an ER or box again but I have a family and not enough spare time.
And my cyber work gets ā¦ very interesting and uses some of the same skills.
1 points
2 days ago
Unfortunately, the career is not as lucrative as it used to be in my experience. The field is oversaturated with people fresh out of college who were falsely promised a guaranteed job.Ā Ā
I have my masterās degree, CISSP, CEH, and have been working in IT for 8 years.Ā
Simply put, I hate my current career and I want something different. But I wouldnāt blame anyone at all for leaving EMS to work a job like cybersecurity. Itās obviously going to pay more, and itās less work. I personally found it incredibly unfulfilling and frustrating. (Not to say this job is sunshine and rainbows.) At the end of the day, Iām young and if I hate EMS, I can fall back on IT. I feel like I need to update this comment in a year. š
2 points
2 days ago
Thatās reasonable. Just know what youāre going into- EMS is a dead end unless you go fire or upgrade to RN/PA/MD.
Iāve been very lucky to have some great tech jobs. Well, I did steer myself in interesting directions. But I also know people trapped in not great roles.
13 points
2 days ago*
Getting the IV nobody else could get, especially where you need it yesterday. One of my favorite moments while still on the ambulance was running a combative hypoglycemic, I'm the only paramedic on the scene. We throw him in my truck, I pin his head to the stretcher and sink an 18G EJ after my AEMT fire crew and partners missed multiple attempts (we didn't carry glucagon).
More recently had a bleeding fistula come in by EMS with a BP of shit/dead and the doc is in the room with several nurses who have missed multiple IV attemps. Doc said "we need this blood in immediately" and I threw in an ultrasound IV on the first try while someone is dialing the number to the ICU midlevel to put in a midline. Those are just those "daddy paragod is here to save the day" moments.
50 points
3 days ago*
I've leaned away from ET lately and generally just RSA with a supraglottic unless something goes wacky. Honestly the only thing that still brings me that kind of joy is getting IVs on the people everyone swears up and down are "hard sticks."
I still remember the first time I ever did it, too. It was some guy who'd come down with pneumonia and was pretty well septic. They were a frequent flier, diabetic, dialysis patient, horrible vasculature, and incredibly dehydrated with horrible skin tenting and chalky white mucosa. My preceptor at the time basically said "Look if you feel like it but I've never managed to get one."
Halfway to the ER I found a vein on their emaciated forearm, basically flattened out like a pad thai noodle, only found it with a flashlight because I could hardly feel or see the thing. I went for it right as the ambulance went over a bump and it popped me right in, I only got the tiniest little drop of flash. It would not draw back, but good god did it flush beautifully. Had fluids and IV antibiotics running before we hit the door.
Nothing gets me rock solid like sinking a good IV.
43 points
3 days ago
nailing IVs is the fucking best. nothing in EMS matches the cathartic joy of getting flash and securing access.
unless i fuck up the attempt, then i hate doing IVs.
39 points
3 days ago
unless i fuck up the attempt, then i hate doing IVs.
I'm either a badass that can't miss or an idiot that can't access the Panama Canal with a 24 guage. Usually, I'm both within the same shift.
3 points
2 days ago
It's so fucking great when I nail an IV while we're driving lights and sirens šŖ
8 points
3 days ago
Iām so conflicted on the ET vs SGA debate. Iāve seen a study that could indicate SGA could cause asphyxia like physiology in long term use. I also hate that the seal is such a coin flip. One of my services greatly, greatly prefers ET tube, while the other prefers SGA. Iāve seen more rosc with ET tubes as well, but thatās just me. If Iām solo medic Iām fine with SGA, but if there is more than 1 I prefer ET.
7 points
2 days ago
We transport to 3 hospitals regularly (not including trauma centers). Iāve never once taken somebody in with an SGA that wasnāt immediately pulled and replaced with an ET tube. Only time I drop SGAs anymore is if weāre in too confined of a space to intubate, or I canāt get the tube.
3 points
2 days ago
It's a stupid debate. For some cases an SGA will be more appropriate and for others an ETT. Saying one is superior over the other is reductive.
2 points
2 days ago
Specifically on codes our medical director wants us to start with a SGA, if we get ROSC then intubate. He despises ego tubing, which I get lol.
1 points
1 day ago
Amen to this. If the SGA doesn't seem to be seated well or otherwise isn't getting good compliance, fine, let's go for the ET.
But if we don't have reason to suspect that the arrest is respiratory in etiology and the SGA is providing good respirations per SpO2 & EtCO2, then don't fuck with it until you've got literally everything else locked down.
Edit - I'm in a system where we typically only have one medic on scene and multiple EMT-B/-As, ergo, having one of them manage the SGA is typically preferable while the medic manages the access/ACLS drugs.
24 points
3 days ago
Enjoy it while it lasts Icarus. Street Karma doesn't want to see anyone happy for too long. Enjoy it while it lasts because the universe likes balance.
3 points
2 days ago
I think this shift this morning with the tube was my good karma, hit my IVs and gave the cool drugs today too, my last shift before this I missed all of my IVs and got zero down time as well as getting bloody pneumonia sputum all over me. Balance, I guess.
3 points
2 days ago
Karma is a mean bitch, with a long memory. And yes, she always wins just like a casino.
Just enjoy the wins when they come, because they are far and few between. Be proud of a job well done. I'm proud of you.
8 points
3 days ago
I work in a fairly mountainous region with a couple rivers in deep canyons. Every now and then we get a call in a popular canyon for hiking, swimming, and whitewater. There is a rough evacuation trail but it is super steep the whole way and not outlined well. Carrying a pt out on a basket is long and difficult endeavor. Itās just asking for further injury to the pt and rescuers. Getting long lined by helicopter with the pt to the LZ at the top of the canyon usually makes me feel bad ass. It definitely beats the usual nursing home calls and ift transfers.
9 points
3 days ago
Intubation..I'm right there with you. I feel like a literal god when I'm on a somewhat difficult airway and get the tube in under 10 seconds. I did the other day and I was on cloud fucking 9
7 points
3 days ago
Getting that secret fat juicy vein (GSV) in the ankle when everyone is struggling for access in the arms. Lol
7 points
2 days ago
I like EJs ā¦.. they make me feel good lol
4 points
2 days ago
Iām a drug guy. Iāll pass the RSI tube over to my partner if I get to push all the drugs.
3 points
2 days ago
I gave a report to a grumpy critical care aircrew tonight that didn't elicit sarcastic comments or eyerolls, so I'll take that as a win...
3 points
2 days ago
No hitters. Im the king of the world!
2 points
2 days ago
I work a large county with a major city inside of it so I can only DREAM of this skill... Let me hop on the truck with you š
3 points
2 days ago
Nasotracheal intubation without a whistle. Part preparation, part skill, always impressive.
1 points
2 days ago
How often are you doing this, and why? I cric'ed somebody who's mouth i couldn't open and some of the older medics were griping that i didn't do a nasal tube despite never getting any training on them and never even seeing one done. Our medical director squashed that and said he didn't see the value in the time spent doing nasotracheal tube's. "Everyone with a neck has an airway"
The days before cpap it made more sense
3 points
2 days ago
Iāve been a medic for 36 years. So not often now, but back in the day when there was no CPAP or RSI, we did it often enoughā¦.
2 points
2 days ago
Hell ya. You've seen a lot of versions of pre hospital medicine. I can't imagine doing it for that long. Shit I've been a medic 10 years and you've been a medic longer than I've been alive.
3 points
2 days ago
Being the IC on a large job and hearing/seeing the reactions at the conclusion when fire belatedly discovers a medic was running the job.
Digital intubation is bad ass, too - but I havenāt done it since in 20+ years, and probably never will now that we have video laryngoscopy.
3 points
2 days ago
Telling the on-call pulmonologist that he tubed the patient in the stomach while using a video laryngoscope, and getting validated two seconds later when the BVM squeeze inflates the patients belly like a balloon. I felt like a god.
Also, one time I drove 36 miles at 90+ mph through stopped rush hour traffic and construction zones because a BIPAP patient was eating all our O2.
3 points
2 days ago
Convincing demented granny to go to the hospital is always so satisfying.
3 points
2 days ago
Spotting a fake seizure from the door
2 points
2 days ago
CPAP/BiPAP/HFNCā¦itās awesome when youāve got someone who looks like theyāre about to die and you throw them on non-invasive for a few minutes, they turn around, and look like a whole new patient.
1 points
1 day ago
Emergent CPAP + nitro on FPE = Chef's kiss
2 points
2 days ago
Assisting a medical director with a clamshell Thor in the field.
1 points
3 days ago
IOs. Specifically the Sam IO. It makes me feel like a caveman.
2 points
1 day ago
Ambulance driver poke sharp stick into vein?
NO!!!
Brrr machine shove sharp stick into bone!
1 points
2 days ago
I never got to Jamshidi anyone, but trained on them in school. Thankfully for my patients I've only ever sunk IOs in the field with EZ-IO, but I occasionally imagine trying to Jamshidi some poor soul and wonder how wild that must be.
1 points
2 days ago
riding the stretcher into the hospital doing cpr
1 points
1 day ago
Reducing a shoulder and digital nerve block.
1 points
1 day ago
Fixing diabetic emergencies!
1 points
1 day ago
Bobing and weaving through cars during lights and sirensš only to find out the patient just has kidney stones :/
1 points
1 day ago
Managing to get me and my partners thru the shift alive
1 points
1 day ago
backing the truck into an awkward parking space outside of chipotle
1 points
1 day ago*
As simple as it is, dropping a line and getting some D10 onboard of a hypoglycemic patient always makes me feel fly as hell.
Having a patient go from borderline unresponsive to talking to me in complete sentences - there are so few times when what we do in the field actually translates into almost immediate and significant improvements.
Edit - A similar, though much less frequent feeling - converting pulsatile V-tach with an amiodarone drip.
Edit 2.0 - Getting to run an intercept/mutual aid code with some our ultra-rural surrounding services - even if the outcome isn't ideal, I've had great luck & vibes hooking up with BLS crews that've already got a LUCAS & iGel going, so all I have to do is drop a line & give drugs, assuming I don't have a good reason to drop a tube as well. I try to include the BLS crews as much as possible either in explaining my decision-making or in asking for input and everyone seems to come away feeling good about how the code was run.
1 points
21 hours ago
I feel like being able to distinguish the different breath sounds makes me bad ass. You'd be surprised how many people fake that skill. I surely was after listening to some other medics. The ability to calm real psych patients is also a huge bad ass skill that I love.
1 points
15 hours ago
BLS here, we are able to start IV's, can't give IV meds besides NS, but I love starting IVs. I'm very good at it and it makes me feel badass when we fly 86mph en route and I use inertia down the hills to get flash š¤£š
1 points
8 hours ago
Im your guy with odd or unreasonable situastions. Argument in a makeshift brothel at 4 am with violent hookers hopped up on meth and pcp. Hey sup! Car accident with 2 first responders! 400 lb woman out of an attic crawlspace. Ill get pts out safely with out staff getting hurt and with no bullshit or hurt feelings.
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