PALS / End of Semester

Pediatric Advanced Life Support (PALS) has been going well. I am sure, however, that I do NOT want to work a kid-code. REALLY SURE.

The semester is running 100% full stress mode right now. My research students are all finishing up, and my honors student is doing a great job. All of them remind me that there are really wonderful young adults out there. Smart, creative, hard working and likeable.

There is this weird phenomenon that starts this time of year and will end in two weeks. Right now I can't turn around without being "needed". Intro students needing help in preparation for finals. Upper-level students wanting feedback on last minute paper drafts, studying for the final, etc. And, as mentioned, the seniors who I have worked one-on-one with for a year or more. Some have been with me since they were first-years as they were in a first-year seminar with me. Combined, dozens of e-mails and office hours visits, HOURS pouring over inferential statistics, constant demands for my time. What's odd is the end-stage of this dance. The students very abruptly go away and don't need me. All of a sudden, my lab, office and classrooms sit empty. I can go to the bathroom and not have someone ask me a question at the urinal. I can eat lunch. I'm free. But you know what? It hits me every year. This weird sense of emptiness. They were are part of my day-to-day life, and suddenly - poof. They're off. The close ones still call or write, but it isn't the same as the constant day-to-day contact. It's an odd dynamic.

Storm before the calm

Things are busy...

Second to last week of classes at "work", which means preparing exams, meeting with students who have avoided help all semester and now want to turn their D- into an A+, crunching data with seniors doing their senior research, planning a big end-of-semester conference, etc.

EMS stuff also finishes in this home stretch. My medic class is PALS (Pediatric Advanced Life Support) this coming week. I hope they do a better job than they did with ACLS.

Ran a cardiac call with my squad the other night (under the supervision of our paramedic). The paramedic just sat back and let me run the call. The lady was having an AMI and I think I ran the call well.

My posts may be a bit infrequent until I get through mid-May.

DJ

Ride Time is Over!

EMS Update:

Class
Our last module exam was tough and killed off two more people. I really feel bad for them, as we've been going at this for over seven months now. I have a system down now such that without worrying about things much I score between 91 and 95 (I got a 93 on this one). I have given up trying to score in the high 90s as there are always a few strange questions that I'll never anticipate.

Ride Time
Ride time is over! My last call came Sunday late-afternoon. I rode from 0600 to 1800 on Sunday, so it was a long day. The call came in as difficulty breathing. To make a long story medium, my patient had some adventitious lung sounds, but based on her presentation I thought her problem was not acute pulmonary edema (which is what the nursing home staff claimed it was). My preceptor twice asked me what drugs I was going to push. The first time I told him I needed to finish my assessment and see how she responded to the improved positioning and O2 (when we got there, she was flat on her back and on 2 liters of O2 via simple face mask!). The second time he asked, which was right after I finished my assessment, I told him that if I was by myself I would not push anything, to which he said "You're running the call". After the call was over he said "Well, thats it, we're done. You are ready. I knew you knew what drugs to push on most calls, but this call let me know that you know when to NOT push them, and this is very important. Combined, I've seen enough to know you are ready to go out there on your own. Just remember that it is always OK to ask for help from medical control, and you can always call me on my cell if you have a question. Nice job."

My preceptor is a great street paramedic, and in many ways a great mentor and teacher, but he is very quiet. His positive words meant a lot to me. Someone else told me that he was saying (when I wasn't around) that I have a special combination of street skills and book learning, which was nice to hear. I certainly have a lot to learn, but this experience with a higher volume agency, with very experienced providers, was great. I suppose the fact that they asked me if I wanted to work there part time is a sign that they think I can do ALS in a tough environment.

Things I noticed during my ride time (note that I rode in a small urban and suburban environment while my home agency is very rural):

* Many nursing homes are staffed by people who either don't know or don't care how to treat potential medical emergencies like difficulty breathing. I can't count the number of DB calls I went on where the patient was flat on their back and not receiving sufficient oxygen therapy. Truly frightening.

* Some people un-intentionally commit suicide by being stubborn. There are a subset of patients who refuse to allow that they are having a heart attack and will refuse medical treatment against medical advice.

* Compared to my area, the area I rode has a large number of psychologically disturbed patients who are not compliant with their meds. These people are known BY NAME by entire EMS agencies. This is a problem for the patient, the agencies and the hospitals.

* It really sucks that we have a system where some people receive their only medical care by calling 911. This is a REALLY expensive way to do socialized medicine (someone is paying for the ambulance and the emergency department, and it isn't some of these patients).

* Professional EMS providers, on the whole, care about their work, are well trained, provide a vital function to society, and are horribly underpaid. I saw VERY few EMS workers in their 30s. Most were in their teens or 20s OR in the 40s. There seems to be a large burnout factor.


Getting closer yet - State practical exam on 5/14 and State written 5/19.

DJ

Something in the water?

Recent events:

2 student DWI cases.

E-vited (by accident) to a drinking party.

Sent these links (again, by accident):

Student Drinking Games

Suck and Blow (it's bad, but not THAT kind of bad)

Custom Tables (if you don't know what these are for, good for you!)

How do I get sent things "by accident"? Imagine my name is David Jones. My e-mail address at work would be DJones@myschool.edu. Now imagine a student with the name of Donny M. Jones comes to school here. Our computer people, in order to keep us separate, set up his e-mail address as DMJones@myschool.edu. However, if his friends type in djones in the "to" field while they are inviting him to a co-ed naked drinking fiesta...

DJ

ISO – “Total Protocol Recall”

Wednesday my medic class will take our second to last “module exam”. Originally this exam was to cover abdominal, endocrine, behavioral, environmental and OB/GYN emergencies. Now it will include all of the above plus 55 questions on cardiology. Why? Because Wednesday we had TWO quizzes – one on OB/GYN and one a REPEAT cardiology quiz from over a month ago. People did fairly well on the OB/GYN quiz, but only 5 of us passed the cardiology quiz. Our instructor was not pleased that people had purged their memory banks of previously acquired information and decided that putting 55 cardiology questions on the next test would encourage us to keep that material fresher. Indeed.

We are also at the point in the course where a fair amount of emphasis is being placed on “practical skills stations” (where you demonstrate a skill or skill set). What is weird about these stations is that you don’t just “do”, you “say”. It is the “saying” part that is strange, as you need to remember to verbalize things you would NOT verbalize in the field. For example it would be good to glance at the crotch of a patient who lost consciousness to see if (s)he lost bladder control. I assume it would be BAD to be talking to a patient and say (“I am now going to visually inspect your crotch to see if you wet yourself”), though you are expected to say this in a practical skills station. It really is a separate beast.

The hardest skill station for me has been “static cardiology”. In “dynamic cardiology” you have a patient whose condition changes based on treatment. For some reason this is easier for me than static, where you read an EKG and describe, from top to bottom, our protocol for treating that patient. For example, the tester might slide a strip of asystole to you, and you are expected to say “That’s asystole: Begin CPR, confirm asystole in two leads, obtain IV and ETT access, consider transcutaneous pacing if arrest witnessed, administer 1 mg of epinephrine via IV and repeat every 3-5 minutes, administer 1 mg of atropine via IV and repeat every 3-5 minutes to a maximum of 0.04 mg/kg, consider sodium bicarbonate at 1 meq/kg, confirm asystole in two leads and call medical control for permission to terminate”. Whew.

Anyway, to do this you need, in the words of my instructor, “total protocol recall”. It is slow in coming for many in my class, and I just got it in the last couple of days. For me, the trick was to combing trying to memorize the protocols with what the goal of each intervention is. When I just tried to memorize things, I’d get on the “wrong track” sometimes and recall the treatments for another rhythm. Now, by thinking about what the drugs actually DO, I avoid this problem. I am dangerously close to having “total protocol recall”. What is still a long way away is being able to look at my patient and knowing, without skipping a beat, what’s wrong and what to do about it (this is still a very analytic process for me).

DJ