Kushigs syndrome

[manfredvonrichthofen]

Well here's the cool thing, I passed them all the first attempt. So all that is left is my written exam.

[EMT-83]

Hey, congratulations. I'll chime in with a couple a practical exam tales:

They presented us with a diabetic crisis. My brother was a very brittle diabetic, and I had grown up dealing with it. I asked a couple of questions, stated my intended course of action and was stopped by the evaluator. He said it was obvious that I knew what I was doing and told us to move on. We were in and out after about two minutes.

My partner and I were waiting in the hallway for the next scenario, where we heard the very distinctive sounds of a traction splint being cranked. No problem, we had that thing down cold. When it was our turn, our examination of the "patient" indicated a tib/fib injury. The evaluator noticed our confusion and commented that the previous students had failed the station big time.

Afterwards, I couldn't believe how much we had worried about that exam.

[manfredvonrichthofen]

My medical was a fire victim with smoke inhalation. Trauma was sky diver with spinal fractures and bilateral tib-fib fractures. Our random was a joke it was oxygen administration. And yes we had people fail because they didn't listen to the lungs and actually pick up their steth.

[Major Lord]

Die rot baronne,

I figure if you have to use a Combitube, whether you use a stethoscope or not, those things are brutal. I carry a #6 and #7 ET tube and a disposable laryngescope in my jump kit, but I think I still have a couple of adult medium combitubes in my medical junk pile. I would like to see a ruggedized, and really portable, AED, suitable for wilderness medicine ( I gave my Lifepack unit to my daughter in law ( A Spaatzen) in medical school.....15 pounds or so, but a great piece of gear for a fire truck, not so much if you have to haul it around. It made it through a year on the ground for Katrina, but we had no cardiac saves. Most of the dead guys were double-dog dead ( stop me if I am getting too technical for the non-medical people here)

I did learn something cool, that in a pinch, if someone is still breathing, and (pre) anaphylactic, OTC inhalable epinephrine (Bronotine mist?)  for asthmatics is almost as good as 1-1000 epi. ( Note, I also found that Veterinarians buy it in something like one ounce vials, for horses and pigs, but its the same drug and the same manufacturer. I picked some up, but fortunately did not have to use it. Veterinarians also get Dermabond with blue dye in a reusable bottle for 1/10th the price of surgical dermabond tubes for humans. Same old super glue, and if you are doing work where you get lots of boo-boo's and owies ( other technical medical terms) Dermabond is the shiz for getting people back to combat effectives!

Guten Nacht,

Major Lord

[CAP4117]

I'm just curious, who were you working for during Katrina?
Edit: I ask because I'm interested in disaster medicine.

[CAP4117]

Well here's the cool thing, I passed them all the first attempt. So all that is left is my written exam.

Congratulations!! I'm jealous - I still have the final written, final practical, AND the National Registry to get through. Kinda freaking out 

[manfredvonrichthofen]

CAP4117, don't sweat it too much. I almost freaked myself out of taking the practical.

Lord, I carry three tubes of super glue, non-toxic of course, because I know how absolutely awesome dermabond is. (I just had to try to spell dermabond four times before my phone took it HA!) but I haven't been able to get my hands on dermabond yet. I have used about four tubes so far on cuts, and one near laceration, the laceration was myself, I got cut on a piece of metal lying around the woods on a training excercise, advice to everyone, keep up on your TDAP shots.

Being an EMT I still can only use albuterol and nitro, things of prescription status if they have a prescription already, and with medical control. But we had an awesome instructor who taught us a lot of medic stuffs. He taught us to intubate a patient, it makes assisting a lot easier if you know how to do it, and he taught us about tracheostomy.

I plan on getting my hands on a couple of COMBITUBES for my go bag and some extra Sam splints. Also going to get a c-collar and head pads for our litter. We still don't have any.

I enjoy playing with COMBITUBES though, I have gotten it to where I can insert one and only have respirations stopped for fifteen seconds. but I keep getting weird looks because I use NPs over OPs every time.

This is really neat talking medical with someone other than others in my class!

[Major Lord]

I'm just curious, who were you working for during Katrina?
Edit: I ask because I'm interested in disaster medicine.

A contract prohibits me from mentioning the company, but it was ( and still is, under a different name) one of the paramilitary contractors, sometimes called "Private Military Companies" contracted by FEMA to provide security services. My initial job was recon and report writing, followed by establishing a base personnel level of about 30 People, to Babysit FEMA and their contractors going into a somewhat less than friendly and safe environment. I was the XO and sole medic for our group, until we managed to bring in a huge Navy Corpsman as my backup. ( Note, contrary to what our CIC says, it is not pronounced :Corpse-man") Most of our operators  had at least "combat lifesaver" training, but the vast majority of our medical issues were with the government employees, who we had promised to bring back with all their fingers and toes. Their are some paramilitary companies that will stil hire you as a Paramedic with no prior experience and put you through their schools to learn the tactical parts,  but the days of PMC's working in the U.S. are likely over in my estimation, and since we have had a few semi-wars lately, the job market is flooded with prior military, and wages have gone down. Those $300,000.00, 18 month Executive Protection gigs in dirkadikistan have gone the way of the dinosaur I am afraid. A lot of PMC's are recruiting personnel in the third world. FYI, probably everything we did would be illegal in any other time or place, but desperate times call for desperate measures.

Katrina was a one-off, don't look to it as the standard. ( Unless the very fabric of civilization was torn and we degrade into anarchy, which seems very possible....) If you are interested in disaster Medicine, you ought to get hooked up with a group like DEMAT or even the Red Cross. Or walk into any jungle clinic, tell them you are an EMT of some flavor, and they will hand you a pair of gloves and a scalpel and tell you to do what you can with what you've got. Kind of a "full immersion" medical school.

Major Lord

[manfredvonrichthofen]

I have thought about PMC, considered it heavily in Iraq or Afghanistan... Iraq being out of the question now, and Afghanistan dwindling with Obama's blunder about the war being over... That won't end well. But disaster medicine is really on the way side these days. CAP really seems like the closest you will get, and. Elieve me when I say using your training will be seldom in CAP is a bit of an understatement. People are so afraid of nature these days that getting lost doesn't happen that much anymore. I mean come on they try to say that drinking from the hose will kill you dead where you stand. People need to come back to the real world and realize that sitting on your couch eating Cheetos will kill ou pretty quick too... Oh wait you can't eat Cheetos anymore either... Sitting on the couch eating tofu cheese lumps... People look at me like I'm crazy when I talk about taking my seven year old daughter to the archery range and teach her to shoot a long bow and make a fire with flint and steel. It's especially bad when they listen to her say that squirrel sure looks tasty. We better watch out and prepare for a new line of work soon as no one dies from anything but choking on their cheesy tofu lumps.

[SARDOC]

Can you elaborate? I can't find cushings reflex at all in my textbook.

Try Cushing's Triad.


Edit...Never mind got beat to it.

[Major Lord]

manfredvonrichthofen,

Maybe we can get the Mods to set us up a medical sticky topic so we don't get accused of CAP blasphemy! There are a ton of medical people in CAP, and many are combat, tactical, or wilderness medical people of various species. ( When I go to the Doctor, and they ask if I am allergic to any medication, its all I can do to keep from saying "Yes, everything! I am in CAP!") I checked and found I have a small, adult sized Combitube on the shelf. Expired, but still sealed int he original tray with all the junk ( syringe, etc) I don't think anyone who needed a tube would mind that its expired; Better the tube than the patient..... PM me your mailing address and I will send one out to you. Soon, we can even get spellcheck to recognize medical terminology!

I am not one who wants to make CAP into a medical first responder, but as they say, "feces does occur" ( to paraphrase) a few years back I on-viewed a multi-fatality, 3 car accident at the Napa/Sonoma county line, and although there were quickly about 20 people their, I could not get one so much as to even hold C-spine on a survivor; The limits of their willingness to jump in ended with jumping out of their cars and blocking traffic, but they were willing to make cellular phone calls, and take photos. ( vultures!) Sometimes its just us. Ever see one person giving CPR and other people standing around watching? Hopefully, the one giving CPR is a CAP-SAR kind of guy, and the one's standing around gawking are lawyers, administrators, and wing commanders.......

My next contract after Katrina came to an end, was supposed to be Afghanistan, as a personnel officer/ XO for active convoy duties for an airbase supply.......but a bacterial and parasitic infection ( don't drink the water) have taken me out of field work forever. Unless the Merde strikes the Venilateur close to home, in which case, I may not have a choice. Still have my CAR and my stethoscope, and can use both if I have to!

Major Lord

[sarmed1]

Combitubes are overated: just like in the military cirlces my agency has switched to the King series of tubes as an alternate airway device (or sometimes primary device depending on the situation)  less guess work, better range of sizes to patient (and I have found fit in smaller spaces...ie tactical gear.....better)

mk

[fyrfitrmedic]

Combitubes are overated: just like in the military cirlces my agency has switched to the King series of tubes as an alternate airway device (or sometimes primary device depending on the situation)  less guess work, better range of sizes to patient (and I have found fit in smaller spaces...ie tactical gear.....better)

mk

+1

[manfredvonrichthofen]

I agree the King is better than the combi, but I haven't really gotten any training on it, but what I hear is all good. Our natty tor spoke of them fondly but didn't want to get into them because we had to learn combi and didn't want the King to interfere in any way, though I'm not sure it would have.

I will take you up on that Lord. Thank you.

[SARDOC]

The King Airway is leaps and bounds better than the Combitube.  My former Agency switched over because it was so much easier to use.  A lower level provider can qualify to insert it, there is less likelihood of error and they were cheaper.

That being said...it's still not as effective as a properly inserted Endotracheal Tube.  I'd still tube them when the opportunity presents itself...the King would be the back up even though some places are using it as their primary.  If a King was inserted before I got there, I'm confident enough with it that I'd leave it in place and not mess with it. 

[manfredvonrichthofen]

The endotrach is ok, but I'm not as confident in it as it only has one bubble to inflate. It seems like it could get dislodged easier than a combi or king. Plus, if you insert it just the right way you are inflating the epigastrium, and don't have a second hose to try for the lungs. Just an opinion, I haven't gotten to use one though.

[fyrfitrmedic]

The endotrach is ok, but I'm not as confident in it as it only has one bubble to inflate. It seems like it could get dislodged easier than a combi or king. Plus, if you insert it just the right way you are inflating the epigastrium, and don't have a second hose to try for the lungs. Just an opinion, I haven't gotten to use one though.

Not being snarky here, but that's why ET tubes are generally an advanced skill, and it's also why the Tube Tamer was invented... which is a hell of a lot better than the tape method.

Keep in mind that the gold standard is ventilation; if the method you're using gets air where it needs to go, then you're golden.

[manfredvonrichthofen]

Ok, I am finished with all of my tests. I am done. I should get my card and what not in the next few weeks. What do I need to do to NREMT certification?

[SARDOC]

Ok, I am finished with all of my tests. I am done. I should get my card and what not in the next few weeks. What do I need to do to NREMT certification?

Congratulations.  Make a Copy of it and send it to your state to get reciprocity.  Then Go Forth and Do No Harm.

[manfredvonrichthofen]

Ok, I am finished with all of my tests. I am done. I should get my card and what not in the next few weeks. What do I need to do to NREMT certification?

Congratulations.  Make a Copy of it and send it to your state to get reciprocity.  Then Go Forth and Do No Harm.

I got lucky with a wicked cool instructor, he takes everybody's paperwork and drives it up himself. I have faith in him that he will do it properly, it's no where near his first class. Plus just in case I have copies of all of it. But after I receive reciprocity what is my next step to get onto the NREMT registry? I am sure it's more testing, but who do I need to talk to to get it? Homeland Security or DOT?