Kushigs syndrome

[manfredvonrichthofen]

Ok so I have been lookin for this all day, and I just can't seem to find it in my textbook, and my exam tomorrow is on trauma and OB emergencies so I just don't see the correlation to what I am able to find online. What I am finding is that Kushings is related to cortisol in the boy. Any EMTs or Paramedics able to give me a hand?

[Al Sayre]

Try Cushings Syndrome, Wikipedia has a rather lenghty description with references...

[manfredvonrichthofen]

Thank you, i found that earlier, However, I am still having issues figuring out how it relates to trauma.

[capmedic]

You are thinking of cushing reflex and is related to ICP.

[Al Sayre]

I'm not a doctor, I don't play one on tv, and I didn't even stay at a Holiday Inn Express last night, but my first guess would that since corticosteroids are frequently given to reduce inflammation and people often purchase and use OTC topical corticosteroid ointments etc, that they may be contra-indicated in the case of trauma, (especially things like road rash and other abrasive injuries) where there is a likelyhood of secondary infection due to lowered immune response, and according to my understanding of the article, may result in Cushings Syndrome.  As I said I'm no expert, but I'd pick either that or C as my final answer. 

[manfredvonrichthofen]

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

[capmedic]

In a head injury, with increase intracranial pressure, you may experience a patient who is having a cushing reflex.  This would display the following signs and symptoms:

decreased loc
increased systolic bp
widening pulse pressure
bradycardia
irregular respirations or apnea

most patients will die.

[manfredvonrichthofen]

Thank you CAPMedic!!! That is great!
Thank you Al Sayre, that is good info, I would never think about the contraindications, and that is one contra that I doubt we will ever touch on it in class but I will brig it up. I am really glad to have you guys around. Thank you.

[capmedic]

glad i could help.

[Private Investigator]

You ever thought about being a police officer?

Tests are easier   

[manfredvonrichthofen]

I did, I originally wanted to after I got out of the Army, but found out I couldn't be ause I am blind in one eye. I don't quite get that one. So I went for EMT, I love to help people who need help the most, so I figured EMT was my other option. And I am glad I took it, I love the course so far, and am almost done, and I thoroughly enjoined my clinical shifts. So I think it will fit.

[Private Investigator]

I know several police officers who have only one eye. You have to look at a smaller agency.

Example LAPD medically retired an officer who lost an eye in a shoot out. He applied to Fullerton PD and got hired.

[Major Lord]

Cushing's is often ( mostly) caused by steroid use, but the chances of you making it worse by administering inhalable steroids in the field are very low. If you suspect Cushing's its a good idea to look for the "moon face" sign so typical of long term steroid use. Some people have no other options besides long term steroids, so its not always possible for someone to taper down and off the drug.  ( Not anabolic steroids so much) Of course, finding 37 empty bottles of prednisone in their bedroom is a good indicator. You can field test for excessive intracranial pressure by testing for Radovici's Sign ( Tell your instructors that is what you are checking for- you will blow them away!)

The world needs more EMT's, just remember, that if you go into that field, you are not going to have as many saves ( I can count my real "saves" on my fingers....) but it will make you an expert on bodily fluids, and once in a while, you will know that you have done God's work. You will probably kill a few people, and you have to be emotionally prepared to have the universe reject your will!

Major Lord

[MSG Mac]

There was a CMH recepient during Vietnam who was blind in one eye when he was initially inducted. He managed to remain in service for over 20 years.

[Major Lord]

I know several police officers who have only one eye. You have to look at a smaller agency.

Example LAPD medically retired an officer who lost an eye in a shoot out. He applied to Fullerton PD and got hired.

U.S. Marshall Rooster Cogburn in "True Grit" had only on eye, and he was John Wayne!

Major Lord

[manfredvonrichthofen]

I would love to be a cop, if I find the right agency that will take someone with one eye, the EMT cert can only help.

[CAP4117]

Another good resource for questions like this is the forum at www.emtlife.com. You can ask technical questions, questions about employment, training, etc.

[manfredvonrichthofen]

I will most definitely take a look at that... Tomorrow, for now it's time to hit the sack so that I can get up and go through my notes one more time for my exam and then rush the kids to school and rush myself to school.

[Flying Pig]

In 15yrs and 3 departments Ive never met an officer with one eye.  Staying a cop after losing an eye or getting picked up by another agency is a lot different than trying to get on as a new hire.  I dont know of any agencies that would hire a rookie missing an eye.  Its a [darn] shame a person like you is in that position.  From reading your posts you seem like youd be a solid addition to any dept.  If you do get hired just be ready to have to prove yourself on more ways than your peer rookies. I was an FTO for several years. Im wont sugar coat it. A cop missing an eye is at a huge disadvantage tactically.

[CAP4117]

I will most definitely take a look at that... Tomorrow, for now it's time to hit the sack so that I can get up and go through my notes one more time for my exam and then rush the kids to school and rush myself to school.

Good luck on your exam! I've got the trauma one next week 

[fyrfitrmedic]

See also: "Cushing's Triad."

[manfredvonrichthofen]

That's why I didn't fight the Army when they told me I was done, I knew I would end up being a hazard on the battle field. The big thing to me now is that I know I wouldn't be on a battle field as a cop, but I do understand there would be risks. I also know I am not legally obligated to inform an employer of my disability, but I don't know if that is true for a police force, and I don't care, I would feel obligated to tell them. But, until I can find a replacement  I will serve any way I can. I love CAP, and I think it is a good fit for me.

Thank you to those of you who are able to protect us at home and thank you for giving yourself to us.

And good luck CAP4117, it's not an easy test so far as I can tell. But at least the next one is the final, and then We are done, until the state testing.

[Flying Pig]

Not legally obligated to inform them of disabilities?  OK maybe not on the intitial application.   There will be plenty of other phases of the process where it is legally required.

No, fortunately the US isnt a battlefield, until you walk up to the front porch of a domestic violence call and end up on the recieving end of a hail of gunfire coming through the front door, end up pinned behind you patrol car by some gangster with an Uzi wearing body armor or get sucker punched on your blind side.  Just because this isnt Iraq dont underestimate the need for the same abilities. 

However....what you need to do if its something your interested is start calling around to departments and talk to their HR.  Dont ask the regular desk Sgt.  Most will say on their recruiting documents "Must have vision in both eyes" or "vision correctable to 20/20 in both eyes"   You may find one.  Or you may be able to get a hole of veterans services and see if there are agencies that dont care. 

[manfredvonrichthofen]

I meant that not every day is a battle field, oh believe me, I don't underestimate that it gets rough and violent.

[SJFedor]

Cushing's Triad (increased B/P, decreased HR, irregular respiratory pattern) is indicative of severe intracranial hemorrhage, and moreso it's typically present during herniation of the brainstem out of the foramen magnum (opening in the base of the skull). You get this "triad" of symptoms because the brainstem contains a lot of the body's control centers that manage respirations, heartrate, and blood pressure, and it subsequently causes alterations. If you're seeing Cushing's, you're not far from seeing cardiac arrest.

Cushing's disease, on the other hand, is a disorder of the pituitary gland where it's releasing too much ACTH.

How much longer do you have in EMT school?

[manfredvonrichthofen]

I have one two weeks left, my final is on Thursday, and then we meet two more times and we will be going back over the assessments. Then our state testing is on Saturday the 5th. I will take the written state on that Monday.

Thank you guys for the info! I passed that last test and I even got the Cushings questions right. You guys were a lot of help!!!

[SJFedor]

Rock on. Best of luck, and if I can help you with anything, let me know.

[manfredvonrichthofen]

Just thought I would let you guys know, thank you for the help with Kushings, it really helped me on my final this morning. I passes with a 92%! CAP4177, how are you doing in EMT?

[commando1]

I would love to be a cop, if I find the right agency that will take someone with one eye, the EMT cert can only help.

One of the fine gentlemen I work with was let go from the police dept for political and budget reasons. He had gone to school to be a EMT-IV and turned around and got hired by the ambulance service within a week.

[CAP4117]

Just thought I would let you guys know, thank you for the help with Kushings, it really helped me on my final this morning. I passes with a 92%! CAP4177, how are you doing in EMT?

Congrats!! That's awesome. Our final is next Tuesday, and I'm really nervous about the practical portion. It's hard to believe the class is almost over!

[Major Lord]

Just walk around for a few days narrating everything you are doing. "I am unlocking the door, and being cautious of family members who may be standing inside, I open the door, listening for creaking hinges, and any indication that the door may be unstable"

When you do your practicals, narrate your actions and if you forget something, make sure you say out loud that you have gone back to check it, without apologizing or making excuses. Make sure you don't do any of the big safety no-no's, which they are looking to ding you for; Think tactically. Don't stress or panic, you'll be fine. Congrats on your test!

I remember that my instructors stuck me with a one man response multi-trauma, and no gear. I used a pen to write on peoples foreheads to triage them., note vitals, etc. (resp, pulse, blown pupils, etc.) I lost points for using a permanent marker though....... It was good experience for when it really happened a number of times.

Major Lord

[manfredvonrichthofen]

I plan on going in and doing whatever I want...

It's mostly common sense stuff, other than the medical assessment, and that is mostly memorizing the sheet. other than that, assessing someone medical is all learned, and you will only get better at it as time goes on. Biggest thing to remember is to just chill when you are in the assessment and remember you have ten whole minutes.

The hardest thing is getting your combi tube in the patient and only allow 30 seconds between stopping respirating while doing it... Putting the combi in itself is easy, but in 30 seconds is tough.

Indiana has also made it a critical fail on the medical and trauma assessment if you don't actually pick up the stethoscope.


But hey so this doesn't get locked due to having noting at all with CAP... While we were at the GTE this past weekend with Indiana Kentucky and Illinois, our team actually had an EMT kit with them, but didn't know how to use it, no one was qualified, but luckily it didn't have anything advanced at all, no adjuncts either.

But I have been thinking of getting a kit for myself and was thinking if it made it to a mission with me... Some of that just might end up being useful. I would like to see us able to use some of it, EXCLUDING THINGS LIKE COMBITUBES, in the field, I know of one mission I was a cadet on, that now looking back on it it would have been a nice thing to have that stuff just in case.

I already carry trauma shears, and butt loads of curlex, along with a Sam splint, but nothing else other than Israeli dressings. But an AED would be really nice as well as some OPs and NPs. There are many units that have backboards already, and some that have bag litters. I would like to see it become a requirement that if your team has a litter, it must be a rigid one, and it be against regulation that you must also secure the head if you use it. You shouldn't use a litter without securing the head anyways, but I see it happen a lot.

[Spaceman3750]

SAM splints are good stuff. I talk about those at every first aid class I teach, yet I keep forgetting to pick one up for my gear.

HINT: If you're bored, curl the SAM splint to make it ridged, ball up a piece of paper, and play SAM splint stickball.

[fyrfitrmedic]

Just walk around for a few days narrating everything you are doing. "I am unlocking the door, and being cautious of family members who may be standing inside, I open the door, listening for creaking hinges, and any indication that the door may be unstable"

When you do your practicals, narrate your actions and if you forget something, make sure you say out loud that you have gone back to check it, without apologizing or making excuses. Make sure you don't do any of the big safety no-no's, which they are looking to ding you for; Think tactically. Don't stress or panic, you'll be fine. Congrats on your test!

+1000

As both an instructor and an evaluator, I can't agree with this strongly enough.

[ProdigalJim]

^^^ this.

As if you needed any more affirmation, do what m'lord says. I used the same procedure when I was preparing for my medic practicals a few years ago, and it absolutely works.

It drove my wife and kids bonkers after awhile, though, so beware. We wound up making a family gag of it: "I'm throwing this wet rag at my unsuspecting Dad, after determining that the scene is safe and I have at least two escape routes." *FWAP* (That's the best text-approximation I can come up with for getting hit with a wet rag...) 

[manfredvonrichthofen]

SAM splints are good stuff. I talk about those at every first aid class I teach, yet I keep forgetting to pick one up for my gear.

HINT: If you're bored, curl the SAM splint to make it ridged, ball up a piece of paper, and play SAM splint stickball.

Nice, I'll do that with my old one.

[manfredvonrichthofen]

Ok, first round of state testing this morning.

[sarmed1]

Sometimes over narration can sink you too; so be carefull.  My previous EMT partner failed the IO station of his paramedic exam because of over talking his actions.  He performed the skill appropriately but while talking his way thru the measurements he said tuberal tuberosity instead of tibial tuberosity...even though he measered appropriately.  Fail!!! for not knowing the proper landmarks.  If he had just done the skill and not narrated his way thru it he would have passed.

Indiana has also made it a critical fail on the medical and trauma assessment if you don't actually pick up the stethoscope.

I agree and disagree with these type of actions:  I assume this is in relation to lung sound assessment.....assessment tool in an assesment station ok  My problem comes in with treatment tools. You are required to voice treat all injuries/illness.....once you start to use to much equipment you increase the risk of station failure for "...providing a dangerous intervention...." ie you oopsed and put the collar on upside down you fail the assessment station.  There is a seperate station for immobilization...its almost like double jeapordy.

mk

[fyrfitrmedic]

Sometimes over narration can sink you too; so be carefull.  My previous EMT partner failed the IO station of his paramedic exam because of over talking his actions.  He performed the skill appropriately but while talking his way thru the measurements he said tuberal tuberosity instead of tibial tuberosity...even though he measered appropriately.  Fail!!! for not knowing the proper landmarks.  If he had just done the skill and not narrated his way thru it he would have passed.

Indiana has also made it a critical fail on the medical and trauma assessment if you don't actually pick up the stethoscope.

I agree and disagree with these type of actions:  I assume this is in relation to lung sound assessment.....assessment tool in an assesment station ok  My problem comes in with treatment tools. You are required to voice treat all injuries/illness.....once you start to use to much equipment you increase the risk of station failure for "...providing a dangerous intervention...." ie you oopsed and put the collar on upside down you fail the assessment station.  There is a seperate station for immobilization...its almost like double jeapordy.

mk

I had to break someone of the habit of saying "tubular tibiosity" all the time; this was the same guy who also described cleaning an IV site by using a "clavicular motion" - paging Yogi Berra... I've seen verbal diarrhea sink more than one test candidate.

Speaking from my experience as an evaluator, there's sometimes a troublesome amount of latitude in interpretation regarding a "dangerous intervention"; I know of an evaluator who was failing people on the oral station based on hair-splitting answers on the pathophys-related questions he asked after the scenario. His rationale was that if he didn't like the answer to the question then obviously anything in the scenario related it to it, no matter how correct or appropriate in that context, must therefore then be dangerous.

[Flying Pig]

When I did my EMT I got myself into trouble by over-expanding my answers and ended up getting things confused with other areas.  Then I tried to salvage it while the evaluator just smiled at me.   I was relieved.  He told me he'd be back around in about 20 minutes and I could try it again.     Kinda like an FAA check ride when the examiner sits back, folds their arms and says "Really, why dont you tell me more about that."

[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?

[SJFedor]

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.

ETI has it's place, as do the combi/king/PTL/LMA. When you're placing an ET tube, you HAVE to know where it's going, which is why it's an advanced level (AEMT/PM) skill. And, while they teach you to listen for epigastric sounds and lung sounds with the combi (and you always have to switch to the 2nd lumen during testing), for ETI they have us do a whole lot more. Colormetric and waveform EtCO2, equal/bilateral breath sounds, absence of epigastric sounds, using an EDD/EID, condensation in the tube, etc. However, ETI is more of a definitive airway, whereas the combi/king/PTL/LMA are only really meant as rescue airways, and if the patient requires continued ventilatory support, they're getting an ET tube eventually anyway. Not to mention, your king/combi/PTL/LMA have limitations on use (contraindications, size of pt, etc) whereas you can find an ET for essentially every patient population from your 5min old neonate to your 104y/o cardiac/respiratory arrest, and there's really no contraindications to an ET tube when the patient needs it.

Any tube can get dislodged with carelessness, combi, ET, king, or otherwise. I would encourage you to get in the habit of ALWAYS keeping 1 hand on the tube, against the pt's face, even with it secured. If I have an EMT/EMR/FR/insert other abbreviation here/ doing the ventilations after ETI or placement of a rescue airway, I still have them hold onto it. And always get in the habit of disconnecting your BVM before you ever move the pt (including in/out of truck), and re-verify your placement of your advanced airway after EVERY move. Doesn't matter if the tube was good for the 30min before you get to the ED, you show up there w/ a bad tube, they'll think it was bad the whole time, and you're in for a chewing/counseling.

And remember, the cuff(s) on any of these devices are NOT meant to hold them in place, they're there to either provide a seal to keep air from escaping, or moreso, to keep nasty things (GI contents) from migrating into the airway. Your tube securing methods, and moreso your attentiveness, keep the tube in place.

Congrats on passing, and welcome to the world of EMS.

[SJFedor]

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?

I'm assuming youre in Indiana, correct? You'll need to create an account with NREMT, and the specifics of it I can't remember (its been a while) but I believe you select your school and whatnot. Your Program director should have access to go in there and see you, be able to throw the switch that you've completed the program of study and your practical examination, which should generate your authorization to test. You'll have to do the NREMT written examination at a secure facility, and once they have everything, they generate your certification. Your school's program director should be able to help you out with this process. You can also go to www.nremt.org, there's lots of helpful things on there to get you going.

Edit: here's what you need to do: http://www.nremt.org/nremt/downloads/NREMT%20EMSStudent%209.23.pdf

[manfredvonrichthofen]

Thanks for the info secret squirrel, I will be getting onto that tomorrow so it's setup when I get my certification papers.

[fyrfitrmedic]

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?

I'm assuming youre in Indiana, correct? You'll need to create an account with NREMT, and the specifics of it I can't remember (its been a while) but I believe you select your school and whatnot. Your Program director should have access to go in there and see you, be able to throw the switch that you've completed the program of study and your practical examination, which should generate your authorization to test. You'll have to do the NREMT written examination at a secure facility, and once they have everything, they generate your certification. Your school's program director should be able to help you out with this process. You can also go to www.nremt.org, there's lots of helpful things on there to get you going.

Edit: here's what you need to do: http://www.nremt.org/nremt/downloads/NREMT%20EMSStudent%209.23.pdf

100 percent spot-on.

[manfredvonrichthofen]

How long about did it take yu guys to get your certification?

The reason I ask is because I am going out of state soon for a bit over a month and wanted to make sure I got it before I leave because INDHS sends it so that you have to sign for it. And if you don't get it at the house you have to go the PO to sign for it, and if you don't get there in time they send it back. I was thinking I would follow the guidance of a friend who said he went to the office in Indianapolis and picked it up himself. If I have to I will do that, but I would like to get it before I leave so that I can start sending my info to hospitals while I am gone.

I know it likely varies state to state, but I was just hoping for a roundabout guesstimation as to the timeframe it actually takes.

[SJFedor]

How long about did it take yu guys to get your certification?

The reason I ask is because I am going out of state soon for a bit over a month and wanted to make sure I got it before I leave because INDHS sends it so that you have to sign for it. And if you don't get it at the house you have to go the PO to sign for it, and if you don't get there in time they send it back. I was thinking I would follow the guidance of a friend who said he went to the office in Indianapolis and picked it up himself. If I have to I will do that, but I would like to get it before I leave so that I can start sending my info to hospitals while I am gone.

I know it likely varies state to state, but I was just hoping for a roundabout guesstimation as to the timeframe it actually takes.

I believe I got mine from Indiana about 3-4 weeks after I passed my practical. I took the state written the day before the practical. It all really varies on how quickly your program director/state rep gets it to IDHS, and how quickly they turn it around. I didn't have to sign for my cert from them, though.

Tennessee was very nice, because if it shows on their licensure verification system, it's legal to work by, and usually the cert follows within a few days of it posting online.

[manfredvonrichthofen]

Thank you Major Lord, I got the ET tray in the mail just now. Thank you, you rock!

[CAP4117]

Finished my final written exam on Tuesday and did the practical today. I was really nervous, but did better than I thought I would. Now I just have to pass the NREMT!

[manfredvonrichthofen]

Finished my final written exam on Tuesday and did the practical today. I was really nervous, but did better than I thought I would. Now I just have to pass the NREMT!

I suggest you take your state test first. It is supposedly harder, but if you can pass it you can pass your NREMT. But Indiana requires you to take your state test before your NREMt exam.

Just study how to use the hazmat guide book, there were about 25 questions that you have to use it for.

[CAP4117]

In IL, if you take the National Registry you automatically get a state license. That's not how it is in all states, though.

[manfredvonrichthofen]

In IL, if you take the National Registry you automatically get a state license. That's not how it is in all states, though.

You're lucky. I wish I only had to take one test. But I also found out that you can take another test and that is all you have to take to be an EMT instructor.

[CAP4117]

That's cool! Something to think about for the future. Honestly, I don't mind taking the tests because, as I understand it, there are tests to get hired with any company, on any department, to get into paramedic school, or virtually anything else we might want to do. I feel like I should try to get used to it! I just need to learn not to get so stressed out about the practicals... 

[manfredvonrichthofen]

I don't know about taking tests to get on any job, here it is mostly who you know sadly. I wish it were all tests. But I am going to take my instructor exam after I get my cert papers.

[CAP4117]

Entrance exams are pretty standard in the Chicago area, even for private companies. It may be because the EMT market here is over-saturated and they need additional ways of weeding people out! (One reason why I am moving elsewhere after I graduate from college - the other being that I really want to run 911 calls and that opportunity just doesn't exist for EMT-Bs around here.) The instructor thing sounds like a good way to stay up on your knowledge and earn extra money - definitely worth checking out someday.

[manfredvonrichthofen]

Entrance exams are pretty standard in the Chicago area, even for private companies. It may be because the EMT market here is over-saturated and they need additional ways of weeding people out! (One reason why I am moving elsewhere after I graduate from college - the other being that I really want to run 911 calls and that opportunity just doesn't exist for EMT-Bs around here.) The instructor thing sounds like a good way to stay up on your knowledge and earn extra money - definitely worth checking out someday.

Here EMTs are not dime a dozen. IU hospital is constantly understaffed. EMTs get calls constantly. Generally they are paired with paramedics, but sometimes they get paired together. But no, we don't have enough EMTs to meet the need. Plus IU hospital is moving to a new idea for the ED, half nursing staff and half EMT. So there too they need EMTs.

[CAP4117]

Wow! I'll put that on my list of possible places to move then! 

[manfredvonrichthofen]

How's it coming along 4117? I am still waiting on my final cert to come in from DHS.

They say they are waiting for my written exam score to come in and they will get it loaded and into the system ASAP, they are really nice here. Hopefully it will be done in the next day or so.

[CAP4117]

I'm taking the National Registry tomorrow, and feeling apprehensive about it. I hope your scores come in soon! What kind of job do you plan on applying for?

[manfredvonrichthofen]

I'm taking the National Registry tomorrow, and feeling apprehensive about it. I hope your scores come in soon! What kind of job do you plan on applying for?

I have my scores... And an 85 on my written and I got perfect scores on my practicals except I strapped the torso then the hips on the backboard, and got a bit gigged on that. But I also found out we don't have a set testing center for NREMT here in In, and I just might have to go to IL to get it.

But I am going to try to start off at the local hospital on an ambulance. What about you?

[CAP4117]

Congrats! That's great. Here in Chicago EMT-Bs don't run 911 calls, so I guess I'm stuck with a private company for the time being.

[manfredvonrichthofen]

That's too bad, but I am glad it's not that way here... I think the reason they are good to go here is because you have to take a test at any hospital you try to work for, and that is just the beginning of the process. Big pita... Take a final... Take the assessments... Take the state test... Take a written employment exam... Take an assessment employment exam and hope you get the job.

[SJFedor]

That's too bad, but I am glad it's not that way here... I think the reason they are good to go here is because you have to take a test at any hospital you try to work for, and that is just the beginning of the process. Big pita... Take a final... Take the assessments... Take the state test... Take a written employment exam... Take an assessment employment exam and hope you get the job.

Oh, that's nothing. Wait til paramedic school. We were sorting all our files last week in preparation for medical director review, and had to sort all our tests into a month by month order. There's now a folder 6 inches thick with all the exams I took in medic school. And that's not counting all the computerized ones we do throughout the year.

I've worked for three 911 services as an EMT (-B and -IV), and all the hiring processes were.... unique. Louisville Metro had me do a written exam (pretty simple), physical agility (carry jump bag/immob equipment/monitor up stairs, assess a patient, code said patient, resuscitate said patient, immobilize and carry pt down stairs on LSB w/ partner, place on stretcher, and load patient and stretcher into med unit in under 15min), panel interview, polygraph (yes, really), and chief's interview. Quite an interesting process, but it was also a fun job while I was up there.  First county service I worked for in TN (part-time) was a written (hardest test I've ever seen, actually made by the guy who is now one of my paramedic instructors), a simple practical mega-code like scenario, and a panel interview. My current employer doesn't believe in written examinations, so we had an HR interview, and then a 5-station interview process with a peds scenario, a trauma scenario, airway management, ops manager interview, and chief's interview, all of which were not too terrible.

Some places love tests, others feel that tests aren't really a good thing. My feeling, if you're someone motivated, dedicated, and willing to learn with a decent educational foundation, I can teach you whatever you need to know for the job. I'd rather have someone who needs a little extra education, but a good attitude, then someone who can ace the test but is a crappy person.

[Spaceman3750]

If EMS is anything like IT, the written tests are just used as an easy way to screen out the goobers before you waste time interviewing them.

[CAP4117]

Good news, I passed the National Registry today. Now it's time to find a job!

[manfredvonrichthofen]

Congratulations brother!!!!

I talked to IDHS yesterday and they told me that they finally found my written exam and it would be entered today. So today I should be a registered EMT.

[CAP4117]

Congratulations brother sister!!!!

I talked to IDHS yesterday and they told me that they finally found my written exam and it would be entered today. So today I should be a registered EMT.

Congrats!!! Good luck with everything! 

[manfredvonrichthofen]

Congratulations brother sister!!!!

I talked to IDHS yesterday and they told me that they finally found my written exam and it would be entered today. So today I should be a registered EMT.

Congrats!!! Good luck with everything! 

Sorry, had no idea... Man my foot is lodged so far down my throat right now...

[CAP4117]

Don't worry about it!  There's no reason you should have known. Thanks for your support through all this!

[Major Lord]

What, you guys couldn't tell that "4117" was a girl's name? Anyway, congrats to all my newborne EMS brethren, and its perfectly fine to use the male form when discussing members of the race of man collectively. Just remember to be courteous and kind to all those with whom you come into professional contact....but have a plan to kill them just in case! If they did not tell you about important things for the practicing EMT, like the "reverse stethoscope maneuver" or "O" sign and "Q" sign, you will get to learn about it now!

Major Lord

[manfredvonrichthofen]

What, you guys couldn't tell that "4117" was a girl's name? Anyway, congrats to all my newborne EMS brethren, and its perfectly fine to use the male form when discussing members of the race of man collectively. Just remember to be courteous and kind to all those with whom you come into professional contact....but have a plan to kill them just in case! If they did not tell you about important things for the practicing EMT, like the "reverse stethoscope maneuver" or "O" sign and "Q" sign, you will get to learn about it now!

Major Lord

I have to hear it... What is the reverse steth maneuver?

[CAP4117]

I'm not sure I want to know 

EDIT: I wasn't trying to give you hard time, manfredvonrichtofen.

[manfredvonrichthofen]

I'm not sure I want to know 

EDIT: I wasn't trying to give you hard time, manfredvonrichtofen.

Not a problem, all is well on my end... I just didn't know... All the numbers threw me for a loop... They all sound like boy numbers lol.

[Major Lord]

What, you guys couldn't tell that "4117" was a girl's name? Anyway, congrats to all my newborne EMS brethren, and its perfectly fine to use the male form when discussing members of the race of man collectively. Just remember to be courteous and kind to all those with whom you come into professional contact....but have a plan to kill them just in case! If they did not tell you about important things for the practicing EMT, like the "reverse stethoscope maneuver" or "O" sign and "Q" sign, you will get to learn about it now!

Major Lord

I have to hear it... What is the reverse steth maneuver?

This is one that I can talk about in mixed company.  The RSM is for when you come in contact with people so old that the only way to talk to them is to put your scope in their ears and yell into the bell. You see? And you expected something really evil, didn't you? ( BTW, did you know that you can inject Narcan sublingually from under someone's chin with a long enough needle? Now that's evil!) Another evil test, for LOC for in people who would otherwise go to jail is to say loudly "Partner quick!, he's unconscious! Get a syringe and draw some fluid out of his eyeball! This is even better that the "hand, face drop test" since any junky worth his salt knows how to handle that one. If they keep their composure after you tell the you are going to stick a needle in their eye, then you can also use an alcohol prep pad on their eyelid to add to the terror factor. I have only had one guy ( A pickup from San Quentin Prison) who let me stick a nasopharyngeal airway up his nose and still do a credible job of feigning unconsciousness....

Don't mention "O" sign and "Q" sign to non-emergency medical people...they won't like it....

Major Lord

[CAP4117]

That's why I didn't want to know Stop polluting our young and eager minds, we have years to get cynical on our own! 

[manfredvonrichthofen]

https://myoracle.in.gov/reports/rwservlet?dfbsipnpdf&report=acadis_person_detail.rdf&p_personid=931865

As of five minutes ago, I am a certified EMT!!!

YEAH! This is awesome!!!!!!!!!!!

[Major Lord]

Congratulations!

Major Lord

[CAP4117]

Congratulations, that's awesome!!