Ask A Medic

sounds about right. I would look more into H's and T's, more specifically possible overdoses or toxins that would cause a brady arrhythmia. but at least you didn't go straight to electricity like most book medics would.

I hate the way we are educated now. There are so many new medics (I am as new as they come...less than one year...but...) out there that dont hesitate to go straight for invasive, dangerous interventions.

I love seeing facebook posts with an OBVIOUS sinus tach at a rat of like 160...and people want to shock the shit out of it...dangerous...

 

I'm at 18months of being a medic. But a total of 5 years on an ambulance. I'm new but comfortable. Sometimes questioning myself too much

 

I agree since they are unstable immediate transcutaneous pacing is needed and or with atropine 0.5mg IV push.

 

Really? You would immediately pace? What if they are conscious and talking? They might be septic.

 

Hemodynamically Ubstable is the key here.

This is an interview question, not a real-life call with an actual patient and changing circumstances.

I absolutely agree that in person, there are a ton of variables that need to be taken into account that will change your treatment plan...

An interview question like this is meant to make sure you know the protocols for treatment. We don't know if the patient is conscious, talking, possibly septic or any of the other H's + T's.

Hemodynamically unstable = Immediate pacing, per ACLS or local protocols.

 

I agree for books. When I went to pacing they were surprised "you would pace this person? How would you do that?"

Which is why I am questioning my answer

 

I'm not saying your answer was wrong, BTW. You certainly conveyed the fact that you know the treatment protocols for symptomatic bradycardia, and that you are more concerned with actual patient presentation than just treating the monitor; but saying you'd go immediately to pacing is not incorrect when the only information you have is unstable brady.

I agree with Tacomx, "cookbook medics" tend to treat dynamic patient conditions with blanket solutions.

 

Did you change your answer? Sometimes they will question you to see if you do the "Oh, well on second thought, I wouldn't pace this person".

 

Didn't change it. Just backed it up with "if those treatments were not working I'd call OLMC and tell them what I've got, what I've done, I'm xx mins away. What do you want me to do?"

I think its a good fall back

 

its all in your head man, motrin, advil, ibuprofen... all the same thing, if you take too much or have a history of stomach issues its gunna bother you.

motrin really isnt hard on the liver, more so kidneys, tylenol is horrible on the liver, hopefully you dont have underlying liver problems that you chalked up to the advil

 

im a nurse in an ER. i had just this yesterday a 41 y/o male drove himself in with a inferior wall STEMI, gave him the usual, ASA, NTG, Heparin, Morphine, he was almost pain free, gave Retavase and prepared to ship him to a cardiac cath lab (we dont have one) about 20 minutes after Retavase he started to have some reperfusion arrythmias including bigeminy and runs of Vtach lasting 10-30 seconds while remaining conscious but dumping his BP, i gave him a fluid bolus and put him on the pacer / defib pads. just as i did that he started with brady arrythmias, including rate 20-30 with SBP 60-70 and pauses of 10+ seconds which in my book is asystole haha. I did a few compressions he woke up but bradycardic and obviously unstable. I had my finger on the pace button on the lifepack but decided to pull atropine and give 1mg, worked like a charm, the Dr came in and wondered what had just happened ( all that happened in like 1-2 minutes) i told him and said i decided atropine would be worth a shot before pacing and he agreed. the guy is fine now, had a 90% occlusion of his RCA and had is now stented and needs to take better care of himself

 

I woke up this morning with a whole new empathy for people with pleuritic chest pain... I'd never had it before, but it seems I got it secondary to a strep-like or viral throat infection. Shit feels like someone using their elbow to support their entire weight... On my sternum.

 

Well I'm not as cool as you guys but I start EMT school pretty soon then plan to go for EMT advanced then paramedic eventually. Want to get a job as a FF/Medic. Most places won't hire FF's around here unless they are medics I want to get a job on a BLS unit as soon as I can to get as much experience as possible, and practice.

 

for the Brady question. 12 lead first. A mobits II or 3rd degree atropine won't work and pacing is required

 

Even though its an interview and they wanted to know whether you knew your algorithm to this or not, I personally would have bombarded them would alot of questions to have a better idea of the call. Age, gender, scene safety / location, BP, Pulse, Respirations, Spo2, Co2, skin color / condition, appearance, mentation, is patient alert enough or family member present to provide history. This paints a much larger picture for yourself when answering the question to unstable bradycardia and to the Interviewer, it shows you know what to check & look for before going straight to a treatment modality.

 

Just got done a shift at the nursing home, was a good time and let me tell you I do not want to do that job. Was actually fun though the nurse I was shadowing was f*cking awesome!

 

how bad is the NR EMT test, practicals are done but i havent taken the written test yet

 

easy

 

This.

Don't let the questions trick you, remember your safety and other responders' safety/BSI, C-spine, ABC's (CAB now).

The most stressful part of the test is the atmosphere. You basically get your picture taken, a palm scan, you can't have anything on your person except ID, and you're being recorded on video and audio (mic on testing station). If you use the dry erase board for notes, you can't erase it, the proctor has to. It's a trip.

 

Right?? You feel like an effing criminal.

Then when I became a medic, and took the FL test...I walked in, took it, then walked out...no security BS...haha