Tag: mental-health

  • I Deserve to be a Supervisor, Despite My Criminal Record

    At my particular agency, we employ various field supervisors that oversee the crews out on the road. And for the most part, these supervisors are awful. They are the paramedics that couldn’t actually do the job well enough to justify keeping on the ambulance, but somehow didn’t screw up enough to be fired. As someone who has been nearly fired numerous times, I’ve proven that I’m capable of that aspect of the job.

    But I obviously know more than all of them. So often supervisors are showing up on MY scene and trying to tell me how to run MY patient. “Confirm that intubation” they’ll say, but why should I waste time confirming my skills? I saw the stylet go into a hole! I know it’s good! And if the only qualification for supervisor is ruining their best medic’s scene, then it’s time I throw my hat into the ring.

    So, let’s talk about the reasons I should be a supervisor:

    1. I’m a woman. Our current lineup of managers is very much a sausage party. As I mentioned to the HR representative when they brought me in for my last ‘disciplinary’ meeting, I’m not above suing for gender discrimination.
    2. I’m better than all of our current lineup. Not only have I been a medic for nearly two entire years, but I am constantly researching and practicing new techniques, such as using an IO drill to create an emergency cerebral ventricular shunt.
    3. I am willing to stand up for my coworkers. And by coworkers, I mean my fellow supervisors. I will have your back and punish anyone who dares to question our authority. This is for the good of the company, which means its for the good of the employee.
    4. Not al the crimes I committed are illegal in all states. And the ones that are currently have no active warrants. That means I’m a safe bet as long as I stay within Oklahoma and don’t cross any state or county lines.

    So if you know me, and many of you do, mention my name next time there is a potential opening. Frankly, I’m having trouble making rent and vape prices keep going up, so I could really use the money. Just remember that I have plenty of blackmail material on all of you and I’m willing to use it.

  • Intubation: We’ve Been Doing It Wrong

    We’ve all been there. A 56 year old female, chief complaint of chest pain, with a history of anxiety and diabetes. Her skin is warm and pink with rapid respirations in the range of 38. Irregular and shallow ventilations and with clear lung sounds. If you’re a decent medic (and if you’re reading this, you are) then you can tell one thing just from what I’ve mentioned above: this patient in unable to control her own airway and is a candidate for rapid sequence intubation.

    Here’s the problem with the scene: time is limited. One thing other fields of medicine don’t understand about paramedicine is that our scene time, legally and morally, cannot be more than ten minutes. So taking time to push sedatives like ketamine or etomidate ()both of which are incredibly lethal drugs even in small doses) is a waste of time and resources. But for too long we’ve tried to accommodate the opinions of so-called ‘doctors’ and ‘medical experts’ and ‘the court of law’ just because they’re the ones in charge. But it’s not their patient. And it’s not their life to save.

    I think it’s time us paramedics really buckle down and focus on what we are: life-saving heroes. And life saving heroes don’t have time for Delayed Sequence Intubation (an oxymoron if I’ve ever heard one). Instead, it’s paralytic time.

    In the above scenario, the patient shows all the traditional signs of imminent respiratory collapse: rapid respirations, an inability to stop crying, and a recent breakup with her boyfriend of three years. (His name was Marko and he had shaggy blonde hair and a smile like a sunrise.) The traditional way would say to administer a sedative like versed or etomidate first. That’s wrong. If we waste anymore time, the patient could crash on us. Not to mention all the dangerous side effects we could be introducting. So, what’s the correct way?

    We skip straight to the Succs.

    A proper dosing of Suchsinocholine (.3 – 5mg/kg) will have the desired effect of controlling the patients airway and decreasing their respirations while we prepare for ventilation. By reducing their respiratory rate, we allow a proper build of carbon dioxide to help reset their respiratory drive. We can even supply 4 ppm of O2 via a non-rebreather to help support ventilation efforts in this time.

    After preparing for intubation (remember to forego the flex-guide or stylet as these will damage the airway 70% of the time), we immediately intubate the patient. We’ve now controlled the respirations and ventilations and have saved yet another life. This is the new way we should be operating and the which that modern science actually teaches us.

    So next time you go out into the field and run that chest pain call that turns into respiratory distress? Remember this simple phrase: intubation before relaxation.