first day of field internship

Dear diary


Today was the first day of field internship.  I'm happily paired with a great preceptor that took the time to explain why we were doing things, and even apologized when I didn't get to start any IVs (which I'm fine with).  He taught me how to better write a narrative (and I wrote half a dozen, all improving I hope) and gave good tips for interviewing.


Tomorrow we're back at it for another day.


Oh, and the lesson for the day: drinking and driving is bad, mmkay :)

code blue

Code blue the ICU tonite. Those rarely end well. Sure, you get cpr started rapidly, but the person is usually quite sick with multiple problems. As was the case here, there just wasn't enough reserves to handle it.

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almost internship time

We turned in our choices for internship the other night in class.  Our instructors match us for internship based on GPA, with the top person getting their first pick and then down the line.  With 15 people and 7 locations nearly everybody is getting their first pick. 

I put in for the 2 closest spots so I can still sleep in my own bed every night (plus, it's nice knowing the town).  During my ride-alongs I hated not knowing where I was in relation to the hospital since it affects the load n go vs stay and play decision.  Also, being stationed in a rig that moves around stinks if you're in the back -- you never know where you are, where you're going, and you aren't part of the conversations that go on between partners.

Lately everyone in class has been in clinicals at the hospital all the time so the stories we share with each other have been great.

I wish I'd recorded more of what happened in class and on clinicals, especially after listening to Ron Davis and Kelly Grayson over at emsnewbie.com and their weekly podcast.

new drawings from class

Writing about class has been hard, but I can still draw (well, not really, my drawings are terrible, but they help me learn).

Class is going great (we're done with the first of 3 didactic quarters), I had my first ambulance ride time, did my OR rotation (intubations) and ended the quarter top in class.

The second quarter is supposed to be quite a bit harder. I learn/think best when my hands are involved drawing things and, well, anyone reading this has to suffer my horrible artwork (Brushes for iPad rocks! )

brick walls

The brick walls are there for a reason. They're not there to keep us out. The brick walls are there to give us a chance to show how badly we want something. 

Randy Pausch, The Last Lecture. 2008

I don't tear up or cry very often, but Randy Pausch's story is one of those times.  One of the best lessons from him is about how "stuff" isn't as important as people. 

Once, about a dozen years ago, when Chris was seven years old and Laura was nine, I picked them up in my brand-new Volkswagen Cabrio convertible. "Be careful in Uncle Randy's new car," my sister told them. "Wipe your feet before you get in it. Don't mess anything up. Don't get it dirty."

I listened to her, and thought, as only a bachelor uncle can: "That's just the sort of admonition that sets kids up for failure. Of course they'd eventually get my car dirty. Kids can't help it." So I made things easy. While my sister was outlining the rules, I slowly and deliberately opened a can of soda, turned it over, and poured it on the cloth seats in the back of the convertible. My message: People are more important than things. A car, even a pristine gem like my new convertible, was just a thing.

As I poured out that Coke, I watched Chris and Laura, mouths open, eyes widening. Here was crazy Uncle Randy completely rejecting adult rules.

I ended up being so glad I'd spilled that soda. Because later in the weekend, little Chris got the flu and threw up all over the backseat. He didn't feel guilty. He was relieved; he had already watched me christen the car. He knew it would be OK. 

a couple inspirational quotes

Let me tell you the secret that has led me to my goal. My strength lies solely in my tenacity -- Louis Pasteur



Let me win. But if I cannot win, let me be brave in the attempt. — Special Olympics Oath

What we learn with pleasure we never forget.  -- Alfred Mercier

a million articles on your ipod touch

So, I'm late to the blogging (and reading others blogs) game with EMS.  I've been in the bicycling blogging community in my fair city, and before that myspace (eww, we could just forget about that).  I spend a lot of time reading the back posts.

I've been trying to catch up, because I truly love all of the medical knowledge contained in the stories of the bloggers I follow.  I love reading Peter Canning's stories about naloxone, adenosine, epi and other drugs.  When I'm in class and my instructor starts to talk about it -- I've got a leg up.  I think about the patient in his story "That Narcan Shit" and have a vivid reminder of the effects and side effects, and why it should be titrated to bring the breathing up (so they live) but not to slam it in full dose.

So there's this great app/website called Instapaper.  It's really genious.  You add a little bookmark to your list of bookmarks.  Then, whenever you get to a really awesome article/blogpost but think "darn, I don't have time to read this right now" you can click your special "Read Later" bookmark.

Through some crazy magical techie wizardry, the Instapaper machine turns that article/post into a nicely formatted, advertisements removed, newspaper-style article for you to read later.  All of these articles get queued up on your iPhone/iPod Touch, or (as of next week), the iPad, or your Kindle, or you can go login on the Instapaper site and see a list of all the article's you've saved.

I guess in the Pro version (which I'm buying next week, since it's got new features etc for the iPad which is already ordered) you can share articles with other people, and it has this really cool looking tilt to scroll.  You just lean your device forward to scroll down the page, or lean it back to scroll back up.  I usually do a ton of article reading on my Blackberry and on my old one I think I wore out the spacebar and trackball from reading so much.

Now, instead of grabbing my blackberry and hoping to find something good to read when I've got time to kill, I can grab my iPod and KNOW that I'll have tons of great articles to read.

great timing

excellent post full of videos over at Life Under the Lights.  It's great timing for me (we started on airway tonight).  One of the videos is embedded below, take a look at Ckemtp's blog for the rest

http://lifeunderthelights.com/2010/03/videos-for-an-airway-management-lecture/

drug testing at paramedic school

Now that the Anatomy and Physiology test  is behind us our paramedic class moved on to the beginnings of pharmacology.  Our teacher grabbed a drug box and let us try the different drugs on each other - then separated us into groups based on the outcome.  All the paralyzed people stayed put, everyone on B1 agonists got to run outside, all the people on Beta Blockers laid down to rest, the one dude on opioids sat there tripping, etc etc.  It was a really good way to learn what the drugs did as well as how to reverse the effects (naloxone is COOL!)

It's too bad the cops came to break up the party before it was my turn :(  I'm sure our new teacher won't be as fun

In other news, the book to the left (Dr. Jeffrey Guy's Pharmacology for Prehospital Professional) is great.  I bought it a few months ago to study from and took it along to study group the other night.  We sat around doing all the drug calcs from the book so we'd have a leg up on class.  It made the drug calc worksheet our teacher gave us really easy :)

Medical Terminology

I bought these flashcards (see left) a few months ago and started flipping through them whenever I had time to kill but didn't want to open up a textbook for serious studying.  To be honest, all of the diagrams and picture seemed a bit goofy.  Tonight all the terminology studying paid off being able to deconstruct words on the quiz like

gluconeogenesis
glycogenolysis
glycolysis
glycogenesis


(the questions was something about what glucagon does).  All the words were close enough that without the ability to break the word down into its components they'd be really hard to tell apart.  I'm glad medical terminology (now that I'm starting to understand it) means that I won't need to memorize everything :)

Return on Investment (or, studying gets rewarded)

Yesterday was the big test.  3 chapters of Anatomy, Physiology, Pathophysiology and aging/development.    I spent 2 weekends studying, plus nights, class, and listened to podcasts about anatomy (thanks iTunesU East Tennessee State for posting the lectures.)  We got together Friday night for 6 hours and studied the book, workbook and all the class lectures they put online for us.

(Side note. Did you know that the hyoid bone is the only bone in the body not connected to any other bones. Fascinating bit of trivia that's worth 1 point)

Fast forward to the end of the test (about 11am).  I always have this moment of nervousness when I turn in the test and we go outside to talk about it.  A classmate asked me how I thought I did, and I said 95, but felt bad, like I was bragging.  Turns out I underestimated myself and ended up with a 98 before arguing for more points with the teacher (I think I got one more).  

At lunch today with the munchkin I got a fortune which confirmed I'm on the right path.

  

I eat enough fortune cookies that I can just wait until I get the perfect fortune that confirms what I already believe, then post it and point everyone to it :)

new anatomy drawings

I downloaded Brushes on my iPod Touch and started painting pictures from paramedic class.  

I love this program, I'm not exaggerating when I say it's one of the coolest programs I've ever used.

I can't wait to try this on the Apple iPad.  

diagramming the heart

I'm trying to figure out a cool way to draw out the various body parts we're learning in paramedic class.  I'm a big believer in the learning theory that states the best way to learn is to

read

write

listen

say

draw

teach

My erasable white boards for the EMT-B were covered with drawings like this (sadly not in color).

I did this drawing with the Paint application on Windows 7 using a tablet computer I borrowed from a friend. I think the next thing I'll try is Brushes on the iPod Touch/iPad.  I was checking out some of the brushes pictures on flickr and they look really cool.  It might not measure up to Gray's, but it should be good enough for blog posts and as a learning tool for myself.  Plus, I love drawing and I love tech toys, so this looks like a great $5.  

Oxygenated blood & vessels

de-oxygenated blood & vessels

electrical impulses in the heart

Lung :)

Paramedic in the news

So this is probably old news, but I just watched the video at http://www.wfsb.com/video/22594581/index.html
 where the paramedic called in a STEMI and activated the Cath lab so the patient would get the angioplasty as soon as possible after arriving at the hospital.  It was especially cool that the medic on the news was a blogger (Street Watch) I've been reading for awhile.  Way cool.

Now, I need to get back to studying so I know what they were talking about.  What's a STEMI anyway?

rocked the first test

Yesterday was the first exam for paramedic school. I got one of the top scores in class. Slowing down and reading each question (and picking the best answer, not the first one I thought was "close") helped a ton. On almost every test in my Basic class I'd hurry through and lose 4-5 points to rushing. All those practice tests for the Basic National Registry improved my test taking by a fair margin.

After that we took the ALS post test(not graded). We were supposed to answer everything we could, but no guessing. I got a 44/100, which, considering we're on chapter 2, is fantastic. I got kind of lucky, since there was a question on Vasopressin (which I just read about, thanks Medicscribe! ) and a few questions about Cushing's Triad, which I knew all about since I diagnosed a friend and rushed him to the hospital a couple months ago (long story, golf ball sized mass in his head). I'm super happy with my score on that.

Onward to A&P, studying all day (and all week).

study sites, books, podcasts and lectures

Sharing some stuff for classmates and other medic students

Peter Canning writes a blog called "Street Watch: Notes of a Paramedic". Right now he's going through a list of the 32 drugs he carries, explaining what they do, alternatives, why he uses or doesn't use them, experiences with the drugs.  I love learning from stories, so this is awesome for me.

Get more at http://medicscribe.com/

Kelly Grayson, aka Ambulance Driver, from http://ambulancedriverfiles.com/ wrote a book compiled of his stories. I liked it lots. It's mostly humor with a bit of soul searching and tear jerking. I read it in about three sittings -- I had to, since I was always fighting my wife for the book. You can buy it at Amazon (or, if you know me, borrow it).
En Route: A Paramedic's Stories of Life, Death, and Everything in Between

I've spent the past 6 months listening to a ton of medical related podcasts - especially ones focused on the prehospital setting. One of the best podcasters I found is Dr. Jeffrey Guy. He wrote a pharamacology book and helped write a Trauma book

Pharmacology for the Prehospital Professional

PHTLS Prehospital Trauma Life Support (Phtls: Basic & Advanced Prehospital Trauma Life Support)

I bought and read both books after I started listening to his podcasts. I thought if the book is half as good as the podcast, it'd definitely be worth buying.

Dr. Guy's podcasts can be found at

http://www.icurounds.com/

http://www.prehospitaldrugs.com/

http://www.phtlspodcast.com/

iTunes (iPod not required) has a ton more podcasts available. iTunesU has a number of college classes (lectures, sometimes notes) available. I haven't found any specifically for Paramedics, but anatomy and cardiology never go out of style. Just make sure when you search the iTunes store for "anatomy" you skip over all the "Grey's Anatomy" stuff-- wrong Gray and a focus on the wrong anatomy :)

If you have any other suggestions, hit the comments

How to memorize drugs

My paramedic textbook was nice enough to come with 101 note cards with drugs names on the front and a pile of details on the back including

Name/Class
Description
Indications
Contraindications
Precautions
Dosage/Route

Any tips for memorizing/learning them?  What worked for you?

2345

23 hours, 45minutes (and a big fat check) until I'm a paramedic student.

365ish days until I take my EMT-P national registry.

this reminds me of the saying - how do you eat an elephant? 1 bite at a time. Now? time to go read chapter 1.

Ten pounds of paramedic knowledge