Thursday, October 25, 2007

CCEMT-P

Well, it's official.... I am now a Critical Care Paramedic. But to get to this point, I have to talk a little bit about the past five days. It's been hairy.

As I write this I am held up at the Douglas Airport in Charlotte, NC. I'm on my way home and when I flew into here from Augusta, I discovered that my flight is going to be delayed by two hours while we're awaiting the plane that is supposed to be coming here from Fort Lauderdale, FL. The weather here as I write is drizzly, damp, and overcast. Approximately 60 degrees outside. When I left Augusta it was beautiful - 73 degrees and sunny. However, as I said, that is not the case here.....

I don't recall what I said when I posted over this past weekend. I did a shift in the Shock-Trauma unit Saturday night. It was pretty dead, all things considered. No really intense procedures that needed to be done, no sick people that came on to the unit while I was there. Just the existing sick people that were already there when I arrived. I hooked up with Kim, RN, the charge nurse for the 1900-0700 shift (I figured out that most of the nursing staff works 12 hour shifts), and she was awesome. She's also a Captain in the Army Reserve, having served one tour in Iraq, as has her husband. Very competent nurse, and extremely direct. The kind of person that I like dealing with. Anyway, she had a couple of difficult patients that I assisted her with. One in particular that I'll mention is a 28 year-old male that blew half of his face off with a shotgun. Amazingly, he is still alive, cognitively unimpaired, and healing after skin grafts to his face. He has a long road ahead of him, I suspect, as far as continuing to repair the damage that he did himself, but he at least is not a vegetable or a quadriplegic. Unfortunately, he has other issues; besides the psychiatric problems he needs to deal with, he also has a mother who is quite smothering, to say the least. It was interesting to watch her; in my opinion, she herself has problems that she needs to deal with, just based on my observations. One of the big things I saw going on was her attitude towards the nursing staff who are doing a great deal to help get her son healed. It was terrible. I felt like she was trying to drive the bus and dictate what she thought her son's medical needs were. The staff were really patient with her, but I could tell that that line of patience was wearing thin.

On Monday, the lectures continued. We had classes on Acid-Base balance, RSI, and we dissected pig hearts. The teacher we had for the day was one of the third year Emergency Medicine residents, Dr. Eric Greenfield. He's also a Paramedic, which made him able to relate to what we do and how we do it. On top of that, he is an excellent teacher; he made lab values really easy to understand as they relate to what I need to know, and his RSI class was really a lot of review, but it was quite good.

Tuesday was Arterial Blood Gas and the lung lab in the morning, taught by the head of the Respiratory Therapy department at the medical school. He was really good; I understand what to look for in an ABG now, but I wish he'd spent more time dealing with ventilators, in terms of settings, that sort of thing. I would have been helpful. And it isn't that I don't know how to set up a ventilator, but I (and others) would have liked to play more. He had this really neat set of lungs that he used for demonstration purposes, though; they were pig lungs that have been treated to not disintegrate. He showed what lung inflation looks like both with and without PEEP, and it was a clear point that says we do our patients no favors when we don't include PEEP with ventilation. They need to have it; the pressure applied holds the alveolar sacs open so as to all better inflation and, ultimately, gas exchange.

The afternoon was a lecture on burns, conducted by John, our host. That was a good lecture; my feeling is that he should have taught more of the classes as he is really good at teaching. There is "instruction", and there is "teaching." Anyone can instruct, but not everyone can teach. John has the talent to teach. The person that taught the Multi-System Organ Failure class, however, does not. She is one of the Emergency Medicine residents, and she'd been up for nearly 30 hours and clearly needed sleep. That said, she should have either not taught the class or had been more fully awake when she taught, after rest. She really sucked! It was horrible; gave death by Power Point a new meaning.....

Yesterday morning we had a presentation on the Intra-Aortic Balloon Pump. Kathleen Nugent, RN, from Datascope, was the person who taught the class. It was extremely good; she clearly knows her business, and she is passionate about IABP therapy and its effectiveness. I learned some really important things, one of which is that the theory of the IABP is really simple. Basically, it inflates at Systole and deflates at Diastole, and in doing so it positively affects coronary perfusion and reduces afterload, which is what someone who as an IABP in place needs. It's not hard to set up, and it's not hard to operate. The balloon itself is placed either surgically or percutaneously in a Cath Lab setting. There is potential for complications, like anything else, especially balloon failure or infection, but those seem to be the most prevalent things that could go wrong. All in all, it was one of the best classes of the course.

We took the exam this morning. One hundred and ten questions (apparently the range of questions is anywhere from 110 to 130). I was amazed at how specific the questions were; not like the National Registry exam. And nothing terribly tricky, either, also a pleasant surprise. I scored an 88%, which I was pleased with; I scored an 87 on the National Registry exam.

So, as I said, I am now a CCEMT-P. And from here, the real learning begins....


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6 comments:

NH Mind said...

Congrats on your CCEMT-P cert. When I have the "big one", MI, CVA, traumatic amputation via chain saw or whatever, I hope you'll be on duty. :-) Safe travels home.

manchmedic said...

Thank you! I got home, all said and done, at about 3:00 this morning. Unpacking sucks.....

Heather said...
This comment has been removed by the author.
manchmedic said...

And Happy Belated Birthday, my dear maritime friend..... :-)

Anonymous said...

Well congratulations. I had no doubt you would pass it all with flying colors. Your buddy John sent me an e-mail asking for your address..you might want to shoot him a note.. magno_docu@yahoo.com
Glad you are home safe and happy. Jay

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