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Rites of Passage

Ask any prospective paramedic student what they worry about trying to learn and you will likely get an answer that contains at least one of these words: Cardiology or Pharmacology. For some students – myself included the answer contained them both. Adding to my level of anxiety is the fact that the program I am attending is all but legendary locally for its program – and more legendary then the program is the exam – 200 questions – 100 multiple choice and 100 short answer questions relating to 14 different rhythm strips, with roughly a four hour time limit – Highest score ever on the test was a 98.

Interesting to me was the number of practicing medics sitting in the back of the room to “refresh” their knowledge base. The program allows it’s employees to sit in on Paramedic School lectures for CE’s – typical classes have one or two medics back there – Pharmacology had 5 or 6 – Cardiology had 15 – 20 easily EVERY NIGHT for the entire section.

We were told to purchase calipers – as there was no way we could pass the exam without them… Granted most medics don’t even carry them let alone use them in the field – but they wanted to be sure we knew how to break a strip – even the most complicated strip down.

The exam lived up to its reputation – it was EASILY the most difficult test I have ever taken – memorization wouldn’t have helped – the exam required a genuine understanding – after we took the test they told us that as far as they were concerned anyone who got a 70 on that exam was an expert in the field of pre-hospital ECG interpretation – I got a 92 – but I certainly don’t FEEL like an expert…

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If only it was this easy

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Cardiology started with the warning that the instructors goal for us was if someone ever asked us where we learned cardiology we didn’t embarrass them when we gave their names. Both of the instructors are captains at the division I want to work at and one of them is instrumental in the hiring process – cause you know the standard student anxiety over cardiology wasn’t enough for me – I had to ramp it up a little.

I have heard many times so far during school we don’t use a certain book for this because a good one doesn’t exist to teach you what we want you to learn (More experienced providers that write – take notice) Cardiology was an exception – they did have a book for that – but it’s interesting the one they choose.

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Practical Guide to ECG Interpretation By: Ken Grauer MD FAAFP

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Available from Amazon here if you are interested.

What makes Dr. Grauer’s book so interesting is that it is out of print – The program actually contacted Dr Grauer (he includes his contact information in the book in case you want to contact him about the book or cardiology in general – wow) to ask his permission to copy the book for their students – all 500 pages of it.

The process they taught us for breaking down a strip was methodical but lengthy – in fact it takes me 10 to 15 minutes to go through each step and wrote the findings out –

  • Rate
  • Rhythm
    • P- Are p waves present in lead II
    • Q – is the QRS wide or narrow – (if wide examine for BBB)
    • R- Regular or irregular
    • S – Single or married – are the wave complexes married to each other or separate
  • Intervals
    • PRI
    • QRS
    • QT
  • Axis (fasicular blocks?)
  • Hypertrophy
    • Right or Left atrial abnormality
    • Left Ventricular Hypertrophy
    • Pulmonary Disease pattern
  • Infarction – any signs of infarction, strain or ischemia?
    • Q – are Q waves present in any lead? are they pathological? are they expected in that lead?
    • R – Is the R wave progression normal? where is the zone of transition?
    • S – ST segment changes – Elevation, depression, strain pattern?  Are the changes related to a vessel or global? What area of the heart is affected?
    • T – Are there T wave changes? what do they indicate?

The answers to all of these questions only give you HALF of the information you need to interpret the strip – This just gives you the descriptive analysis of the strip – you have to take the patients presentation and past medical history into account or the “clinical impression” as the book calls it.

Dr. Grauer also says that to get the most accurate information possible from a strip you should try to have a prior strip available for comparison – and our instructors took that one step further – if you can actually get a prior strip (unlikely in our setting – but stranger things have happened) was it the patients strip on admission or on discharge ?

My head has been spinning with all the information contained in this module – Brugada’s Syndrome, Ashman’s Phenomenon, WPW (Type A & B),  Default Vs. Usurping rhythms, differentiating between V-Tach and SVT with aberrant conduction, Fib-Flutter, the potential causes of a tall R wave in V1, the causes of QT prolongation…To the point where I have to run through the steps I listed above mentally or I end up staring at the strip with a blank look on my face.

The most reassuring message came after the exam – you don’t have to be an expert at this stuff now – nor do you have to be an expert during your rides… or even during your Field Internship when you get a job as a Medic… You DO have to be an expert when you are cleared to independent duty and are making the interpretation “solo” – That’s a relief I have probably another year of practice then.

Our instructors recommended several books and a few blogs to take our studies further – I’ll share them here in case some of you may be interested

Practical Electrocardiogr aphy by Henry J. L. Marriott (Hardcover) - Called the bible of ECG by our instructors

Pathophysiology of Heart Disease 4th (Fourth) Edition by Lilly (Paperback)

Pure Practice For 12-Lead ECGs: A Practice Workbook by Robin Purdie RN MS (Paperback)

 

The blogs they recommend – Dr. Grauer’s Blog , www.ecgpedia.org , www.ems12lead.com , Dr. Smith’s ECG Blog

Be good – get good – or give up

 

Posted by on February 15, 2012 in Cardiology, EMS, Paramedic School

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Endings, Beginnings and the Quest for the Disco Patch

So in less than 24 hours The Quest for the Disco Patch begins… First things first for my non EMS friends who read this blog as well as my unenlightened brethren who are sitting with a puzzled look wondering what the hell a disco patch is and why in the world would anyone want to start a quest for one… This is the disco patch

And if the old saying is true that a picture is worth a thousand words, there is no need for me to explain why it is sometimes called the disco patch. (It would be more true if you could tell that the gold thread is all glittery)

I knew as I got closer and closer to the actual start day of school my anxiety level would begin to ratchet up (and I was right 😉 ) So I decided to work as much as I could the last few days before school started… this resulted in me working 78 of 96 consecutive hours – I know it sounds crazy but it served a two-fold purpose, first it is good training for the demands and lack of sleep the upcoming year is certain to be filled with and it kept my mind from running through the imaginary scenario of the first night of class over and over again. (How I’m going to feel about an average of 2.5 hours a night of sleep over the past 4 days by the end of this weeks classes remains to be seen)

SO now you are wondering why my anxiety level was ratcheting itself up so much right… (maybe when I’m too old for EMS I’ll go into mind reading) Every single person I have ever talked to has described p-school with same word “hell” – the length of time has varied, the adjectives before hell have changed (some wholly inappropriate for our little discussion here) but the word hell has been in every description I have heard. I didn’t choose any p-school either I chose one that was competitive to get into and is renowned for its difficulty. The medics that work for the service that runs the program are the US Marines of EMS providers locally. SO in my estimation that at least doubles the challenge level of school.

I am a planner, I like to take a list of obstacles and plan for how I’m going through, over or around each of them to get to the destination, while I have a general idea of the obstacles (cardiology, pharmacology, pathophysiology and scene management) I have no idea at this point in what order or how long of a time frame I have to master them. For me that is VERY unsettling. Throw that onto the above mentioned stuff and maybe you will glean a shred of understanding into the ratcheting stress level.

Some good did come out of it though, I had a very interesting discussion with one of the firefighter medics in the station I worked in this weekend. She pointed out what in her opinion were some of the “weaknesses” an EMT who works in a system like mine are likely to have going into to P-school and strategies to overcome said weaknesses. This was all helpful information, the particular department my service is quartered with are among the best fire medics I have ever worked with so her advice was both appreciated and respected.

A friend pointed out to me as well today “You do realize that today is the last day you will ever be “JUST” a basic (emphasis hers not mine)” While that thought hadn’t actually crossed my mind I suppose they were right, starting tomorrow “I am Paramedic student” not that that isn’t still “just” a basic, but they were right somehow it is different (in my mind at least)

The text is sitting on the desk – the first 4 assigned chapters (due the first night of class) have been read (for those interested below is our main text and work book)

Let the quest for the Disco Patch begin…

 

Posted by on September 18, 2011 in Anxiety, EMS, Paramedic School, Personal

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Dry spell

It started with working 64 out of 72 hours, and in one of the funny EMS twists it was for all intents and purposes a stand up 64. After some MUCH needed sleep, I sat down here and stared at the cursor’s impatient blink in the vast white space I am typing in now. Funny how our perception of things can change, at that moment the screen was this huge empty vacuum that demanded I put something into it. The screen was way too bright, way too needy, and the blog was crying out for sustenance, just a morsel of a thought was all it wanted. To my mind though it was starving, it needed a meal and simply put my mental cupboard was bare.

A few days passed, each one of them whispered into my ear – hey dude that blog thing you started… how bout pecking out some words… I heard the whisper, but something inside chose to ignore it. At those moments while it nagged persistently in my ear, a root canal seemed more enjoyable than the prospect of logging on here and finding something to talk about with some semblance of intelligence.

It wasn’t until today that it dawned on me, that I have been subconsciously taking a character inventory, as well as a performing a mental remodel of sorts.  It sounds like something I would have been rather conscious of, but the truth is it was rather insidious, dwelling just below the consciousness of my psyche.

It wasn’t until today when I read Kelly Grayson’s blog post containing a letter for EMT students on their first day of class that it dawned on me what was happening just below my parietal bones. You can read Kelly’s letter here

In all honesty by the time I reached the end of the letter I was choked up, not quite crying, but as close as I can remember being to tears in a long time. For the record – I am a 41-year-old former Marine and anyone who knows me will tell you I am not the crying king of guy. Why then did Kelly’s letter move me in such a profound way? I spent the day trying to answer that very question after a few hours the fog in my head parted and I saw what had been going on.

I had been examining the reasons I wanted to make the leap from basic to medic, trying to find what need inside myself becoming a medic would fill that wasn’t being filled now. I have heard more “horror” stories about the difficulties of completing paramedic school than I can count, how difficult it would be, how little I would sleep in the coming year, how I would never be around anyone but my preceptors, how when I was around I would be grumpy, stressed and exhausted.

Undaunted by all these stories, I submitted my application the very first day that I met the criteria, having now been officially accepted I thought I better make sure I was doing it for all the right reasons. Yes I did perform this mental inventory of sorts before applying, but now that I have a letter in my hand that says I am accepted, somehow it’s different. I suppose it’s my minds way of giving me one last out… nice of it to be so considerate, but totally unnecessary.

While taking that inventory, I have been trying hard to change my attitude from the extremely confident basic (did I mention I was a former Marine… I’m pretty sure the last time I truly lacked confidence when I got off the bus at Parris Island – the instilled enough in me after that to last a couple of lifetimes) to the I know absolutely nothing paramedic student. That has been quite the paradigm shift for me, I spent all this time getting comfortable in my own EMS skin, growing comfortable in my skills, expanding my knowledge etc, and now I was working to “undo” all of that. Yes, I do realize that I’m still going to need to know this stuff when I arrive for p-school, however, I don’t want to be the arrogant ass that the instructors are always trying to show how little they actually know. On top of that, I know me… If i think I know it already, I won’t work as hard to master the concepts as I will going in with the attitude of “I don’t know shit”.

As the icing on my cake, anything that has happened at work over the last week or so that didn’t go absolutely perfectly, anytime I perceived anything on a call could have gone better, I questioned myself – are you sure you are really ready for p-school?

It’s been an interesting awakening and a rather insightful look under my own hood, I am happy to see me again when I look in the mirror and to see words in the vast empty white space in front of the little blinky cursor.

I almost forgot to answer the question I’m sure you are asking… why did Kelly’s letter choke me up… That’s another days post

Til next time…

 

 

 

 

Posted by on August 11, 2011 in Anxiety, Paramedic School, Personal

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T minus 5 days and counting

As many of you already know, I am anxiously awaiting a decision letter regarding acceptance status into paramedic school, I had my interview back on the 6th and was told to expect a decision before the 1st. Though always lingering in the recesses of my mind, thus far it has been fairly easy to stave off any anxiety regarding that decision with the calendar, it’s simply been to far away to dwell on. Then this week started and since Monday I have been checking my e-mail every 5  minutes, not because I really expect an answer yet, instead more because I just can’t help myself.

Every decision I have made with regard to my career has led up to this decision. I have passed all the tests, sat through the interview process and have completed the pre-reqs all with a 4.0 GPA, but now I am in this state of limbo where there is nothing further I can do to positively influence whether or not I am going to be a paramedic student in September or if I will have to wait another year. It plays with my head a little to be involved in such an important decision and have it totally out of my hands.

I made the decision on which school I wanted to attend early in my career here and made no effort to even apply anywhere else, I would rather wait another year then attend another program. Knowing that letter SHOULD arrive at some point this week, has led to a bit of anxiety. While working the box it’s pretty easy to push the thoughts off – there are simply more important things to focus on at that moment, but I just finished a 48 and I have the next 4 days off… I anticipate that the send/receive buttons on both my phone and the computer are in for a workout.

I will announce the decision here when I find out… in the mean time maybe one of you will do the math for me and figure out how many times I will press the get mail button in the next 5 days…

 

Posted by on July 27, 2011 in Anxiety, EMS, Paramedic School, Personal

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