First halloween shift. It's a night shift too.
I'm a college premed student so I know the absolute insanity of college life. Our station is near a high school and a nightclub.
I'm fully prepared that I probably won't get a lick of sleep all night, which is fine since I don't really have exams near halloween.
What calls should I ready myself for?
I'm 20M if it's relevant but otherwise, yesterday during a 911 shift, I bought 4 5 hour energies. One for the shift and 3 because I'm a premed college student and need energy to remember the 10 fucking steps of glycolysis and their enzymes. Yeesh.
Yesterday I threw it back like a shot glass and pretty quickly, it felt like someone started an IV on me and pushed propofol through the line. Super quick sleepy feeling, but I chalked it up to getting 6 hours instead of 8. This last night I got 8, did the same thing and threw the bottle back like a shot, and now I am literally fighting to stay awake to write this post.
My heart rate is high, interestingly enough, but I feel sleepy.
Does this happen to anyone else?
we're both 20 year old premed people and she's honestly doing her best to give me some advice lmao
i told her about the fiasco of my partner losing his shit when i could not park with a one inch clearance in reverse, and she said the following:
"baby, that sounds very hard and i'm very upset for you and that isn't okay for him to say that to you especially since it's literally your second day. but, i have a little advice for you. you should work on growing thicker skin. not only in medicine but in life. people will be assholes and i don't want you to be hurting everytime some unhinged asshole hits you with an insult. learn to understand that some people are assholes by nature and you and your formal teachers are the best assessor of if you get something or not. and if you don't, that's okay, you can always learn. just take a deep breath and try to learn."
she's not an emt (an MA) so i have no idea what to think here. thoughts?
I'm just a 3rd year undergrad premed so I'll admit I don't know shit bedsides all the EMT stuff and some ALS stuff I need to know to work effectively on a 911 municipal paramedic unit. I was reading some of the literature since I'm really, really interested in emergency medicine. I love learning about it. It's all to help the next scared and vulnerable person on the stretcher I get, either as an EMT or a doctor.
Per my knowledge, ketamine is a catecholamine reuptake inhibitor due to NMDA antagonism. This means it can mimic the effects of a beta agonist since it increases the concentration of those chemicals (aka sympathomimicity per my research). This can be helpful in asthma or anaphylaxis due to its bronchodilatory properties.
I read in a paper that in trauma scenarios, ketamine is still preferred. Maybe a dumb question, but wouldn't that increase blood loss since you're pumping more blood out of a traumatic injury?
Obviously the clinical priorities remain the same (control the bleed if it's profuse, ABCs). I know it's preferred since it provides significant analgesia (and traumatic injuries aren't exactly painless). Why wouldn't something like etomidate that keeps the patient at a similar hemodynamic status be preferred? Is it because it's a shitty analgesic that doesn't do much to blunt the pain?
My reasoning is that they're already high in terms of catecholamines (they just had trauma) so a simple reuptake inhibitor wouldn't do anything particularly significant to compromise their hemodynamic status. I could be wrong though. Or because they've already lost a lot of catecholamines (hence why they're shocky as fuck)
Freshman year me would be terrified for the chem exam I have coming up since I'm premed. Junior year me (right now) would be terrified for the day I'm working IFT since that just means yelling. Biochem exams no longer phase me since I'm no longer getting yelled at while I'm taking it. A calm place to use my brain effectively.
I have a 911 service that pays me for all the training I did at the end of training (the person in charge says it's now just a matter of checkboxes and driving since my clinical skills have gotten really, really good). If I resign right now (won't, I love it here) I get the money I worked for. WHEN I finish, I get the money I worked for. He said "listen man, I know you know you know how to be a medical person. You're gonna be an ER doctor someday for christ's sake. You just aughta learn how to do driving and learn the equipment here" at the beginning of my training.
I guess that panned out pretty well since when the 3 of us are in the box together stabilizing before transport, one of the other people is taking notes, another is doing ALS skills while I'm setting up BGL, spiking bags, EKGs, vitals, O2, nebulizers, etc.), mostly without being asked (I anticipate the need and confirm with the medic). I'm an EMT-B.
Yesterday at my IFT service (need hours for premed and PRN 911 EMT doesn't give me a lot), my medic wanted me to back out the box where we have 1 inch clearance (our garage). I kept parking slant and he kept yelling at me for getting out and looking, saying "I'd rather you not get out and look while we have a critical patient, because I'm just gonna unload them and leave you to figure it out."
The other guy (on caller who just came in to say hi) said "he yells alot, you have to just nod and say ok. you're a smart kiddo. don't let no one steal your thunder. you'll make a great ER doctor."
I feel my confidence shatter a little whenever I hear him yell for parking at a slant or getting out and checking.
He banished me to the back to do patient care (yay, I actually like this part better so silver lining I guess? I just want to be competent man)
Thoughts?
Sure, you're saturating the remaining blood cells with oxygen, but you're also increasing how much the red blood cells hold onto the oxygen because of the Oxy-Hb dissociation curve. Maybe I'm dramatizing the effect of this but I'm still curious. Sorry if this is a stupid question.
I might literally buy other job shirts, nonuniform, just to wear day-day. I love the feeling that feels like you're being hugged. Mhh.
Holy shit, I slept like a baby istg. I almost missed one call but my paramedic partner woke me up. I had a good night's rest otherwise :)
The blanket was off the bed, shocker. I also confirmed that I don't snore, because the medic was like "lowkey I was confused if you were asleep or awake, since you didn't snore at all"
We got a 0300 call, but my brain was mangled as fuck and I looked like such a moron trying to get the nasal cannula out. It's okay, I handled the other two calls really well apparently. My medic (after I begged him to assign me a grade for the day) assigned my performance a grade of A/B+.
I really hate sunday mornings. Next day is school.
I had an EMS shift today and all the dryers were taken by some jackasses that left it in but never took it out. I ended up having to yank someone's clothes out because it was either that or go to a 911 EMS shift (not collegiate, municipal, so quite a bit stricter) with no uniform. It's just tactical pants and a T shirt, but I don't want to eat with pathogens (my immune system is as delicate as a flower, so I like to wash it before).
I heard someone else saying "someone pulled your clothes out" and they said "what the fuck, what an asshole. they couldn't wait? it was only 15 minutes" sorry, but 15 minutes would have made me quite late!
My first night shift (EMT) is tomorrow. I'm going to an event with some of my college friends tmr as well (you're only 20 years old once in your life!)
It runs 10p to 10a. My scheduler told me to bring a blanket and a pillow.
I don't snore, at least I don't think I do (I've had a tonsillectomy, and I've fallen asleep on my dorm couch before and my friends say I'm a really peaceful/quiet sleeper.
Only issue - I kick/squirm in my sleep. A lot. I can't count the number of times I woke up and my drawsheet is almost fully ripped off the bed. At home and at my dorm, both queen sized beds.
Other issue, I sleep pretty deep. My fear is sleeping through the station tones here. I'm premed so I need the hours (especially the 911 hours, god knows how I got so lucky here) so getting booted due to missing tones would be pretty bad.
Anything I can do so I don't piss off the other EMTs/medics or sleep through the tones?
I'm 20 and really interested in emergency medicine. Like genuinely love doing stuff in the field, researching it, all of it. My partners so far have been really jaded. I'm premed and an EMT for a municipal 911 service.
I know time may take away the glimmer in my eyes as well, but right now I really love emergency medicine, EMS, and whatnot and caring for people that couldn't have seen that the day would have been a really bad one or even if a new mom just needs reassurance that her baby's 98.9 temperature probably won't kill him.
My coworkers (911 ambulance and ER) are all like "ugh another shift" while I was jumping up and down when my shift request was approved for the next day (ER tech).
I (20m) usually do days. I'm premed and my shift runs from 10-10, so I'm planning on knocking out some biochemistry studying, taking my pillow and blanket, and going to bed. We're moderate volume (4 calls during my shift yesterday).
I don't snore (fell asleep in dorm's common area and some guy literally poked me since he thought snoring was the norm lol, he said "i thought you died bro").
I usually wake up to alarms (fire alarm went off in my dorm and when it went off at half past midnight, initially my brain woke up and was processing what the hell was going on, but when it finally hit me, I grabbed my shoes and ran).
Any tips to survive the night? /j (but still, I'd like tips).
Yesterday, during an hour where we had no calls, my medic and I for our 911 service (municipal/service area, not collegiate EMS) sat down in the back of the truck and talked about life (I'm an EMT and he's a medic)
Then he said one thing:
"I have no doubt you're really good at the medical stuff. On the three calls we went on this morning, you did pretty well. I mean, you told me you wanna be an ER doctor for crying out loud. Whatever I don't teach you, there's a solid chance you learned it from school. Several new EMTs have to be cued in saying "this is an AMS call.. what two labs do we always get on AMS.." You didn't. The only thing I want you to work on is the rescue part of EMS. You didn't know what a clutch was in rescue. Otherwise you'll be great with medical stuff."
How do I learn the rescue stuff 🥹
There was one very arrogant CCMA I had when I was getting bloodwork. I could tell she was a little green and very young, so I let her pin-cushion me a little bit for practice. No harm, I'm 20 years old myself and premed. Also young. I'm also an EMT and probably don't understand how hard medical assisting can be. I let my students in the ER do it all the time. It's one of the only ways to get better - practice.
She ended up sticking me 12 times before I said "hey - I'm an EMT in the ER and start IVs all the time for emergent patients dealing with dehydration and stuff and I think I'd pick this vein. it's bouncy, big enough to take a 14 gauge no problem."
Then she said "y'all the ER and only see the patient for 2 mins and send them away, y'all just some glorified send-awayers. i was in the ICU in college. that's why we have beds and y'all have stretchers"
I'm sorry, what the fuck? Okay. Just pick the vein I suggested or one you can actually see because it's starting to get painful.
After attempt 20, she picked the vein I suggested and finally got blood.
Yesterday, since I was an EMT-B, I was stationed front desk (since we can recognize when someone needs to go back ASAP). Other days I can do cool shit like start IVs, vitals, and splint if there's another EMT-B.
A patient comes in saying that, verbatim:
"my asshole is sore and my dick feels like it got rug burned"
I successfully held it back, but later, my partner and I burst out laughing after he was roomed. It wasn't the chief complaint that was funny, it genuinely must have been uncomfortable for the patient. It was the way he said it that made me giggle.
I was a seventh-year high school student in the auto shop, and the mechanic was like Robert go ahead and hammer the bumper into place. When I held that hammer in my hand, it did something to me. I knew then I wanted to be an ortho bro. Now every time I hold a hammer in my hands before I make the first incision, that first cut on a patient, I get an erection. My 208th bone stands up. Does anyone else get that feeling as an ortho bro? Lol, or am I a sick bastard?
There are certain.. specialties that y'all gravitate towards. I had orientation with a massive medical network a bit ago. I was one of like 5 out of the 50 in the room that picked the ER or Urgent Care (2 ER one being me, 3 being Urgent Care). Most picked plastics, derm, or a surgical subspecialty. Or anything else.
Several and I mean SEVERAL of them were premed as well. A lot of them actually told me when we were told to get to know everyone else.
Initially this scared me, especially since I was literally restless when I was a CCMA in the medical ICU. My coworkers literally said "calm down. please. i can't stand to see you take another lap around the unit or whine about wanting to do stuff."
I got my EMT since it interested me. I'm premed, so I needed the hours anyway.
I say this with my heart:
**I LOVED THE ER. I LOVE THE ER.**
I love seeing a chest pain pt and being tasked with being as outwardly chill as possible while getting an IV and getting labs for a CBC, CMP, D-dimer, BNP, and trop and a 12 lead EKG. I love giving nitroglycerin and seeing them immediately feel better. I love reassuring a terrified new mom that comes in with a screaming baby that a 99 temp is fine. I love teaching my students. I love watching netflix documentaries with my coworkers when our ER is quiet and empty. The muddling of scopes is a decent touch in shortstaffed ERs. I love being a voice of calm when everything seems to be falling apart for the patient.
I was more curious as to why everyone flocks to these. Maybe it's a sampling bias. Maybe not. Idk. These specialties are fine, I'm honestly just curious.
There are certain.. specialties that y'all gravitate towards. I had orientation with a massive medical network a bit ago. I was one of like 5 out of the 50 in the room that picked the ER. Most picked plastics, derm, or a surgical subspecialty. Or anything else.
Initially this scared me, especially since I was literally restless when I was a CCMA in the medical ICU. My coworkers literally said "calm down. please. i can't stand to see you take another lap around the unit or whine about wanting to do stuff."
I got my EMT since it interested me. I'm premed, so I needed the hours anyway.
I say this with my heart:
I LOVED THE ER. I LOVE THE ER.
I love seeing a chest pain pt and being tasked with being as outwardly chill as possible while getting an IV and getting labs for a CBC, CMP, D-dimer, BNP, and trop and a 12 lead EKG. I love giving nitroglycerin and seeing them immediately feel better. I love reassuring a terrified new mom that comes in with a screaming baby that a 99 temp is fine. I love teaching my students. I love watching netflix documentaries with my coworkers when our ER is quiet and empty. I love being a voice of calm when everything seems to be falling apart for the patient.
I love the ER.
I was starting an IV. TQ on and everything. Flushed fine, patient tolerated the flush and I didn't see the skin rising. then a few minutes later on a saline drip, she complained of pain. we removed it and it seemed fine. then all of us tried and couldn't get it. luckily it wasn't that i fucking suck at IVs at least, she was a deceptively easy (but actually hard) stick lol
Not to disparage front desk, they do very important things. It's just not for me.
My brain needs challenge. The hard stick. The challenging case. The awkward splint. Anything that requires you to put forth cognitive effort. I always try to go clinical, but I'm not allowed to since there's either someone else there or a higher ranking staff member (LVN or medic, I'm a basic).
Even running labs is fine.
I feel physically unwell doing repetitive shit. I used to do triage, labs, and other clinical. After a transition, triage was off the books, and was replaced by front desk for techs. Usually the lowest ranking person is here, and that's mostly the basic.
How do I avoid the sickening feeling of doing nothing while things are happening around you?