12/16/2009

End of the First Semester

Well the semester ends this Friday. I cannot believe how short the time has seemed and how little I feel like I have learned.

My classmates and I have grown quite close in the past few months. We have our inside jokes and we know exactly how to annoy each other to no end, and tend to do so. However we have also learned how to motivate each other and how exactly we all learn.

We wrapped up ACLS today and we still all feel like we do not know enough. Our teacher sensing this pointed out how far we have come. However he made sure we all knew that we have so much still to learn.

In the beginning for chest pain we had pretty much 1 route to follow.
*Aspirin 324mg chewed (as long as they were not allergic).
*Nitroglycerin up to 3 tabs (As long as the patient hadn’t taken any and BP was above 110 systolic. Also no sexually enhancing medications).
*Oxygen 15L by NRB
*3-5 lead EKG. We can see if the rhythm looks strange and potentially send to the hospital for prewarning.
*Gasoline to Hospital.

If they happen to code on the way to the hospital we did what the AED told us to do and we called for more trained help. Performed CPR and used a BVM, OPA, NPA, or Combitube.


Now we know why we do what we do and have more options.
*Aspirin: to make the platelets slippery so the clot does not get worse (be careful of allergies, ulcers, active bleeding. It does it by blocking Thromboxane II.)
*Nitroglycerin: up to 0.12 mg. Vasodilates vessels in the body. Is used in the hope that blood will then be able to squeak past the blockage. (Can be repeated as long as systolic above 90 systolic)
*Oxygen- At whatever level will keep the patients O2 sats WNL and in the hopes of getting more oxygen to the ischemic tissues causing the pain. O2 also vasodialates in high concentrations.
*5-12 lead EKG- We can see abnormal variations in rhythms and the electrical activity in the heart. Using all of its capabilities and our basic knowledge we can now tell roughly where the problem is, and potentially even how bad it is.
*Morphine: We can give morphine to reduce pain. It also reduces preload, afterload, and myocardial oxygen demand.

Now we can treat some of the abnormal rhythms we see in the hopes of preventing codes. We do this with medications, and electricity. However if they do code we can monitor their rhythms and provide appropriate shocks to treat the severely disorganized electrical activity. We also give many medications dependant on what we see. Amiodarone, diltiazem, lidocaine, epinephrine, atropine sulfate and more. We still perform CPR and use BVMs, OPAs, NPAs, and Combitubes. However we can also intubate via the oral- or nasal- pharynx.


Looking at what we have learned I guess we are in a vastly different place then when we stated the class. However we still get stuck sometimes. Some days we do not think enough like Paramedics and we under treat the patients. Some days we think too much like Paramedics and forget a basic intervention that would have been easier, and just as effective as the advanced skills we jumped to.

It is a challenge to remember to start basic and move towards advanced; while still remembering that there are advanced skills for a reason. This is especially challenging with the growing sleep deficit the class is beginning to experience.
40 hours of class a week
+ >10 hours of HW and reading to do a week.
+ 30-40 hours of Clinical time a week.
= >80 hours a week

None of that includes drive times to and from all of these places, sleeping, eating, bathing, laundry, second jobs, or families.

Not that I am complaining I am loving every minute of it. Despite my new caffeine addiction or ability to fall asleep when and where I want.