I have now been in position as ED paramedic for 4 months, 2 left to go.
My skill set is still rising and the role getting more defined.
Again the days are quite different depending on which consultant is on, but essentially I am selecting my own patients fro majors and minors. In minors I am trying to see patients that the nurse practitioners can't see, such as head injuries, collapses and more time consuming complexes jobs. This is because I review all my patients with a consultant and I am keen to.see as wide a variety of patients as possible.
In majors I feel the junior docs have the edge with more complex medical patients and I dong really pick up the eg. Collapses with loads of co morbidities. However I feel I can get through the traumas and eg cardiac patients quickly and efficiently.
I was told when I started it is a lot of pattern recognition. Definitely true! For example a chest pain requires immediate stabilisation and pain relief, clinical assessment, history taking, ECG, referral (generally) bloods, chest xray, review with consultant and clinical coding before they are taken up to the ward.
I have also been given my own patients in resus. Really satisfying. Slightly terrifying although it is something we do every day on the ambulances. Just slightly different In terms of taking and interpreting blood gases, bloods, xrays, urinalysis and clinical symptoms. Some of the people you refer to can also be a bit funny about taking a referal from a paramedic but that is entirely understandable due to the new role.
The lead consultant and I have started making plans to write up the role in the form of a clinical paper. Probably a reflection and we are also beginning to talk about a replacement.
Performed a femoral nerve block last week and decompressed a chest aspirating nearly 3 l of air the week before.
It's a good role.
Tuesday 7 June 2011
Thursday 21 April 2011
Bank holiday Friday. Technically I should be in work in 30 mins but I have been asked to work a late tomorrow to help with the anticipated large numbers of patients.
It's been a really productive week. I have been working with some great people and realised that more often than not the way your day goes is closely linked to who you have worked with. That said, I did have a bit of a dissapointing day last week. I was working with someone I had not worked with much before and asked them to review one of my patients with an injured foot. Fortunately I did nothing that was dangerous or was likely to affect patient outcome but I didn't really present my case as well as would have liked and felt like a bit of an idiot. He assured me it was no big deal but I am aware of the importance of reputation and credibility and feel I have a bit of a way to go to make it up. Annoying having worked so hard to create a good impression.
Rest of the week was really good. I have had much more of a free reign and people have been putting their trust in me to select my own patients from minors, majors and resus, assessing, managing and treating their conditions. I have selected trauma cases, SOBs, chest pains etc but am still erring slightly away from the elderly complex medical patients. I am happy with initiating emergency treatment but complex pathologies and co-morbidities mean that a more medical view point is required. Whilst I am keen to push my self and step outside my comfort zone (where real learning takes place) I think it is important not to step too deep onto the turf of the more medically minded doctors, especially when I am trying to gain their confidence and carve out a role that others can follow.
It's been a really productive week. I have been working with some great people and realised that more often than not the way your day goes is closely linked to who you have worked with. That said, I did have a bit of a dissapointing day last week. I was working with someone I had not worked with much before and asked them to review one of my patients with an injured foot. Fortunately I did nothing that was dangerous or was likely to affect patient outcome but I didn't really present my case as well as would have liked and felt like a bit of an idiot. He assured me it was no big deal but I am aware of the importance of reputation and credibility and feel I have a bit of a way to go to make it up. Annoying having worked so hard to create a good impression.
Rest of the week was really good. I have had much more of a free reign and people have been putting their trust in me to select my own patients from minors, majors and resus, assessing, managing and treating their conditions. I have selected trauma cases, SOBs, chest pains etc but am still erring slightly away from the elderly complex medical patients. I am happy with initiating emergency treatment but complex pathologies and co-morbidities mean that a more medical view point is required. Whilst I am keen to push my self and step outside my comfort zone (where real learning takes place) I think it is important not to step too deep onto the turf of the more medically minded doctors, especially when I am trying to gain their confidence and carve out a role that others can follow.
Saturday 9 April 2011
Morning all, (again apologies for grammar/ spelling, blame minute iPhone keypad)
I seem to say it every week, but that was another busy one! Lots of learning this week. One of the consultants spent quite a bit of time going through epistaxis management. Not just nose packing , but using ENT techniques to evacuate anterior chamber, isolate bleed, cauterise and repack if necessary.
I have also relocated a couple more anterior shoulder dislocations under N2O, propofol or midazolam ( depending on condition and consultant) which is extremely satisfying. One young fit lad came in with a painful shoulder, I assessed it, x rayed it, identified an anterior dislocation, went into resus and relocated it under guidance and discharged patient with a follow up clinic appointment. I later saw the same lad down the pub, carrying his shopping in his injured arm, nursing a pint with the other. He cheerfully thanked me and informed me not to worry, his sling was in the bag!
Friday was entertaining as I attended the ED plastering and minor treatments study day. We spent the day learning how to apply volar, below knee, scaphoid and full leg backslabs, as well as brushing up our skills in thumb spica application, future splints, ankle strapping and other techniques. Really useful skills for the road and expeditions as well as ED! A good day, lots more learnt.
Combined with the weekly consultant led junior doctors teaching sessions, daily lunch time 'teaching bites' and optional middle grade training sessions the formal learning opportunities are endless and are definitely things we could do more of in the ambulance service! It really does create a learning culture that I feel we sometimes lack. This culture really motivates people to search out new techniques and develop best practice hence making the job much more rewarding for the clinician to say nothing of the benefits for the patients. OK, soap box moment over.
In short, many skills learnt this week.
Thoughts of the day;
1. Ongoing work based teaching/education is a very good idea for many reasons
2. Continuously self critiquing own practice makes for a better, more confident and contented clinician
3. Simple practical skills can keep people out of hospital
I seem to say it every week, but that was another busy one! Lots of learning this week. One of the consultants spent quite a bit of time going through epistaxis management. Not just nose packing , but using ENT techniques to evacuate anterior chamber, isolate bleed, cauterise and repack if necessary.
I have also relocated a couple more anterior shoulder dislocations under N2O, propofol or midazolam ( depending on condition and consultant) which is extremely satisfying. One young fit lad came in with a painful shoulder, I assessed it, x rayed it, identified an anterior dislocation, went into resus and relocated it under guidance and discharged patient with a follow up clinic appointment. I later saw the same lad down the pub, carrying his shopping in his injured arm, nursing a pint with the other. He cheerfully thanked me and informed me not to worry, his sling was in the bag!
Friday was entertaining as I attended the ED plastering and minor treatments study day. We spent the day learning how to apply volar, below knee, scaphoid and full leg backslabs, as well as brushing up our skills in thumb spica application, future splints, ankle strapping and other techniques. Really useful skills for the road and expeditions as well as ED! A good day, lots more learnt.
Combined with the weekly consultant led junior doctors teaching sessions, daily lunch time 'teaching bites' and optional middle grade training sessions the formal learning opportunities are endless and are definitely things we could do more of in the ambulance service! It really does create a learning culture that I feel we sometimes lack. This culture really motivates people to search out new techniques and develop best practice hence making the job much more rewarding for the clinician to say nothing of the benefits for the patients. OK, soap box moment over.
In short, many skills learnt this week.
Thoughts of the day;
1. Ongoing work based teaching/education is a very good idea for many reasons
2. Continuously self critiquing own practice makes for a better, more confident and contented clinician
3. Simple practical skills can keep people out of hospital
Wednesday 30 March 2011
Sunday 27 March 2011
Good, pretty full on day yesterday.
Started the morning in Minors picking up some seemingly straight forward complaints that had interesting twists. Needless to say I learnt quite alot about autism and Christmas disease (haemophilia b). The afternoon slot was pretty epic in Majors and resus. I managed to select a patient with an array of differential diagnoses that finally was diagnosed as pneumonia, after an initial presentation of central chest and abdo pain. Required a thorough assessment as well as bloods, cultures, chest X-rays, urinalysis, ECG and aggressive pain management. Great consultant support too.
Then went on to manipulate an open ankle fracture dislocation as the boss administered ketomone. Was pretty chugged as they really had to look hard for the fracture on X-ray as the relocation was so successful. Boosted my confidence after the shift the day before endedwith a simple head lac that turned out to be a 15 cm full thickness scalp lac with arterial bleeding! Again good support from some of the senior docs. Learnt an excellent way to make a head pressure dressing with bandages!
Lessons:
Ask for help early if things look bigger than expected
Give antibiotics in first 2 hours if they are required
Started the morning in Minors picking up some seemingly straight forward complaints that had interesting twists. Needless to say I learnt quite alot about autism and Christmas disease (haemophilia b). The afternoon slot was pretty epic in Majors and resus. I managed to select a patient with an array of differential diagnoses that finally was diagnosed as pneumonia, after an initial presentation of central chest and abdo pain. Required a thorough assessment as well as bloods, cultures, chest X-rays, urinalysis, ECG and aggressive pain management. Great consultant support too.
Then went on to manipulate an open ankle fracture dislocation as the boss administered ketomone. Was pretty chugged as they really had to look hard for the fracture on X-ray as the relocation was so successful. Boosted my confidence after the shift the day before endedwith a simple head lac that turned out to be a 15 cm full thickness scalp lac with arterial bleeding! Again good support from some of the senior docs. Learnt an excellent way to make a head pressure dressing with bandages!
Lessons:
Ask for help early if things look bigger than expected
Give antibiotics in first 2 hours if they are required
Thursday 24 March 2011
Just finished a fantastic Patient Management in Hostile Environments course at the Shelterbox International Academy on the Lizard Penninsula, Cornwall, with students from the Rescue and Emergency Management FdSc course at Cirnwall College. Final scenario included 2 real downed helicopters and 5 serious trauma patients on an operational airbase at 2300!
Back to the day job today! Another excellent and varied day managing patients with serious facial trauma, cauda equina syndrome, spinal damage and the usual array of limb injuries. Without wanting to sound corny, every job is a learning experience. Trying to look up each condition as, or after, I deal with it.
Lesson of the day:
Don't be complacent! An old lesson that needs re emphasising every so often!
Back to the day job today! Another excellent and varied day managing patients with serious facial trauma, cauda equina syndrome, spinal damage and the usual array of limb injuries. Without wanting to sound corny, every job is a learning experience. Trying to look up each condition as, or after, I deal with it.
Lesson of the day:
Don't be complacent! An old lesson that needs re emphasising every so often!
Saturday 19 March 2011
4 th week completed and to be honest I'm pretty knackered!
It's been pretty full on and the learning curve is still going up. I am now selecting patients from mainly minors, but also majors lists at my discretion and seeing them through to discharge or referal. I have done lots of wound closure and limb assessments but also enjoying the challenges of managing majors patients. A lot more time consuming than I had anticipated.
All patients are reviewed by consultants even if they don't see the patient ( which is happening more regularly). You really couldn't pay for the learning opportunity. I also am beginning to feel like I am actually contributing to the dept (even though I had a breach today :(. There are still some nurses and docs who I think are a bit resistant to the idea of paras/ ECPs working in ED but overall the support has been fantastic!
Learning points:
1. Anatomy
2. Anatomy
3. Anatomy
4. Biochemistry
It's been pretty full on and the learning curve is still going up. I am now selecting patients from mainly minors, but also majors lists at my discretion and seeing them through to discharge or referal. I have done lots of wound closure and limb assessments but also enjoying the challenges of managing majors patients. A lot more time consuming than I had anticipated.
All patients are reviewed by consultants even if they don't see the patient ( which is happening more regularly). You really couldn't pay for the learning opportunity. I also am beginning to feel like I am actually contributing to the dept (even though I had a breach today :(. There are still some nurses and docs who I think are a bit resistant to the idea of paras/ ECPs working in ED but overall the support has been fantastic!
Learning points:
1. Anatomy
2. Anatomy
3. Anatomy
4. Biochemistry
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