More sharp items today; subcutaneous stick with 0.3 ml 0.9% NaCl via 27 gauge needle, intramuscular stick with 2 ml NaCl through a 23 gauge, blood glucose with a lancet. My blood glucose was highish at 140 mg/dl; I’d been pounding peppermint patties all afternoon. I did a full IV setup on a fellow student today giving him 250 ml of normal saline; in exchange, he gave me the same. I also set up for and drew two tubes of blood from another student. So, now I’m done with my lab sticks though I owe my arm one time to another student; he may get me tomorrow.
Don’t believe what they tell you; an eighteen gauge catheter hurts more than a twenty, though you can put a lot more fluid through it. Size does matter.
I’ve been doing well on the daily quizzes; today’s was especially fun… Given a condition, state the expected symptoms and treatment. The conditions were all big-ticket items; closed head injury, flail chest, congestive heart failure, open pneumothorax, cardiac tamponade, open femur fracture. Understanding the anatomical and physiological processes really helps both with coming up with the list of symptoms as well as the treatments. Treatments at the Intermediate level are similar to the treatments at the basic level with advanced life support add-ins; IV access for fluid replacement and medical administration, a few more meds, better airway management, cardiac monitoring.
Many Intermediate treatments start with oxygen and IV access. Oxygen, of course, helps in any situation with shock; IV access is usually obtained by an ALS practitioner (Intermediate or Paramedic) even if no fluids or meds are to be given immediately since access may be more difficult to gain at the hospital in worsening hypotensive (low blood pressure) situations, also, having an IV in place makes med administration by the Intermediate, an intercepting Paramedic, or the hospital much more straightforward if the patient should ‘crash’. Oxygen is actually a Basic medication and most patients get it; good perfusion is crucial to good patient outcome.
Today was day nine; two more to go. Seven of the days have been eleven hours, one was eight hours, one was seven. We’ve had one day off. Tomorrow is a half day each of classes and labs and will be another eleven hour day; Friday we will have practical testing in the morning and the written in the afternoon.
I ran into a SOLO instructor in town yesterday; he was an instructor on my Basic course in ’02 and at a wilderness refresher I took last year. He is an Intermediate and graduated from ALSI, the school I am attending. He asked how my EMS life was going; I told him I was in Conway at ALSI. He asked me what week I was in (week two), laughed, and asked if I was burned out yet. I’m not sure ‘burned out’ is the right term; I am enjoying what I am doing although, to be honest, I am ready to break up the monotonous schedule of sleep, school, study, sleep. I miss my family, though it’s a good thing they are not here.
Everything is starting to gel; I feel that taking this course will allow me to provide a much better standard of care even before I can apply the Intermediate treatments. Clinicals, the Registry exam, and applying for Vermont reciprocity will take several more months, of course, during which time I must operate as a Basic. I think I will feel less like a blind person groping in the dark, though, especially at medical calls.