Life of a Trainee Paramedic

Well, we had a lecture today on pregnancy, and how I am so glad that I am a man, as I think that it cannot really be a nice experience.  We had a midwife in from a local birth centre who had 20 years experience delivering babies.  80% of births go without a hitch, but it was emphasised on the 20% that didnt, which really scared me, not just me, the whole group!

There are so many ways that a baby can ‘come out’ for want of a better description, that problems can occur with them all.  Feet first, arm first, one leg bent the other straight, bum first with the baby completely folded in half.  These are known as breach births. The problem with a lot of these is that with the head being the biggest part, it can get stuck.  If it is a breach birth, the advice is to do nothing, as the mother will still be having contractions that will most likely push the baby out on its own.  We just have to give a helping hand to stretch the arms and legs out. 

The baby isnt the only thing that we have to consider, there’s also the cord, the placenta, and the mother herself.  The baby doesn’t actually have any legal rights until it has been born, so if something is happening to the mother, for example cardiac arrest, then it is the mother that takes precedence.  We have to beware that the cord doesn’t get wrapped round the baby’s neck or that it tears by itself as this could cause both the mother and baby to bleed to death. 

After the baby has been born, the mother will still be having contractions to get the placenta out.  Most of the time it comes out all by itself, yet there are occasions when this doesn’t happen.  As the placenta is really one big ball of blood vessels, the risk of haemorrhage is great.  It can also block the exit of the baby between the cervix and the womb, in this case, a caesarian section is generally performed.

One rare complication is to do with the amniotic fluid.  This is the fluid that the baby is surrounded by, and it really is just made up of urine, merconium (baby poo) and other substances.  If this were to leak into the blood vessels, it could cause an embolism in the lungs, and the mother would die.  Our midwife has only seen this once in her career.  In the UK, the death ratio is around 1/4600 pregnancies which is very high considering what can go wrong.  In Ethiopea, it is 1/7!

There was a lot more besides what I’ve talked about her.  This lecture should be given to teenagers that are thinking about doing something stupid, I can promise you that it would bring the birth rate down.  I would hope so anyway.  The midwife said the worst case she had seen was a girl of just 10 when she got pregnant, and 11 when she had the baby.  That was over 20 years ago, so teenage pregnancies are not just a recent problem.

TP

Well this Essay that I have just received the mark back for has been a complete disaster.  I just scraped through with 40% which is totally rubbish.  I thought that the essay was ok, obviously I was wrong.

The main points were that I had identified the key points, but I hadnt really expanded on them, and that I used to many websites as references when I should try to expand my reading.

Its going to be difficult getting used to how the lecturers want the essays written. When I was at Chester, I got to understand how the lecturers wanted the essays and what they wanted in them.  It seems i’m going to have to learn those lessons all over again.  When I write an essay, I think its ok and I’ve answered the questions fine, it’s when I get the result that I know I didn’t. I’m going to wait to get the text back so that I can see where the red pen has gone and obliterated my work. 

The only good thing is that I don’t have to resit it, but I’ve really let myself down with this.  I would have been gutted to get this at Chester and I’m absolutely gutted about it now.  It’s incredibly demoralising when you see this through the post when i’ve been anticipating it all weekend.  Gives you a good kick up the backside. I DO NOT want a mark like that again.  Time to get my head down, shut up and concentrate.

TP 

Well today was the end of my second week back at Uni, and it actually went quite well.  We had some drug assessments today, taking the form of multiple questions rather than the usual one to one questioning.  We had to learn all the JRCALC info on:

• Adrenaline
• Dextrose 40%
• Glucagon
• Ipratropium
• Salbutamol

If you know anything about these drugs, then you would know that we have recently been learning about Diabetes and Asthma/COPD and there treatment methods.  There was 24 questions in the test, each selected randomly by the computer so we all had different tests.  Originally I got 17/24, which to be honest is pretty crap.  Even though it is 70%, that is not good enough when it comes to patients health.  We were then told that the computer had not worked out our answers correctly and was deducting more marks than was actually necessary. After the lecturer went through each our tests, I ended up with 21/24, which I was very pleased about.

When we had the Aspirin and GTN assessments, we had been talking about these drugs for a week before hand and went through several scenarios with there intended use.  With these drugs, we had not ran through any scenarios so it was a lot harder to remember things.  Today, after we had done our revision and done the test, we went through some scenarios which were more easily able to stick into my head.

Its been a pretty short week, we ended up having thursday off as well due to there being no point in our service lecturer starting off in the middle of something due to the missed wednesday lecture.  It seems we will be catching up with that next week.  I also may be getting my provisional essay mark through the post tomorrow, as one of my colleagues had his today, so fingers crossed!

TP

After a good weekend, I had to finish moving all my stuff over to the new house.  I now have a living room and a kitchen all to myself if necessary.  My room also has an en-suite, as this house used to be an old hotel, so it still has the same layout.

On monday, it was our usual Anatomy and Physiology lecture, but this week it took on a different turn.  Instead of dying by powerpoint, we were split into groups of 4 and there was 4 tables for us to go to.  We were given a generic case study, and for each of these tables there was different things that we had to find out. One table had information on the drugs the patient was taking, while others had info on the conditions that she had.  We then had to try and figure out what was wrong with her, whether is was an exasperation on her condition, something to do with the drugs, or something new. 

Tuesday we had our usual clinical education lesson, but like monday’s, instead of the powerpoints, we were split into 3 groups to go and prepare our own presentations for the group for the subjects that we should have had by powerpoint. In the afternoon, we then had a go at doing BM’s.  This is a test for blood sugars, and is generally what diabetics use.  The other new thing for the day was giving our first IM (Intra-Muscular) injection.  The was done in some plastic buttocks, which were spongy like the real thing (unless your super fit or anorexic).  It was the called the ‘beeping butt’ due to the fact that it would beep if we hit the nerve that runs through your buttocks to your leg.  If in real life, this nerve is hit, then it would be very painful!

Today, we’ve been given an im-promptu day off due to our lecturer being ill.  I thought last night that we were going to be snowed in, but there wasnt exactly a lot.  Its given me a chance to do some work! We have a delightful 3000 word essay to be in for the middle on March, so the sooner I start it, the better!

TP

* An interesting fact I learned yesterday was the fact the the distance between the prime minister and the leader of the opposition is exactly 2 sword lengths apart.  Talk about adversarial politics!

Well, thankfully, I passed my exam, and I’m now qualified for another 2 years.  This will be my last resit exam as I will be qualified at that point, not including any major disasters!

It wasn’t as bad as I was expecting it to be.  I was told to be there for 6pm, but I had a call at 5 saying our trainer-assessor had told him 5 so could I go in.  I was just in the middle of a last minute revision as well so it got me a little stressed.  There was only the two of us retaking our exam so it wasn’t going to take to long.  It usually takes around 2 hours but we were finished in an hour as the examiner wasn’t asking us all the questions that he would ask someone new.  He knew that we would know the simple things like how many whistles are blown in certain situations and asked us only the harder, more important questions.  Just in case anyone doesn’t think I know them, they are:

1 Whistle - Attract bathers attention

2 Whistle - Attract other lifeguards attention

3 Whistle - Emergency - Lifeguard going in

1 Long Whistle - Clear the pool

This helped to make us less nervous, and we were able to progress more quickly.

The other dryside activities included resuscitation techniques of adult, child and baby, both dryside and wetside protocols.  There are a little different to how it is done in the ambulance service.  For wetside, rescue breaths are still given, due to the fact that the casualty would most likely have spent time under water and wasn’t breathing so it is deemed necessary top give them breaths before starting compressions. 

The pool side of the exam involved fetching a heavy manikin off the bottom of the pool, 3.5m deep.  Time swims which involve swimming 20m to the conscious casualty and towing them back in 65seconds, and swimming 20m to the unconscious  casualty and then towing them 10m in 45 seconds.  We had to pass both of these 1st time or we would have failed and would have had to re-do this particular section. We also had to do a ’spinal turn’ which is a special grip and turn under the casualty’s body to keep there spine secure if we suspect an injury.  they then had to be put onto the spinal board securely and transferred to the side.

After that was the end of the exam, and we were done.  I’m off back up to Uni in a few hours, hopefully avoiding all the stupid drivers that I had coming back home on friday. I was driving up a hill with another car about 2 bus lengths in front of me, and there was a side road.  This lady in her sports car was coming out and looked left at the car in front and just started to pull out, without even looking right for the oncoming traffic.  she was half way out before she saw me, and i’m sure you can imagine the thoughts that went through my head.  I kindly gestured to her that she was in the wrong, and mimed through the window, “what the hell do you think you are doing”.  She was a good looking woman as well, and usually I would let them out, but this time I was having none of it.  They shouldn’t presume that there looks will get them everything! 

TP

Friday was quite a chilled day.  It didnt start off that well as the University got the rooms mixed up, due to them not understanding the lecturers email saying “we want room F335″.  As if that wasnt clear enough.  We were then given a tin of Roses to share between us although I wasnt sure whether this was a bribe to keep us sweet (pardon the pun) due to the mix up.

Once we did get into the room, the equipment which we though was in there, wasnt.  More chocolates followed and then we were given a break so the technicians could get the stuff ready.  When we did finally get down to some work, it was all good and interesting stuff.

For the first skill station, we had another go at using the laryngoscope (see previous post).  This time was a little more successful than the last, no teeth clicking this time, although I did find it really hard to get the tube down the ‘trachea’.  I could see it but the tube just would not go down.  Luckily were provided with a little wire that can fit down the tube which can guide it into the trachea, and can then be removed leaving the tube in place.

The second station, we got to practice this on a life size dummy lying on the floor.  this is the most likely position, patients are not generally going to collapse face up on tables.  A comment made by one of our service tutors, was that “you’ll be spending most of your working life on your knees, out onb the job, and in the office!”.  This made me laugh, although I hope I wont be spending to much time in the office!

The next station was the highlight of the day.  We actually got to cannulate some dummy arms and hands.  This was our first time using the needles, so we had the talk about sharps and safety before we were allowed to try it out.  These dummy’s are real-life in the fact that there is tubing running through which carrys a red liquid to mimic blood, so we knew if we had hit a ‘Vein’ or not.  Whe nit came to my turn, I dont think that I took a breath throughout the whole time.  I think I lost half my body weight in sweat, and this was all just a dummy!  When I had other goes it was fine, but the first time, everyone is cncentrating really hard and you do forget to breath.  When I’ve finished the course, I think it will be easier then the Endo-Tracheal Intubation, as your not really in danger of damaging anything like teeth or the voice box.

The fourth station was revisiting Intermediate Life Support.  We went over the protocols which we had all forgotten on tuesday, and tried to get the dummy breathing again.  I had a stupid moment which it was my turn, and I was in charge of the Lifepak 12.  I was wondering why I could not get a rhythm, even though I was pressing the right buttons.  It turned out that I hadnt even collected the leads to the dummy, so there was never going to be a rhythm. Whoops!

Then that was the end of the day.  This week has gone incredibly fast, and sunday i’ll be moving into the new house.  I started to move things over and i’ll be heading home earlier so I have more time to sort things out. Hopefully tonight will go well, and I’ll be qualified again for another 2 years.  this will be my last resit, as hopefully, i’ll have qualified and be out and about!

TP

Now I know some of you may have already seen this, but I have pillaged it from Random Acts of Reality, and I thought that I would share it with you all. 

I promise you will play it several times!

PANDA

TP

Well, yesterday and today involved the start of our new module and it doesnt look like its going to be to bad.  We going to be studying examination techniques for different systems and areas of the body including respiratory, cardio-vascular, nervous and the abdomen. 

This week was the respiratory system and it was our first lesson where we actually got to use our Stethocope for real.  We got to show of our christmas present, and who got which one.  Most of us got a Litmann Classic II.  There were however some who had these huge ones and looked like they had come from the future.

Before we started, we had a presentation where one of our colleagues kindly volunteered (volunteered = voted for by group) to be the dummy that the lecturer can draw on and point out where about the various parts of our anatomy are located.  Luckliy the lecture was split up with several breaks as our concentration can seriously lapse after a long period of time sitting in one place.

An interesting piece of information that I learned from my readind was that your lungs come up much higher than I realised, even higher than your Clavicle (the bone across the top of your chest). 

After the presentation we had to follow the lecturers example and:

1. Palpate the area (feel around),
2. Compress the area,
3. Percuss the area (tap around),
4. Auscultate the area (listen around).

This was the part where we all had to get personal with one another and bare our chests.  No-one was bothered, were going to have to do it on patients so it made no difference that we were practising on each other.  Apparantely its actually the clinican that gets more embarassed rather than the patient in these circumstances.

I think that most of us are getting back into the University life, and the work that goes with it.  When on placement, I didnt really have to do that much reading, if at all.  Now the lecturers are making up for it with vengance!

Tomorrow i’m heading back home, for my Lifeguard exam resit.  We have to retake the exam every two years and my time is up next month.  It will probably be the last time im back until Easter so im going to make the most of it.  Im going out for a meal tomorrow night with my parents which we should have done over christmas but didnt have time.

I hope everyone has a good weekend!

TP