My Biggest Blogging Fears and Heart Attacks

Want to know what my biggest fear as a blogger is? Itís that one day you may find out that Iím an idiot. Youíll find out that there are things that I donít know, and those things that I donít know will be something that ďany idiot should knowĒ and if I donít know them youíll think that Iím not as smart as ďany idiotĒ.

Take this issue for an example. Say you have a 48yo M Pt with substernal chest pain. He indicates with his hand that itís radiating towards the lower left part of his chest from the manubrium. He stresses that he doesnít perceive it as ďpainĒ per se, but that he feels it more as a ďpressureĒ and he rates it at a 4 out of 10. He denies that it exacerbates to movement or palpation, and it doesnít change with respiration. His skin is slightly flushed and moist and he complains of some shortness of breath. He states that heís been experiencing it for an hour or so, and that itís getting worse despite antacid tablets and an aspirin he took. The patient has no medical history and takes no meds. He does have a family history of heart disease but has never experienced any problems.

What would we do here? Easy: a 12-lead, IV, o2, and EKG Monitoring is in order. You do that and getÖ

A normal 12-lead EKG. Nothing is wrong with it. Not a darn thing.

Doesnít that suck? I mean, no, not for the patient of courseÖ but for you. Now what are you going to do? Are you sure that this patientís chest pain isnít caused by cardiac ischemia? Youíve seen the 12-leadÖ but you also see the patientís presentation. They seem to contradict each other, donít they? If this patient had three boxes of ST segment elevation in three leads, youíd know right what to do and the treatment would be pretty straight-forward, right? Now itís not so clear.

Iíve vacillated in my career between giving nitroglycerine to these types of patients to make sure that there isnít something Iím missing with them. My usual decision is to prophylacticly give one NTG tablet (0.4mg SL) after the IV is in place under the doctrine of treating the patient and not the monitor; but I donít call the cavalry, activate cath lab, or give them the bigger drugs we have to give them (Our STEMI protocol includes: o2, Asprin, Nitroglycerine tablets and paste, Morphine, Metoprolol, and Heparin while bypassing the closest ER by a minimum of 45min to go direct to a hospital with interventional cardiology capabilities)

You tell me that I should contact medical control for these cases and I do if I have something vital to ask that Iím unsure of. I do know that I canít possibly know everything about everything there is to know about. I also, like probably a good number of providers out there am sometimes afraid to be found out as an idiot by asking a question that ďany idiot should knowĒ.

So there you have it. Like most people, Iím afraid to be found out as an idiot and itís keeping me from asking questions that may give me the appearance of being stupid and ignorant.

Unfortunately for my urge to go hide underneath a rock, I have a blog about EMS that I feel compelled to write something on every day. This means that eventually, Iím going to write something that is so stupid and ignorant about something that you are going to find me out for being an idiot. I may even ask a question about something that I should know by now and you may laugh at me for not knowing the answer to the question I ask.

So Iíve made up my mind. From now on, with you as my witness, I am going to be unafraid to ask dumb questions about things I should already know about. If I donít know something, Iím going to assume that thereís someone out there that doesnít know it eitherÖ and Iím going to write those answers down here on this blog just for that personÖ and for you.

I hope that maybe you might start being unafraid to ask those types of questions too. You never know what you might learn. The only cure for this affliction is to buck up and ask the questions, knowing full well that every single person out there feels the same way that you doÖ and is scared of being found out themselves.

Or you can come here and find out the answers that Iíve found out for you. Iím already a known idiotÖ no sense in you risking your own neck.

See you tomorrow, Folks.

  • mr618

    Okay, ckemtp, now you're a “collective” “premium” “idiot”?!? Give it a rest. Getting through paramedic school is not quite like getting through third grade: you have to acquire and retain a whole big poopload of knowledge in a wide range of fields, in addition to having the magic touch of a good bedside manner AND the masochistic desire to do all of this without the extra money you'd make as an MD.

    I, a lowly EMTB, have learned quite a bit from you (and the other premiums), stuff that — perhaps — should have been covered in our training but wasn't. You and Kaiser and Glencourse and the others should be commended for doing what you do and for sharing your knowledge (and obvious love of your profession. Yes, Johnny, I said “profession”). Don't knock yourself, for in doing so, you knock them too, which I know is anathema to you.

    Remember, “the only dumb question is the one you don't ask.”

    With deepest respect (and a little bit of a raspberry)…
    Mr618

  • mr618

    God, I'm just having one brain fart after another. I MEANT to say “you and Schorr and Glencourse…”

    Will your defibrillator cure brain cramps? Or do I just need a coffee IV?

  • mr618

    Okay, ckemtp, now you're a “collective” “premium” “idiot”?!? Give it a rest. Getting through paramedic school is not quite like getting through third grade: you have to acquire and retain a whole big poopload of knowledge in a wide range of fields, in addition to having the magic touch of a good bedside manner AND the masochistic desire to do all of this without the extra money you'd make as an MD.

    I, a lowly EMTB, have learned quite a bit from you (and the other premiums), stuff that — perhaps — should have been covered in our training but wasn't. You and Kaiser and Glencourse and the others should be commended for doing what you do and for sharing your knowledge (and obvious love of your profession. Yes, Johnny, I said “profession”). Don't knock yourself, for in doing so, you knock them too, which I know is anathema to you.

    Remember, “the only dumb question is the one you don't ask.”

    With deepest respect (and a little bit of a raspberry)…
    Mr618

  • mr618

    God, I'm just having one brain fart after another. I MEANT to say “you and Schorr and Glencourse…”

    Will your defibrillator cure brain cramps? Or do I just need a coffee IV?

  • http://www.firedaily.com Fire Daily

    With all due respect to Mr618, who sounds like a fine upstanding professional- I would offer the following opine: Don't let anyone tell you there are no such things as dumb questions. You and I have both heard them. But dumb questions are still questions- and still require answers. I'm never afraid to ask a dumb question if I need to know the answer. I'm past protecting my ego. You've already seen me step on 'myself' in my blog. Yes it sucks. But If my fingers tap thousands of keys a week, I would be kidding myself if I thought otherwise.

    We're not quite 'there' yet, but at least we're on our way down the road. You write with clarity, purpose, and humor, Pop in some humility, self-deprecation and some of them-thar big paramedicky words and all of a sudden people want to read what you send out.

    I know you're not looking for a reassuring comment but you're going to get one now. I think you're one of the most insightful, sharing, and communicative new bloggers on the block and you'll only get better with time. I'm proud to be your partner on the FireEMSblog.com team

    And I hope you screw up before I do again. Sorry, but I do!

    p.s. ahem, what's a stemi?

  • Anonymous

    I’ll ask a dumb question… a question I have consistently been answered with two very different answers. If a patient has a suspected hip fracture/injury, do you roll them onto the injured or uninjured hip.

    The way I see it is, I would rather ask the question and get an answer than wing it and DO something dumb rather than ASK something dumb. :)

  • mr618

    Fire Daily, I agree there are some “dumb questions,” (i.e., to us, they sound dumb) but it seems to me that the person asking the question is either legitimately looking for an answer (maybe he missed a particular class) or trying for a cheap laugh (for instance, “what's a stemi?”). Certainly, I have no qualms asking questions that may seem dumb to others, but that is because I do not know everything (unlike my ex-mother-in-law). In fact, you make my point quite nicely: “I'm never afraid to ask a dumb question if I need to know the answer.” If you need the answer, by definition, it's not a dumb question.

    My background is primarily physical security, so my knowledge of pharmacology is probably as limited as CK's knowledge of infrared camera technology.

    The differences between aspirin, Tylenol, Advil, and Motrin? Old stuff for you, but since as a basic I can only use aspirin, I have no idea how they are different.

    As I said above, I've learned a lot from you folks, and I appreciate it.

  • Mike

    “there are calls out there just waiting to humble the best paramedic”

    CK – the fact that you understand that statement is what makes you a good Paramedic and certainly no “IDIOT”

    Keep on blogging – what you have to say is very worthwhile, that's why we read you.

  • Todd A. Bluhm

    Knowing what you don't know is a sign of intelligents. Remember the quote, “Wake up dumb, dumb all day.” It is the foolish medic that runs headlong into every call, with their cap flapping in the wind confident that they know the answer to every medical problem presented to them.
    While I do agree that some questions can be foolish. Take for example the 6 year medic taht is still struggling with lead placement for a 12 lead and should probably be struggling with career placement instead.
    I applaud anyone who is will to acknowledge their challenges, this allows them to seek answers, even if the answer is “Change professions”.

  • Ambulance_Driver

    Dude, I have been humbled more times than I can count.

    Luckily, I have so massive an ego that I can get over it quickly.

    One thing that I have learned, is that if you scratch a good doctor, you will find a frustrated teacher underneath. I use that to my advantage.

  • Ambulance_Driver

    Dude, I have been humbled more times than I can count.

    Luckily, I have so massive an ego that I can get over it quickly.

    One thing that I have learned, is that if you scratch a good doctor, you will find a frustrated teacher underneath. I use that to my advantage.

  • http://www.firedaily.com Fire Daily

    Mr618- Ha! I was just pulling your leg, my friend. I know that there are such things as dumb questions- because I ask them all the time. What color is the White House? When was the War of 1812 fought? Who's buried in… aww forget it.

    Irregardlessly, (see?) I want you to know that I truly know what a STEMI is. Every time I think about that, it freaks me out. I don't know if I could ever get wunnadem throat-holey thingys….

    Stay safe, and keep following CK. That dude is going places!

  • http://www.999medic.com Medic999

    I have never been afraid to ask ANY question. I have learned more from seeking out people who know more than me, and asking questions that maybe they think I should already know the answers to,than I have ever learned in my Paramedic course, Technician training or any book I can read.

    Hey, who can know everything right?

    I would be so bold as to say that it is only a fool who thinks that they have nothing left to learn.

    One of the easiest things to learn from is when you get a kick up the arse from a patient that tripped you up (medically speaking!).

    Keep up the good work mate!

  • http://www.firedaily.com Fire Daily

    Mr618- Ha! I was just pulling your leg, my friend. I know that there are such things as dumb questions- because I ask them all the time. What color is the White House? When was the War of 1812 fought? Who's buried in… aww forget it.

    Irregardlessly, (see?) I want you to know that I truly know what a STEMI is. Every time I think about that, it freaks me out. I don't know if I could ever get wunnadem throat-holey thingys….

    Stay safe, and keep following CK. That dude is going places!

  • http://www.999medic.com Medic999

    I have never been afraid to ask ANY question. I have learned more from seeking out people who know more than me, and asking questions that maybe they think I should already know the answers to,than I have ever learned in my Paramedic course, Technician training or any book I can read.

    Hey, who can know everything right?

    I would be so bold as to say that it is only a fool who thinks that they have nothing left to learn.

    One of the easiest things to learn from is when you get a kick up the arse from a patient that tripped you up (medically speaking!).

    Keep up the good work mate!

  • http://www.firedaily.com Fire Daily

    Mr618- Ha! I was just pulling your leg, my friend. I know that there are such things as dumb questions- because I ask them all the time. What color is the White House? When was the War of 1812 fought? Who's buried in… aww forget it.

    Irregardlessly, (see?) I want you to know that I truly know what a STEMI is. Every time I think about that, it freaks me out. I don't know if I could ever get wunnadem throat-holey thingys….

    Stay safe, and keep following CK. That dude is going places!

  • http://www.999medic.com Medic999

    I have never been afraid to ask ANY question. I have learned more from seeking out people who know more than me, and asking questions that maybe they think I should already know the answers to,than I have ever learned in my Paramedic course, Technician training or any book I can read.

    Hey, who can know everything right?

    I would be so bold as to say that it is only a fool who thinks that they have nothing left to learn.

    One of the easiest things to learn from is when you get a kick up the arse from a patient that tripped you up (medically speaking!).

    Keep up the good work mate!

  • http://www.firedaily.com Fire Daily

    Mr618- Ha! I was just pulling your leg, my friend. I know that there are such things as dumb questions- because I ask them all the time. What color is the White House? When was the War of 1812 fought? Who's buried in… aww forget it.

    Irregardlessly, (see?) I want you to know that I truly know what a STEMI is. Every time I think about that, it freaks me out. I don't know if I could ever get wunnadem throat-holey thingys….

    Stay safe, and keep following CK. That dude is going places!

  • http://www.999medic.com Medic999

    I have never been afraid to ask ANY question. I have learned more from seeking out people who know more than me, and asking questions that maybe they think I should already know the answers to,than I have ever learned in my Paramedic course, Technician training or any book I can read.

    Hey, who can know everything right?

    I would be so bold as to say that it is only a fool who thinks that they have nothing left to learn.

    One of the easiest things to learn from is when you get a kick up the arse from a patient that tripped you up (medically speaking!).

    Keep up the good work mate!

  • Sizp

    Wow! Very good content, the analysis depth, so I understand! Like the authors way of thinking, and writing style! Compliment, ha ha! Thanks again for the selfless sharing of, I have learned a lot! At the same time I like LED Moving Sign and LED street light very much !

background image Blogger Img

Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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  • Comments
    Ianto Jones
    The Natural Alignment Movement – Freedom of Choice from the Orthopedic Conspiracy
    Oh, dear G-d. This was hilarious, but I'm fighting not to find it dangerous as well -- someone's gonna share it on FB, and one of _their_ friends is going to send it to Bright Star MorningGlory Rainbow, who will send it to her YahooGroup, and someone there will reply that he *thinks* he broke…
    2014-11-18 09:54:00
    Thad Torix
    Patient Friendly Jokes
    Have you heard my construction joke? I'm still working on it.... (Credit to my youngest daughter for that one. My partners are absolutely sick of hearing that joke...) On another note, what a fantastic blog. If you are ever in SW Missouri, stop by and say hello. Thad Torix - EMS Instructor & Clinical Coordinator…
    2014-11-03 18:27:00
    mr618
    Welcome to the Club
    Well said, Chris. We can't save everybody, but the ones we don't save tend to stick around a lot longer than the ones we do save.
    2014-10-18 14:40:00
    Steel City Medic
    Welcome to the Club
    Particularly appropriate for me this week. Thanks.
    2014-09-23 21:46:00
    DiverMedic
    Welcome to the Club
    Very well done, Chris.
    2014-09-17 22:15:00

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