I went dark last week because I was in Washington, D.C. for our annual conference, EMS Today. It was a whirlwind of a trip, what with the "Snowquester," a new location and a new corporate parent. But it was, as always, a great experience. I got to see EMS friends I only see occasionally (but bug for favors often).

And I got to feel a lot of people's radial pulses. (Thanks to Dr. Slovis for reminding me that the bone is my friend and to be gentle lest I occlude the vein.)

I found out last night in class that we haven't really had any more drops. I think the class roster is still at 37. However, the student who sits next to me said if it weren't for another student pushing her to stay, she would've left on Wednesday. Too many things going on in her personal life, felt like she just needed to walk out and give up ... fortunately she was convinced to stay.

I was glad she was still there. I feel like my side of the room, my little corner, is a team. I rely on them for emotional support through this process, and I think they rely on me too (a feeling that was reinforced by the warm welcomes from having been gone).

We went through a lot of material last night. We ran through all of the cardiac and respiratory problems we get called for. What percentage of calls do those illnesses make up? I would guess it's a lot because from the little experience I have had, it seems that "chest pain" and "difficulty breathing/short of breath" are common. Is that because these calls are so commonplace, or because they're challenging and therefore require more focus?

What I have a hard time understanding is how EMTs and paramedics in the field know when someone calls for "shortness of breath" whether that's due to their CHF or emphysema. In other words, how do you know shortness of breath is pulmonary or cardiac in nature? I know it comes out of the history-taking, but how do you know which road to go down? 

I'd love some tips on classic signs for common cardiac and pulmonary issues, like the Levine sign. Other than being able to spot and ID "pink puffers" as emphysema and "blue bloaters" as bronchitis, it would take me a while to determine the cause of some other common illnesses and diseases. 

And do these patients ever/often have more than one of these? Take your smoker with emphysema. Do they ever have chronic bronchitis or diabetes or CHF? Can you assume a patient who is sick with a disease has another? I would assume so, but are there some illnesses that classically go together? Like the emphysema patient who also has a history of CHF? How do you treat them then? Do you focus first on their shortness of breath or their cardiac problem?

I guess I have a lot of questions today. That's what happens when I go to a conference and talk to EMS professionals from around the country: I come back with more questions than answers. Hopefully some of you out here can help me out with them!

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Comment by Jennifer Berry on March 13, 2013 at 4:26pm

I was just editing an article for April JEMS when i came across this sentence, "There, a nurse saw Priscilla in uniform, wheeling her ill partner, who presented with Levine’s sign, pallor and diaphoresis." Now, because of this class, I understand how important the "who presented with Levine's sign" is!

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