Working

Working.  What's new.

Work - Got rudely woken by a fantastic MVA job sent to my pager early this morning.  I wish my brain had been screwed on a bit tighter before starting the job, but it went ok anyway.  One learns how to do this job in one's sleep out of necessity.

I was beating myself up about my poor scene control skills, but my wiser and more experienced co-worker talked me down and was very nice at reassuring me that I'm good at what I do.  That was nice and generous of her. 

TAM - Hmmm... so I'm not as tired today as I have been all working week but I still feel like I need a day off before I can regroup and relook at this fitness thing.  One of the reasons I wanted to do my PT ticket was to always make sure I made the time to keep in shape.  I'm starting to think of fitness as being like maintaining a clean house - it's always there, waiting to be done.  You can leave it for a few days or even a week, but then it gets ugly and takes a lot of work to get back on track.  You don't have to do much but the more you do, the better it looks.  It's not fun at times, but if you just get it done then you like what you see.  The difference between doing the minimal and looking extraordinary requires and exponential increase in effort - like climbing a mountain that keeps getting steeper.

My friend explained to me what climbing Mt Kilimanjaro was like - he said by the last day reaching the summit it was like it took 30 secs to take each step.  The progress what ridiculously slow due to the altitude.

Study - I'm missing study.  I just reviewed bundle branch blocks and wrote up a sheet for the clinical board on how to diagnose BBBs on a 12-lead ECG.  Most ambos don't really get into 12-leads as we only have 3-leads (in my ambulance service - except for the [Mobile] Intensive Care Ambulance paramedics) as we really only treat shockable rhythms and we call for MICA for other arrhythmias causing perfusion problems, ie bradycardia with hypotension, or SVT.  But really, we're not expected to DDx even SVT or ST-elevation.  But we do.

So, yeh, BBBs are not high on the priority of ECG diagnosis.  We're more about treating symptomatically, ie chest pain => acute coronary symptom protocol.  It is good for me starting out, in a way. because we are taught to really concentrate firstly on the patient's clinical presentation, and secondly on the other information like the "numbers" and the ECG.

It was good to go over ECGs again and just refresh on a few things.

Two weeks until term starts.....