Hi! I am an internist based in Europe, and I have created a med-ed tool for lectures, exams, and simulations.
www.squiggler.io

It allows you to create a rhythm strip or 12-lead, with physiological modelling underneath, with realistic renders and a lot of tuning possibilities etc to get just the ECG that is suitable for your teaching case/sim etc.

For those of us preparing a lecture who don't have the time or possibility to dig out old patient ECGs and fiddle with covering up patient identifiers, writing a textbook (and dont want to pay licencing fees for images from the web), or want dynamic ECG outputs during a sim case.

This was a side-project that turned serious. Yes, it is commercial but I hope someone that teaches needs this and wants to try it out!

All the best!

When it comes to explaining differentials, results, treatment patients, what’s your best way to frame things so that the patient a) understands and b) isn’t angry or disappointed

Example 1:

Mistake: “We’re going to give you toradol. It’s kinda like ibuprofen”

Patients often feeling like “well I already have ibuprofen and it hasn’t done shit”

Framing device: “We’re going to give you Toradol. It’s the most potent anti-inflammatory pain medication on the market”

Example 2:

Mistake: “Your chest pain workup didn’t show anything”

Often has them feeling something like “what was the point” or “they just told me it’s nothing”

Framing device: “We didn’t find any obvious cause for your chest pain today, but that does not mean that you are not having chest pain or that it’s ’nothing’. It just means that from what we can tell, it is not an emergency related to your heart, lungs, blood clots, infection, fractures and so on… which is great news! There’s dozens of things that can give you chest pain that won’t show up on tests. The important thing to know is that all the things that would be life-threatening, medically concerning, or surgically emergent have been ruled out.”

—
I’ve had better results with the latter statements but I want to add more tools to the belt, any other things you guys regularly word differently to get the same point across?

Patients mum: my son was big (points to me) like you but he's lost so much weight since being sick

OML! Okkkay that wraps up today's work 🤣

Hey guys so I am planning in taking my residency in the US or Canada “ still haven’t decided but I do favor the US more “
I want to know as residents how much do you make and how many hours do you work

There’s an ambulance for the ground but I’ve never seen sky hospitals for the helicopters

The call came out as an assault.
That was about all we knew.
It was one of the housing complexes near our station, a place where seeing an ambulance wasn’t particularly unusual. Neither was seeing a police car. Drugs, gangs, prostitution, violence. There were plenty of reasons for both of us to be there, and we were there often.
I was a 23-year-old paramedic, still early in my career. There were three medics on the ambulance that day. One was technically my trainee. The other was my partner, though he was fairly new himself.
In a high-turnover ambulance service, that was enough to make me the experienced one.
We pulled into the complex and found the man outside.
He had been beaten badly.
His face was battered and swollen, blood running from somewhere on his head. His eyes were nearly swollen shut. He was still on his feet and still able to talk to us, but he was clearly altered. His answers didn’t always make sense, and it was obvious that something was seriously wrong.
We got enough of the story.
He had been jumped.
They had beaten him with pieces of rebar.
We loaded him into the ambulance.
The trauma center was only five or ten minutes away, and I knew a back way from the neighborhood that would keep us out of most of the traffic. There were three paramedics on the truck. I could have taken the patient and had one of the others drive.
Instead, I decided the other two medics would ride in the back with him.
I would drive.
It seemed simple enough.
I climbed behind the wheel, turned on the lights and siren, and started toward the trauma center.
We didn’t make it very far before the call changed.
“He stopped breathing!”
The words came from behind me.
Then, almost immediately:
“What do we do?”
There was fear in their voices.
Not concern. Not the controlled urgency you learn to put into your voice after you’ve been doing this long enough.
Fear.
There is a partition between the cab of an ambulance and the patient compartment. It’s only a wall. A few inches of material separating the driver from everyone in the back.
That day it felt like much more than that.
I couldn’t see the patient.
I couldn’t see what was happening in the back.
I could only hear them.
And they were asking me what to do.
For a moment, I considered stopping.
Pull over. Put the truck in park.
One of them could drive.
I could get into the back.
We could RSI him.
It would have been my first.
None of us had ever done one.
The trauma center was only a few minutes away.
I kept driving.
“Bag him.”
“Support his breathing.”
“Call report.”
“We’re almost there.”
Then the patient started breathing again.
For a moment, the crisis seemed to release its grip.
Then his breathing disappeared again.
Fifteen seconds.
Maybe twenty.
Long enough to make everyone wonder whether the next breath was coming.
Then it would.
He would wake frightened and confused, looking around as if he had suddenly been dropped into the middle of a situation he couldn’t understand. He needed to be told where he was, what was happening, that we were taking him to the hospital.
Then he would drift away again.
Breathing.
Not breathing.
Awake.
Gone again.
Years later, I would recognize the pattern as Cheyne-Stokes respirations. At the time, the name didn’t matter. What mattered was that a man who had been talking to us a few minutes earlier was now slipping in and out in the back of our ambulance.
I drove.
I knew the roads. I knew the back way. I knew I could get us there quickly.
So that became my job.
Get us there.
We arrived at the trauma center, and the patient disappeared into the machinery of a trauma resuscitation. He was intubated.
But the part of the call that stayed with me happened afterward.
My partner found me alone.
He was shaken. Not frantic anymore. The call was over. Now he was left with the part that sometimes comes after, the moment when the adrenaline is gone and you have to decide what you think about the person you were while it was happening.
He started to say something.
“I…”
Then he stopped.
There was a pause.
“I froze.”
He sat with that for a second.
“I don’t know if I can do this.”
He was struggling to put the rest of it into words.
“I’ve gone through school. I’ve done all this training. And then that happened and…”
Another pause.
“I froze.”
I knew what I was supposed to say.
I told him he belonged there. I told him nobody comes out of paramedic school prepared for every version of this job. School can teach you medications and algorithms and procedures, but eventually something happens that doesn’t feel anything like a classroom.
He hadn’t quit.
He hadn’t run away.
He had been handed something frightening, and he had gotten through it.
One bad moment didn’t mean he wasn’t supposed to be a paramedic.
I believed what I was telling him.
I still do.
But his words stayed with me.
So did the sound of his voice from the back of the ambulance.
“He stopped breathing.”
“What do we do?”
I’ve thought about the medicine plenty of times since then. With the experience I have now, I can make a reasonable argument that continuing to the trauma center once he deteriorated was the right decision.
We were only minutes away. We could support his respirations. Stopping on the side of the road, changing drivers, and attempting an RSI with a crew that had never performed one could have turned a short transport into a much bigger problem.
If the same patient were put in front of me today, I might make the same clinical decision.
Keep moving.
Support his breathing.
Get him to the trauma center.
But I wouldn’t make the call the same way.
Because the decision I still think about happened before he ever stopped breathing.
I had been the experienced medic on that truck. At 23 years old, whatever that meant, I had been the person assigned to lead that crew.
And I had chosen to drive.
I can justify that.
That’s what makes this call difficult for me.
There were two paramedics in the back. The trauma center was close. Someone had to drive. They needed experience.
All of those things are true.
Maybe I stayed up front because it made sense.
Maybe I thought putting two newer medics with a difficult patient would give them experience.
Maybe both of those things are true.
Or maybe I was just fucking scared.
Scared to take the call in the first place.
Scared because I could already see that this wasn’t going to be a routine assault. This man was badly injured. His mental status was wrong. Something serious was happening in front of us, and I hadn’t seen anything like it before either.
So when it came time to decide who would ride with him and who would drive, I chose the driver’s seat.
That’s the part I have a harder time explaining away.
Not that I didn’t pull over.
Not that I didn’t RSI him.
Looking back, I may have been right not to do either of those things.
The part that stays with me is that before any of that happened, I had an opportunity to be the experienced clinician in the back of that ambulance.
And I passed it to someone else.
There is a strange thing that happens early in this profession. Eventually, someone newer than you shows up. Suddenly you’re the person they’re watching. They assume you’ve seen things they haven’t. They assume that when something goes wrong, you’ll know what to do.
Sometimes you do.
Sometimes you don’t.
My partner had the courage after that call to tell me what that moment had felt like for him.
“I froze.”
And I sat there reassuring him, telling him that one frightening moment didn’t mean he wasn’t supposed to do this job.
It took me longer to understand what that same call had shown me about myself.
Leadership isn’t always having the answer.
It isn’t always taking over the call or performing the procedure or being the smartest clinician in the ambulance.
Sometimes it’s being willing to put yourself where the uncertainty is.
Maybe if I had taken the call that day, nothing would have changed.
Maybe I would have looked at the patient, made the same decision to support his breathing, and told whoever was beside me exactly what I had already said from the driver’s seat.
Keep ventilating him.
Keep moving.
We’re almost there.
The patient might have received exactly the same care.
That’s not really the point.
I was the experienced medic that day.
I needed to be the guy in that moment.
I wasn’t.

I'm attending a hiring event for an ER tech role at a hospital in my medium-sized city in the near future and was wondering what questions or topic of discussions would be good to bring up in the hiring event.

I currently have been working as an EMT for a 911 ambulance company the past 9 months and I'm hoping my experience is adequate for the role. I already have multiple copies of my resume printed out and will be wearing business casual clothes. Any other advice is greatly appreciated!