One of the favorite sayings of someone I worked with decades ago was "What's sauce for the goose is sauce for the gander", by which she meant either "what goes around comes around", or "If it's good enough for you, it's good enough for me."

During our formative EMS years a good EMS program will try to work some of that philosophy into the training. We've all been backboarded and learned first-hand the importance of void space padding, for instance. Some courses allow us to partner up and practice IV sticks together, which is another good first-hand experience. Better EVOC programs will allow the driver-on-deck to ride strapped to the cot, to feel exactly what a pothole or speed bump is like for the patient.

But there are certain things we just can't do, like try out the drugs in the drug box. We don't for instance stare in horror at the spreading stain on our crotch and say, "Oh, yeah, I get it - Lasix sure does work!"

It happened Monday though that I had an appointment with a full-sedation dentist. The tooth which needed a crown refused to go numb no matter how much novocaine my regular doc pumped into it, and this is what happened. I'm skipping over the initial meet & greet and exam from last week.

I was given a 25mg tab of Meclizine, two 500mg tabs of Acetaminophen, and 0.3mg of Clonidine to take 90 minutes prior to the appointment. I was told that the Clonidine might make me woozy, so I had She Who Must Be Obeyed drive me to and from the procedure. Additionally, I applied some Burt's Bees lip balm to make my lips happier about being open for long periods. I also used a Vicks inhaler in each nostril to chill out the nasal passages, knowing I was getting a nasal intubation.

At the dentist's office I felt not the slightest bit woozy despite their warnings. Okay, no biggy.

I was called back to the room - a regular dental exam chair, a bit more equipment. Expecting a chilly OR I had worn a sweater, but removed it and hung it behind the door at their request.

A young lady introduced herself as a doc at the practice, though not the doc who would be doing the dentistry. She put a #20 in my right hand and start a WO drip of lactated Ringer's. They knew your humble narrator is a paramedic and were very understanding and patient with all my questions.

Another tech placed a standard 3-lead EKG. She then placed a short headband over my forehead which connected to an EEG. This, I had been told, was to ensure that the anesthesiologist knew I was really "out". We've all heard the stories of the patient who was "sedated" and paralyzed, but could hear, think, and - shudder - FEEL everything going on, yet unable to alert the OR staff. None of that for DTs!

All this had taken perhaps five minutes. I turned to ask the doc who had started my IV what the initial drug given would be.

"Oh, Versed," she said. Oh, good, I thought.

I was standing in the doorway of their bathroom, facing out towards the hall. I noticed I had my sweater on. I could feel the dental work with my tongue. My left sinus felt strange and I asked what gauge they'd used (#8). One of the techs asked if I needed to use the bathroom. I said "I guess not."

I was in the car.

I was in bed, and slept for six hours.

I woke to use the bathroom and noticed my lower lip was tingling in that "coming down from novocaine" feeling.

Slept for two more hours.

Woke up, more or less intact. Tooth pain 0/10, gum pain 0/10, jaw pain 0/10, lip pain 0/10, left nasal passage 1/10 and a slightly sore throat and somewhat raspy voice.

"So," said She Who Must Be Obeyed. "Are you going back like you said you would?"

"I what now?"

"After your procedure, you had so many questions - which they considered good questions indeed - and showed such professional interest, they invited you back to watch one whenever you liked."

"Really?" Oh shit oh dear, DTs, you have no recollection of that at all. How much did you run your mouth, just out of anesthesia?

So there, for we who give it, was my first-hand experience of midazolam.

I think.

Hey - nobody take offense at the post title; I just got done watching Full Metal Jacket the other night.

My, but time does fly, and it became time for DTs to recertify his NREMT-P this month.

Now, generally we know what we're doing here in EMS-land. But doing things "the street way" and doing them "the NREMT way" are sometimes different in expression, if not action. The NREMT written test is sometimes a little vague in their questioning:

"You find a patient struck by a light aircraft, breathing 14 times a minute with shallow respirations, spurting blood from a thigh wound and showing four feet of eviscerated bowel wrapped around a pair of chopsticks. The patient has a DNR bracelet and a necklace stating he is diabetic. The patient states he has an allergy to seafood, and a lobster tail is partially dangling from his left nostril. What do you do? What DO you do?" a) begin BVM respirations; b) call for medivac; c) verify the patients identity; d) run in circles, scream and shout.

"Well, shit," you think, "What I want to do is not a listed option."

And here, because that's the way they roll, one should note the key word is "shallow" - shallow respirations require positive pressure ventilation (PPV), with a bag-valve mask (BVM). That's the answer they want.

Yeah.

Now, at this time, the NREMT allows you to take the recert test ONCE, for a $110 fee.. If one doesn't pass, it is REQUIRED that one complete a paramedic refresher course, and that costs big dineros I'm sure. It seemed prudent to invest in some small-ticket items to prep for the test.

A++ Would Read Again:

Stephen J Rahm's Paramedic Review Manual for National Certification ($29.95 at Amazon)

This contains gobs of questions and multiple-choice answers. Each answer is backed by a short paragraph explaining why it, of all the choices, is the correct answer. There are also sections which give hints for prepping for the practical examinations.

I spent a weekend typing in the entire book to a free Palm program called Anki, which lets one build flash cards. Anki allows you to associate a pile of information in each "record" and then build on-screen flashcards on-the-fly. I told it to put the question, and each possible answer on one side of the card, the correct answer and rationalization on the other. Running the program I could select categories (Trauma, Airway, Medical, etc), or the whole shebang, or just those items I marked (either as "wrong" when last I took the test, or those I checked the little "Mark" box for further review/study). The book itself is very good without all that PDA prep stuff, though. If anyone wants it I'd be glad to provide the Anki database, but you'll need Rahm's permission of course.

A-, Would Recommend

Building on that it was time to subscribe to the Pearson / Prentice Hall / Brady online Paramedic review ($32.00 from Brady)

One logs in to their web site and is given four practice tests, Content Area tests in Airway and Breathing, Cardiology, Trauma, Medical, OB/Peds, and Operations; a set of Practice Quizzes in same, and something called "Resources" - "Thousands of media-rich learning resources such as photos, illustrations, animations, and video." I sure didn't see any media-rich learning resources..

Clicking Resources gives you a Tutorial section (how to use the online test prep), Helpful Links to the Brady Catalogue of Stuff You Can Buy, and the Results Reporter - this is where your quiz and test taking is scored. Right answers are listed, along with the rationale behind them.

It's a good resource, but I have a major bone to pick with Brady.

There is no way to contact them via web or email, concerning this product. And SOME OF THE INFORMATION IS WRONG. Correcting it would be simple and quick, if one had a way to point it out to them.

"Airway & Breathing. When performing tracheobronchial suctioning, you do not want to insert the catheter past the carina. Which of the following methods would be most appropriate to guide the insertion of the suction catheter?"

Brady lists the correct answer as "Measure from the mouth, around the ear, to the xiphoid process." Hey Brady - that's an NG tube. Take a look at where your xiphoid process is - several inches below the carina. Somebody somewhere is going to scrape a catheter tip across the bottom lobe of a lung if they listen to Brady.

As well, sometimes a question will deliberately misspell a possible answer (I'm making this one up): "What is the name of the bone connecting the forearm to the shoulder?" a) arm bone; b) funny bone; c) humerous; d) humerus

And the answer here would be D, because C is misspelled. That's legitimate.

But when Brady insists that the most dire patient in my trauma scene is the one with the "scaffold abdomen" when they clearly mean "scaphoid abdomen"... well.

Anyway, the loveliest phrase in the English language (that can be uttered by the NREMT): "CONGRATULATIONS! You have successfully demonstrated continued cognitive competency by examination."

In EMSish: "You passed."