Top three questions on-scene

[mycrofft]

Over the years I developed my personal order of questions for the patient, working on the premise that something might d/c the questioning at any time, like loss of consciousness or the room catching fire.

The first three are these:

Are you allergic to anything?
Are you taking any medications on a regular basis? Are you supposed to be?
What is the matter?

My reasoning:
1. I don't want to kill this pt with an allergy I precipitate (doing no harm).
2. I don't want to precipitate a drug interaction or overdose, and the drugs listed will give me a clue as to history.
3. By this time I'm looking, feeling, smelling and vital-signing the pt and filling in the blanks. I try for subjective description of feelings and events, then their history as they understand it. Their doctor's name also, but that is #4, we can treat based on the information gathered so far.

What about you?

 

[Joe]

For me its always name, birth day, and why do you feel you needed an ambulance today?

 

[EMTBell]

Name first!

I feel like I have to get the name, so at the very least I can set up some rapport with the patient (or know who to contact if everything goes south.) After that I go into a quick history (allergies and medications.) Next I work with the signs and symptoms (why did you call 911?) and the relevant history to the complaint.

The way this stuff is taught in class is way too regimented, I know if I did it in that order I would have failed my state practical exam!:rofl:

 

[DesertMedic66]

Name, C/C, medical history.

 

[MediMike]

Name
Do you realize what time it is?
Your tooth has been hurting for how long?
You REALLY feel the need to go to the hospital?
...
Really?
...
Damn.

 

[EMTBell]

You REALLY feel the need to go to the hospital?
...
Really?
...
Damn.

He says as the patient lay there bleeding out :rofl:

 

[Bullets]

Name DOB Why am i here/onset

 

[Veneficus]

What brings you here?

How did you do that?

What do you want?

 

[Meursault]

Can you walk?
Are you sure?
Where do you want to go?

or

What did you take tonight?
Right. So why are you naked at the T station again?
Fine, do you want to go with us or the cops?


I'm a little surprised you start with allergies, mycrofft. I don't put them high up my list because I'm likely not going to be giving my patients anything. Even with ALS interventions, unless they're allergic to ECG electrodes, saline, or being poked, the allergy question can wait until I have some sense of what's going on and what, if anything, I'm going to do.

As far as medications, they're much more important to me, but they're still a bit down the line. Asking for medications usually prompts a scavenger hunt: in the house for the shopping bag of bottles, in a purse or stacks of discharge papers for a med list, or in decaying memory for an answer. I'd rather get enough information to articulate a chief complaint and HPI first.

I usually start with some variant of "What's going on?". If things look relatively calm, I'll introduce myself first. My dispatch information is usually vague to nonexistent, and figuring out why we were called helps me decide how far I can stroll down the avenues of working diagnosis before I need to package and go. It also seems to make sense from the patient's perspective; they don't call to fill out a triage form, they call because they have some problem acute, chronic, acute-on-chronic, or social that they want fixed.

 

[TatuICU]

"Are you familiar with our service's refusal form?"

 

[mycrofft]

Aw, I missed posting these as an option:

1. Who do you think you are?
2. Why did you call me at this hour?
3. What were you thinking when you did this?

(Orientation to name/self; chief complaint; mechanic of ...injury? Honest!)

 

[crispymedic]

1. Hi there, my name is crispy, what is yours?
2. How may I help you today/night?
3. Hx/MEDS/Allergies?

Respectfully,
crispymedic

 

[mycrofft]

Crispoy, true, need to intro self and ask for permission. Sorry.

 

[fast65]

For me it's:
1. Name
2. History
3. Chief complaint

I feel it's important to establish that rapport for the rest of our interaction, without knowing their name right off, it tends to make for awkward conversation when you're 20 minutes in and saying "btw, what is your name?".

That being said, those are usually the first three questions I ask, there are of course many other inquiries I make prior to doing an intervention.

 

[mycrofft]

What if the pt has a fragile level of consciousness?

 

[rwik123]

Name, DOB, C/C, onset, past Hx, and pertinent negatives.

 

[tnoye1337]

I feel it's kind of weird just going on scene and immediately asking their allergies and meds, unless the patient is in some serious condition and time is imminent. You have to treat them like people.

 

[mycrofft]

"Jim, what are his allergies, what sort of drugs is he taking, and can Spock get his fee-grubbing hands OFF my patient over there?

 

[crispymedic]

What if the pt has a fragile level of consciousness?

Then you assess them and take care of them as if they gave you consent.

crispy

 

[Tigger]

For me it's:
1. Name
2. History
3. Chief complaint

I feel it's important to establish that rapport for the rest of our interaction, without knowing their name right off, it tends to make for awkward conversation when you're 20 minutes in and saying "btw, what is your name?".

That being said, those are usually the first three questions I ask, there are of course many other inquiries I make prior to doing an intervention.

Is there anything more embarrassing then rolling into the ER and being asked by the triage nurse "who do we have here?" and having to go "uh well aw [shuffles paperwork] uh well you see her name is Jane?" "MY NAME IS SANDRA NOT JANE DAMMIT!" Not that has ever happened to me, promise. Some days I'm good with names, others not so much.

I'll ask there name first, then their chief complaint, then their history. Within their history there is usually a place for getting meds and allergies. Should I have forgotten their name at this point, I will ask them to spell it for "paperwork purposes," which makes me look slightly less dumb.