"What do you do first" questions

[vandurmejm]

In my education we are going through a lot of trauma and medical assessment. The biggest type of question I have trouble with deal with "What is the FIRST action that should be done?"

Any suggestions as to where I could find a bank of questions like this? It drives me crazy thinking about scenarios with helmets and if they should be removed first or if I should check a pulse vs. breathing etc.

 

[byoung57]

Therein lies the challenge of critical thinking. The short answer is...it all depends!

Bill

 

[firetender]

Before all else...

The FIRST action that should be done has nothing to do with the actual call. It has to do with YOU! And it's something you do EVERY TIME, regardless.

In this thread you're providing the best example of what NOT to do.

First, you BE AT THE CALL YOU'RE AT.

Prepare yourself to see what's really there. Don't stick your head into a book of memories of things you've been taught and then expect the scene to conform.

You haven't presented us with a specific situation or scenario, only your fears. I don't think anyone can, or would even want to, direct you to a "bank" of first-things-to-do.

Because the first thing you do is to BE AT THE CALL YOU'RE AT, Period.

...and anyone who lays out a scenario will be telling you the first thing you do is what THAT PARTICULAR SITUATION WARRANTED and maybe what they did or could have done better. That ain't your situation because you're not there.

If you fill your head with "first things to do" you'll set your patients up for a lotta pain and delay in recovery because it's highly likely you'll miss what the situation really IS.

You treat what's there, not what falls out of your cookbook of symptoms. Chest pain then shortness of breath, and then unconscious for a twenty year old in the ghetto is what you're told. First, set up for an MI, right? That may be a little broad but it includes preparing for further cardiac diagnosis and getting ready for the worst.

Or first should you see if there's a small-caliber bullet-hole in his back?

...or could that half hot-dog on the floor mean anything?

 

[MrBrown]

It really depends on what has happened to your patient and the environment they are in.

 

[abckidsmom]

You need to establish what the priorities are for all patients: conscious? breathing? pulse? bleeding? trauma? motivating toward a destination?

What are the priorities for moving toward a destination? SAMPLE history? Demographics?

In those test situations, it's usually safe to pick scene safety, ABC (in that order, unless it's officially changed with the test agency you're under), and from there it depends on the patient.

Oh, if it's a spinal immobilization question, the answer is check distal CNS before and after immobilizign the patient.

But like everyone else says, in real life, it all depends.

 

[94H]

In class it was Scene Safety, BSI, A-B-C, then CC

In real life...whats the problem today?

 

[Shishkabob]

Easy:


You treat the most pressing matter presented.

 

[Enigma]

You need to establish what the priorities are for all patients: conscious? breathing? pulse? bleeding? trauma? motivating toward a destination?

What are the priorities for moving toward a destination? SAMPLE history? Demographics?

.

I highly agree here and also with firetender

 

[mycrofft]

We could use a FAQ department, and the first one would be...

"How do I find the right answer for my class about this subject?"

Study your manual, ask your instructor, know your protocols.

Second one will be "What about a real scene?". Answer is : see the excellent answers above.

If you are a Star Trek fan, or not, look up "Kobayashi Maru". Sometimes there is no right order, just better and much-better. Start out by getting to the right address in one piece, make sure your scene is safe, then it's up to you and your training.

 

[Melclin]

You're looking for a single formula where none exists. At least, not to give you the exact words. But undoubtedly you have a primary survey. Start with that. DRABCD or something like it. Whether it be in class or in reality (although some instructors may have some particular language that they need to hear from you to tick a box).

D: Your safety is paramount. That means gloves. It means thinking about the look of the house when you're walking towards it, considering your exits. If you question your safety at all from your first impression then you're first words to the pt should be about that. "G'day mate, you mind if I leave this door open, its important that we be able to get our stretcher in (READ: I need to be able to bugger off if you try and stab me)". "Hello sir, now firstly, have you got anything sharp on you that might hurt me"?

R: Usually comes in the form of introducing yourself and getting a socially acceptable reply. Probably will include something like, "Hiya, I'm James and this fine looking gentlemen with me is ______. What can we do for you today?" You're then presented with a chief complaint that you investigate. If not, then you continue with your unconscious pt assessment and question bystanders while you do it.

A: This isn't just part of check list for CPR. Its conceptually important in every job. If you've noticed something that makes you worry about their airway, whether it be a puddle of vomit in their hypopharynx, a nasty stridor or a history of anaphylaxis with respiratory compromise, then question that first.

B: "Any trouble breathing at all?" is something I ask early on in many patients.

So on and so forth. I can't be arsed writing it all out, but you get the picture.

Most of all, don't get flustered and move too fast. Its not your emergency. Be calm and methodical. Something that features most commonly in letters of thanks and things that people say about us here is, "Oh they were so lovely and calm and they just walked into the room and I knew everything would be okay". That sense that everything will be okay stems from our confidence. Research suggests that people call ambulances because they lose the ability to cope with a situation that is medical in nature, not necessarily because they have a medical emergency. What they need is someone who CAN cope with that situation. Take a long, deep breath (literally, its always helps me) and move at your own pace. Its better for you and, in turn, better for your patients.

Just practice it. Again and again. Say it to yourself while you're on the toilet, walking to school, waiting for a bus. "High, my name is James what can I do for you? You have some chest pain? Anything else? Any trouble breathing or anything like that? Tell me more about the pain? How would you describe it?....."

Don't you have lecturers or instructors or whatever you call them to ask?

"How do I find the right answer for my class about this subject?"

Study your manual, ask your instructor, know your protocols.

Second one will be "What about a real scene?". Answer is : see the excellent answers above.

If you are a Star Trek fan, or not, look up "Kobayashi Maru". Sometimes there is no right order, just better and much-better. Start out by getting to the right address in one piece, make sure your scene is safe, then it's up to you and your training.

Unless you change the program so you can win it...

 

[Tommerag]

If you are looking for textbook answers to what to do for and how to react, you wont find any. No two calls are the same and every situation will require something different. Call A and Call B maybe similar, but not the same.

You could give 1 scenario to 20 different people and get 20 different answers back on what to do first.

 

[MrBrown]

Brown is not a gentleman, Brown is a Brown

That funny looking Australian bloke has the right idea, its impossible to define what kind of response each job gets, it all depends on the job.

Some fella who is in handcuffs after the coppers wrestled him to the ground and is now covered in vomit and sweat from fighting the law is going to get a different response from nana who cannot sleep at night because of her CHF who is going to get a different response from a lady trapped in her car because its been munted by a truck

 

[mycrofft]

Melclin, sometimes you gotta alter the program.

I am NOT advocating ignoring protocols and texts; , but as Haweye Pierce told Dr Hooker about "meatball surgery", "This isn't par golf, and I don't care if I have to put the ball in the hole with my knees" or some such golf metaphor.

 

[Melclin]

I am NOT advocating ignoring protocols and texts; , but as Haweye Pierce told Dr Hooker about "meatball surgery", "This isn't par golf, and I don't care if I have to put the ball in the hole with my knees" or some such golf metaphor.

Yeah, for EMS, "Changing the program" is probably a great extension of the Kobayashi Maru metaphor, as long as we steer clear of golf. We don't want people dying of boredom

That funny looking Australian bloke has the right idea, its impossible to define what kind of response each job gets, it all depends on the job.

Some fella who is in handcuffs after the coppers wrestled him to the ground and is now covered in vomit and sweat from fighting the law is going to get a different response from nana who cannot sleep at night because of her CHF who is going to get a different response from a lady trapped in her car because its been munted by a truck

Who you callin' funny lookin' ?

Munted by a truck...munt must mean something different in Kiwi.

 

[mycrofft]

At least it wasn't a cricket metaphor.

 

[82nd medic]

scene safety, bsi, triage...