# Sick/Not Sick: A Guide to Rapid Patient Assessment



## JJR512 (Feb 22, 2011)

http://www.jblearning.com/catalog/9780763758769/

I'm wondering if any of you are familiar with this publication and can offer any opinions about it. Or if you're not directly familiar with it, what do you think about it after reviewing the description and sample cases. Is it worth buying? (I can get it on Amazon for ~$40.)

The description says it's for both experienced and inexperienced providers. I'm in the latter category. As such, I'm not necessarily looking to improve my _speed_ at this point, but rather my _quality_.


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## MrBrown (Feb 22, 2011)

Both the sample case studies are absolute rubbish and this book does not seem to be worth the paper it is printed on, which is not uncommon for AAOS.


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## Veneficus (Feb 22, 2011)

JJR512 said:


> http://www.jblearning.com/catalog/9780763758769/
> 
> I'm wondering if any of you are familiar with this publication and can offer any opinions about it. Or if you're not directly familiar with it, what do you think about it after reviewing the description and sample cases. Is it worth buying? (I can get it on Amazon for ~$40.)
> 
> The description says it's for both experienced and inexperienced providers. I'm in the latter category. As such, I'm not necessarily looking to improve my _speed_ at this point, but rather my _quality_.



Not familiar with it.

Looked at your link, it looks like a waste of money to me.


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## usalsfyre (Feb 22, 2011)

Agree looks kind of simplistic. 

I will add this, I used to think a quick "sick not sick" assessment was the core of EMS practice, and should determine whether transport was needed or not. The more you learn, the more you realize someone can be incredibly ill and not require EMS resuscitation.


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## Veneficus (Feb 22, 2011)

usalsfyre said:


> Agree looks kind of simplistic.
> 
> I will add this, I used to think a quick "sick not sick" assessment was the core of EMS practice, and should determine whether transport was needed or not. The more you learn, the more you realize someone can be incredibly ill and not require EMS resuscitation.



or look fine and be seriously ill.

http://www.emtlife.com/showthread.php?t=21618

and I didn't even charge $50 for it.


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## 46Young (Feb 22, 2011)

JJR512 said:


> http://www.jblearning.com/catalog/9780763758769/
> 
> I'm wondering if any of you are familiar with this publication and can offer any opinions about it. Or if you're not directly familiar with it, what do you think about it after reviewing the description and sample cases. Is it worth buying? (I can get it on Amazon for ~$40.)
> 
> The description says it's for both experienced and inexperienced providers. I'm in the latter category. As such, I'm not necessarily looking to improve my _speed_ at this point, but rather my _quality_.



I'm sure it can help you somewhat. 

In the meantime, just do what I do:


As you approach the pt - as you walk in the room, approach them on the street, whatever, take a good look at them. Are they sitting comfortably, standing steadily, are they doubled over in pain, are they relaxed, do they look terrified? Intorduce yourself. As you ask them how they are, note their reaction. Are they quick to respond, does it take them a few moments to reply, do they have to catch their breath between words, do they have accessory muscle use, can you hear rales, wheezing, or coughing from across the room? Can they converse with you, or do they appear altered? Anxious/combative or lethargic? 

Walk up, kneel beside them, and check their pulse while you get their chief complaint. Before they even begin to tell you anything, you have their skin CTC, and their pulse. You're not taking an actual number yet, but a quick check to see if it's regular or not, is it fast or slow, weak or bounding. 

You can tell a lot in under 30 seconds before you even get to their chief complaint. If they're SOB and can't complete a sentence, they're clutching their chest, if they're pale and sweaty, if they're profoundly weak and unsteady, if they're altered, to include combativeness/irritability or lethargy, you need to get to work. The most telling sign of perfusion is mental status. If the brain isn't getting enough O2 or glucose, for whatever reason, they'll become altered. You need to get to work. At the BLS level, why they're altered, why they're not breathing well, why they have orthostatic changes, may be above your head. You need to intervene a/p your scope, package, and be ready to deliver the pt to the medics on a chair, LSB, or Reeves, whichever is appropriate.

Get their chief complaint. Off the C/C and your findings in that first 30 seconds, you may choose to do a stroke assessment, check for orthostatic V/S changes, a temp, their BGL, etc. I'm not mentioning ALS diagnostics because your training says BLS; I'm trying to keep the assesment at that level. You're always going to get general vitals, lung sounds (do this before BP, pulse rate, etc.). A good number of our treatments depend on the pt's L/S. If the pt had a fall not attributed to tripping, or if the pt had a syncopal episode or memory gap before crashing their vehicle, strongly consider addressing their medical needs before addressing that broken arm, any lacerations that aren't bleeding copiously (that would be an apparent lifre threat), initiating spinal motion restriction if appropriate at first, of course.

Just follow that template, position the properly, get O2 and bleeding control if necessary (the need for CPR would be obvious), package right after that, and you can't go wrong.

If you have any questions regarding the above, let me know.


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## JPINFV (Feb 22, 2011)

I went through it the first time I recerted when I wasn't sure how much credit for college courses I would get. Essentially it boils down an assessment to respiration, position (sitting vs standing vs laying down, etc), skins, LOC, and pulse. Based on some simple criteria (e.g. anything but sitting or standing is "sick" for position), if there's more "sick" criteria than "non-sick" then the patient is emergent. 

In reality, it's extremely simplistic and completely inapplicable to anyone who isn't otherwise perfectly healthy. If you can perform an appropriate assessment and have any smitten of appropriate clinical decision making, then it's a complete waste of time. In short, this CME represents EVERYTHING wrong with the EMT level.


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## medicdan (Feb 22, 2011)

Did anyone start their career with the "60 second EMT"? I haven't opened the book in a while, but I remember it was a great resource for determining patient acuity quickly-- but I fear makes too many "doorway EMTs".


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## NomadicMedic (Feb 22, 2011)

The "Sick/Not Sick" model is taught to all of the King County EMTs and it's one determination used to determine if the EMT on scene can justify an ALS response.

The author of the book, Mike Helbock, is one of the King County EMS training guys.

I have the book. I'll sell you my copy cheap.


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## Akulahawk (Feb 22, 2011)

emt.dan said:


> Did anyone start their career with the "60 second EMT"? I haven't opened the book in a while, but I remember it was a great resource for determining patient acuity quickly-- but I fear makes too many "doorway EMTs".


While I didn't start my career with that book, I found it to be a good book for pointing out things... stuff to be aware of. That book had it's place and some of it's quite dated now, but it's primary goal was to get EMT and Paramedic personnel thinking and paying attention to the patient. And yes, assessment begins before you've even said "hi."


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## medicdan (Feb 22, 2011)

absolutely. I haven't looked at the book in a while, but it's tenants remain in my assessment and priorities on scene.


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## Melclin (Feb 22, 2011)

Less than useless for any vaguely competent provider. 

My first aid students could run rings around the scenarios in this book. If this thing offered anything to actual professional health care professionals I would be very worried about the level of competence. 

Honest to God, last night my first responders were doing a basic differential and risk stratification of chest pain based on risk factors, hx and DOLOR and vitals after an hour presentation. They are only a few weeks into it and they are already mostly beyond this sort of rubbish. They'd finish the case studies in five mins with no trouble and pitch into the rubbish. 

Don't get me wrong, I'm a big believer in using a patients general appearance and a basic provider (first aid and FR; they don't even have BP cuffs) instincts to get a quick and dirty impression. But this is for people who have an hour or two of training once a week and volunteer as event first aiders, CPR and badaids, not actual health care providers. But even for this very most basic level, the book really doesn't tell you anything you don't already know.


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## MrBrown (Feb 22, 2011)

Frank never did explain what DOLOR stood for mate, enlighten Brown ...


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## ffemt8978 (Feb 22, 2011)

n7lxi said:


> The "Sick/Not Sick" model is taught to all of the King County EMTs and it's one determination used to determine if the EMT on scene can justify an ALS response.
> 
> The author of the book, Mike Helbock, is one of the King County EMS training guys.
> 
> I have the book. I'll sell you my copy cheap.



The problem with that whole concept is that way too many people thought that "Not Sick" equaled "No Transport Required".  I hated the fact we were required to use it but it's starting to fall by the wayside here.


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## JPINFV (Feb 22, 2011)

Another problem is that the vast majority of patients in a nursing home would fall under the "sick" side. No, the patient with alzeimers and A-Fib does not necessarilly require an emergent trip to the hospital. Not saying that they may, but it's hardly a sure thing like that system says.


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## AndyK (Feb 24, 2011)

I think, like a few training methodologies, one needs to put the process into perspective. The S/NS thought process (as I understand it) is focused towards determining if you have time to perform prolonged field stabilisation of a Pt. or if you need to be aiming for rapid extrication and transport. 

In reality, we all formulate a "take it easy" and an "oh dear" plan for pretty much every patient, as second nature, through our own experiences. However, for new trainees, and used in conjunction with primary and secondary surveys, I can (sort of) see how this could be a useful training aid.


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## Melclin (Feb 24, 2011)

MrBrown said:


> Frank never did explain what DOLOR stood for mate, enlighten Brown ...



Its the mnemonic of choice for chest pain assessment in StJ. Description, Onset, Location, Other signs and symptoms, Reliving factors. I'm not a huge fan of mnemonics but it does seem to be the one most easy to remember.

What do you blokes use?  



> The S/NS thought process (as I understand it) is focused towards determining if you have time to perform prolonged field stabilisation of a Pt. or if you need to be aiming for rapid extrication and transport.



I just don't see the value of this in a healthcare provider because your interventions depends entirely on what kind of sick.

Sure its an alright tool for a first aider sitting at a school with his box of band aids to say, "I have no idea whats wrong with this kid, but he's big sick, I'd better call an ambulance". But in a real healthcare environment where half the pts could be considered "big sick" by this type of algorithm and there is more complexity to most presentations, I just don't see what this type of thinking really offers. 

Even in a basic provider, it just puts adds a pretty diagram and an expensive book to something they already know.


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## JPINFV (Feb 24, 2011)

Melclin said:


> Its the mnemonic of choice for chest pain assessment in StJ. Description, Onset, Location, Other signs and symptoms, Reliving factors. I'm not a huge fan of mnemonics but it does seem to be the one most easy to remember.
> 
> What do you blokes use?



OPQRST
Onset, provoked, quality, region/radiation/recurrence, severity, time.


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## AndyK (Feb 24, 2011)

Melclin said:


> Sure its an alright tool for a first aider sitting at a school with his box of band aids to say, "I have no idea whats wrong with this kid, but he's big sick, I'd better call an ambulance". But in a real healthcare environment where half the pts could be considered "big sick" by this type of algorithm and there is more complexity to most presentations, I just don't see what this type of thinking really offers.
> 
> Even in a basic provider, it just puts adds a pretty diagram and an expensive book to something they already know.



It's my understanding that the whole S/NS isn't meant for those of us who already have experience of dealing with patients, it's there as a training aid for those taking an academic, rather than the traditional "learning the trade" route into the ambulance and paramedic services and is meant to go some way to giving them a "gut instinct", for want of a better phrase, for when a Pt. is time critical.

I think you hit the nail on the head by saying it's "an alright tool" though - like anything else, it's only ever going to be as good as the person that uses it!


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## Veneficus (Feb 25, 2011)

*perspective*

You can not replace the abilties gained from experience by reading a book.

But you need an aweful lot of experience and books to figure that out.

Given that most things marketed towards US EMS from initial training texts to equipment and educational supplements are just utter trash, the bar to impress the more kowledgable/experienced providers is very high.

From what I have seen in the preveiw and the comments of providers I respect on this site. I think my impression was initially accurate.


overpriced garbage.

Yo could get a case files medicine, surgery, peds, etc which are not only cheaper but considerably more informative as they are aimed at medical providers. 

Better and cheaper, hard to beat that.


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