# A little help for the new EMT?



## ChewyEMS13 (Feb 12, 2018)

Hey y'all. So I'm about halfway through my EMT-B course, and I;m doing really well. I have a 95% in the class so far, but I am concerned a bit.. A lot of the questions on the test are quite easy, and I feel like they don't reflect the real world accurately at all. For example, I had my cousin (paramedic for AMR) test me out with a mock patient assessment. He said that the pt was complaining of 8/10 abd pain that radiates to the back. I blanked and totally forgot to ask pertinent questions. He said, "Hint: it hurts when she urinates." ... still drawing a blank. Finally he said, kidney stones, man! What a simple answer!! I am a little concerned that my school isn't properly preparing me for the "real world"

Any advice any of you guys have is welcome.


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## mgr22 (Feb 12, 2018)

To what extent can any school adequately prepare you for the real world? Not much. Your EMT course just gives you a foundation for continuing your education in the field. For now, concentrate on passing. The real world will make more sense after you've been in it for a while.


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## DrParasite (Feb 12, 2018)

ehhh, speaking from experience, I didn't have any abd pain when I had my first stone.  well, other than the extreme nausea and vomiting, but it was mostly back pain.  I was grossly diaphoretic, extreme back pain (which sucked, but after 15 years in EMS, i thought i just twisted wrong), and nausea.....  TBH, I was worried I was having an MI or a AAA or something more serious.  kidney stones were the last thing on my mind, until one of my fellow EMT instructors suggested it.

good pertinent question to add to your assessment: are you pooping and peeing normally?

don't worry, the more patients you assess, the better you will get at differential diagnosis and what questions  you need to ask when.


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## Flying (Feb 12, 2018)

EMT class probably won't prepare you for the real world in full, it's too different. You should come out of the class able to do the minimums of the job and be able to see and learn further.


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## ChewyEMS13 (Feb 12, 2018)

mgr22 said:


> To what extent can any school adequately prepare you for the real world? Not much. Your EMT course just gives you a foundation for continuing your education in the field. For now, concentrate on passing. The real world will make more sense after you've been in it for a while.



I guess I just wanted to stand out from other new EMTs. Be keen and aware of things most new guys(gals) aren't so that I wouldn't "annoy" my future partner. I don't want to be "that guy", y'know?


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## ChewyEMS13 (Feb 12, 2018)

DrParasite said:


> ehhh, speaking from experience, I didn't have any abd pain when I had my first stone.  well, other than the extreme nausea and vomiting, but it was mostly back pain.  I was grossly diaphoretic, extreme back pain (which sucked, but after 15 years in EMS, i thought i just twisted wrong), and nausea.....  TBH, I was worried I was having an MI or a AAA or something more serious.  kidney stones were the last thing on my mind, until one of my fellow EMT instructors suggested it.
> 
> good pertinent question to add to your assessment: are you pooping and peeing normally?
> 
> don't worry, the more patients you assess, the better you will get at differential diagnosis and what questions  you need to ask when.



Ugh.. I have seen relatives go through kidney stones, and it looks like a real pain.. literally.. I was just thinking of all the things that could possibly be the cause of an acute abdomen, which as you know, there are countless


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## luke_31 (Feb 12, 2018)

ChewyEMS13 said:


> I guess I just wanted to stand out from other new EMTs. Be keen and aware of things most new guys(gals) aren't so that I wouldn't "annoy" my future partner. I don't want to be "that guy", y'know?


You're going to be "that guy" when you first get your patch no matter what. It takes seeing multiple patients to start to become proficient in assessments and differential diagnoses. If you start out acting like you know what the job is and everything about the job, you will be known as the "I know it all and don't need to learn anything guy". Believe me it's better to be the guy who knows he doesn't know more than the basics of what to do guy in the beginning.  If your future partner is annoyed with having a new guy, that's their issue. The learning doesn't stop when class ends and you get your patch. The patch signifies that your learning is just beginning. The only reason some of us on the board and in person seem like we know it all is, we've been doing this job for years and have lots of experience, but ask anyone of us and we would all tell you there are things we still need to look up and things that we know are still our weak areas to work on.


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## ChewyEMS13 (Feb 12, 2018)

luke_31 said:


> You're going to be "that guy" when you first get your patch no matter what. It takes seeing multiple patients to start to become proficient in assessments and differential diagnoses. If you start out acting like you know what the job is and everything about the job, you will be known as the "I know it all and don't need to learn anything guy". Believe me it's better to be the guy who knows he doesn't know more than the basics of what to do guy in the beginning.  If your future partner is annoyed with having a new guy, that's their issue. The learning doesn't stop when class ends and you get your patch. The patch signifies that your learning is just beginning. The only reason some of us on the board and in person seem like we know it all is, we've been doing this job for years and have lots of experience, but ask anyone of us and we would all tell you there are things we still need to look up and things that we know are still our weak areas to work on.



That helps a lot. Thank you! I know that there is a lot to learn, and I know i'm going to be a white belt at this for a while. The responsibility of having the health of another person in your hands is both exhilarating and terrifying at the same time. I love it already.


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## Kevinf (Feb 13, 2018)

ChewyEMS13 said:


> Hey y'all. So I'm about halfway through my EMT-B course, and I;m doing really well. I have a 95% in the class so far, but I am concerned a bit.. A lot of the questions on the test are quite easy, and I feel like they don't reflect the real world accurately at all. For example, I had my cousin (paramedic for AMR) test me out with a mock patient assessment. He said that the pt was complaining of 8/10 abd pain that radiates to the back. I blanked and totally forgot to ask pertinent questions. He said, "Hint: it hurts when she urinates." ... still drawing a blank. Finally he said, kidney stones, man! What a simple answer!! I am a little concerned that my school isn't properly preparing me for the "real world"
> 
> Any advice any of you guys have is welcome.




Many of your patients will have forgotten to read the same book you did. Let's try this scenario and see what you think:

Pt complaint of lower back pain, generalized achiness/fatigue, poor urine output, and severe headache for the last 24 hours.


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## ChewyEMS13 (Feb 13, 2018)

Kevinf said:


> Pt complaint of lower back pain, generalized achiness/fatigue, poor urine output, and severe headache for the last 24 hours.



I would ask how much water the pt has drank in the past day or so. Does the back pain radiate, or is it localized? Does the headache get aggravated with certain positions? What is the color and smell of the urine?


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## StCEMT (Feb 13, 2018)

No decent partner will care that you are new. They will care if you are new and start displaying all the negative stereotypes while not being functional in basic tasks or striving to improve yourself. Helping a new person learn is different than baby sitting incompetence. Ask questions, learn from your partner(s) & hospital staff, and think things through. Do that and you will be fine.


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## Kevinf (Feb 13, 2018)

ChewyEMS13 said:


> I would ask how much water the pt has drank in the past day or so. Does the back pain radiate, or is it localized? Does the headache get aggravated with certain positions? What is the color and smell of the urine?



Normal fluid intake. The most severe pain is localized to lumbar region radiating to flanks. Headache is constant. Urine is darker than usual. Vitals WNL. Patient is a fit male in his early 30's. States he's "feeling like an old man" due to joint pain/stiffness and aching all over.

Regarding partners, the only time I've seen anyone new get flak is after they gain a reputation for being "unteachable", whether that be by thinking they know everything or by not retaining anything.


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## ChewyEMS13 (Feb 13, 2018)

Kevinf said:


> Normal fluid intake. The most severe pain is localized to lumbar region radiating to flanks. Headache is constant. Urine is darker than usual. Vitals WNL. Patient is a fit male in his early 30's. States he's "feeling like an old man" due to joint pain/stiffness and aching all over.
> 
> Regarding partners, the only time I've seen anyone new get flak is after they gain a reputation for being "unteachable", whether that be by thinking they know everything or by not retaining anything.



Renal failure of some sort? That would be my best guess. My next question would be if he's had any kidney problems, but from the info I'm hearing now, I'd go with kidney failure of some degree


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## AZEMSPRO (Feb 13, 2018)

The NREMT is a National Certification. Your state will have different protocols for a lot of things and your Medical Director can allow you to do certain things you didnt learn in school. EMT-B is exactly what what the class is, Basic. Your basically only learning ABCs and a little prevention. Everything else you will learn in the field over time.


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## Trvlr (Feb 13, 2018)

DrParasite said:


> ehhh, speaking from experience, I didn't have any abd pain when I had my first stone.  well, other than the extreme nausea and vomiting, but it was mostly back pain.  I was grossly diaphoretic, extreme back pain (which sucked, but after 15 years in EMS, i thought i just twisted wrong), and nausea.....  TBH, I was worried I was having an MI or a AAA or something more serious.  kidney stones were the last thing on my mind, until one of my fellow EMT instructors suggested it.



I've had kidney stones twice, first time felt like someone stabbed me, I dropped to my knees and vomited. I was leaning more toward appendicitis, second one wasn't near as bad.


For Chewy:  Another note is not all patients will have the same symptoms for the same illness. Some people will have different pain tolerances, or their body copes better. We were taught in my class that we really can't diagnose abdominal pain, we can just try to rule out certain things, make them comfortable, and transport. In my area most of the time this would become an ALS call so we'd have a Medic riding with us to the hospital.


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## ChewyEMS13 (Feb 13, 2018)

AZEMSPRO said:


> EMT-B is exactly what what the class is, Basic. Your basically only learning ABCs and a little prevention. Everything else you will learn in the field over time.



That's kinda what I figured. It just seems like the class is "indirectly" saying that we should know all the pathology associated with the different organ systems _because _we have to diagnose them. We spend more time on pathology than we do treatment and such. Maybe I am reading the class wrong. And like I said before, it's because I want to be the best EMT that I can be, so I am a little bit knowledge hungry


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## AZEMSPRO (Feb 13, 2018)

ChewyEMS13 said:


> That's kinda what I figured. It just seems like the class is "indirectly" saying that we should know all the pathology associated with the different organ systems _because _we have to diagnose them. We spend more time on pathology than we do treatment and such. Maybe I am reading the class wrong. And like I said before, it's because I want to be the best EMT that I can be, so I am a little bit knowledge hungry



We don't Technically "Diagnose" but I know what you mean. The best thing I learned in class is to form a Study Group. Trust me it goes a long way. If you don't understand something then ask the instructor. They want you to ask questions because they aren't there to try and get you to fail, they want you to succeed. Everyone learns differently.

What Chapter are you on?


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## ChewyEMS13 (Feb 13, 2018)

AZEMSPRO said:


> What Chapter are you on?



We just finished Medical. We ended last class on Trauma Overview and Soft Tissue Injuries


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## ChewyEMS13 (Feb 13, 2018)

@AZEMSPRO 

Our entire class is 7 weeks. We are 3 weeks in. This Thursday we start our 4th week and have midterms


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## AZEMSPRO (Feb 13, 2018)

Damn, your in an accelerated class. lol Mine is a semester long and we just finished Chapter 13 BLS Resuscitation. What I like to do is go on pintrest and just search EMT, lots of good stuff there.


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## ChewyEMS13 (Feb 13, 2018)

@AZEMSPRO 

Yeah, you're telling me. BLS was a fun chapter! In all honestly, chapters 15 and 16 were the toughest. It is the respiratory emergency and cardiovascular emergency chapters.


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## AZEMSPRO (Feb 13, 2018)

Ya, im not looking forward to it.


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## ChewyEMS13 (Feb 13, 2018)

@AZEMSPRO 

To be honest, the thing that got me through the chapters was anatomy and physiology. I knew those like the back of my hand because I read chapter 6 so many times. A&P helped tremendously. If you know what you start out with, it was super easy to understand the pathology behind any underlying disease. Where I struggle is matching the signs & symptoms up with each certain diseases because so many of them seem to overlap. If you want, you can PM me and we can have an over-the-computer study sesh. I am always down with studying


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## Kevinf (Feb 13, 2018)

ChewyEMS13 said:


> Renal failure of some sort? That would be my best guess. My next question would be if he's had any kidney problems, but from the info I'm hearing now, I'd go with kidney failure of some degree



*Food poisoning*; E. Coli from a bad salad. No nausea/vomiting or diarrhea. The back pain and decreased urine output was referred kidney pain from the bacteria affecting the kidneys. Asking about last oral intake could have been helpful here. Any uncooked foods (salad, ice cream) in the last 24-48 hours should put food poisoning into your differential depending on their symptoms.


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## VentMonkey (Feb 13, 2018)

This question seems to be asked fairly frequently. The main pointers rarely change.

Have a mind like a sponge, skin like a rhinoceros, and gallons of humility. Do you have to have these things? No, but if you want to last any amount of time doing this, then those are the key pointers that got me, and those I’d trust my family with through.

Someone always knows more, or is better; a lot of the times it’s simply their own accord, the rest is based solely on the providers actions. The latter being the providers that I Iearned, and grew from the most. The “two ears, one mouth” thing holds true in so many invaluable ways. Don’t be a storyteller, be a story maker.

Like others have mentioned, there’s nothing wrong with being new. There’s also nothing wrong with being labeled because guess what? You will always be labeled to someone something other than what you’d consider yourself so what’s it really matter to you?

The best clinicians are perpetual students, and listen to the actions of the mentors before them. To me, mentors serve as the bar, or example, so again, way less talking than actions. 

These guys and gals spend more time doing and learning, and so much less time talking about what they would or would not do. 

As far as your scenario, well if I didn’t have patient presentations that didn’t/ don’t stump me...again, goes back to the humility thing, right? How else would you truly “learn” pathologies and the like? 

Like someone else mentioned we’re almost always looking up things constantly. So sure, some providers might say “ah, ok kidney stones” and stop there. Others might be more inclined to want to say “I wonder what else it _could_ be, and/ or what else would cause things such as kidney stones?...”

You will never know every single underlying dx regardless of your training, but if you know where to look you’ll learn root causes and the branches that they might spawn. Good luck.


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## ChewyEMS13 (Feb 13, 2018)

Kevinf said:


> *Food poisoning*; E. Coli from a bad salad. No nausea/vomiting or diarrhea. The back pain and decreased urine output was referred kidney pain from the bacteria affecting the kidneys. Asking about last oral intake could have been helpful here. Any uncooked foods (salad, ice cream) in the last 24-48 hours should put food poisoning into your differential depending on their symptoms.



Yeah, that's straight from SAMPLE history. I am feeling like what y'all said about more practice hones skills, but isn't food poisoning super obvious? I guess I should realize that SAMPLE history, OPQRST, and PASTE are focused on in the book for a reason.. lol


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## ChewyEMS13 (Feb 13, 2018)

VentMonkey said:


> Have a mind like a sponge, skin like a rhinoceros, and gallons of humility.



I like this a lot. This is a really good piece of advice. Thank you for that!



VentMonkey said:


> Like others have mentioned, there’s nothing wrong with being new.



And this.. It settles me that experienced people like yourselves view beginners in this light. I guess I was just worried that the experienced EMTs and Medics were going to expect me to know all this stuff. It takes a big weight off my shoulders just knowing that I'm not expected to come out of EMT-B school with vast and photographic-esque knowledge of every underlying pathology to every Dx. I think that was the biggest thing worrying me.. I don't have to lead a BLS truck right after EMT-B school, and honestly, that was the impression I was getting


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## ChewyEMS13 (Feb 13, 2018)

Kevinf said:


> Any uncooked foods (salad, ice cream) in the last 24-48 hours should put food poisoning into your differential depending on their symptoms.



This actually (after playing around with it in my head) makes absolute sense. My route that led me to the kidneys was correct, but why was the kidney affected in this way? It does actually make sense in my head now. This actually helped me a lot. I really appreciate that mini-scenario


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## Kevinf (Feb 13, 2018)

E. coli can cause kidney dysfunction and/or bloody diarrhea. Both are potentially serious complications. Not all food poisoning leads to nausea/vomiting. That's where gathering a good history comes in to help your differential when the patient has an atypical or vague presentation (ex, what the patient thought was muscular back pain was actually kidney pain).


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## ChewyEMS13 (Feb 13, 2018)

Kevinf said:


> E. coli can cause kidney dysfunction and/or bloody diarrhea. Both are potentially serious complications. Not all food poisoning leads to nausea/vomiting. That's where gathering a good history comes in to help your differential when the patient has an atypical or vague presentation.



Would E. Coli present with a fever as well, or not often? I'm assuming since it's a bacterial infection


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## VentMonkey (Feb 13, 2018)

Kevinf said:


> E. coli can cause kidney dysfunction and/or bloody diarrhea. Both are potentially serious complications.


Yep. OP, look up hemolytic uremic syndrome (HUS). That’s essentially what @Kevinf is referring to; or at least a variant of. I had this as a kid, and was not fun. It took several specialists to figure out what exactly the dealie-yo was.

Side note: nothing scarier to a parent than their kid receiving a blood transfusion in the early 90’s.


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## ChewyEMS13 (Feb 13, 2018)

VentMonkey said:


> Yep. OP, look up hemolytic uremic syndrome (HUS). That’s essentially what @Kevinf is referring to; or at least a variant of. I had this as a kid, and was not fun. It took several specialists to figure out what exactly the dealie-yo was.
> 
> Side note: nothing scarier to a parent than their kid receiving a blood transfusion in the early 90’s.



Dang! That wasn't in the Orange book xD


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## AZEMSPRO (Feb 16, 2018)

ChewyEMS13 said:


> @AZEMSPRO
> 
> Our entire class is 7 weeks. We are 3 weeks in. This Thursday we start our 4th week and have midterms


Where are you going to school?


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## MSDeltaFlt (Feb 18, 2018)

ChewyEMS13 said:


> Hey y'all. So I'm about halfway through my EMT-B course, and I;m doing really well. I have a 95% in the class so far, but I am concerned a bit.. A lot of the questions on the test are quite easy, and I feel like they don't reflect the real world accurately at all. For example, I had my cousin (paramedic for AMR) test me out with a mock patient assessment. He said that the pt was complaining of 8/10 abd pain that radiates to the back. I blanked and totally forgot to ask pertinent questions. He said, "Hint: it hurts when she urinates." ... still drawing a blank. Finally he said, kidney stones, man! What a simple answer!! I am a little concerned that my school isn't properly preparing me for the "real world"
> 
> Any advice any of you guys have is welcome.



Here's the deal about EMT school.  The school isn't long enough to be able to teach you about each and every situation.  So they only have enough time to cover the worst case scenarios.  If you'll look at your check off sheets they won't cover stones.  All pain concerning the torso will require lots of oxygen and rapid transport (P.U.H.A.)/call for ALS intercept.

See, there is so much more to abdominal pain than a one semester school can truly cover.  Is it an aneurysm?  Do they have kidney stones?  Are they having a heart attack?  Are they having a small bowel obstruction?  Bladder infection?  Pregnant (if female)?  Acid reflux?  Did they eat too much spicy food and now they have the "bam-beetus of the blow hole"?  

There's just too much to cover.  So National Registry wants to you get them to higher level of c are (hospital or prehospital) as quickly as possible.

So don't sweat it too much just yet.  You're just now getting started.  Like what's already been stated repeatedly, be a sponge, be humble, and ask questions.


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## EMTlash (Mar 15, 2018)

DrParasite said:


> ehhh, speaking from experience, I didn't have any abd pain when I had my first stone.  well, other than the extreme nausea and vomiting, but it was mostly back pain.  I was grossly diaphoretic, extreme back pain (which sucked, but after 15 years in EMS, i thought i just twisted wrong), and nausea.....  TBH, I was worried I was having an MI or a AAA or something more serious.  kidney stones were the last thing on my mind, until one of my fellow EMT instructors suggested it.
> 
> good pertinent question to add to your assessment: are you pooping and peeing normally?
> 
> don't worry, the more patients you assess, the better you will get at differential diagnosis and what questions  you need to ask when.


I thought he was going for a UTI gone Kidney Infection, since kidney stones are really an emergency but again anything could be an emergency I guess ).


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