A little help for the new EMT?

OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
@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.
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
@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
 

Kevinf

Forum Captain
350
131
43
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.
 

VentMonkey

Keyboard Warrior
Premium Member
4,910
3,999
113
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.
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
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
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
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!

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
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
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
 

Kevinf

Forum Captain
350
131
43
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).
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
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
 

VentMonkey

Keyboard Warrior
Premium Member
4,910
3,999
113
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:).
 
OP
ChewyEMS13

ChewyEMS13

Forum Crew Member
73
13
8
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
 

MSDeltaFlt

RRT/NRP
1,420
32
48
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.
 

EMTlash

Forum Probie
13
3
3
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 :)).
 

Top