a rhetorical question

[abckidsmom]

I didn't suggest advanced heart sounds,

but I don't think: "That sounds abnormal" is requiring too much.

For lungs I expect better.

But if you could skillfully listen to heart sounds, wouldn't that make you a very skilled (and therefore respected and valuable) EMT?

Not necessarily. A skilled EMT is one who can control a scene, make a few decisions, and work with people to bridge them into the health care system. If they can hear mitral regurg, great, but it's not going to really effect things that dramatically, beyond being very cool and improving the image of the EMT in the eyes of the ED staff.

An EMT can have all the exam skills in the universe, but if they can't manage the people, they're useless in their role.

 

[JPINFV]

An EMT can have all the exam skills in the universe, but if they can't manage the people, they're useless in their role.

Knowledge without power is impotent.
Power without knowledge is dangerous.

Besides, who wants to go into neurology?

 

[mycrofft]

Knowledge without power is the path to doing something regretful.

...because we never know as much as we think we do.

That said, what actual pragmatic value to an EMT-B would knowing heart sounds and the different between a rale and a rhoncus be? (Wheeze versus stridor I know can be important and of use, but they hardly even need a steth for those). I'm ignorant, but are there devices or meds they can use, the selection of which is affected by those findings?

I'm in favor of inquiring individuals learning all they can, and of services to train their folks all they can, but EMT is still predicated on getting shoals of trained people out quick, so the left side of the bell curve (not as adept) will still get more certificates than maybe it ought to.

 

[Veneficus]

...because we never know as much as we think we do.

That said, what actual pragmatic value to an EMT-B would knowing heart sounds and the different between a rale and a rhoncus be? (Wheeze versus stridor I know can be important and of use, but they hardly even need a steth for those). I'm ignorant, but are there devices or meds they can use, the selection of which is affected by those findings?

I'm in favor of inquiring individuals learning all they can, and of services to train their folks all they can, but EMT is still predicated on getting shoals of trained people out quick, so the left side of the bell curve (not as adept) will still get more certificates than maybe it ought to.

I was thinking that knowledge, competence, and skill lead to respect, which is the first step towards becomming a true profession.

But as of late I have seen a lot of protocol nazis (common EMS term in no way associated with godwins law) posting. If the the direction EMS providers want to take is mindless laborer, why should I expend anymore effort trying to convince them otherwise? It has no effect on me.

Let them receive all that they wish for in abundance.

 

[mycrofft]

Robert Townsend had it right (Up The Organization)

To condense and paraphrase, don't rave and brag about making things better, dig in and make your corner of it better.

When you wheel into the ED with the patient appropriately treated and alive, the report and hand off smooth and without showboating, all without swagger and lifting a few hemostats on the way out, in time they will notice the excellence.

To the employer, you will be in need of less supervision and thus will suffer less of their attentions, good or bad.

Since the system is predicated upon mass training and matriculation, you will be thought of subconsciously as a good cotton picker, not just a cotton picker.

Personally, train and go past technician slots, into the professional aspects of health care and admin, then help those behind you.

 

[Brandon O]

...because we never know as much as we think we do.

That said, what actual pragmatic value to an EMT-B would knowing heart sounds and the different between a rale and a rhoncus be? (Wheeze versus stridor I know can be important and of use, but they hardly even need a steth for those). I'm ignorant, but are there devices or meds they can use, the selection of which is affected by those findings?

We give nebulized albuterol here. But in most areas EMTs can assist with inhalers.

CPAP is becoming BLS in a few places.

Lung sounds can help distinguish between cardiac and respiratory etiologies, which can affect a number of decisions.

Noting ronchi could affect a diagnosis -- for instance, in the context of apparent fever, tachycardia, and borderline hypotension, it might support a suspicion for sepsis, causing you to escalate your care.

Rales could affect how you choose to position the patient.

Just some thoughts.

 

[mycrofft]

Brandon Oto, thanks for your answer.

Rhetorically speaking of course.

 

[Handsome Robb]

lub dub, lub dub, lub dub. I wont stand here and say that I know a whole boatload about heart tones but I can sure as hell tell you "normal vs. abnormal". It is one of my things on my list to do some more reading on when I have time, right now between studying for school and working 48hrs/week I truly don't have time.