Assessment Questions

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281mustang

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I've been out of school for quite a while but have an interview/scenario scheduled with a department tomorrow. I have a couple questions.

1. How soon can you leave the scene if the pt is in shock? Does the rapid trauma assessment really need to be completed prior to leaving?

2. Regarding the sequence of events, is it acceptable to obtain an OPQRST right after a SAMPLE?

Thanks!
 
1. Not all shock is trauma. As far as the time, ASAP once the hospital is determined to be closer than paramedics.
2. OPQRST would actually fall under the "S" of SAMPLE.
 
Thanks for the reply. I have one additional question, if I leave the scene early with an unconscious pt, how would I go about obtaining the SAMPLE? Should I just verbalize that I would bring a family member with me?
 
281mustang said:
Thanks for the reply. I have one additional question, if I leave the scene early with an unconscious pt, how would I go about obtaining the SAMPLE? Should I just verbalize that I would bring a family member with me?
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Even if you load and go quite quickly with a critical patient you can still take a small amount of time to get a basic history from family. Hopefully this avoids something like scooping and running hot to the hospital with an unconscious type I diabetic who just took his insulin and didn't eat. A SAMPLE history (and you should really aim for more than this) takes <30 seconds to acquire in many cases.
 
281mustang said:
Thanks for the reply. I have one additional question, if I leave the scene early with an unconscious pt, how would I go about obtaining the SAMPLE? Should I just verbalize that I would bring a family member with me?
Click to expand...
I would attempt to obtain SAMPLE from friends and family. If the patient was at home, check bathroom for medicine, check fridge for any notes or anything in fridge. Sometimes patient have SAMPLE written on them somehow or bits of it like a medical alert bracelet. Could check phone for ICE (in case of emergency) contacts. I wouldn't be too detailed about it in a test, it's understandable that a SAMPLE cannot always be obtained. They'll more likely be interested that you know what SAMPLE means rather than all the ways you can attempt to obtain it.
 
chaz90 said:
Even if you load and go quite quickly with a critical patient you can still take a small amount of time to get a basic history from family. Hopefully this avoids something like scooping and running hot to the hospital with an unconscious type I diabetic who just took his insulin and didn't eat. A SAMPLE history (and you should really aim for more than this) takes <30 seconds to acquire in many cases.
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What are you expecting an EMT to do with an unconscious type 1 diabetic?
 
281mustang said:
Thanks for the reply. I have one additional question, if I leave the scene early with an unconscious pt, how would I go about obtaining the SAMPLE? Should I just verbalize that I would bring a family member with me?
Click to expand...
You can always ask questions while loading the patient.
 
JPINFV said:
What are you expecting an EMT to do with an unconscious type 1 diabetic?
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At least recognize the most likely cause and not run screaming to the hospital in a tizzy. Yes, a trip to the hospital is certainly in order if no ALS is close, but they should probably be able to give the ED a heads up on likely etiology beyond "we saw a sick, unconscious patient so we scooped and ran." Like I said, it wouldn't take long to get a basic history from the family and then initiate transport.

Yes, I am also aware that the ED would clearly be getting a BGL quickly and come to the same conclusion if BLS didn't pass it along.
 
JPINFV said:
You can always ask questions while loading the patient.
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I was thinking the same thing. Get the information you need and start your assessment/treatment while you start the loading process.
 
Don't say to a family member "Follow us there" if you are depending upon them to give hx at the hosp because they will likely be shuttled off to Waiting and Admissions, and have have their car towed. Bring 'em if possible and advisable Next best: get their cell number for ER to call.

If you had forty five seconds (say, pt has coded and your co-wroker is doing CPR), what family or bystander hx would get you the most bang for for buck ?
My vote:

1. What happened (second best: pre-extant conditions. Obvious need)
2. Allergies. (So you don't kill them, maybe)
3. Meds. (Ditto)
4. THEN pt name. (Billing and pt relationship)
5. THEN informant's name and phone. (Reaffirm data, maybe call police if it is abuse or crime)
 
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Or we just need to slow down and take a few minutes to get the information that we need rather than rushing around like chickens with their heads cutoff.
 
Robb said:
Or we just need to slow down and take a few minutes to get the information that we need rather than rushing around like chickens with their heads cutoff.
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Actually….yep.
 
If the patient has coded, you've got all kinds of time to get information. We usually hang out on scene to work em.
 
The time-honored practice in these cases is to start immediately packaging and talk as you go. Unless they collapsed two feet from your rear doors, there's usually ample time to figure out the essentials while you lift and buckle.

This goes under the principle that the greatest BLS medicine is information. You do want this info to pass along (and maybe to guide your choice of destination). But you're probably not going to administer different interventions on scene, hence you might as well start moving ASAP. The medics MAY treat it on scene, so that's a bit different.

The only caveat is you sometimes manage to escape before asking something you wish you had. Bring family.
 
DEmedic said:
If the patient has coded, you've got all kinds of time to get information. We usually hang out on scene to work em.
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Somehow I had this image mentally of two EMT-Bs without ALS along. If you can do something in the interim, then yeah. If all yo can do has been done and the next step is to boogy, then, maybe not so much.

How about multiple casualty cases or just a patient with a descending LOC? Time to get hx is a-tickin'.
 
Just do your best and what's in the best interest of the patient and you'll be fine.
 
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