Assessment
- Thread starter bdoss2006
- Start date
This is where you distinguish yourself as a clinical provider and not a chauffeur. Your care is a foundational part of the emergency medicine the patient is receiving and you are the initial point man for this care. What the patient needs is without regard for each providers scope of practice. You don't need to be a neurosurgeon to start a thorough history, but the neurosurgeon will appreciate everything you got before the patient lost the ability to communicate. You don't need to understand everything (yet), understanding comes with time and experience.
Taking a history gives you an idea of additional considerations, potential problems, and concerns to be addressed. In this case you're looking at decrease in bowel function, but someone has to get to the bottom of it - where's the holdup be it from a weekend of drugs and lack of meals, a tumor obstructing things, any number of physiologic issues, dehydration, or perhaps the issue is a plug or other object that's stuck and the patient doesn't want to tell the room full of firemen and EMT's about the issue.
Questions?
How's it going? - it's polite to ask a person how they are after greeting them
What's going on today or why'd you call? - Chief Complaint
How long has this been going on? - Onset and timing
Do you know what could have caused this? - Provokes
Has this happened before? - timing
What have you done to help with this? - care/treatment
Has or does anything make it better? worse? - care/treatment
Taking a history gives you an idea of additional considerations, potential problems, and concerns to be addressed. In this case you're looking at decrease in bowel function, but someone has to get to the bottom of it - where's the holdup be it from a weekend of drugs and lack of meals, a tumor obstructing things, any number of physiologic issues, dehydration, or perhaps the issue is a plug or other object that's stuck and the patient doesn't want to tell the room full of firemen and EMT's about the issue.
Questions?
How's it going? - it's polite to ask a person how they are after greeting them
What's going on today or why'd you call? - Chief Complaint
How long has this been going on? - Onset and timing
Do you know what could have caused this? - Provokes
Has this happened before? - timing
What have you done to help with this? - care/treatment
Has or does anything make it better? worse? - care/treatment
Asking a history on every person is where you learn.
When you have time between runs, look at the medications that the patient takes: figure out what those medications are for, and you can start figuring out the medical histories of patients without asking them.
Pay attention and learn from what you learn about their history and medications. Years ago I had an app on my phone that I could put in all the medications that someone was taking and it would tell me the side effects the combinations could cause: saved a patients life because she was in a coma and no one could figure out why....... I looked it up later that night when I had a chance and went back to the ED and talked to the doctors about her, and one of them did the same thing, and they were able to give her something to counteract the medications, and help her.
Figure out (learn); what symptoms you should expect from medical issues: you may catch something odd, because their symptoms don't make sense: what could be causing this latest problem?
When you have time between runs, look at the medications that the patient takes: figure out what those medications are for, and you can start figuring out the medical histories of patients without asking them.
Pay attention and learn from what you learn about their history and medications. Years ago I had an app on my phone that I could put in all the medications that someone was taking and it would tell me the side effects the combinations could cause: saved a patients life because she was in a coma and no one could figure out why....... I looked it up later that night when I had a chance and went back to the ED and talked to the doctors about her, and one of them did the same thing, and they were able to give her something to counteract the medications, and help her.
Figure out (learn); what symptoms you should expect from medical issues: you may catch something odd, because their symptoms don't make sense: what could be causing this latest problem?
That makes sense, but I guess what I don’t understand is why would you really need to catch something when a doctor is going to be checking them again in a short amount of time?
If you're looking for safety nets to sloth, you should look into career paths outside of medicine.
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That's a good question. It is true that most patient complaints and problems encountered in EMS are not something that you as an EMS provider can do much about. You aren't going to do anything in the prehospital phase about an obstructing tumor in the colon, a low fiber diet, chronic opioid use and/or alcohol abuse, or any of the dozens of other things that can contribute to constipation. But it isn't necessarily your job to figure out and fix whatever is bothering your patient. That's an important reality to come to grips with very early in your career.
What you can potentially do is make the patient more comfortable and learn enough about what they are dealing with to effectively communicate it to the receiving hospital staff. You could also potentially detect signs of dehydration or peritonitis or sepsis. For those things to happen, you first need to get a handle on what is really going on with the patient, which at a minimum requires a relevant history and vitals and perhaps an appropriate physical exam.
CCCSD
Forum Deputy Chief
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You just made a HUGE, potentially lethal, ASSumption. This field is not for you.
If you have training, you have standards, none of which would be to assume someone else will catch what you miss. Assess your patients, document your findings, treat and monitor as appropriate for your pay grade.
Don’t tell me this field is not for me. That is not for you to say.
CCCSD
Forum Deputy Chief
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So far…your questions and basis of your thought process are not good for any patients you may encounter.
E tank
Caution: Paralyzing Agent
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Did you let them know? That's the kind of thing they'd really want to be aware of. Prolly be really appreciative....
You don’t know the “basis of my thought process” from only a few questions. I’m just trying to ask these questions to get a full understanding of assessment, to make sure I’m giving my patients the best care possible.
E tank
Caution: Paralyzing Agent
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Well, if there would be a difference in where you would decide to bring the patient, like a trauma center v. IR neuro intervention v. cath lab/cardiac intervention center, it'd be important. If all of those things are accessible at the same place, you're correct...don't waste a lot of time teasing out subtle nuances...just load and go. Do all of you're sleuthing en route.
CCCSD
Forum Deputy Chief
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No. You are wanting to skip doing your job and are asking how to get away with it via justification.
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What I bolded is the crux of the problem. You don't understand. We can surmise this by the questions you've been asking. Along with what others have posted, here's yet another reason why you do your own assessments and gather what information you can: Doctors and Nurses at the HOSPITAL might actually need that information you have gathered (or failed to do so) because your patient might actually be at some point unable to relay that information themselves. When that happens, the DOCTORS and NURSES have to do vet medicine and that's not easy. In fact, not gathering information can actually lead to your patient having permanent disability or even suffer death because of all the additional time wasted trying to figure out what the problem is.
berkeman
Forum Lieutenant
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One reason is that the condition may be transitory, and may not present to the docs and nurses in the ED. For example, stress can be one contributor to PVCs in the heart rhythm (which you can detect with a pulse check or a simple EKG), but may resolve by the time you get to the ED.
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EMS is a lot of translating and navigating. Take their story (and other cues from their environment) and whatever objective findings you have and synthesize that into something that the busy ED can quickly and easily understand. Also finding the right the destination for your patient is IMO a big part of prehospital care.
cruiseforever
Forum Asst. Chief
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I do miss that option of a metro area. Now I only have a critical care access hospital, with higher level of care 100 miles away.