BLS Skills -- What Should We Add?

[Veneficus]

yes it is. spelling is not my forte.

also i think the pathophysiology of the interventions we take would be helpful so that we can obtain some critical thinking skills. thankfully my preceptors helped me with that.

I do not understand this.

Pathophysiology is the the study of disease mechanisms.

"Pathophysiology of the interventions we take" would mean the mechanisms of the disease we cause.

I don't think your preceptors helped you as much as you think.

 

[EMT B]

pathophysiology was defined to me as the study of changes in the bodys normal functions due to some outside factor. Also someone asked for examples to my previous statement. Teacher stated respiratory distress could be caused by pulmonary edema, pulmonary embolism, chf, asthma, copd, etc. but he never talked about WHY it could have been those things. My preceptors helped because i asked them about it.

 

[Veneficus]

pathophysiology was defined to me as the study of changes in the bodys normal functions due to some outside factor..

Not correct.

Most of the factors are intrinsic, easy ones to name are autoimmune diseases and cancer.

Even asterosclerosis is a defect of human metabolic evolution. Making it instrinsic.

Multiple causes of CHF are instrinsic, like cardiomyopathy. Actually the only external factors I can think of for heart disease are trauma, poisoning, and infection.

 

[Veneficus]

Not to worry, hang around here and we will sort you out.

 

[NYMedic828]

respiratory distress exasorbated by dry air.

Does not warrant the administration of supplemental oxygen.

If someone is "suffering" respiratory distress secondary to "dry air" administering oxygen will only further exacerbate the condition.

The underlying cause is discomfort, not hypoxia or decreased FiO2. The environmental air being inhaled by that patient still contains 20.9% oxygen and as long as their oxygen saturation is sufficient and no factors of your assessment reveal hypoxia oxygen supplementation is not indicated.

The only time supplemental oxygen is indicated is in the presence of presumed hypoxia. Asthma, pulmonary edema, COPD are probably the most common that we see out of hospital. Believe it or not oxygen is actually not indicated and furthermore completely useless in the treatment of ischemic or hemorrhagic conditions such as CVA/MI/Trauma (as long as pulmonary function is not impaired). If the body can maintain adequate SpO2 then giving more oxygen won't have any effect as you cannot raise PaO2 without increasing pressure.

 

[EMT B]

i was thinking more along the lines of the elderly living in a nursing home (since that makes up about 90% of the calls in my area).

 

[NYMedic828]

i was thinking more along the lines of the elderly living in a nursing home (since that makes up about 90% of the calls in my area).

But what is wrong with them that they have called for EMS?

 

[Christopher]

How is specious limitations in scope without special permission any different than any other specious limitation in scope of practice? Seriously, what the heck kind of "real medical provider" relies on a machine interpretation for a STEMI AND online permission to transport to a STEMI center (orthopedic surgeons excluded)?

Limiting BGL acquisition to ALS because it is "invasive" is by definition specious.

Relying on online permission to transport to a STEMI center is also specious. Machine interpretation of STEMI...if your providers aren't educated then perhaps this is a reasonable bridge to an appropriate model of care. That being said, if you're a paramedic in 2013 (weee) and can't read a 12-Lead for at least a STEMI, you're actually an EMT-Intermediate.

Thankfully those are not my reality. We use "permission" for above and beyond, not the "bottom line". We're also not geared towards the lowest common denominator...so it isn't like I do not see where you're coming from.

 

[EMT B]

But what is wrong with them that they have called for EMS?

respiratory distress <.<

 

[EMT B]

nurse was lazy and figured sending them to the ed for a few hours would get her a break.

*cna

 

[NYMedic828]

Nurse was lazy and figured sending them to the ED for a few hours would get her a break.

O stopppp that never happens...

respiratory distress <.<

Ok, but why? If "dry air" is the cause, odds are they for one can't live in that environment and what do you think your most effective treatment for this problem is as the immediate care provider?

 

[EMT B]

buy them a humidifier

 

[STXmedic]

respiratory distress exasorbated by dry air.

 

[Veneficus]

*cna

Don't pretend like that never happens.

O stopppp that never happens...

There is another reason they send people out? :lol:

 

[Handsome Robb]

yes it is. spelling is not my forte.

also i think the pathophysiology of the interventions we take would be helpful so that we can obtain some critical thinking skills. thankfully my preceptors helped me with that.

Referring to medications you'd be looking for pharmacokinetics and pharmacodynamics, not pathophysiology.

Like Vene said, pathophysiology is basically the study of disease processes.

 

[NYMedic828]

buy them a humidifier

So then the answer is not to transport them to the hospital on humidified oxygen now is it? :blush:

Administering oxygen over 20.9% has repercussions, especially in elderly populations whose bodies are no longer capable of adequate anti-oxidation.

So in summary you have answered the question. They need a humidifier or they need to be removed from that environment. A bedroom humidifier does not supplement humidified oxygen. It humidifies environmental air and it solves the problem.

By this means, we have created a solution while not administering a drug to the patient in order to do it. Always a win.

Don't pretend like that never happens.



There is another reason they send people out? :lol:

 

[NomadicMedic]

Okay gang... This is starting to get a little off topic. Lets get back to the discussion at hand.

There have been some good sidebars here. If anyone would like to expand on them, please feel free to start a new topic.

 

[Veneficus]

How fast do you think granny could suck down a 60 minute bottle? :lol:

I was thinking more alonfg the lines of just wraping her in a blanket and turning on the AC

 

[mycrofft]

1. Ask a panel of MD's what more data could they use from prehospital providers.
2. From that list, ask what simple measures could be protocolled (word trademarked:lol profitably for prehospital use by techs, probably the same as family members can do, but they need to make a difference.
3. Then draw up protocols and test them.

I'm not sure BLS needs pulse-ox. Fingerstick glucometry would be a good thing to record, but oral sugar can be given presumptively; if parenteral sugar is needed, isn't that above basic?

 

[NYMedic828]

I'm not sure BLS needs pulse-ox. Fingerstick glucometry would be a good thing to record, but oral sugar can be given presumptively; if parenteral sugar is needed, isn't that above basic?

I think it is valuable for how simple it is to evaluate but at the same time I think 1/10 EMTs (if even) actually understand what they are measuring.

Furthermore, in my experience it is irrelevant to most EMTs treatment. Half the time they get an O2 sat of 98-100% and I still walk in to find the patient on oxygen.

Worse still, they check baseline saturation while the patient is on oxygen.


Side note, I know more than a handful of paramedics who are equally bad...