Really? Like what? Let's take the case of a pt with Guillian-Barre Syndrome. Their only presenting symptom is some weakness to the lower extremities. No other problems. And no changes during transport. Beyond recognition, what magical treatement will YOU do?
OK, enough of the picking on people.
GB has some outlandish symptoms. The last pt I saw with it c/c was "falling down." Sometime in medic class (at least us non medic mill instructors) do teach some physio and patho physio, so when these outlandish symptoms appear medics are not at a loss for ideas. Often my students complain about me giving them too much in class.
The knowledge that this stuff is out there and "could be" what the patient has makes a big difference in pt advocacy. Especially when giving a report to the hospital. It causes providers to overtriage rather than undertriage. (ie err on the side of caution) The glimpse of how much there is to know breaks the "I passed class with a 100% and I know it all" mentality.
Everyone talks about how a good basic can assess for these things as well as a good medic. I call BS. Theorhetical knowledge must be used in conjunction with physical exam techniques in order to be effective. You have to know what is "normal" just as well as what is grossly abnormal. the higher your medical education the more detailed the history you look for.
For brevity allow me to cite one example: When was your last oral intake? What was it? How often do you eat? What do you eat? Do you defecate regularly? What is the consistency? The color? Has it changed? Rapid weight loss or gain?
that is way more information than the "L" in SAMPLE.
Used with your knowledge of nutrition, physiology, and patho phys,along with the signs and symptoms presented gives you a very accurate picture of what the problems could be or it may just create a pool of pertinant negatives. It may give you a clue to multiple pathologies, or one aggrivating another.
How many providers think that a CHF patient's only health problem is CHF? we talked about this on the furosimide thread.
The treatment you give is determined by many things, among them your protocols. I worked on a truck a few years ago that had ~ 50 meds in my bag of tricks and untold pieces of equipment. But sometimes, with the blessing of med command, something had to be made up. Without theorhetical knowledge, that cannot be done. It makes a provider less capable, a hard fact of life. I was once the FR who thought I knew as much as a basic, then I went to medic school, it was an eye opener. The more I learn, the smaller amount of total knowledge I seem to have.
As us old guys are obligated to teach, the younger ones are obligated to learn. It makes for more constructive conversation at any level when you come with a question rather than a demand.
