Do you agree with this statement?

[Ridryder911]

Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient.
No one ever heard of "across the room" assessment?

When you first enter the room, you see the patient sitting, laying, etc. One immediately looks for the posture they are in (tripod position, upright with pillows, etc), look for abd, chest rising and falling; listen (snoring respirations, are they pale, flushed, diaphoretic? do you hear harsh external adventitious sounds? (wheezes, rhonchi, stridor), again a quick overview for bleeding, body fluids, dangers to you and your patient (live wires, weapons), etc.

All of this should be performed even before getting to the patient, and can be performed within the first few seconds. Then when getting to the patient a more detailed of ABC's can be performed if needed.

Majority of the calls, I can tell my patient condition from my first observation of the patient. I am not surprised by making contact with them.

Seriously, does one really think I have perform a head tilt then, look, feel and listen to be able to detect if they are breathing or not? If I have an EMT that cannot detect that, without performing such, it is time to be recycled. Time to get on with the program.

R/r 911

 

[skyemt]

Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient.
No one ever heard of "across the room" assessment?

When you first enter the room, you see the patient sitting, laying, etc. One immediately looks for the posture they are in (tripod position, upright with pillows, etc), look for abd, chest rising and falling; listen (snoring respirations, are they pale, flushed, diaphoretic? do you hear harsh external adventitious sounds? (wheezes, rhonchi, stridor), again a quick overview for bleeding, body fluids, dangers to you and your patient (live wires, weapons), etc.

All of this should be performed even before getting to the patient, and can be performed within the first few seconds. Then when getting to the patient a more detailed of ABC's can be performed if needed.

Majority of the calls, I can tell my patient condition from my first observation of the patient. I am not surprised by making contact with them.

Seriously, does one really think I have perform a head tilt then, look, feel and listen to be able to detect if they are breathing or not? If I have an EMT that cannot detect that, without performing such, it is time to be recycled. Time to get on with the program.

R/r 911

thank you... i have been trying to convey this point throughout this entire thread...

come on Basics! be better than ABC!!!

 

[JPINFV]

Wow! Several posts to describe something that should be second nature and assessed within the first 1-5 seconds before even making contact with the patient.
No one ever heard of "across the room" assessment?

Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs.

http://emtlife.com/showthread.php?t=6634&page=4

 

[skyemt]

Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs.

http://emtlife.com/showthread.php?t=6634&page=4

like Rid said, doing a more detailed ABC's when you get to the patient...
obviously forming a good general impression, you haven't gotten there yet...

i'm sorry you are still smarting from that other thread...

if you go back and reread it, it is totally off topic from this one.

 

[Arkymedic]

Actually, the "across the room" assessment was hashed out about a month ago with people honestly arguing that you can't assess a patient prior to reaching him. Of course this was the same thread where people were trying to hash out if, protocol wise, LOC check comes before ABCs.

http://emtlife.com/showthread.php?t=6634&page=4

Whats the first thing you do? Annie Annie are you ok? lol. LOC does come before ABCs. If the pt is unconscious and unresponsive, chances are they dont have a patent airway. If they are unconsc. they probably are having a breathing and circulation prob as well.

 

[JPINFV]

Whats the first thing you do? Annie Annie are you ok? lol. LOC does come before ABCs. If the pt is unconscious and unresponsive, chances are they dont have a patent airway. If they are unconsc. they probably are having a breathing and circulation prob as well.

The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."

Assessment isn't a check list or cook book that you run down by going:
1. Now I'm going to check LOC.
2. Now I'm going to check ABCs.
3. Now I'm going to check skin signs.
4...

Unless you pervert ABCs to mean any and all conditions that involve or affect a persons airway, breathing, or circulation.

 

[Ridryder911]

Okay, let the bashing begin...LOL Part of the problem is we go back to uggghhhhh training and education. Yes, that dreaded word.

As some of you are aware I am totally against teaching acronyms. The reason being is EMT's attempt to place such in every situation. I actually see students attempting to "whisper" each little letter while performing an assessment. In the manner to teach every crucial step, we do it methodology step by step. Nothing wrong with that, however' here comes the problem; applying it to real life events.

There are very few patients in real life scenarios, that one is going to go step by step on any treatment or skill. In real life situations, short cuts are made, logical deferment is made. For example does one really check cap refill on those with a non-palpable blood pressure, surely one can see cold waxy skin and knowing physiology that is of one has a blood pressure < 40-60 torr one is not going to see cap refill. So would one be in the wrong not checking?

Treatment and assessments should not be as a robotic mode. Not each and every assessment and treatment should be the same over and over, however; it should be systematic. Making sure that all that needs to be covered is.

I get amused reading some of the responses on "the protocols says". The reason I usually do not even pay attention to such posts is they are ludicrous. Perform about 25 to 30 assessments a day five days a week, then tell me you are going to perform each one the same.

Do you await for someone to take vital signs before performing a secondary or physical assessment or await someone intubating the patient before taking a blood pressure? Remember, v.s. is the first step of secondary and by doing so you just jumped to the next phase before the first phase was finished... GASP! Oh my you got out of sequence! Ahhh You broke protocols!
C'mon folks.. one has to use common sense. The reason ..." C-Spine before AVPU"... is made in case the patient awakes and moves around. Then again, technically speaking you have just performed battery and assault. Did you get the permission "to touch the patient?". Again, good old common sense. Unfortunately, something we cannot teach and it appears more and more not that common.

Again, alike scene size up, most are done as a glance and visually looking, "across the room" assessments should be made. If I have a employee that has to await to make contact with the patient before they realize if there is potential problems or not, they will be seeking other employment opportunities. Across the room assessment is taught and encouraged by courses such as ATLS, Trauma Nurse, PHTLS, ITLS, etc.. on and on.

As I have discussed over and over, medicine is a science and practiced as an art. It takes practice, experience, and yes by making mistakes to learn off. (* the key is to learn of your mistakes, and NOT repeating it over!)

R/r 911

 

[skyemt]

The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."

Assessment isn't a check list or cook book that you run down by going:
1. Now I'm going to check LOC.
2. Now I'm going to check ABCs.
3. Now I'm going to check skin signs.
4...

Unless you pervert ABCs to mean any and all conditions that involve or affect a persons airway, breathing, or circulation.

two separate things... training to pass an exam, and real life, which Rid has described...

but, whether you like it or not, the exam is cookbook style, and if you go out of order you can fail, depending on what you flip-flop... so for those learning, as was the one who started the thread you referred to, they must follow that cookbook approach to pass their exam. sorry, but that's the way it is... we can have another debate about whether or not it should be so...

what you do after you pass the exam, as an EMT, is another matter.

 

[Arkymedic]

The actual fact is that much of the initial assessment can be obtained either prior to reaching the patient or simultaneous in the immediate moments after reaching the patient. So, you're checking LOC and you touch the patient. Is the patient warm? Cold? Well, now you've got skin signs down (assuming your also looking at the patient). The problem is that people want to say, "OMG, you FAIL because you're going out of order."

Assessment isn't a check list or cook book that you run down by going:
1. Now I'm going to check LOC.
2. Now I'm going to check ABCs.
3. Now I'm going to check skin signs.
4...

Unless you pervert ABCs to mean any and all conditions that involve or affect a persons airway, breathing, or circulation.

JPINFV, I was being a little sarcastic with my post. Thats why I used Annie lol. I wrote my post in such the way as I did for all those trying to make ABCs fit every medical condition. I personally believe in the across the room theory and like Rid said a lot of it is combined together and shortcutted. Sorry for being a smart *** in the way I attempted to write the post.

 

[Ridryder911]

Another point for common sense. One should be able to apply what is drilled and tested over and then appropriately apply that accordingly to the situation and real life. The point is to know and realize that alike protocols are guidelines and not exacts.

R/r 911

 

[ironguy321]

two separate things... training to pass an exam, and real life, which Rid has described...

but, whether you like it or not, the exam is cookbook style, and if you go out of order you can fail, depending on what you flip-flop... so for those learning, as was the one who started the thread you referred to, they must follow that cookbook approach to pass their exam. sorry, but that's the way it is... we can have another debate about whether or not it should be so...

what you do after you pass the exam, as an EMT, is another matter.

I think your referring [since I started this chaos]. I know I have no experience under my belt other than my ride outs/clinicals but I understand what a lot of people are saying here. My skills are rusty, I'll admit since I'm in fire school, but I remember during my ride outs I ALWAYS looked at ABC's first, than did what I had to from there. My medic never corrected me so I'm assuming I did things correctly.

 

[firetender]

...and let's not forget, acronyms and the like are soon-to-be-discarded tools that carry us until we learn they're tools that get discarded. The learning curve takes what it takes until experience "hard-wires" a personally effective approach toward patient care into our spines.

 

[fma08]

I remember my instructor telling us...

"If you forget everything in this class, ALWAYS remember ABC and you'll be ok"

Agree or disagree?

ABC, ambulate before carry, absolutely agree

 

[paramedix]

Whilst I was on course and doing road pracs with my instructor I learned to go by that rule.

We attended to a call at an old age home and the patient was lying on his bed. After the call we had a debriefing session and the doctor who evaluated me flunked me on the above mentioned call. Her reason was purely I forgot the basics... ABC!!!

I argued I have done the ABC and could prove it. Then the question was asked, on how many pillows was the patient's head? Oops... The patient was in fact lying on three pillows and the airway was NOT fully open.

So always remember the ABC's. The statement is quite right. But don't forget the S before ABC... SAFETY FIRST.

 

[Firesurfer75]

I agree with that.. maintain airway so they can breath to be able to supply oxygen to the body from any cardiac function.