How much anatomy do you need on the job?

[Dearing Baymiller]

Yes, knowing the systems and at least their basic functions will be paramount for your patient as well as your success in the field. Sure, you may not need it every transport if you're running IFT as a Basic... but it will still be essential. Wait until you become a medic (which you will... you'll see).

Case: You are sent to the common EMS call of "altered mental status". Pt is profoundly lethargic and not anywhere near baseline according to family. Along with CHF, the pt has a history of CRF (chronic renal failure) and is dialyized 3 times a week.

So, here is where the cut in quality EMS providers is:

Will you treat this "old lady" as "every other old person" and just check their BGL and 12 lead and put them on a nasal cannula... or will you use critical thinking and knowledge of human physiology to further assess the pt?

Clue: Use a focused assessment and knowledge of the renal system to prompt further questions of the pt!

Focused assessment (thanks to your knowledge of physiology): Pt was supposed to get dialysis on Friday, but missed appointment because family is visiting... well it's now Monday evening and the pt AGAIN missed another appointment to see their beloved family off at the airport. Pt also consumes 3 bananas a day with breakfast and lunch. Oh, and you notice that pt is prescribed Spiralactone.

Working diagnosis: Due to missing dialysis for days, eating food high in potassium, pt is on a potassium sparing diuretic, and having an ECG tracing showing "peaked t-waves"... would it be reasonable to have a working diagnosis of a hyperkalemic pt? (Sorry for being dramatic and providing the silver bullet scenario... need sleep)

nice. i feel a bit better that i actually understood most of that.

question, do you do a working diagnosis like that for the ER?
if so, what do the Dr.'s think of these evaluations?

now i'm getting very curious.


dave

 

[vquintessence]

Well in all honesty they will take most EMS reports with a large grain of salt... about the size of our fist. There are just way too many poor EMS providers out there for the MD to take our word for it.

They will recognize the quality providers over time. However their license took much more education & training to get than our certificates. :sad: More often than not they'll come to their own refined diagnosis. Our satisfaction can perhaps fall into knowing that we potentially influenced their initial work up and the direction it took.

 

[daedalus]

nice. i feel a bit better that i actually understood most of that.

question, do you do a working diagnosis like that for the ER?
if so, what do the Dr.'s think of these evaluations?

now i'm getting very curious.


dave

Varies widely between hospitals, MDs, and paramedics. Sometimes the physician will meet you at the door and ask you what you got. Others will blow you off as an idiot. Some academic attending at UCLA actually ask you what you think. One made me explain the rationale, to him and his resident, on why I wanted a glucose stick stat from the triage RN (I was working as an EMT-B)

Most of the time in community hospitals you will give the RN your report and she or he could not care less what you think, but just wants to know the size of the lock you put in.

 

[boingo]

If you work for a quality system, that places a lot of emphasis on con-ed, with direct physician involvement you will find that the nursing staff as well as the doc's will put a lot of stock in your findings. Pt's will be directed directly to the OR, cath lab, CT scan etc...based on your report. If you work somewhere that a pulse is your only requirement for employment, its likely you will be directed to triage every single time. Incidently, the quality systems tend to hire quality people, ones with college education, a foundation in the sciences, and at the very least A&P. Also, frequent con-ed, rounds, clinical rotations in various specialties, etc...How great would it be to spend a month with Vent dealing with ventilator management, asthma, copd, and sick ped's? She might not even bite! (Might )How many systems require or offer this? You cannot perform at an advanced level without a foundation in the basics. Two medics can have the same certification with their individual abilities being night and day. Sorry, a bit long winded, but take a college level A&P course even if it isn't required, take a year or two of chemistry, biology and micro....some college math wouldn't hurt either, although I would argue if you are competent at algebra you might not need it for medic work, although someone might point out where I may be wrong on that.

 

[VentMedic]

How great would it be to spend a month with Vent dealing with ventilator management, asthma, copd, and sick ped's? She might not even bite! (Might )

Ah gee, I'm blushing.

I do occasionally teach some classes for the medics. I used to do the refreshers but found the attitude towards mandatory classess was less than poor.

Unfortunately, at some FDs/ambulance services I may only be given an hour to teach everything you need to know about CPAP. This is actually possible at the EMS level if those being taught have a decent A&P background and I don't have to explain very basic things like how the blood goes around and around.

I absolutely refuse to teach anything at a medic mill since I do not argree with just teaching skills and recipes without some understanding of the science behind them.

some college math wouldn't hurt either, although I would argue if you are competent at algebra you might not need it for medic work, although someone might point out where I may be wrong on that.

As far as alegebra is concerned, I absolutely believe it is necessary to improve one's critical thinking skills as well as an understanding of just day to day formulas for drugs and equipment. I personally would not trust anyone to touch a ventilator or ICU drip on CCT if they can not do basic algebra.

This link provides 4 very basic equations for oxygen and acid-base.
http://www.globalrph.com/martin_4_most.htm

Few are even aware they exist although the Henderson-Hasselbalch equation is discussed at the Paramedic level. But, few take the time to understand it. There are also a whole list of formulas that should be understood to grasp the concepts that are involved in the cardiac system.

I guess I should be happy some can calculate how much time they have in an O2 tank. This was one of my pet peeves when we used to depend on the local ambulance service to transport our CCT and specialty teams. We would tell them to make sure their main tank had enough O2 for at least 2 hours at 15 l/m with a cushion of 20 l/m and they would show up with an empty K (or J) and two D tanks. Thus, we would do the math for them until we got our own trucks. Now, the drivers from our transport pool have enough college education, even if not in medicine, to understand what we mean when we say we need enough O2.

 

[MedicMorgan]

He should say; it makes the difference between and idiot and a medic.

R/r 911

thats very Coxian of you

 

[DHarris52]

hey guys,
i'm heading into EMT-B this fall, and i'm already taking A&P, and doing pretty good so far. how much of the Anatomy classes do you actually use on the job? obviously the A&P directional terms and etc. , but do you really retain all of the carpal and tarsal bone names? do you tend to forget them over the years, or do you keep independently studying to the point you can name them in your sleep? just curious to see what to expect in the future.

thanks!

dave

edit: i'm heading into the Medical Terminology class in the fall as well, looking forward to that.
i pulled out of it to take in the fall, to make sure not to take a compressed summer class for that. i wanted the full semester to take my time and really absorb the material in my mind.

Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig.

Remember - you're a basic, not a doctor. Keep it simple.

 

[JPINFV]

Is it necessary? Well, it depends on if you want to be in the "I give O2 because it doesn't hurt and everyone needs O2 to live" crowd or be in the crowd that knows what they're doing beyond reading a protocol written at an 8th grade level.

Personally, I like to know what I'm doing and why instead of being in the group that thinks that every patient needs a NRB at 15 l/m.

 

[redcrossemt]

pseudo provider

<= perfect for reports, i.e. "the pseudo providers had *attempted* RSI before our arrival."

 

[daedalus]

Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig.

Remember - you're a basic, not a doctor. Keep it simple.

This is the type of thinking that prevents EMS from ever being recognized as a profession. No, do not keep it simple. Every other allied health field has a pretty decent understanding of A&P through actual college classes.


It is absolutely necessary and I cannot think of how it would not be. You are only selling yourself short if you think that you cannot learn mire anatomy than in your EMT class.

 

[VentMedic]

Is an extensive A&P knowledge good to have? Sure, it doesn't hurt and could be useful while giving a report to a higher medical authority. Is it necessary? Absolutely not. Anyone who tells you otherwise probably doesn't have a great deal of experience riding a BLS rig.

Remember - you're a basic, not a doctor. Keep it simple.

I really hate to say anything negative about vollies but then not everyone has the same standards for patient care that BossyCow has as a volunteer.

This post is why many do look down on the volunteer. They don't have time for education or to even consider EMS as a profession so they want to drag it down to their own low standards and expectations for patient care.

Those who have not taken any classes beyond the 120 hours of EMT class have no idea what they are missing. By also comparing an EMT with a doctor just further shows how removed one is in their knowledge of providing patient care and of medical professionals.

 

[ResTech]

Anatomy & Physiology is very important to have and does a lot to make learning easier since you actually have an understanding of how the body works and enables you to think and put two and two together on your own.

Now, will you forget a lot of it? yes you will... all the names of the bones and muscles will fade from ur mind... it all goes to the wayside. But the important stuff from A&P you will retain and expand upon.

If I'm not mistaken, before you can take National Registry Paramedic, you have to have a college level A&P course. Is this correct? I know my program requires A&P I and II.

 

[EMTrainer]

Knowledge is the foundation of critical thinking

Learn all the A&P, biochemistry, pharmacology, etc. that you can. You can really tell the medics who come from programs that teach you to pass the test and those who come from programs that strive to graduate competent medical professionals. Remember that what you need to pass the test is the legal minimum you must have before they will let you out on the street. It is nowhere near the level of education that you need to provide the best possible care for your patients.

I sometimes put it to my students this way. "When we bring a trauma code into the ER at our regional Level II Trauma Center, you are met by an ER Physician, an RN, at least two or three specialists, a few technicians from various disciplines, and probably an intern or a student of some kind. Fifteen minutes earlier you were all alone in the back of an ambulance with that same patient. Now how much do you think you need to know?"

We are lucky here, our physicians and ER staffs treat us very well and listen to what we have to contribute, often asking for our input. That didn't come overnight. Our service earned that respect by holding ourselves to high standards of education and professionalism.

 

[Dearing Baymiller]

well next week is the last week of summer class and i'm pulling an A in my Essentials of A&P class. i see where it will be a good foundation to build on for A&P I. i'll be taking that inext spring, and most likely a biology and a chem class.
assuming all goes well in EMT-B this fall of course.
here's hoping!

dave

 

[EMTrainer]

Hang in there

Hang in there, Dave. It's a lot of work but well worth it. B)

 

[Dearing Baymiller]

heh. i'm actually enjoying the mental challenges so far.
years of factory work had dulled my brain. that sounds a bit dramatic but it's how it felt.

i'm motivated and i'm taking it one semester at a time, one day at a time.
looking forward to tackling what's coming down the pipe.
my EMT-B doesn't start until October, and i've got several classes and some independent studies, on top of my workouts and dieting to get my fat self into shape for the first time in my life, to keep me focused and busy.


i would like to thank everyone here, even those of opposing viewpoints. i've learned a lot here the last few weeks, in what to expect and what will be expected of me, educationally and professionally, assuming i make it.

Dave