Need some tips!

[exodus]

Okay, I need some tips. I did some narratives today in the back of the rig while we were moving, does anyone have any tips for writing on a clipboard while you're moving?

Also, I have a hard time finding a radial pulse on some patients. Does anyone have any tips helping find one?

 

[EMTinNEPA]

Do it a lot so you get used to it. And use a lot of shorthand. I have my own personal method of shorthand that gets me by.

 

[Shishkabob]

You get used to both of those problems after a while. The only true way to get better is to get used to it.


As stated, use shorthand, but check with your company as they probably have a list of approved abbreviates to use.

 

[EMTinNEPA]

As for finding a radial pulse... start by placing your hand on the end of the radius (the big bump in your wrist on the thumb side of the hand), then slide your fingers back and in toward their core, so you feel down into that little "valley" in the wrist. You should feel the pulse in their. If you don't, try pressing harder. Still don't, try softer than you originally did. If you still don't, a carotid pulse will be just as accurate as a radial pulse. If you're palpating a BP, you might run into some problems, though.

 

[exodus]

We can only used county approved shorthand. But it's still hard because we're urban ems so lots of starts/stops/bumps

 

[EMTinNEPA]

We can only used county approved shorthand. But it's still hard because we're urban ems so lots of starts/stops/bumps

County approved shorthand in your narratives? Or in your personal notes that you take while actually on the call?

 

[medic417]

Your actually trying to right the real report as you go down the road? Who's treating the patient?

 

[exodus]

Your actually trying to right the real report as you go down the road? Who's treating the patient?

IFT's. We do vitals, then talk to the patient for a little bit and write a narrative while moving.

 

[exodus]

County approved shorthand in your narratives? Or in your personal notes that you take while actually on the call?

Narratives, notes we can do whatever.

 

[medic417]

IFT's. We do vitals, then talk to the patient for a little bit and write a narrative while moving.

So when you get where they are going and find them dead do you rewrite the narrative?

 

[JPINFV]

I've always found it easier to write on the captain's chair than the bench seat. I've also found that wearing a seatbelt helps because now I don't have to worry about tightening up to avoid bouncing around.

Your actually trying to right the real report as you go down the road? Who's treating the patient?

Not all patients need the entire trip to treat, especially for basics who will reach the limits of their scope rather quickly. Especially with IFTs, anything over 15 minutes and I can complete most of the run sheet, including narrative, before we reach the destination.

 

[exodus]

So when you get where they are going and find them dead do you rewrite the narrative?

Don't forget we're BLS. We transport non-critical patients. Of course they can crash, and we have had patients crash, but that's why you sit right next to them and keep an eye on them. I'm not going up front or into lala land. What I did was write like one sentence on the narrative, looked up at the patient, saw that they were still breathing or if anything has changed, and went back into report...

Our transports are all 15-25 minutes. Have you worked BLS IFT's before medic?

 

[Sasha]

So when you get where they are going and find them dead do you rewrite the narrative?

Goodness. You don't have to sit and stare at your patient for the entire ride. Write your report, talk to them while doing so. you can ensure an airway because they're talking. Talking? Alive. If they're a vegetable, peek up every so often to see how they're doing, make sure nothings hanging off, etc.

As for writing, I rest my clipboard on my knee/leg to write, I find everyting is more steady there. Everything else is practice. The radial pulse, follow the thumb.

 

[Shishkabob]

I had a 91 year old lady on Friday, AOx4, yapping my ears off for the entire 40 minute IFT, and I still got the report done. It doesn't take much skill to do a narrative while keeping an eye on the pt.

 

[medic417]

Any one ever hear of subtle changes that could indicate something major about to happen? While distracted oops missed it, bye bye Mrs IFT.

 

[BossyCow]

Any one ever hear of subtle changes that could indicate something major about to happen? While distracted oops missed it, bye bye Mrs IFT.

When those eyes go up into that fixed deviated gaze.. if you weren't really watching, you'd miss that one.

 

[JPINFV]

I seriously want to know where everyone is being taught that the patient magically becomes unstable during the 15 minute ambulance ride, but not the rest of the day when they don't have someone staring at them.

 

[Sasha]

Any one ever hear of subtle changes that could indicate something major about to happen? While distracted oops missed it, bye bye Mrs IFT.

So how do medics treat their patients? Don't they have to look away to draw up meds, get the monitor ready, prepare to cannulate?

 

[medic417]

I seriously want to know where everyone is being taught that the patient magically becomes unstable during the 15 minute ambulance ride, but not the rest of the day when they don't have someone staring at them.

It happens. Your lack of attention may be why this patient does not get returned to ER for needed treatment and instead dies at home or in the nursing home. Patients can change quickly or show briefly signs of an impending event yet you missed while writing. Dissappointed in our future doctor I am.

 

[BossyCow]

I'm not so sure that the pt needs to be watched every second. Face it if the pt is going to develop something that serious, that fast, they are doing the Drano anyway. If its serious, its going to last more than a second and there will be obvious changes in their appearance, vitals, noises, etc.

I certainly do not spend the entire 45 minute ride to the hospital peering at my patient constantly. That would be creepy.