Not quite a newbie....

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Keens

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Hi all,

I start EMT training next week and was wondering if anyone had any insight or advice to a peon in the field. I'm going in completely green (aside from my CG experience but I was a flight mechanic so...). I'm pretty excited about it but thought I'd get some info from all of you. Any and all is appreciated. Take care.

Keens
 
It's not coincidence that one of longest chapters in the Brady Prehospital Emergency Care book is patient assessment. One of the biggest changes I saw from being a student to a professional in the field, is how patients actually present themselves. In a classroom setting, it's impossible to truly replicate signs and symptoms besides having the "victim" or proctor verbalize them. In addition, start to become comfortable with being hands on and actually touching whoever is the "victim" when doing classroom scenarios. Never assume simple stuff like C/R < 2 and eyes being PERL. Take your patient's hand and depress the nailbed a/o skin and pull out your fancy little pen light to check pupils. Don't be afraid to check the conjunctiva a/o lips for S/S of hypoxia. Get as involved as you can when doing patient assessments. I'm sure others will touch on many other important factors, however, this was the biggest adjustment for me when entering the field.
 
Welcome to the life.
 
When doing ride time or practicing scenarios, write reports on every patient. You can redact the personal info on real patients but get practice putting what you hear, see and do in writing in a report format.
 
Thanks for the info so far (though I was a little lost on Code 3's, I really am that green.) I found out also that an EMT-B does alot less than I thought. CG EMT does more than a B does which is good news to me. I'd rather get used to the basics.
 
Welcome!

Welcome to the tribe! :D:D:D
 
Code 3 is trying to say that assessment is an important aspect of the EMT and Paramedic's job. Welcome. You will find an interesting career path in emergency medicine. Its exciting and is a field where there is near infinite learning opportunities. My advice is to explore beyond whats in your book. Look up everything. Not to long ago we had a discussion about LVADs (ventricular assist devices,,pumps to support a dying heart). There is so much to know, but at the same time, you can always fall back on your basic training.
 
Kaisu said:
Total and complete waste of time in a conscious patient as it will give you NO meaningful information.
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Actually, it is not a waste of time, rather there is more important assessment that could be performed. If one was to ask most Paramedics, what does sluggish or unequal really mean (not head injury)? Most could not answer correctly.

There is nothing about learning in patient assessment a waste of time, rather when and how to interpret appropriately.

R/r 911
 
Ridryder911 said:
Actually, it is not a waste of time, rather there is more important assessment that could be performed. If one was to ask most Paramedics, what does sluggish or unequal really mean (not head injury)? Most could not answer correctly.

There is nothing about learning in patient assessment a waste of time, rather when and how to interpret appropriately.

R/r 911
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I'm not questioning the validity with a practitioner with your experience and scope of practice. I was referring primarily to the EMT-B and in most instances, paramedics.
As you correctly stated, most don't understand the correct significance.
 
Actually, I think almost all of us could correctly answer that sluggish and non reactive pupils are a sign of increased ICP and sometimes brain stem injuries. Atleast I would hope so...
 
daedalus said:
Actually, I think almost all of us could correctly answer that sluggish and non reactive pupils are a sign of increased ICP and sometimes brain stem injuries. Atleast I would hope so...
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See.. now that would be wrong. Your patient would have long ago lost consciousness. By the time ICP reaches the stage where herniation is compressing the 3rd cranial nerve to cause pupillary changes, the patient's demise is imminent.
 
Whether or not it is a waste time (until I get some schoolin I wouldn't know), I can assume from Code 3's post that at least thinking outside the box is a good practice. When I was with the CG, I would train people to to look deeper into the discrepancies on the helos. Sometimes what we automatically assume a discrepancy to be is not always the case. In that scenario, we can make a mistake with little impact, not so here. I also believe that every person brings something different to the field. Again, falling back on my CG xp, a mech may catch a gripe that another wouldn't simply because they have a better understanding of a particular system. Since I was more familiar with software than the majority of the mechs, I was able to find gliches and system crashes much more easily. In this case (hypoxia), either experience or a better understanding of the condition may be contributing to Code 3's stand point on assessment. And I personally don't believe that ruling out a possible contributor to a victim's condition to be a waste of time. Time permitting of course.
 
Actually if you were to review neurological evaluation assessment, checking for PEARL has really fell out of light. Many physicians are not being enforced or even taught such, again a very poor technique to assess and as was mentioned a very late ominous sign.

Yes, I routinely check the pupils.. but; not just reactivity. Looking for accommodation and usually checking for oculomotor reflexes as well, nystgmus, and a brief vision acuity.

I have always wondered why we still continue to teach an outdated assessment tool when there are so many other techniques that are just as easy and more valuable in the prehospital arena.

Unfortunately, neuro assessments are not even gone in to detail very much in most Paramedic schools, in which they really should. A condensed version can be performed in about 45 seconds testing all XII cranial nerves and giving much more information about your patients neurological status than just checking the pupils...

Again, one of those.. I was taught it, therefore you should too....

R/r 911
 
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You know, this is one of the things that kills me about our "profession". On another site, I exposed an ignorance that was taught to me - this being the fallacy that discoloration from the nipple line up is a S and S of PE. It reflects badly on us when we spout nonsense that has been taught to us. I don't know how many paramedics question EVERYTHING that we have been taught, or whether that would even be worthwhile. Daedalus, it was not my intention to call you out in public. What you state is indeed what we were all taught. I remember my basic instructor on my case during clinicals (laughably brief that they were) because I neglected to shine that stupid little pen light into a patient's eyes. It shakes my confidence everytime something that I was taught turns out to be crap, but I guess it's something I have to get used to if I am going to do a good job in this field.

Rant over - :-)
 
Different instructors are gonna teach different things for better or worse. That's a fact of life. Like I said, some people may think it's more important to check for one thing before another. You won't ever agree. All you can do is state your opinion and move on.
 
Keens said:
Different instructors are gonna teach different things for better or worse. That's a fact of life. Like I said, some people may think it's more important to check for one thing before another. You won't ever agree. All you can do is state your opinion and move on.
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You are right. Anyone looking for absolutes needs to avoid medicine BUT there are informed, educated opinions and there are ignorant, out-dated ones. Short of researching everything we come across, what are we to do? Staying up to date and informed is a never ending challenge and one that we will always fail to some degree or another.
 
Well, having just come out of class myself (almost 7 mos. now) Remember this. (In addition to remembering the whole textbook so that you could recite it backwards in your sleep;))

A book EMT (anyone who takes the class and passes the state test)and a field EMT are two totally, completely, no doubt about it, opposite ends of the spectrum things. When I came out of class my head was huge. I thought I was really something, that I was gonna save the world. After my first call, a drug OD, I felt about this big. No, actually, much smaller. Yes, class is very important, but it only teaches the facts. EMS is all about learning more and improving on what you already know. (at 0300 on your third 12 hour shift) My teacher used to say: "You have learned your greatest lesson when you learn that no matter how long you do this, you can always learn something more."





Good luck!!!!!!!!
 
Well said lightsandsirens. I probably should come up with some better background knowledge but again, I spent 10 years in the CG and while training was nice to have, it was OJT that really did the trick. There's nothing in mech training that prepares you for decapitated bodies, dead children, or profusely bleeding victims. Each one is handled differently and IMHO the most important thing is how you react. I look forward to my first day in the field but know that I will see things I've never experienced before and only that experience will teach me.
 
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