Paramedic level pt. assessment

rhan101277

rhan101277

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I have worked with a preceptor who likes do things very quickly and I have also worked with ones who spend time on scene getting additional info and having discussions with patients.

I am finding it hard to focus in on a family member for info because they all try to talk. Also after I am sure ABC's are good, I find myself unsure as to what may be going on. My preceptor says I need to be quicker, I have only a small amount of experience as an EMT, I am hoping that I do get quicker as time goes on. I worry if I get to quick, I will miss important things, I realize everyone has to have their own way of doing things. I am just trying to get some insight from experienced medics.

I mean if they are stable and you are unsure what is going on.

Example:

56 y/o male patient c/c of shaking. First impression, you find patient diaphoretic and jerking on the right side, pupils are equal and reactive, BP 180/100, EKG shows sinus rhythm. Patient has history of a CVA in Feb. this year and has had surgery for it. He is on seizure meds as well as many anti-hypertensive meds, although his family says he has no seizure history.

The family claims that his incoherent speech has been the way it is since his stroke. He can't follow commands, due to his jerking etc. His ABC's are intact. Start IV W/O due to possible dehydration or to prevent it. Since he does make mumbling sounds medic rules out seizure, instead he believes this guy has tardive dyskinesia. I am impressed, I have heard of it before and am researching it. He gives 50mg benadryl and it doesn't stop. At the hospital they give Ativan, no luck, then diprivan, no luck, then valium. He is so out of it now that the activity stops.

Anyhow I am a bit overwhelmed in my field phase of clinicals. I am hoping to get more confident and become more steadfast in my decision making. Most medics tell me it takes years and that most learning is done out in the field. School just teaches you enough to be dangerous.

Any suggestions or advice? I feel like I did good on this call, but I am having a hard time putting everything together.
 
A major focus of the field internship is so you can develop your personal habits and routines as a medic while still having a safety net. You'll take parts from all your preceptors that you like and eventually have your own personal way.

Your preceptors job isn't to run the call. It's to let you run the call, help you when stumped, and keep you from hurting the patient.


Don't worry about not always knowing what going on with a patient. We won't always know and that's when we fall back to ABCs and supportive care to the hospital if the situation deems it. Don't be afraid of staying on scene for a bit either.
 
Accuracy builds speed, speed does not build accuracy.

Take your time.
 
Slow is smooth
Smooth is clean
Clean is fast


You'll get it man. Half of the time doctor's don't even know what's wrong until they run a million tests.

Don't try to diagnose, assess, intervene, re-evaluate and deliver to definitive care when necessary.

As long as your intimidation is only available to you, no one else knows you are scared!

That little bit of fear that you have, will keep you from hurting someone. Don't be so quick to dismiss that warning voice in your head.
 
What you are feeling is quite normal! You have been given a substantial amount of information to sort through and digest. Muddling through all of it initially takes some time. Your assessments will get quicker over time, try not to worry about it.

Like others have already said, your preceptor's job is to provide you with a safety net while you try to sort through all of that newly acquired info. That being said, we all know preceptors who want things done a certain way when you are with them. Just suck it up, and do the best you can.

Field internships/precepting prepare(s) you for your first several runs "on your own." Your first year as a medic you will have lots of runs that make you feel totally clueless and wondering what the heck you are doing. Trust yourself - you will find that you really do know how to do this stuff. It is during that first year that you will develop your rhythm, your "style" for handling calls. Once you are comfortable with the "how to be a medic" part of the learning curve, then you can begin to learn how to be a good medic. There really is a huge difference between just doing the job, and doing the job well. Never stop learning and you will be fine.
 
When I got my card and was released to run as crew chief of an ambulance, I was told, roughly, "There will be calls when you have no idea what to do. If you act like you have a plan, people will believe you. If you start to look panicked, everyone else will do the same."

Basically, you have to exude a certain degree of confidence, even if you're trembling on the inside. But it seems like you're on the right track (not that I'm a medic, but the principles are the same. If I see a medic getting flustered, I start to get a bit concerned that things are going south real fast.)
 
Bro, I am entering my second year as a medic (SCARY!) and I am just now getting settled into a rhythm and getting a good sense of things. It WILL take you time, and good partners to watch your back to get good at this.
Take things slow, repeat them to yourself, to make sure you haven't missed anything, and write things down the same way on every call.

You will get the hang of it, it just takes time.
 
BLSBoy said:
Bro, I am entering my second year as a medic (SCARY!) and I am just now getting settled into a rhythm and getting a good sense of things.
Click to expand...

And that's what scares me as a new medic. I don't have the safety net that students do... especially if I'm on a medic/basic truck. :wacko:
 
If it isn't a critcal pt (majority are not) I don't see the rush? Why is your preceptor rushing you on a non-critical call? If you are new what is the point in speeding through your assessments?
 
Linuss said:
And that's what scares me as a new medic. I don't have the safety net that students do... especially if I'm on a medic/basic truck. :wacko:
Click to expand...

Seems pretty scary! I think services that hire and/or train new medics should always pair them with an experienced medic, not an EMT.
OP, I'm not a medic but I find when I take my time I am more thorough and can catch a lot of information---I loooove getting thorough patient histories. And maybe it depends on the service you are being precepted at. I hear some are more stay-and-play and some are load and go.
Good luck!
 
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Most places typically pair you with a medic FTO for a while, but it's only a few months at most and you still end up going Medic/EMT at some point (if you work in that kind of system and not a dual medic)
 
BLSBoy said:
Bro, I am entering my second year as a medic (SCARY!) and I am just now getting settled into a rhythm and getting a good sense of things. It WILL take you time, and good partners to watch your back to get good at this.
Take things slow, repeat them to yourself, to make sure you haven't missed anything, and write things down the same way on every call.

You will get the hang of it, it just takes time.
Click to expand...
As others have stated, accuracy builds speed... in the shooting world, they say slow is smooth. Smooth is fast. Slow is fast. Take the time to get yourself into good pattern for doing things. Do things the same way every time. This way you won't forget things as you go along.
Bloom-IUEMT said:
Seems pretty scary! I think services that hire and/or train new medics should always pair them with an experienced medic, not an EMT.
OP, I'm not a medic but I find when I take my time I am more thorough and can catch a lot of information---I loooove getting thorough patient histories. And maybe it depends on the service you are being precepted at. I hear some are more stay-and-play and some are load and go.
Good luck!
Click to expand...
Sometimes you get lucky and you get partnered with a good Medic FTO. Sometimes... well... you don't and they throw you on a bus with a "go forth and don't kill anyone..." When I can, I really like getting as good a history as I can. Many times you get some insights into your patient's current condition from that. Here in Sacramento County, I see both load & go and Stay & Play mentalities at work. Urban areas tend to be more L&G while the rural areas tend to be more S&P. Each system has it's own personality.

I tend towards L&G as I prefer to be rolling towards more definitive care in the event something goes sideways. That doesn't mean that I won't spend as much time on scene as I need though. But that's just me...

Learn to do things the right way and speed will build itself. Your FTO might have been around so long that some things that he sees as "basic, easy stuff" might not yet be for you.
 
+1 for "slow is smooth, smooth is fast". There are some calls where you need to high-tail it and transport ASAP. However, 99.8% of calls are not like that.

Take a deep breath, and a few moments to set everything up right. Position the pt. just the way you want, pre-plan your equipment/set it out where it's ready to go, and you'll find things like IV starts and intubation attempts become much easier.

If your patient is not time sensitive/doesn't have a problem that requires rapid transport (STEMI, CVA, major trauma, etc.), take some time to do a good head-to-toe physical examination, get a good history from the patient and their family, and get all the vital signs you'll need (don't forget temperature, BGL, and pupils...I always see my fellow paramedics forget those!)

As my former medical director said...we bring medicine to our patients, we don't just take them to "the medicine" (hospital).
 
rhan101277 said:
Example:

56 y/o male patient c/c of shaking. First impression, you find patient diaphoretic and jerking on the right side, pupils are equal and reactive, BP 180/100, EKG shows sinus rhythm. Patient has history of a CVA in Feb. this year and has had surgery for it. He is on seizure meds as well as many anti-hypertensive meds, although his family says he has no seizure history.

The family claims that his incoherent speech has been the way it is since his stroke. He can't follow commands, due to his jerking etc. His ABC's are intact. Start IV W/O due to possible dehydration or to prevent it. Since he does make mumbling sounds medic rules out seizure, instead he believes this guy has tardive dyskinesia. I am impressed, I have heard of it before and am researching it. He gives 50mg benadryl and it doesn't stop. At the hospital they give Ativan, no luck, then diprivan, no luck, then valium. He is so out of it now that the activity stops.
Click to expand...

From the info you gave us I really don't see how your preceptor thought it could be Tardive Dyskinesia. Was the pt on a antidopaminergic neuroleptic? If so, how long?

R sided benign tremors are not seen in a pt w/ Tardive Dyskinesia that I know of. Repetitive hand gestures (rolling hands), contracted lower extremities, total body tremors, lip smacking, teeth grinding, torticollis, etc. are generally seen. Benadryl isn't going to do anything for TD since most of the time it is a irreversible condition. A dystonic reaction w/ EPS yes, but not TD.

Sounds like he was trying to be a hotshot to me. Judging by the pt's hx of CVA, htn, and taking seizure meds; TD would have been far down my DD list. Maybe a Jacksonian March seizure? Who knows.....

Anyways, I think you did fine asides from the W/O IV. You have to walk before you can run!
 
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