Patient assessment Advanced Level

[xrsm002]

I am apparently having difficulty with my patient assessments at the advanced level, I am not sure exactly what I'm doing wrong, but I did perform a physical exam on my trauma patient today, I am guessing my preceptor didn't see me do it the first time so I did it again. I also need to work on interpretation of findings, (field impression) should I be telling my preceptor what my field impression is? I also thought I was doing my ongoing assessments just fine what should exactly should I do during an ongoing assessment I currently take an initial set of vitals, check make sure the IV is still patient, check the patients pain scale if they had any pain complaints and check the monitor if they are hooked to it. I had a call today I thought I did quite well on but my preceptor didn't really comment. I wish they would comment on the individual calls.

 

[NYMedic828]

I am apparently having difficulty with my patient assessments at the advanced level, I am not sure exactly what I'm doing wrong, but I did perform a physical exam on my trauma patient today, I am guessing my preceptor didn't see me do it the first time so I did it again. I also need to work on interpretation of findings, (field impression) should I be telling my preceptor what my field impression is? I also thought I was doing my ongoing assessments just fine what should exactly should I do during an ongoing assessment I currently take an initial set of vitals, check make sure the IV is still patient, check the patients pain scale if they had any pain complaints and check the monitor if they are hooked to it. I had a call today I thought I did quite well on but my preceptor didn't really comment. I wish they would comment on the individual calls.

I realize you are a student so you don't have much choice as far as passing your program goes but the first thing I would recommend for the real world is not being a robot.

That skill sheet they expect of you which your instructors tell you is good for every patient is a lie. You need to vector your exam and treatments to the needs of your particular patient. Don't just follow the recipe over and over it won't work a good portion of the time. It just isn't practical.

Trauma is easy and should by no means by considered an advanced assessment. Every provider should be capable of a trauma assessment for the most part. Unfortunately in most cases a real trauma patient only needs you to get them to the hospital. What they need is cold steel and hot lights. Find all the issues you can, get moving ASAP, put in an IV if you must and get them to the ER/OR.

Also, from the minimal information we have it sounds like your preceptor is not the best person to be learning from. A good preceptor should actively engage in critiquing you helping you to improve.

 

[xrsm002]

I am not using the NREMT skill sheet to do any of my patient assessments. I have been an EMT for 6 years but the last service I worked for was a transfer service and we didnt' really do any assessments unless we took them to the ER and the paramedics handled those 99% of the time. I really want to get my medic and I also want to be a teacher, I am learning from this preceptor how not to critique, I will however ask the preceptor if they will critique me after every call. Maybe they are wanting to know what I need from them in order to learn.

 

[Melclin]

Having a preceptor who doesn't get too involved can be frustrating. I found my time as a student very difficult and frustrating.

Now days I consider three things. Whats wrong with my pt, what I'm going to about it and a rationale for both.

When you're a student you have to reconcile how you would do the above with how your preceptor would do those things, what your preceptor thinks about how you're doing it (order/speed of actions, demeanour etc) as well as other ideas about decisions students should or shouldn't be making. Its tough.

If you're not getting feedback, ask for it. Discuss what you thought about what went well and what didn't and ask his/her opinion. If its not happening after that, then maybe it just won't happen. I wouldn't be inclined to push too hard or complain for fear of biting the hand that feeds you. Look to other people in the field. Talk about jobs to other medics in ED or at the station, people you've heard are sharp, people you've seen work well. Your preceptor can't be the only paramedic you've ever met.

As far as communication goes, keep talking to you preceptor during a job. Its probably something that should happen anyway, student or not. Call out the vitals & pertinent results of your exam as you find them. You want your partner to have the same information as you do when you get to the stage where you tell your pt/partner what you feel is wrong, why and what you're going to do about it. As a student this is a way of showing your preceptor whats going on in your head and of gaining his/her tick of approval for the course of action you hope to take.

 

[Veneficus]

There are 2 things needed to be good at physical exam.

1. is a commanding knowledge of pathophys.

2. Is practice.

Without number 1, the best you will ever be is "ok."

Whether it is a gunshot or an endocrine disorder, if you do not know the patho, you will not be able to focus your exam, pick out important details, understand when to ask various questions, or deviate from the academic skill sheet in any way.

You may not even know what you are looking at when you see it.

As just a personal preference, even when I focus my exam to specific complaints, I always do a quicl cursory check for major systemic problems.

No matter what unicorn your find, it is always a bad day when you miss the elephant in the room.

 

[xrsm002]

Thanks for the tips experienced EMSer's I will ask my classroom instructor for some helpful hints as well. I am also thinking about doing a rideout with him to see if he can see what I am doing "wrong" if anything in the field. I missed an IV stick but I didn't feel bad about it, and I got critiqued on another way to try it next time.