Pharmacology and Patient Assessment

[sjlamb77]

Hey guys,

I just started my EMT-B classes a few weeks ago, so I'm still getting oriented to what all I'll be doing on the job. But from what I've gathered is that the book isn't going to teach me all that much useful stuff for being out in the field. I know a lot comes from experience, but I love to read and study, so I'm looking for a couple recommendations.

I really don't know a thing about pills. I know that a patient's medications are important and can tell me a lot about what's going on, but it won't help me if I don't know what any of their pills are for! Is there a basic pharmacology book where I can learn not only emergency medicine pharmacology, but also lots of common medications? It's probably important to note that I'll most likely be staying basic, so while it would be helpful to learn all the drugs ALS includes, I mostly want to learn all about common medications. Book or website recommendations would be wonderful.

The second thing I'd love to learn more about is patient assessment. I want to be able to do a great head to toe assessment and a neurological assessment. I've seen those books titled things like "Physical Examination and History Taking." Those are more geared towards doctors using differential diagnoses, but I was curious if that's the kind of thing I should be studying, or if the EMS patient assessment is an entirely different type of thing. Either way, what books have helped you guys learn a great head to toe/neurological assessment?

Thanks for your help!

 

[STXmedic]

Hey guys,

I just started my EMT-B classes a few weeks ago, so I'm still getting oriented to what all I'll be doing on the job. But from what I've gathered is that the book isn't going to teach me all that much useful stuff for being out in the field. I know a lot comes from experience, but I love to read and study, so I'm looking for a couple recommendations.

I really don't know a thing about pills. I know that a patient's medications are important and can tell me a lot about what's going on, but it won't help me if I don't know what any of their pills are for! Is there a basic pharmacology book where I can learn not only emergency medicine pharmacology, but also lots of common medications? It's probably important to note that I'll most likely be staying basic, so while it would be helpful to learn all the drugs ALS includes, I mostly want to learn all about common medications. Book or website recommendations would be wonderful.

The second thing I'd love to learn more about is patient assessment. I want to be able to do a great head to toe assessment and a neurological assessment. I've seen those books titled things like "Physical Examination and History Taking." Those are more geared towards doctors using differential diagnoses, but I was curious if that's the kind of thing I should be studying, or if the EMS patient assessment is an entirely different type of thing. Either way, what books have helped you guys learn a great head to toe/neurological assessment?

Thanks for your help!

If you're like me and just enjoy reading about it, I'm a fan of Basic and Clinical Pharmacology by Katzung.

If that's a little too in depth for what you're looking for, then another suggestion: Once you're in the field, look up any patient medication that you come across. If you've never heard of it, look it up. If it sounds familiar, look it up. If you know it, look up something about it that you didn't know. Repeat to your hearts desire. Good resources on a smart phone include Micromedix, Epocrates, and Medscape.

As for physical exam, the book I'd recommend is Bates' Guide to Physical Exam and History-Taking. The difference between an EMT/Medic's exam compared to a physician's is the depth that the exam goes, and the ability to understand and correlate the findings (excluding use of diagnostic tools/procedures).

Caveat to both pharm and physical exam: you won't truly understand what's going on, how something works, or what you find until you have a thorough grasp on anatomy and physiology. I'm not talking about the superficial brush-over you get in EMT class.

If you don't mind my asking, why do you plan to stay as a basic? If you're as driven as you make yourself out to be, you will become very bored very quickly.

 

[Aprz]

Home medications you'll learn with both experience and education. Books commonly will mention something like "These types of patients take X, Y, and Z medication." For now, ask the patients (in your scenario and real life) "What do you take this for?"

I sent you a PM with a list of home medications that paramedic students were required to memorize and be tested on. It's not the most elegant way to learn them, but feel free to try to learn 1 a day, 5-10 a week, or something.

I don't know if Alabama is an NREMT state or not, but since most states are, I think it's a safe bet that you will be tested on NREMT patient assessment algorithm.

Bates' Guide to Physical Examination & History Taking is an excellent book. You will likely not use all the techniques, ask all the questions, or see everything it provides, but you should be familiar with them so you know when to use them when needed. It will not help you learn the NREMT patient assessment algorithm.

Experience and knowledge are important for performing procedures like intubation or assessing a patient. Unfortunately, experience is over emphasized in EMS. You wouldn't believe how many EMT and Paramedic instructors have told me "I'm really good at a patient assessment", and when they are asked to demonstrate it, they verbalize "Okay.. I'm walk in the room. Scene is safe. The patient is tracking me with their eyes," as they wave their hands around and shake their head side to side, "Hey! I'm a paramedic. What's going on? Boom! Boom! I'm done! I did a patient assessment in less than a minute. That's how good I am and one day you will be this good too." Awful.

 

[sjlamb77]

Thanks you two, I had seen both of those books before and was hoping in a nerdy way I would have an excuse to get them. PoeticInjustice, as much as I would love to at least go advanced, I'm currently taking pre-reqs for med school. I have 8 classes to take, and time and money are unfortunately tight. I may consider doing my advanced training next summer though, if the funds will allow for it.

I noticed I can get a new edition of the physical examination book used for around $25-30, but I can get the 1999 version for like $5. Does it matter on that book or the Katzung book which edition I get?

 

[STXmedic]

Thanks you two, I had seen both of those books before and was hoping in a nerdy way I would have an excuse to get them. PoeticInjustice, as much as I would love to at least go advanced, I'm currently taking pre-reqs for med school. I have 8 classes to take, and time and money are unfortunately tight. I may consider doing my advanced training next summer though, if the funds will allow for it.

I noticed I can get a new edition of the physical examination book used for around $25-30, but I can get the 1999 version for like $5. Does it matter on that book or the Katzung book which edition I get?

Focus on getting in to med school. Don't worry about going further advanced unless you just really want to be a paramedic for the hell of it.

I've had the two most recent editions of Bates' and didn't really notice too much of a difference. Some updated information, but no huge changes. I honestly can't comment on Katzung though; I've only used one edition.

 

[Bullets]

Epocrates and Medscape are your best bets as smartphone apps. They are updated every month or sooner.

While there are some good pharmaceutics references, the paper versions cant update with the newest names and versions of meds that come out often.. There is also a lot of meds that youll never encounter included in Those books

 

[Shishkabob]

Is there a basic pharmacology book where I can learn not only emergency medicine pharmacology, but also lots of common medications?

No such thing as 'basic pharmacology'

If you want a book that has it all, the PDR, or Physicians Desk Reference is it. However I doubt you'll want to spend that kind of money and that kind of time for it, especially since it's outdated the moment it's printed.


Epocrates + Google are your best bets. See a medicine you don't know? Look it up. Not only is that the cheapest way, but really is the best way to learn the medications people take. It's no uncommon for me to be looking at a patients medications at their house, pulling out my phone and looking the meds up. Makes the big picture come together.

I've seen those books titled things like "Physical Examination and History Taking." Those are more geared towards doctors using differential diagnoses, but I was curious if that's the kind of thing I should be studying

That is precisely what you should be studying as that's what you end up doing: Differentials and working diagnosis'.



A good A&P book + class would suit you far better though.

 

[JPINFV]

Here's the thing with physical exam books. Outside of specific techniques/regions which you won't be examining in the manner described (i.e. things like bimanual pelvic exams or speculum exam/pap smears), a physical exam is a physical exam. There's no reason not to learn the proper way to examine an abdomen (i.e. look, listen, percuss, palpate) or which points to listen on the chest for heart sounds. Chances are your scope of practice in regards to a physical exam is "perform a physical exam." Unless it's invasive, generally the things you can do with your hands is up to you.

 

[EpiEMS]

Regarding pharmacology, as a fellow EMT with practically no more formal education (training, really) in pharmacology than NREMT requires and my EMT textbook requires, I try to look up every medication I'm unfamiliar with after every call.

 

[sjlamb77]

I do have a very inadequate understanding of A&P. What's a good, affordable book? I'd probably prefer something really in depth so that I can choose how shallow or in depth I'd like to go with each topic.

 

[EpiEMS]

I do have a very inadequate understanding of A&P. What's a good, affordable book? I'd probably prefer something really in depth so that I can choose how shallow or in depth I'd like to go with each topic.

I bought Guyton and Hall's Anatomy and Physiology. If I'm not mistaken, it's a commonly used textbook up through the MD level. I bought last edition, used, from Amazon for less than $50.

http://www.amazon.com/s/ref=nb_sb_s...+of+medical+physiology&sprefix=Guyton,aps,210

I'm doing this to address the same problem you mention -- lack of coverage of A&P in the EMT curriculum.

 

[NomadicMedic]

Take an A&P class at your local community college. The book is a good start, but alone it won't beat the lectures and lab.

 

[Veneficus]

I bought Guyton and Hall's Anatomy and Physiology. If I'm not mistaken, it's a commonly used textbook up through the MD level. I bought last edition, used, from Amazon for less than $50.

http://www.amazon.com/s/ref=nb_sb_s...+of+medical+physiology&sprefix=Guyton,aps,210

I'm doing this to address the same problem you mention -- lack of coverage of A&P in the EMT curriculum.

Guyton is used through the MD level, t is probably the best physio book out there.

Not because it is used in medical school, but because of how it is written.

Each chapter assumes the reader does not know how to apply basic sciences like chemistry in physiology. So it takes you step by step from the basics and shows you how it applies and/or why it is relevant.

But it has only a bit on pathophys and basically nothing in anatomy. (Because it is a med school text where anatomy, phys, and pathophys are seperate disciplines.)

When it comes to being good at physical exam, it is knowledge of pathophys that is most important. The more you know about it, the more useful and accurate your exam findings will be.

But it is a stepwise progression. You have to learn phys to deal with patho.

If anyone is planning to teach this to themselves, I would suggest against it. Not because there is any harm in doing so, but it is so much work, you really should sign up for a class and get some formal credit for it that you can apply or market later on.

 

[silver]

Take an A&P class at your local community college. The book is a good start, but alone it won't beat the lectures and lab.

Along these lines if your end goal is med school, a solid understanding of A&P would be helpful for the MCAT biological section and beyond.