Pt assessment to treatment and transport.

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EMSSam

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I've been busy on placement with the local ambulance as part of my course and I have been spending a lot of time trying to come up with some differential diagnoses while 'attempting' to assess patients.

It seems though, that unless it's blatantly obvious, the paramedics don't usually come up with a diagnosis, they just treat the symptoms (pain, fever etc) and transport.

How would they decide who to provide what treatment to?
This probably sounds like a dumb question but it would be useful to get a clearer idea of this.

Thanks,
Sam
 
Have they specifically told you that they aren't coming up with a differential diagnosis?

There are going to be those calls where you can't always come up with a differential diagnosis, so treating the symptoms is all you can do. However, if every call is run like that, it can be a problem. I try to at least form a general idea of what's going on with a patient after my primary assessment, if I don't do that, then am I really treating my patient effectively?
 
Are they just not saying it out loud? Next time, when you're on the way to the hospital and you're done with all your work, ask them to talk with you a little about what they think is going on with the patient.

Depending on whether they have he heart of a teacher, this could be a fruitful question.
 
I would ask them after the run; they may not remember during the run that you are there and they need to help you learn.

When I precepted I always tried to talk out loud of what I was thinking that way the preceptees could learn. I also told them to always talk out what they were thinking and how they were developing their line of thought/treatment.
That way I knew and could tell if they were going somewhere that could get them or their patient in trouble
 
communication is key, dispatch to crew, partner to partner, and reporting to nurses/physicians.

though i will say I've found EMS to be less about diagnosing, and more about asking questions, observing, and treating what you can before or during transportation given the nature of the call.

too many times I've had calls for leg pain without a fall, or abnormal labs. I'll decide whether OPQRST or SAMPLE would be valid, and i'll run through one or both depending on nature of the call.
 
Unless its mostly cardiac, diabetic, or another known condition you would keep an almost definite diagnosis.

In other calls you get more of a working diagnoses because of the fact that most of the times they call they are in the beggining stages of what becomes their allment.

For example it is simple to diagnose a fluid overload, but why is the fluid being built up. Thats when you look at their history, if you don't find nothing their then you dig deeper with your symptoms.
 
How do they decide?
Protocols plus their assessment divided by how long it will take to get to the hospital=treatment.

Glad I could clear that up.:mellow:
 
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