Regarding question in book.

[Cody1911]

It's called a critical thinking exercise. I also have a few questions!

"As an EMT, you are called out to a teenage boy who has taken a hard fall from his dirt bike. He has a deep gash on the outside of his arm about halfway between the shoulder and the elbow and another on the inside of his right arm just above the wrist. His left leg is bent at a funny angle about halfway between hip and knee, and when you cut away his pant leg, you see a bone sticking out of a wound on the front side. You take the necessary on-scene assessment and care steps and are on the way to the hospital in the ambulance. How do you describe your patients injuries over the radio to the hospital staff?"

So basically it sounds like this kid is more messed up than a child on different strokes. Obviously I just got done reading my anatomy and physiology chapter and did not miss one question in my workbook. So I feel good about the material! However... I was curious on how you would describe your patient to the hospital staff.

Also... I know it may be different for all agencies but does the ambulance driver describe this while driving? Or would the Paramedic in the back be the one to radio the hospital staff?

I am so used to the fire side of things where we just hand everything over to the ambulance I never understood how it quite worked from there. Thank you guys a bunch. EMT school starts in June but I am already on chapter 5 in my book. I figure I may as well have a head start.

Hope you all are well!

 

[DesertMedic66]

How would you describe the patient? And normally it would be the person treating the patient to do the call in.

 

[NomadicMedic]

Think about all the important things you would want to say to the doctor to make him aware of what was coming in… And do it in less than 30 seconds.

 

[Cody1911]

How would you describe the patient? And normally it would be the person treating the patient to do the call in.

Lets see if I get this right. If not... More reading for me! Alright since it said to always refer to anatomical position for every patient no matter what position they are in during the injury etc... This is what I would go with.

A deep gash on the outside of the left arm halfway between the shoulder and elbow. Since they are referring to the outside... It would be posterior right? I would consider that proximal since it's closer to the torso.

The other gash inside of his right arm just above the wrist... I would consider this distal, as well as anterior.

Considering his left leg is bent at a funny angle between his hip and knee (patella) and there's bone sticking out of the front side, that would be a femur fracture.

So it would go something like this... (Keep in mind I don't know how the process of describing a patient goes but I will learn this no doubt but I will give this a go.

I would say something like...

I have a teenager who has taken a fall from a dirtbike, who has a posterior wound on the left arm about halfway between the elbow and the scapula. PT also has a distal gash to the right arm on the anterior side. PT also has a left femur fracture which has punctured the skin on the anterior side between the hip and the patella. Is this close to being right?

 

[Sublime]

Lets see if I get this right. If not... More reading for me! Alright since it said to always refer to anatomical position for every patient no matter what position they are in during the injury etc... This is what I would go with.

A deep gash on the outside of the left arm halfway between the shoulder and elbow. Since they are referring to the outside... It would be posterior right? I would consider that proximal since it's closer to the torso.

The other gash inside of his right arm just above the wrist... I would consider this distal, as well as anterior.

Considering his left leg is bent at a funny angle between his hip and knee (patella) and there's bone sticking out of the front side, that would be a femur fracture.

So it would go something like this... (Keep in mind I don't know how the process of describing a patient goes but I will learn this no doubt but I will give this a go.

I would say something like...

I have a teenager who has taken a fall from a dirtbike, who has a posterior wound on the left arm about halfway between the elbow and the scapula. PT also has a distal gash to the right arm on the anterior side. PT also has a left femur fracture which has punctured the skin on the anterior side between the hip and the patella. Is this close to being right?

When using terms such as distal or proximal, you need to specify what part of the body it is distal/proximal to. For instance "patient has a laceration proximal to his right wrist." or "patient has a laceration distal to his right elbow on the anterior portion of his arm."

Also when describing a specific bone or muscle, you don't need to further explain where it's at. You could just say "pt, has a right femur fracture"... they know where the femur is. In this case I would just say "pt. has an open femur fracture on his right leg"'.

You need to re-read the terms lateral, medial, posterior and anterior. Radio reports you will get better at in the field when you practice them and get more experience. You'll most likely do them a lot different than the book says to also.

 

[Cody1911]

Thanks a bunch sublime. It sounds like I am making it harder than it really is. :wacko:

 

[DesertMedic66]

Lets see if I get this right. If not... More reading for me! Alright since it said to always refer to anatomical position for every patient no matter what position they are in during the injury etc... This is what I would go with.

A deep gash on the outside of the left arm halfway between the shoulder and elbow. Since they are referring to the outside... It would be posterior right? I would consider that proximal since it's closer to the torso.

The other gash inside of his right arm just above the wrist... I would consider this distal, as well as anterior.

Considering his left leg is bent at a funny angle between his hip and knee (patella) and there's bone sticking out of the front side, that would be a femur fracture.

So it would go something like this... (Keep in mind I don't know how the process of describing a patient goes but I will learn this no doubt but I will give this a go.

I would say something like...

I have a teenager who has taken a fall from a dirtbike, who has a posterior wound on the left arm about halfway between the elbow and the scapula. PT also has a distal gash to the right arm on the anterior side. PT also has a left femur fracture which has punctured the skin on the anterior side between the hip and the patella. Is this close to being right?

It varies depending on your area and the hospital. For my area it would be more of "lac (laceration) on left arm between shoulder and elbow on the posterior aspect. Lac on the anterior aspect of right arm just proximal to wrist (if the lac "gash" is above the wrist is that meaning on the hand or on the arm?). Patient has a left open femur fracture (this would be said before the other lacerations)

 

[Sublime]

Thanks a bunch sublime. It sounds like I am making it harder than it really is. :wacko:

No problem. In real life my report would probably sound something like this "patient was involved in a dirt bike crash. He has multiple lacerations to both arms and a open femur fracture to his right leg." Then go on to vitals, treatment, ect.

But you have to do it the way your book wants it done, and in this case it looks like they're just testing that you know your anatomical terms.

 

[Cody1911]

Thank you desert. I guess I was confused on the proximal and distal thing because of how it looks in the book... I will definitely go over those terms again. (open femur fracture) I meant to say that instead of puncturing through the skin lol.

 

[Cody1911]

No problem. In real life my report would probably sound something like this "patient was involved in a dirt bike crash. He has multiple lacerations to both arms and a open femur fracture to his right leg." Then go on to vitals, treatment, ect.

But you have to do it the way your book wants it done, and in this case it looks like they're just testing that you know your anatomical terms.

I think so sublime, they have these "critical thinking exercises" quite a bit through the book. It's funny almost everyone I talk to says what I read in my book I will almost never be using out in the field. I am working out of the Emergency Care 12th edition. It's laid out pretty nicely!

 

[Sublime]

I think so sublime, they have these "critical thinking exercises" quite a bit through the book. It's funny almost everyone I talk to says what I read in my book I will almost never be using out in the field. I am working out of the Emergency Care 12th edition. It's laid out pretty nicely!

The parts about patient conditions and pathologies, A&P, and treatments will definitely all be used in the field. Little things such as radio reports / charting will all vary based on where you work.

 

[Cody1911]

I gotcha. Different protocols etc...

My class is a month long apposed to the 4 month long class. I am sure we will be going over everything pretty fast, that's why I am getting a headstart on this while I can.

 

[Handsome Robb]

This is how I would give it. The numbers are made up so take it for what it's worth

"Xxx hospital, medic 338 inbound with a 10 minute ETA, on board I've got a 17 that's one-seven year old male patient who fell while riding his dirt bike at approximately 25 mph. No loss of consciousness, pt is a&ox4 with a gcs of 15. He has an open left femur fracture with various other suturable lacerations, bleeding is controlled, vitals are 136/82, 115 sinus tach without ectopy, 98% on a couple of liters, respirations are 16 and uncomplicated. He's in spinal precautions, I've got bilateral lines for ya, I've given him 200 of fentanyl, 2 of versed and 4 of zofran. Unless you have any questions we'll see you in 10 minutes."

Easily done in under 30 seconds. That's an ALS report but for your class just take out everything past spinal precautions and just tack the "unless you have any questions I'll see you in x minutes" on the end and you're golden.

You don't need to be super specific on the radio, tell them how far out you are, what you've got, their mental status, a quick blurb of your interventions and that's all.

 

[Cody1911]

This is how I would give it. The numbers are made up so take it for what it's worth

"Xxx hospital, medic 338 inbound with a 10 minute ETA, on board I've got a 17 that's one-seven year old male patient who fell while riding his dirt bike at approximately 25 mph. No loss of consciousness, pt is a&ox4 with a gcs of 15. He has an open left femur fracture with various other suturable lacerations, bleeding is controlled, vitals are 136/82, 115 sinus tach without ectopy, 98% on a couple of liters, respirations are 16 and uncomplicated. He's in spinal precautions, I've got bilateral lines for ya, I've given him 200 of fentanyl, 2 of versed and 4 of zofran. Unless you have any questions we'll see you in 10 minutes."

Easily done in under 30 seconds. That's an ALS report but for your class just take out everything past spinal precautions and just tack the "unless you have any questions I'll see you in x minutes" on the end and you're golden.

You don't need to be super specific on the radio, tell them how far out you are, what you've got, their mental status, a quick blurb of your interventions and that's all.

"I've given him 200 of fentanyl" I would want some of that with an open femur fracture too.

Robb thanks a bunch. I think after MANY calls this is something I will get better at as time goes on too.

By a&ox4 you are meaning alert and oriented right? Just curious... what does this x4 mean? (haven't gotten to that chapter yet)

Edit: Just did a google search. to person, place, time, and circumstances... x4. Makes sense... I remember when I did a ride along and they asked an intoxicated pt who the president of the united states was and he said bummus.

 

[Martyn]

Well done for reading your books ahead of time but...reading the books without actually attending class can be very confusing. In class your instructor will explain a lot more and make it easier to understand. By all means read the book, but bear in mind a lot of the text will seem like a foreign language until you are actually in the lecture, by all means ask on here, thats what we are for, just don't fret too much about it.

(AOxwhatever means alert and oriented to time place and person, I asked an elderly man last year (whose nursing notes said he was pleasantly demented) Me:can you tell me what year it is sir? Pt:Er, 2011ish? (first week in january) Me: OK, thats pretty close can you tell what city you are in? Pt: don't you know? Me: I know what city I am in Pt: Well if YOU know then I don't have to tell you (me thinking, OK, not gonna argue with him on that one) Me: OK sir, can you tell me who the president is? Pt: yeah, that damn nXXXXr Me (thinking) oh crap. I had to put him AOx1 because he knew the president is black).

 

[J B]

This is how I would give it. The numbers are made up so take it for what it's worth

"Xxx hospital, medic 338 inbound with a 10 minute ETA, on board I've got a 17 that's one-seven year old male patient who fell while riding his dirt bike at approximately 25 mph. No loss of consciousness, pt is a&ox4 with a gcs of 15. He has an open left femur fracture with various other suturable lacerations, bleeding is controlled, vitals are 136/82, 115 sinus tach without ectopy, 98% on a couple of liters, respirations are 16 and uncomplicated. He's in spinal precautions, I've got bilateral lines for ya, I've given him 200 of fentanyl, 2 of versed and 4 of zofran. Unless you have any questions we'll see you in 10 minutes."

I'm also a newbie. I think there's a lot to learn from the way you give this report:

I like how you made the age of the patient clear. My inclination is to just say "teenage male", but there's a big difference between someone who is 13 and someone who is 19 even though both are technically teenagers.

I also like how you didn't go into great detail describing non-critical things: "Fell from dirt bike @25mph, no loss of consciousness, open femur fracture, several controlled lacerations, vitals within normal limits, x y z medications given" pretty much tells them everything that will be useful for them to know right now. They don't need you to warn them in advance of the exact location of a superficial laceration on his arm.

It's interesting how everyone seems to be very focused on describing his physical condition. This seems like it could almost even be a trick question. It seems to me that his mental status is actually probably more important than anything else. If he hit his head in the fall, a fractured femur could be the least of his worries. No loss of consciousness, a&ox4 gcs 15 allows the hospital to sort of discount most of the more serious things that could happen after a fall like this. Bones and skin are easy to fix, the brain is not.

 

[Brandon O]

I think so sublime, they have these "critical thinking exercises" quite a bit through the book. It's funny almost everyone I talk to says what I read in my book I will almost never be using out in the field

Just remember that the report you give in person, what you document, and the notification you give over the radio or phone may all be quite different. Prior to your arrival, they usually want to know mainly that you're coming, how sick the patient is, and what (if anything) they need to do about it.

In that vein, some patches will be a somewhat formalized version of "we're bringing you a patient, they're cool, see ya soon." Obviously your kid here is a little sicker than that, but the principle still holds. You hear many things spouted into the radio when the nurse's responding thought bubbles are a non-stop stream of, "don't care... don't care... don't care..."