Shouting at Elderly?

Noctis Lucis Caelum

Noctis Lucis Caelum

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You are called to the house of a 85 year old female. As you approach, you hear the patient begin to moan. You learn from the patients daughter that her mother was cleaning a kitchen cabinet and had slipped. In order to get a chief complaint, you ask the patient if she feels any pain anywhere. The patient responds with a moan. Of the following, which is not an appropriate coarse of action in dealing with this patient?

A. Apply supplemental oxygen to the patient.
B. Prepare for spinal immobilization via a backboard.
C. Obtain baseline vital signs.
D. Shout your question louder because most elderly are hard of hearing

The answer is (D)

I was taught never to shout at geriatrics
 
Noctis Lucis Caelum said:
You are called to the house of a 85 year old female. As you approach, you hear the patient begin to moan. You learn from the patients daughter that her mother was cleaning a kitchen cabinet and had slipped. In order to get a chief complaint, you ask the patient if she feels any pain anywhere. The patient responds with a moan. Of the following, which is *****not******* an appropriate coarse of action in dealing with this patient?

A. Apply supplemental oxygen to the patient.
B. Prepare for spinal immobilization via a backboard.
C. Obtain baseline vital signs.
D. Shout your question louder because most elderly are hard of hearing

The answer is (D)

I was taught never to shout at geriatrics
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Of course the answer is D. Re read the question and I hope I made it easier for ya.
 
Err, sorry about that. The answer says its A but i chose (D)
 
Um, was there a question here? cause, this looks like you're just posting a test question, just to post a test question.
 
A. Apply supplemental oxygen to the patient. is only appropriate if the patient actually needs oxygen. if they are satting well, exibiting no signs of resp distress, theres no need for 02.
B. Prepare for spinal immobilization via a backboard. would arguably be appropriate.
C. Obtain baseline vital signs. also not a bad answer.
D. Shout your question louder because most elderly are hard of hearing further asses their level of conciousness. if they are responsive to painful only, you could shout at them all day and just make your throat sore.
 
Only reason I agreed with A is because he is EMT and as we all know, on almost every single exam, the proper answer is high flow O2 and transport.

I chose D because you would not keep shouting at the person. My normal tone is enough for me to determine if a patient is going to answer or not, no further yelling required.

I do agree with KEV's explanations.
 
EDIT: I missed the *NOT*, makes my whole post obsolete lol
 
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Unless indicated (i.e. respiratory distress) our protocols say give 4L via nasal cannula
 
rhan101277 said:
Unless indicated (i.e. respiratory distress) our protocols say give 4L via nasal cannula
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Meaning you would go NRB if resp distress? Almost makes it sound as if you would withold oxygen if there was resp distress:wacko:
 
I dislike the use of the verb "shout" in this question. I don't shout or yell at patients I'm standing next to. I will, though, if need be talk with a higher volume for assessment and/or disability reasons (ex. hard of hearing)
 
so what your saying is your protocols basically want you to do this:

if the patient has no difficulty breathing/respiratory compromise, give them 4l n/c.

if the patient does have difficulty breathing/respiratory compromise, give them high flow by mask.


so the question comes up again, why give oxygen to patients that dont need it?


and yes, im aware that the standard answer to every emt test question is high flow o2 and rapid transport to the closest appropriate facility, doesnt mean i have to agree with it.
 
KEVD18 said:
so what your saying is your protocols basically want you to do this:

if the patient has no difficulty breathing/respiratory compromise, give them 4l n/c.

if the patient does have difficulty breathing/respiratory compromise, give them high flow by mask.


so the question comes up again, why give oxygen to patients that dont need it?


and yes, im aware that the standard answer to every emt test question is high flow o2 and rapid transport to the closest appropriate facility, doesnt mean i have to agree with it.
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Common sense isn't covered in the 100 hour course.
 
In my very humble opinion.

While I was in school we was taught that a patient can always benefit from o2.But,in this case,I'm not so sure I wouldn't grab a quick set of baseline vitals first to get a good benchmark of where the patient stands,especially airway and breathing since she was 82 yo.
 
That idea of giving oxygen just for the hell of it is wrong, what if the patient is intoxicated with Paraquat? What if the patient suffers from COPD? In case of Paraquat you could actually kill the patient for giving him O2, and in the COPD you could cause him respiratory distress.
 
Labareda said:
That idea of giving oxygen just for the hell of it is wrong, what if the patient is intoxicated with Paraquat? What if the patient suffers from COPD? In case of Paraquat you could actually kill the patient for giving him O2, and in the COPD you could cause him respiratory distress.
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First of all, I want to thank you for posting something that sent me on a search to learn more. I wasn't familiar with Paraquat until now. From what I have been able to find, while it is not recommended to give O2, I did read that if the patient was exhibiting signs of hypoxia that it should still be considered. It appears that it needs to be administered cautiously, and everything states it is best to contact medical control for advice first.

Now, for the COPD myth. If you have a patient with COPD that presents with any complaint that would indicate O2 should be administered, do not with hold it. The short amount of time that a patient is with EMS is not enough to disrupt their respiratory drive. It drives me nuts that this is still being taught, because it is completely false. Heck, these patients will also receive O2 in the ER as needed. O2 in COPD patients only becomes an issue in the long term, and even then some patients may very well end up on supplemental O2.
 
It's true what you say about COPD. The thing is, im supposed to follow the protocol. And I was told to never administer too much oxygen on a patient with this patology, and if the patient uses oxygen at home, never to give more than the amount that is prescribed by the medic. Thats why I stated it.
I was trying to give examples of situations where O2 isnt that great of a benefict, in an atempt to make him understand why the test says that the right answer was A.
About the Paraquat, intoxications with that substance are very rare. But still, just because it doesnt happen every day, doesnt mean we should not be prepared. ;)
 
I went and looked over the protocols and we give 2L/min for pt's with COPD.

4L/min as a precautionary measure for people with chest pain, stroke (beginning dose), trauma etc.

High flow 15L/min indications for using this are bad perfusion or inadequate oxygenation.

If they are not breathing adequately, assisted ventilations are always better than just plain 02.

I wasn't meaning we slap oxygen on every patient, but if IFT are already on it we put them on what they were on. Throughout my clinicals and now my part-time work I have never seen high flow O2 put on yet or have I seen a BVM in action.
 
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^
There's a difference between continuing an established therapy and starting/adjusting a therapy. Yea, if a patient is on continuous supplemental oxygen, then I'm not going to sit there and go under that limit. I'm free to increase that concentration during transport based off of my assessment, but that's the difference between continuing and initiating treatment.

As far as "high flow" oxygen, the difference between 10 L/M and 15 L/M (this actually makes an interesting question, why is liters per minute abbreviated LPM and not L/M?) most of the time is how fast you're going to drain your tank.


TexasEMTech said:
While I was in school we was taught that a patient can always benefit from o2.But,in this case,I'm not so sure I wouldn't grab a quick set of baseline vitals first to get a good benchmark of where the patient stands,especially airway and breathing since she was 82 yo.
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If a patient can always benefit from supplemental oxygen, then why isn't every patient in the hospital on supplemental oxygen?



I'm curious, though, can anyone give me a link to one of these protocols that actually proclaim "Thou shalt give oxygen to all thy patients?"
 
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