RiverpirateEMT
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I don't really ever believe the, "I feel fine" statement. They called an ambulance for some reason and the symptoms were descriptive enough to warrant a paramedic response. Obviously something is going on. I find old people to be incredibly stoic when faced with huge amounts of pain or discomfort. Even if the patient says they're fine, do a full assessment. You won't find things unless you look. For example, the guy who's having a STEMI and states that he feels fine, just a little tired.
and as for your scenarios, I would answer no to both. I don't treat atrial fibrillation unless it's symptomatic. And not every syncopal episode needs to have a 500ml fluid bolus. However, I would look for other issues and not just sit on my hands and have a staring contest on the way to the hospital.
People say they're fine for a lot of reasons. Maybe they're scared. Maybe they don't know that they're really hurt. I agree that you need to listen to the patient, but you also need to do that assessment and not just take everything the patient says at face value.
Oh absolutely on the assessment. Im talking after that or when someone else calls for them ( MVA or person down ).
Real life example :
female went syncopal for 5-10 seconds , friends called. Arrived on scene , person is cao x 4 . Pt says " I feel fine , this has happened before, I sometimes stand up fast and pass out". " Sure I'll go get checked out".
BP- 116/63 Pules - 70 - did assessment, nothing abnormal
Preceptor - " put a line in her and hang 1000cc normal saline"
Me to the patient - " how do you feel right now? "
Patient - " I feel perfectly fine"
Me - " are you thirsty? have you been drinking fluids? "
Patient - " yep , had breakfast and water and a gingerale before this happened"
Me -" do you feel sick to your stomach or anything?"
Patient - " nope "
Preceptor - " protocol says Iv fluids so do it "
Me- " umm, ok "
Ran the scenerio by my instructor that night
Instructor - " why ???? "
Me - " umm I dont know , because my preceptor controls my grade for the day "
This is the stuf im talking about. Treating those that really dont need treatment. Ive seen this over and over again running with different medics. Treating those that really dont need anything just because they can.
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