Syncope

[captaindepth]

Oh, so 2 years of school with the main end goal of in-depth assessments is the same as what a basic does?

I don't see any difference between an EMT-Bs ability to assess this pt and a paramedics ability to assess this pt. obviously when dealing with cardiac related events, respiratory distress/failure, medication administration, and severe trauma a paramedic has the increased knowledge and scope to address life threatening illnesses. I'd say 75% of 911 calls are truly BLS calls and proficient EMT-Bs are more than capable of handling these calls.

 

[FLdoc2011]

In evaluating syncope the most important element is arguably the history.

Taking a good history will most of the time give you an idea of the etiology, but can be tricky to do.

If he says he had the exact same episode before due to hypoglycemia then just playing the odds that's probably what happened, but I'm sill going to go through my usual questions dealing with syncope to evaluate other more serious causes.

 

[teedubbyaw]

I don't see any difference between an EMT-Bs ability to assess this pt and a paramedics ability to assess this pt. obviously when dealing with cardiac related events, respiratory distress/failure, medication administration, and severe trauma a paramedic has the increased knowledge and scope to address life threatening illnesses. I'd say 75% of 911 calls are truly BLS calls and proficient EMT-Bs are more than capable of handling these calls.

I wouldn't disagree that most calls are BLS, but as stx said, basics follow an algorithm. They more than likely won't know the correlation of the questions they're asking to the processes of what's going on.

OPQRST and SAMPLE do not equal an assessment. Paramedics are clinicians, basics are technicians. There is a separation, and it's not just putting on a monitor and giving meds. That is not to say that there are some exceptional basics with years of experience that could teach me a lot of real world knowledge.

 

[STXmedic]

Does neuro fall into your realm of equal footing, too? And who's to say this isn't a cardiac event? It's fairly apparent that OP is hinting at a zebra. This is not likely going to be "check his sugar and give him an amp", so there will likely be a more thorough assessment. If it turns out that this is a simple hypoglycemic, then I agree that both an EMT and a paramedic can both use a glucometer equally well.

 

[OnceAnEMT]

I'd say 75% of 911 calls are truly BLS calls and proficient EMT-Bs are more than capable of handling these calls.

I think its more like 95%, in all seriousness.

That said, in Basic school we were always told to know the major diagnoses and the common ones, but only to report the S/S, including to the ED. As in, I can't roll in with a Pt who presents apneic and discolored from the nipple line up and say he/she has a PE. Not sure if it is an unsung rule or what, but they really stressed the fact that we need to be knowledgeable but not go as far as diagnosing. What is this like on the Paramedic level?

 

[MidTech]

The NYC BLS protocols for AMS state:
In order of relevance...
* Administer oxygen
* Request Advanced Life Support assistance, if appropriate.
* If the patient is conscious, is able to swallow, and is able to drink without assistance, provide a glucose solution
* Transport
* Assess and monitor the Glasgow Coma score.

Unfortunately glucometers are not used in BLS setting here in NYC. I enjoyed reading all of your thoughts on the limited information I gave.

In ER BGL showed 312

 

[STXmedic]

I'm going to stop reading scenarios from new people.

 

[usalsfyre]

Protocols aside, both BLS and ALS providers are responsible to do a thorough assessment. An EMT-B can and should complete the same assessment of this pt as a paramedic, the only difference is what interventions both can do. An EMTs bread and butter should be getting accurate BPs and completing a SAMPLE history. Never assume anything, most pts cannot tell you why something happened to them, even if it has happened to them before. I trust my assessment more than some some guy wandering around in the middle of the night who fell for an unknown reason.

Not gonna happen for the same reason I can't give as in-depth exam as an EM attending. I don't have the knowledge base to pull it off. I get what you're trying to say and are likely parroting what you've been told but lets be realistic.

Also we carry 50ml premixed D50 syringes. Usually give one whole syringe to the pt if they are altered. Works a lot faster than waiting 20 minutes for the oral glucose to take effect.

This statement alone is enough to show you really have no idea on the ins and outs of care beyond the very basic algorithms you've learned. D50 for this patient is far more invasive than is needed and 25gms is probably a good bit more than needs to be administered.

 

[mycrofft]

I think its more like 95%, in all seriousness.

That said, in Basic school we were always told to know the major diagnoses and the common ones, but only to report the S/S, including to the ED. As in, I can't roll in with a Pt who presents apneic and discolored from the nipple line up and say he/she has a PE. Not sure if it is an unsung rule or what, but they really stressed the fact that we need to be knowledgeable but not go as far as diagnosing. What is this like on the Paramedic level?

:beerchug:

 

[mycrofft]

In evaluating syncope the most important element is arguably the history.

Taking a good history will most of the time give you an idea of the etiology, but can be tricky to do.

If he says he had the exact same episode before due to hypoglycemia then just playing the odds that's probably what happened, but I'm sill going to go through my usual questions dealing with syncope to evaluate other more serious causes.

Personally, regarding syncope cases' histories, I've had a high percentage of difficulty because the subject is unconscious or obtunded.

Couldn't resist.

 

[mycrofft]

D50 mui macho

…..

This statement alone is enough to show you really have no idea on the ins and outs of care beyond the very basic algorithms you've learned. D50 for this patient is far more invasive than is needed and 25gms is probably a good bit more than needs to be administered.

Yeah. Having worked with unstable diabetics for six years, I saw it wasn't the 25 grams of 50% glucose that effects improvement, it is the initial influx of sugar beyond a basic amount. Sort of like using a two inch nail when a one inch nail will do. If the D50 isn't exfiltrating there is no harm done, just keep the pt awake long enough to eat mixed carbs if it is otherwise safe, or go to the hospital as is medically necessary.

 

[Ewok Jerky]

When assessing a pt there should be no difference between and EMT-B and a paramedic until in an ALS situation.

In an ideal world, I agree that a basic SHOULD have the same H&P skills as a medic. The only tools used for an H&P is your brain, eyes, ears, mouth and hands.

In the real world, Bees are not anywhere close unless they have taken it upon themselves to learn more in depth pathophys and have the experience/pt contact to back it up (rare).

 

[Handsome Robb]

I think its more like 95%, in all seriousness.

That said, in Basic school we were always told to know the major diagnoses and the common ones, but only to report the S/S, including to the ED. As in, I can't roll in with a Pt who presents apneic and discolored from the nipple line up and say he/she has a PE. Not sure if it is an unsung rule or what, but they really stressed the fact that we need to be knowledgeable but not go as far as diagnosing. What is this like on the Paramedic level?

I generally will tell the Charge Nurse my differential Dx in my radio report and will tell the RN in my report as well. If we don't diagnose how do we decide what treatments to provide?

 

[OnceAnEMT]

I generally will tell the Charge Nurse my differential Dx in my radio report and will tell the RN in my report as well. If we don't diagnose how do we decide what treatments to provide?

Exact question that I asked, and was answered with we treat symptoms, not diseases.

 

[mycrofft]

If I'm an EMT, if matching observations to protocols' signs and symptoms is diagnosis, then I'm diagnosing.

 

[Chupathangy]

In my county if you suspect hypoglycemia, give them glucose. The fact he has a hx of DM just leads you to suspect it all the more. Im not really sure about CVA causing syncope, but Id do a stroke scale anyways to rule it out before giving him glucose. An O2 sat could be helpful as well.

 

[mycrofft]

Tongue in cheek

Now, wait. You're gathering important info. We can't have that. Chief, make sure none of these ambulances has a thermometer or a glucometer on board whatever you do!

PS on the OP, it isn't common for people to remember losing consciousness unless it was gradual. There's a factoid. But while they look puzzled when you ask them if they blacked out, they may look even more so when you ask if they remember waking up, and they say "Hey, yeah….!".