What is "Normal"??

[medtech421]

I was looking at a PHPCR and keep seeing normal as a possible patient condition. i.e. - L/S Normal, Wheezing, Rales, etc.... or HEART Normal, murmur, irregular, Tachycardia, etc....

What is normal? If someone has been diagnosed with Alzheimers do you check normal or confused on the GCS? If the pt has had a BKA and now has a prosthetic would you say that is an abnormality? In short does "normal" mean normal for that individual or normal according to the standards of idealism? This conversation should be fun.

 

[WolfmanHarris]

Normal and stable are two of my most despised words.

Breath sounds are not normal, they're clear, or adventitious, or diminished, etc.
Now for that patient, some consolidation, wheezing, etc might be their usual state of health and thus "normal" for them at this time.

A pt. with dementia may be usually confused. But even this has degrees. When recording GCS I will put what their actual GCS score is and then in remarks I may state, "As per family this is Pt.'s usual mentation."

 

[JPINFV]

Normal tells me absolutely nothing about the patient. A resp. exam could be, "Clear to auscultation bilaterally. No rales, wheezes, or rhonchi heard." However, a patient with CHF who has chronic rales could be considered "normal" (or, at a minimum, not a concern) as well, despite an abnormal physical exam finding.

 

[medtech421]

Normal and stable are two of my most despised words.

Breath sounds are not normal, they're clear, or adventitious, or diminished, etc.
Now for that patient, some consolidation, wheezing, etc might be their usual state of health and thus "normal" for them at this time.

A pt. with dementia may be usually confused. But even this has degrees. When recording GCS I will put what their actual GCS score is and then in remarks I may state, "As per family this is Pt.'s usual mentation."

I wish I could bypass all the canned responses and just do a narrative, but I definitely love what you do with the GCS and remarks. The little obvious things sometimes escape us.

 

[WolfmanHarris]

I wish I could bypass all the canned responses and just do a narrative, but I definitely love what you do with the GCS and remarks. The little obvious things sometimes escape us.

Ya we've received some negative feedback from MD's at receiving facilities since we switched to a ePCR program (Siren). The flow and formatting of the form makes it difficult to get a coherent picture of what happened. As a result for high acuity calls I usually write a long narrative in the comments area that covers the whole call.

 

[zmedic]

Normal is not a good term, but in your PCR it sounds like "normal" should be when there is not a relevant finding. So for mental status, if the person is confused, put "confused." That plus the history of alzheimers makes sense, and is much easier to defend then when you are in court explaining why you said the mental status was normal but the doctor documented the patient was altered.

More importantly, you almost never know what is normal for the patient. Sure they have alzheimers, but are you sure they aren't more confused than usual? Is that murmur louder? The tremor worse?

Just document what you find.

 

[medtech421]

My apologies for not clarifying, I work for a private service that has Dialysis patients as the bread and butter, and we run emergent calls only as mutual aide to the county service or as primary emergent transport for contracted facilities. One unit could see the same patient as many as 6 times per week (take and return from dialysis), although more commonly it will be 3 or 4 times per week. We really get the unique opportunity to see our regular patients more often than a service that runs exclusive emergent calls. Either way, normal is a scary word on a PCR

 

[DesertMedic66]

i will write what is wrong with the patient then put normal if that is normal for them. if i do a call in to a hospital and give them a low GCS number then they might ask me to upgrade my response along with other things. so i will normally write and say "Pt has a GCS score of 10. this is normal for the patient per the family and on site nurse".

 

[medicstudent101]

i will write what is wrong with the patient then put normal if that is normal for them. if i do a call in to a hospital and give them a low GCS number then they might ask me to upgrade my response along with other things. so i will normally write and say "Pt has a GCS score of 10. this is normal for the patient per the family and on site nurse".

Normal is a very relative term when it comes to EMS. Heck, it's a relative word period. This is what I tend to do as well, I write GCS## normal for pt per *Insert Source*. Throughout my clinicals for my paramedic, I've wrote this down and have yet to get a complaint from my preceptors.

 

[medtech421]

Normal is a very relative term when it comes to EMS. Heck, it's a relative word period. This is what I tend to do as well, I write GCS## normal for pt per *Insert Source*. Throughout my clinicals for my paramedic, I've wrote this down and have yet to get a complaint from my preceptors.

Good to know. I start medic school next week. 8 years as an EMT is enough to prep one for the next level I guess.

 

[medicstudent101]

Of course. I'm sure you'll do fine then. Do you ride with a 911 service or IFT?

 

[glock22brent]

I was always told by our instructor that if they saw "WNL" on our PCR they would fail us no matter what. She made a very good point that within normal limits is pretty much a useless statement.

 

[AlphaButch]

Simliar to most of the folks here. I write down what is in front of me and then will add "Normal for pt. per (family, physician, nurse, etc)".

WNL doesn't cut it on a paper report around here. On a busy day at the ER, it may work it's way into my verbal report to the ER doctor, dependant on the severity of injury/illness and if the patient is being put into a holding pattern or being seen at that moment.

i.e. Pt had 3 ft fall from bed at (time), no loss of consciousness, no visible injury/deformity, pain to r pelvis upon palp, vitals wnl "given age/hx/etc".

On a slower day I'm able to be more detailed, slower days are nice.

 

[flyfisher151]

Normal..... Setting on the washing machine Not trying to be smart, just something my girl said that cracked me up. Pretty much applicable.

 

[usafmedic45]

I was always told by our instructor that if they saw "WNL" on our PCR they would fail us no matter what. She made a very good point that within normal limits is pretty much a useless statement.

Because everyone who sees it reads it as "we never looked".