Will I know it when I see it?

RScott

RScott

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I am finishing my EMT-B course and about to start clinicals. I have a noobie question: how easy is it to recognize the signs and indicators for particular injuries/sicknesses in the real world? The main assessment that comes to mind is testing the stability of the pelvis. We’re taught to apply inward/downward pressure on the iliac crest to check for stability and crepitus. Are those signs going to be apparent when they exist? Or are they subtle and easy to miss? What are other subtle signs/indicators that noobies tend to miss? I’m not confident in my ability recognize JVD, even after watching lots of videos on it. I’m really just trying to get some thoughts from experienced folks about the differences between theory and practice. Thanks in advance!
 
Yes. You will, unless it's subtle.

Then you won't.

Make sense?

If you rock a patient's pelvis and you feel the unstable bones grinding and they scream, it's a pretty good indicator of an unstable pelvis. If you aggressively assess and neither happen, chances are, if they have that injury, it won't be detectable until they get rads at the hospital.

I remember thinking "will I recognize a patient in extremis when I see it?" The short answer is yes. Patients that are on the verge of death or who are serious injured usually present that way. (I stress usually because of the outliers and the anecdotal "I saw a guy with his brains on the road who was asking me for a banana" comments.)
 
I am a student as well, and I've been riding in the rig with Paramedics since November or so. I had the same worry, but then again I'm just (for the most part) observing, although I'll take BPs and backboard the occasional patient. I've come to learn that trauma injuries are much easier to identify right off the bat, but where I am literally 90% of the calls are geriatric. The geriatric calls are a lot harder for me to identify what is wrong because a lot of the time the chief complaint will be 'stomach discomfort' or 'shortness of breath'.

Like I said, I'm just a student as well, so definitely don't take my word over the well-seasoned paramedics on this site. These are just the things I've learned in the area I'm in!

Cheers, and good luck!
 
MedicHacks said:
I am a student as well, and I've been riding in the rig with Paramedics since November or so. I had the same worry, but then again I'm just (for the most part) observing, although I'll take BPs and backboard the occasional patient. I've come to learn that trauma injuries are much easier to identify right off the bat, but where I am literally 90% of the calls are geriatric. The geriatric calls are a lot harder for me to identify what is wrong because a lot of the time the chief complaint will be 'stomach discomfort' or 'shortness of breath'.

Like I said, I'm just a student as well, so definitely don't take my word over the well-seasoned paramedics on this site. These are just the things I've learned in the area I'm in!

Cheers, and good luck!
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Thanks! Good luck to you also!
 
You gain instinct with experience. There's a reason they don't throw you in the back alone when you are new. EMS is a team you work together. You can apply the education you get in school to the education your team gives you on calls. The worst thing you can do is panic, stay calm think and everything will come natural.
 
RobertAlfanoNJEMT said:
Maybe in the paid companies but at my volunteer rescue squad I am on probation for 6 months so I can't ride without another EMT on board and it would be very rare that I am in the back by myself
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I would venture to guess that your personal experience is not the norm for the majority of this group.

Also, the thought of "another (volunteer) EMT" being the highest level of care available is a bit chilling for me.
 
gotshirtz001 said:
I would venture to guess that your personal experience is not the norm for the majority of this group.

Also, the thought of "another (volunteer) EMT" being the highest level of care available is a bit chilling for me.
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A normal 70 year old woman difficulty breathing type of call likely doesn't require more than an experienced EMT-B. We have ALS join us if it is a more serious call. I'm pretty sure that is the norm, I can gaurenty it is the norm for the whole state of NJ.
 
RobertAlfanoNJEMT said:
A normal 70 year old woman difficulty breathing type of call likely doesn't require more than an experienced EMT-B. We have ALS join us if it is a more serious call. I'm pretty sure that is the norm, I can gaurenty it is the norm for the whole state of NJ.
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*guarantee

Also, really?! Difficulty breathing is often a complex differential that is rarely solved with 15L via NRB.
 
gotshirtz001 said:
*guarantee

Also, really? Difficulty breathing is a complex differential that is rarely solved with 15L via NRB.
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The goal isn't to solve the issue its to maintain the patient or make them more stable until they arrive at a hospital and get definitive care
 
Ok... Now I REALLY hope I never get sick in New Jersey.

The confidence you have in the things you just stated is the scariest thing I have heard all week.
 
RobertAlfanoNJEMT said:
Maybe in the paid companies but at my volunteer rescue squad I am on probation for 6 months so I can't ride without another EMT on board and it would be very rare that I am in the back by myself
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At 6 months you are still new, especially at the call volume of volly agencies.
 
gotshirtz001 said:
Ok... Now I REALLY hope I never get sick in New Jersey.
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Listen don't discredit all of new jerseys EMTs, I am new to EMS which I believe I mentioned above.. We have very good medical personnel who know what they are doing. I don't really ap private the tone you have, I am trying to explain how our system works here in NJ and you are attacking me personally.
 
RobertAlfanoNJEMT said:
Listen don't discredit all of new jerseys EMTs, I am new to EMS which I believe I mentioned above.. We have very good medical personnel who know what they are doing. I don't really ap private the tone you have, I am trying to explain how our system works here in NJ and you are attacking me personally.
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*appreciate(?)
 
OP to your general question: the golden rule is if you don't look/listen/feel you definitely won't know it because you won't see it.

If you do check, you are more likely to see it. Some things are obvious on some patients, and a lot of time you'll at least notice something is not quite normal and your partner can help you specify your findings.

If you are looking for JVD, you are looking for something a lot of providers don't look for (even when they should). Remember you can look for a sign when you know it would likely be present rather than looking for a sign to guide you to a working dx. Know you have a heart failure exacerbation or fluid overloaded renal failure patient? Now you know what JVD looks like so that you aren't pondering findings during a trauma when they crumping.

RobertAlfanoNJEMT said:
I agree but at some point you have to break free and apply what you have learned
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I suppose so, but there is also a reason that nearly all EMT interventions fall under the category of "unlikely to hurt the patient if performed inappropriately, might help if done appropriately."
 
There is an old saying in medicine that patients do not read the textbook. The same is true in prehospital care as well.

For example, something like half of all patients who has STEMI have a normal or near normal physical examination, yet it is often taught a patient with STEMI will be nauseous, grey, sweaty and/or pale.

With that said; the "cinch" of diagnosis is a thorough history, examination and appropriate testing. Knowing what to ask, what to look for and what to make of whatever you find comes from a thorough knowledge of anatomy, pathology and physiology, and is a learnt skill. It is something that will take a decent amount of time to develop so don't be too worried about it for now. Look to your preceptoprs/clinical support officers for guidance.

Oh, and "springing" the pelvis is no longer recommended. Bind it if you think it is fractured.
 
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