Two Medical Call Reviews

[rat115]

Hey with our pt her speech wasn't slurred or bizarre, it was simply hard for her to talk because of the trismus in her mouth. Sorry if I confused anyone!

Thanks!!! This makes me think that there was definately something neurological going on. That was an early impression because her blood glucose was only about 30 mg/dL high for her and the fact that there was too much going on with her speech and comprehension.

I may have to go for a walk and see if I can talk to the husband. That's the only way I'm going to find out what the dx was.

[NYCEMS]

I'm sorry, but where did anyone turn this into an ALS vs BLS debate? What guns exactly should NYCEMS stick to and what is it that he is holding dear? This warm and fuzzy stuff is all well and good, but it really isn't making much sense here.

That's funny, Scotty and I understood it just fine.

[NYCEMS]

No, I doubt they do. It's hard to state someone with only a few hundred hours of training and no formal education as in not having a degree to state they make a diagnosis is being asinine. Even stating they can make a clinical impression is stretching it. I even have a hard time accepting most Paramedics as being able to make a good clinical impression can be wishful thinking.

There is no such thing as ALS or BLS except in EMS where they have had to differentiate because of training vs. education. Medical care is medical care, the assumption especially regarding in making a differential diagnosis is much farther advanced than just simplistic signs & symptoms.

There is NO debating this. This is the way medicine is and yes we are division of medicine.

We all can learn no matter what the level but let's be realistic.

R/r 911

I definetley don't agree. I feel with my 17 yrs of responding to 911 calls I can make a good enough impression of what my pt may have. I don't know about you but in my job I'm required to give a rule out of what my pt has. Also the nurses and doctors I deal with actually ask me what I have and if your totally off the mark they"ll let you know. I take it upon myself to fine out if something stumps me. I like knowing. That's how I build my knowledge. I know I'm not a doctor but degree does'nt give you common scents. Nor does it make you smarter then anyone else. And I know some awsome medics that could make some doctors blush.

Thank you for your post there NYCEMS, and no need to apologise in any essence, stick to your guns ad be true to what you hold dear, patient care, not rank or fence posts.

Scotty

Thanks, believe me I will.

[fiznat]

I know I'm not a doctor but degree does'nt give you common scents. Nor does it make you smarter then anyone else.

Wow.

Edited April 19, 2009 by fiznat

[spenac]

I definetley don't agree. I feel with my 17 yrs of responding to 911 calls I can make a good enough impression of what my pt may have. I don't know about you but in my job I'm required to give a rule out of what my pt has. Also the nurses and doctors I deal with actually ask me what I have and if your totally off the mark they"ll let you know. I take it upon myself to fine out if something stumps me. I like knowing. That's how I build my knowledge. I know I'm not a doctor but degree does'nt give you common scents. Nor does it make you smarter then anyone else. And I know some awsome medics that could make some doctors blush.

Wow I was going to argue that we do make field diagnosis, regardless of what Rid thinks, but now instead I want to know what kind of "common scents" that we do not get with a degree?

W/o knowledge one only has experience based on ignorance.

Edited April 19, 2009 by spenac

[celticcare]

Oh lay off the guy for a simple spelling error, its the essense of the message is what he is meaning. There are some great medics and Techs out there without degrees and there are some medics who should have hung up their scope long ago. Are you saying the hospital trained nurses are stupid because they dont have degrees, remember Bachelor of Nursing is only about 15-20 years old and there are nurses who have nursed longer than that and have great knowledge, because they lived it and learnt it, same as there are some great medics and Techs who have lived it, learnt it, strove for knowledge off their own back and perhaps, have actually supportive hospitals and medical staff to guide them.

This deviation is for another thread, not to take over rat's one on the issues of what this patient presented with and what the complaint could be with the patient.

Rat did you find anything out from chatting to the hubby?

[fiznat]

Oh lay off the guy for a simple spelling error

The highlighted error was one of many. It is clear that he doesn't take the time to review what he says before he posts it. That says something to me.

There are some great medics and Techs out there without degrees and there are some medics who should have hung up their scope long ago. Are you saying the hospital trained nurses are stupid because they dont have degrees, remember Bachelor of Nursing is only about 15-20 years old and there are nurses who have nursed longer than that and have great knowledge, because they lived it and learnt it, same as there are some great medics and Techs who have lived it, learnt it, strove for knowledge off their own back and perhaps, have actually supportive hospitals and medical staff to guide them.

Look, I'm not saying that experience isn't a good way to get better at something. It is. My issue is with the suggestion that experience can serve as a surrogate for rigorous education. The poster above seems to have confused years on the street with years at school, and it is my personal opinion that his perspective is not only incorrect, but dangerous. ANY EMS provider (be it EMT or medic) should well understand that he/she is familiar with only a VERY small slice of medicine, and should have a profound respect that which he/she does not know. I think the above poser is proud of his 17 years, as he should be, but to suggest that he - or any EMS provider he knows - comes close to the diagnostic/educational level of a physician is pure hubris.

This deviation is for another thread, not to take over rat's one on the issues of what this patient presented with and what the complaint could be with the patient.

I think it is the same subject. The issue at hand is whether we are even capable of making such a diagnosis in the field. It is my position that we cannot.

Edited April 19, 2009 by fiznat

[mobey]

I think it is the same subject. The issue at hand is whether we are even capable of making such a diagnosis in the field. It is my position that we cannot.

I re-read the original thread and I do not see that question anywhere?

I totally agree with your guys stand on education vs experience (especially since every fricken thread in the last 5 years has that component to it), but this stupid argument over the word "Diagnosis" is a fricken joke.

We make a Differential Diagnosis in the field. We obvioustly do not have the assessment tools necissary to properly diagnose anyone, especially since a huge part of diagnosis includes responce to long term therapy (not for all diagnosis of course).

Definition of Differential diagnosis

Differential diagnosis: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness. The differential diagnosis of rhinitis (a runny nose) includes allergic rhinitis (hayfever), the abuse of nasal decongestants and, of course, the common cold.

From *Medterms.com*

NYCEMS: can you give an example of how common sence is superior to education (In a new thread)?

[celticcare]

I re-read the original thread and I do not see that question anywhere?

I totally agree with your guys stand on education vs experience (especially since every fricken thread in the last 5 years has that component to it), but this stupid argument over the word "Diagnosis" is a fricken joke.

We make a Differential Diagnosis in the field. We obvioustly do not have the assessment tools necissary to properly diagnose anyone, especially since a huge part of diagnosis includes responce to long term therapy (not for all diagnosis of course).

THANK YOU, we make differential diagnosis and that is it, even as RN's we are not allowed to diagnose but can form differential diagnosis. And even our DD's can be more correct than the doc and as conditions change so does the original diagnosis. The arguement of dont diagnose in the field is getting old, and perhaps those making the judgement are ones who have been proven wrong one too many times. We can formulate a provisional diagnosis and a field one as come on we need one to dictate our treatement and what regime to go down, treating symptoms is long gone, treating the condition is here.

[chbare]

I think the OP was not looking for a DDX so much as being retrospective and asking about how best to handle a situation. We all most likely have difficult patients that we frequently take care of, so I understand.

Not to say I disagree with Fiznat's point however.

Take care,

chbare.