Two Medical Call Reviews

[Dustdevil]

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Attention to detail, folks. It's the mark of a professional.

NYCEMS, I ask that you go take a careful read of the Forum Rules that you agreed to when you joined here. If you can't live with them, we can live without you. It wouldn't hurt the rest of you to re-read them either.

[VentMedic]

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,

One little correction is due here. The BSN has been around alot longer than 20 years. The two year degree for nursing started to become required for licensure in some states in the 1970s. That doesn't mean there were not college degrees for nurses. In fact, it was the nurses with BSNs, MSNs and Ph.Ds that were teaching many of the Paramedic classes during the 70s and 80s.

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.

Paramedics make a working diagnosis because of the lack of data for a differiential diagnosis. Some may have to give it their best quess at times in the field to make it work by their protocols. Some protocols are also written so the Paramedic follows them to the letter with little thought or room for much fault when it comes to clinical judgement. I believe there is another recent thread where CPAP was thought to be indicated by several but by the protocols of the OP provider, it was not and one probably didn't dare to deviate from the protocols. Some also get so set on making a "diagnosis" in the field, they will "make the symptoms" fit what they believe, thus they may limit or overlook some very valuable assessment information. This is why other professionals also make a working diagnosis but leave enough room or keep an open mind to take another pathway as the assessment plays out.

Nurses make a nursing diagnosis and it is adjusted to the situation they are working in be it an ICU, Flight team, Code team, Rapid Response Team or med-surg. The difference for RNs is they do have access to more protocols with guidelines that can give them more treatment pathways. A Paramedic will often have to "choose" a diagnosis from a very limited list in order to get a protocol initiated. The differential process comes when it is a toss up between two diagnoses that have similar symptoms.

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.

It would take considerable testing before the actual diagnosis is made and there there could still be other possibilites.