The Patient Assessment

[Eydawn]

At the BLS level, you can only really observe and make crude inferences about what might actually be happening with your patient, especially with more subtle presentations and complex situations. "Oh oh, she's breathing 42 times a minute and her heart rate is 200. She needs to go to the hospital quickly and help controlling her breathing." At the ALS level, not only do you make observations, but you can take those and apply critical thinking to them because you have been given the educational toolbox to work with... and hence, you can initiate more treatments in the field and better communicate what you observe going on with the patient to the doctor once you arrive at the ER.

You see the same things and should be asking many of the same questions at both levels; it's what you do with the information and the other questions that you KNOW to ask at the ALS level that really delineates between an ALS and BLS assessment.

I hope this makes sense...

Wendy

CO EMT-B

[armymedic571]

At the BLS level, you can only really observe and make crude inferences about what might actually be happening with your patient, especially with more subtle presentations and complex situations. "Oh oh, she's breathing 42 times a minute and her heart rate is 200. She needs to go to the hospital quickly and help controlling her breathing." At the ALS level, not only do you make observations, but you can take those and apply critical thinking to them because you have been given the educational toolbox to work with... and hence, you can initiate more treatments in the field and better communicate what you observe going on with the patient to the doctor once you arrive at the ER.

You see the same things and should be asking many of the same questions at both levels; it's what you do with the information and the other questions that you KNOW to ask at the ALS level that really delineates between an ALS and BLS assessment.

I hope this makes sense...

Wendy

CO EMT-B

I am not trying to be smart here. But, are you trying to insinuate that BLS providers are not taught critical thinking skills? Or, are you just stating that treatment modalities are different because of education levels?

Would you agree that the assessment part of it, step for step, is the same?

Edited February 13, 2010 by armymedic571

[JPINFV]

I am not trying to be smart here. But, are you trying to insinuate that BLS providers are not taught critical thinking skills? Or, are you just stating that treatment modalities are different because of education levels?

Would you agree that the assessment part of it, step for step, is the same?

I'm not going to insinuate anything here. I'll flat out say that there's very little foundation material in EMT-B training to do anything but crude inferences and rudimentary DDxs unless serious extracurricular education is sought. You can't think critically about pathologies that you don't know exist.

Edited February 13, 2010 by JPINFV

[armymedic571]

I'm not going to insinuate anything here. I'll flat out say that there's very little foundation material in EMT-B training to do anything but crude inferences and rudimentary DDxs unless serious extracurricular education is sought. You can't think critically about pathologies that you don't know exist.

I am not disagreeing with you. Just wanted some clarification on her post .

[JackMaga]

Kant said that "eyes will see what the mind already knows"... healthcare providers with only basic trainig (such as EMT-Bs) may actually do the same assessment of more educated providers, however they do not have the knowledge necessary to appropriately interpret what they see, so most of the results of their assessment would go.

Even more, patient assessment is part of the providers differential diagnosis reasoning: basics don't have the fundamentals to do a proper diagnostic reasonig since they lack all A&P, patology and so on, so even when they're assessing a patient I don't think they really know what they're looking for...

[daedalus]

You need education in the basic medical sciences to synthesize information obtained from a history and physical exam and turn it into a working diagnosis. While an EMT and paramedic might both notice unilateral leg swelling and warmth, only the paramedic will be able to come up with a list of possible pathologies. What about cardiac and lung auscultation? What about a cranial nerve exam?

[armymedic571]

I'm not going to insinuate anything here. I'll flat out say that there's very little foundation material in EMT-B training to do anything but crude inferences and rudimentary DDxs unless serious extracurricular education is sought. You can't think critically about pathologies that you don't know exist.

I am not disagreeing with you. My original purpose for starting this thread was to highlight that despite the fact that the actual step in the ALS/ BLS assessment, besides diagnostics are exactly the same. That BLS providers do not have the base level education to properly allow formulation of differentials and treatment modalities.

Even more, patient assessment is part of the providers differential diagnosis reasoning: basics don't have the fundamentals to do a proper diagnostic reasonig since they lack all A&P, patology and so on, so even when they're assessing a patient I don't think they really know what they're looking for...

As above. However, I would agrue that a BLS provider who does a complete and thorough assessment should be able to formulate a general impression between "Sick/Not Sick".

You need education in the basic medical sciences to synthesize information obtained from a history and physical exam and turn it into a working diagnosis. While an EMT and paramedic might both notice unilateral leg swelling and warmth, only the paramedic will be able to come up with a list of possible pathologies. What about cardiac and lung auscultation? What about a cranial nerve exam?

Also as above. Lung auscultation is part of the assessment. But once again, the lack of education might prevent the development of differentials, or treatment modalities. But formulating a good general impression between sick and not sick. I am not fully convinced.

I feel that if a BLS provider does a complete exam, they should at least be able to tell the ALS provider that the pt is sick, unstable. They may not know why or how (goes back to education), but know enough to say that all is not well on the Eastern Front .

[JackMaga]

As above. However, I would agrue that a BLS provider who does a complete and thorough assessment should be able to formulate a general impression between "Sick/Not Sick".

Also as above. Lung auscultation is part of the assessment. But once again, the lack of education might prevent the development of differentials, or treatment modalities. But formulating a good general impression between sick and not sick. I am not fully convinced.

I feel that if a BLS provider does a complete exam, they should at least be able to tell the ALS provider that the pt is sick, unstable. They may not know why or how (goes back to education), but know enough to say that all is not well on the Eastern Front .

I think it depends on what do you consider sick/not sick to be... if sick/not sick means unstable/stable as in recognizing a near arrest patient in respiratory distress thatt needs immediate ALS care, or any other immediately life treating condition then yes, I think a BLS provider can and should be thaugh what to look for; however usually it takes only a visual primary survey to recognize such critically unstable patients so that the assesment a basic need to do is really well... basic! For example there's no need to palpate an abdomen or auscultate lung sounds to make a decision between critical and not critical.

If, on the other side, by sick/not sick you mean be able to recognize, based on your physical evaluation and history, that a patient, while stable, is suffering from a condition that might make him deteriorate within a short time (for example recognizing the presentation of a possible polmunary embolism in an otherwise healthy young patient with dyspnea and chest pain) then no, I think most basics will not have a clue... they might tell you what they're seeing if you ask them, but usually don't appreciate the significance of the signs they arere reporting, nor their relative importance.

Edited February 14, 2010 by JackMaga

[Brandon Oto]

I am not disagreeing with you. My original purpose for starting this thread was to highlight that despite the fact that the actual step in the ALS/ BLS assessment, besides diagnostics are exactly the same. That BLS providers do not have the base level education to properly allow formulation of differentials and treatment modalities.

I really think that you can't gloss over the above.

I realize you're trying to emphasize the education gap, as par for the course around here, but the fact remains that a Basic provider could literally be a FACEP in his day job, and a medic could actually be the world's biggest idiot; the first is NOT going to be able to truly assess to the level you're looking for, and the second may very well be able to, even if he's too dense to put it all together.

I CANNOT feel a pulse and tell you a patient's underlying cardiac rhythm or abnormalities. It is literally impossible. I can GUESS, depending on regularity, rate, and strength, and correlating with history and other presentation, but even if it's seemingly a gimme (A-fib, say), it will still only be a GUESS. The medic who runs an ECG can, if he is not brain-damaged, tell me what rhythm the patient is in. The fundamental difference between us is that he can use that tool and I cannot.

So I grant that the underlying assessment follows the same path, and is looking for the same things; but there is a certain level of clarity that is simply unavailable without the appropriate diagnostic tools, and in some cases that level is the critical one for recognizing conditions or narrowing a differential from meaninglessly large ("sick") to useful.

[Mateo_1387]

I voted that assessments are different with 'skill level'. It is really quite simple.

Education is honestly the difference between the assessments. Generally speaking, the more educated and/or more specialized the provider, the more detailed and conclusive an assessment should be. The more you know about how the human body works, the more you can suspect and assess for illnesses. Sure, the actual act of hands being placed on a patient may be similar between license levels, but the depth of the assessment will not be the same. How many Basics do you see perform assessments of the heart tones and cranial nerve exams? How many paramedics do you see perform assessments of tendon reflexes? The list can continue right on up the ladder. What is next, are we going to say that paramedics and nurses perform the same assessments?

Someone said it in another post, but it applies. How can you assess for something if you have no idea it even exists? The quality of the assessment is dependent on the depth of education.

Matty