Never assume

[MetalMedic]

Not too long ago I was assisting a new EMR doing a truck check. We always keep the radio on so we can hear if we are possibly going to be sent for a mutual aid call. We heard a call come in for an 80+ person with AMS and a history of dementia. The town called responded and we continued on.

Shortly after we hear a tone asking for the air ambulance to meet them at the hospital do a transport. The EMR wondered why in the world the helicopter would pick up an AMS. I explained even though there is a history of dementia it could be AMS due to a head injury, there could be massive blood loss from the injury, subdural hematoma, etc. (As we all know that what we get called to and what we find are usually vastly different).

We keep working on the checks and he's listening intently on the progression of the call. We don't always hear the med patches as they are on different radio systems/channels, but about 5 minutes later we hear the air ambulance touch base with dispatch and confirm they are going to pick up an AAA. It kind of threw both of us for a loop, but it was a really good teaching moment, especially for someone who's even more green than I am.

Just a little reminder to always prepare, but never assume.

[FireMedic65]

Assuming will almost always get you in hot water. Something as simple (or seemingly) as AMS can be from many different things. Just because the patient has dementia does not mean their AMS is from that.

Kudos to you for thinking outside the box and teaching someone to do the same.

[DFIB]

What percentage off calls turn out to agree with the dispatch order? One that comes to mind is getting toned out for a dialisis patient having sezures. Yes, he was seizing but the underlaying cause was V-tach.

The only reliable information is your own assesment on the scene. Good call.

[HERBIE1]

Excellent teaching moment, Metal. It's easy to get tunnel vision and not consider ALL the possibilities.

Recently had an AMS call- R/O CVA, Found a slightly confused elderly female oriented to person and place, but was having trouble with short term memory. The family assured me that grandma is always sharp as a tack, but all day today she's been getting more and more confused, unsteady gait, and weak. Vitals not bad, but I cannot recall details.

She was negative on the Stroke scale, but after further questioning, we find out she had tripped and fallen 2 days ago, struck her head on a curb and received a large "goose egg" on the back of her head- no loss of consciousness. Refused to go to ER or allow medical attention per family at that time, said she was fine. No real evidence of trauma now. Light bulb goes off. I press for specifics, and the first responders look at me like I'm crazy. Isn't she having a stroke, they asked. I said it's possible, but more likely I tell them on the side this lady may have a subdural. They say- "But she fell 2 days ago!" I quickly explain the etiology of subdurals, how elderly are very susceptible to them, and this lady may be in big trouble.

Not sure how that one turned out but a CT confirmed the hematoma, and they were getting a neurosurgery consult when we left.

[Just Plain Ruff]

Excellent teaching moment, Metal. It's easy to get tunnel vision and not consider ALL the possibilities.

Recently had an AMS call- R/O CVA, Found a slightly confused elderly female oriented to person and place, but was having trouble with short term memory. The family assured me that grandma is always sharp as a tack, but all day today she's been getting more and more confused, unsteady gait, and weak. Vitals not bad, but I cannot recall details.

She was negative on the Stroke scale, but after further questioning, we find out she had tripped and fallen 2 days ago, struck her head on a curb and received a large "goose egg" on the back of her head- no loss of consciousness. Refused to go to ER or allow medical attention per family at that time, said she was fine. No real evidence of trauma now. Light bulb goes off. I press for specifics, and the first responders look at me like I'm crazy. Isn't she having a stroke, they asked. I said it's possible, but more likely I tell them on the side this lady may have a subdural. They say- "But she fell 2 days ago!" I quickly explain the etiology of subdurals, how elderly are very susceptible to them, and this lady may be in big trouble.

Not sure how that one turned out but a CT confirmed the hematoma, and they were getting a neurosurgery consult when we left.

Same instance for me Herbie. Had a guy come ot the ER after getting his ass handed to him in a bar fight. Bilat black eyes, busted nose etc etc. Refused to be admitted for observation.

Fast forward 24 hours, got a 911 call on a man not acting right. My partner said "he's probably drunk" or on drugs.

I get in the house, the guy is out of it. I remember him from the ER and I treated him that night. History fits that it's a bleed. Partner disagrees but I say no get the helicopter and let's send him to a trauma center.

Put him in the bird, they thought easy flight. 8 minutes out from trauma center patient seizes, goes unresponsive, flight crew RSI's and patient arrives to trauma center. Emergency CT scan shows egg size subdural and they evacuate it but it was too late. Patient died from the injuries the next day. He never lost consciousness.

My partner said that he had never seen something like that and was a little miffed that he assumed alcohol and or drugs.

I told him that this is why we never assume and we never diagnose in the field prior to seeing the patient.

[Richard B the EMT]

As so often repeated from "Felix Ungar", from "The Odd Couple" reruns on TV:

Never assume, becaused it makes an ass of you and me (ass/u/me)