PLEASE HELP ME do better assessments

[FATGROVER]

Hi I've just finished paramedic school and am currently doing my field internship. During class I did great. I know my S.O.P'S back and forth, I can read strips pretty well. know my drugs well . But my huge problem is probably what should be the easiest thing to do. I stink at assesments. When we show up at calls I either freeze like a dee in lights, or I start talking to the patient and end up all over the place and I feel like I am confusing the patient. Does anyone have any tips, or examples. say Chest pain, or shortnes of breathe, or even a trauma. I feel I will be doomed if I can't get this basic skill down. No matter how well I am at ther other things

[Imagine89]

This is going to be through the eyes of a basic, dealing with drugs a basic can give, because that's all I am, so I apologize.

You're dispatched to a call for a 64 y/o male pt complaining of chest pain.

u/a you find pt seated, pale and slightly diaphoretic.

What's your name? As you're putting him on O2, start asking him to describe the pain, go through systematically, When did the pain start? Is there anything that makes it better or worse? Try as best you can to describe what the pain feels like. Does the pain go anywhere, or does it stay localized? On a scale of one to ten how severe is the pain? This will go really quickly. Get a quick set of vitals, then ask if he's allergic to asprin or pks, if not give him 235mg asprin. Get any meds at this point, its important, because we can assist with nitro. At this point, from a basic standpoint, following protocol, ALS would be on scene, and we'd be relocating to the rig. While en route ask what he was doing when teh pain started. What did he eat last? Any PMH? Get more vitals, and continue to check up on the severity of the pain, any other symptoms that should require additional assessment.

----

Essentially, just be systematic. Once you get into the rythym of it, it becomes habitual.

I dunno if this really helped, but I tried.

[noahmedic]

Pt. assessment is #1 in my book. I don't care how good your "skills" are, you can't do anything with them unless you can assess your pt. My best advice is to practice, nothing else is going to help you out. Find yourself an instructor and have them help you.

[medic001918]

Pt. assessment is #1 in my book. I don't care how good your "skills" are, you can't do anything with them unless you can assess your pt. My best advice is to practice, nothing else is going to help you out. Find yourself an instructor and have them help you.

+1. I don't care if you can recite the book to me word for word. If you can't assess your patient you can't perform an intervention. Your knowledge of anatomy and physiology is what should help to guide you through your assessment and determine where it should go next.

If you've made it all the way though paramedic school and are still unable to perform a competent assessment on a live patient, I might suggest that you spend some time working somewhere as a basic until you get the lay of the land. Only when you're 100% confident as a basic provider (including assessment) should you consider providing a higher level of care. With no offense intended, it doesn't sound like you're to that level yet. It would be in your best interests, and more importantly your patients interests to be sure you can perform the proper assessment in order to perform the proper intervention.

Shane

NREMT-P

[FormerEMSLT297]

First let me say that I agree with most of what others posted.... be systematic, have a plan and try to go head to toe....

Another good way to learn is to PRACTICE... and remember practice doesn't make perfect. "PERFECT PRACTICE MAKES PERFECT." LOL

.. practice on family, relatives,,, children,,,, practice with the book open so that you can remember what u need to ask and do....

also read.... a lot of EMS magazines with patient scenarios can help you to think about different patient presentations.

There are also some good books that specifically deal with patient presentations and pt. assessments.

Good luck

[Dustdevil]

I don't know where you got the impression that assessments are the easiest thing about being a paramedic. If your school taught you that, your school sucks. Assessments are the hardest thing about medicine, period. Any idiot can memorise drugs and protocols out of a book. Any monkey can sink a tube or IV. It is knowing when to do it that is the real practise of medicine.

You can't learn assessment through memorisation. Asking all the right questions does you no good if you don't have the education, intelligence, and common sense to put it all together into a correct diagnosis and plan. It takes lots of experience to get it down pat. And again, if your school didn't provide you with adequate experience to get it down pat, your school sucks.

So now your employer is going to have to do what your school should have and provide you with a quality and quantity internship experience in order to develop your assessment skills. Chances are -- if you are employed, that is -- they won't, so it's all up to you, Bro. Whether or not you ever become a functionally proficient medic is now 100 percent dependent upon you taking the initiative. Don't let yourself down.

And, minus 5 for not reading forum rules before posting.

[AZCEP]

One question, did you work as a basic prior to your medic class?

The quality of assessment might not have been there, but the interaction with patients would have made things progress more easily.

One of the great misguided notions about EMS is the BLS assessment is different from the ALS assessment. Truth be told, they are and should be the same. Same A-B-C's, same head to toe exam, same system by system evaluation. The difference lies in the amount of information that can be used when you find something.

If you can't do an assessment, how do you expect to know when to use a medication? How do you determine that a patient needs a procedure?

I will endanger my own sanity, and once again agree with Dustdevil. If you don't know assessment, you really have no business performing patient care. The fact that you are looking for help bodes well for you, but how did your program graduate anyone without the ability to figure out what is wrong with patients?

Get yourself to an ER, or do some extra ride-outs so that you can get this down. Perhaps discuss the issue with the preceptor that you are working with. There is a good possibility that you are doing some form of assessment without realizing it.

[rocket]

One of the great misguided notions about EMS is the BLS assessment is different from the ALS assessment. Truth be told, they are and should be the same. Same A-B-C's, same head to toe exam, same system by system evaluation. The difference lies in the amount of information that can be used when you find something.

...and I think that line of thought can be extended right into in-hospital (ED) care as well. Have a look at this article on Trauma Assessment (particularly the primary and secondary survey sections) and compare them to your assessment protocols. There are many similarities.

http://www.emedicine.com/med/topic3221.htm

The good news of this compatability/similarity between assessments is that they follow a logical sequence. This is not the same as a cookbook list IMHO, but rather they "make sense" in terms of the systems and disease or injury processes that pertain to the part(s) of your patient that you are assessing at the moment.

As for medical assessment:

Have you tried reading a Pathophysiology text? I like this one: Handbook of Pathophysiology, ISBN 1582550468. Reading this book helped me to see "what makes sense" in terms of medical assessment.

Good luck and thanks for caring enough about what you do to want to improve!

-Trevor

[monster_medic]

I agree with all the replies.I dont understand how your state health departments would let a person be able to upgrade there levels without a CLEAR understanding of a very basic skill.It is great that you know your drugs and strips......but are you sure you know when and how to use them.If you are not sure of what is wrong with your pt through assesment..how do you know what treatmentis right for your pt. This scares me now adays people being aloud to go strait from basic to medic.If it was me [and i did]a person should have to stay a a level 6mons to a year before being able to upgrade to the NEXT level and not be able to ''skip'' the intermidiate level.Most everyone that reads this will tell you that on truck EXPIRIENCE will teach you more than most text books will. You can be BOOKSMART ,,,,but are you going to carry your books with you all the time. You need to get the EXPIRIENCE and become ''STREETSMART''......................just my opinion and if i ruffled any feathers............so be it.

[EMS49393]

Get a quick set of vitals, then ask if he's allergic to asprin or pks, if not give him 235mg asprin. Get any meds at this point, its important, because we can assist with nitro. At this point, from a basic standpoint, following protocol, ALS would be on scene, and we'd be relocating to the rig. While en route ask what he was doing when teh pain started. What did he eat last? Any PMH? Get more vitals, and continue to check up on the severity of the pain, any other symptoms that should require additional assessment.

----

Essentially, just be systematic. Once you get into the rythym of it, it becomes habitual.

I dunno if this really helped, but I tried.

Did I miss a meeting? Are basics dispensing ASA now? Did they change the dose to 235 mg and not send me an email at work about it? Ugh, that place. ](*,)

As for a assessments, the above is a fantastic "by the book" assessment one would use to pass, oh say, the national registry. In the real world, if you can't communicate with your patient and build a rapport, you can't treat them appropriately. I don't agree you should practice on friends and family members. I do agree that you should consider doing some more time in the ER or in the field. Friends and family offer comfort, and are quite forgiving. Strangers that rely on you to handle their emergencies are not so forgiving. Take a deep breath and relax. It's not a sin to do more clinical time then required by class. The fact that you do means you care a great deal about being the best provider you can possibly be. You are able to address and overcome in the areas you have trouble with. Good Luck.