Imagine89 Posted July 9, 2006 Posted July 9, 2006 It's protocol for us to give 4 baby asprin (81 mg ea) to any pt complaining of chest pain as long as they aren't allergic.
Imagine89 Posted July 9, 2006 Posted July 9, 2006 Oh and I'm dyslexic, its 325 (324 technically) :oops:
mediccjh Posted July 10, 2006 Posted July 10, 2006 There is a good article in July's Emergency Medical Services Magazine about assessments. Start there. Then, look in the March 2005 issue of JEMS. There is an article entitled "25 Assessment Pearls." I strongly recommend that one too.
whit72 Posted July 10, 2006 Posted July 10, 2006 Monster medic wrote: agree with all the replies.I don't 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 That's pretty funny. Pt assessment basic skill. I don't think so. One of the most difficult things for new ems professionals to grasp is, Who is sick and who isn't. Who needs treatment and who doesn't. Its easy to read the signs and symptoms of chf or copd, seizures, cva's in a book. Rattle them off till your blue in the face, If you don't know what they look like or you cant identify or differentiate them. Then it really doesn't do you much good to know how to treat them. It takes some people years to figure this out. Some people never do. It comes with experience, you will be fine but it doesn't happen overnight. You are already smarter the half of the new graduates, you Identified there might be a problem. You didn't sweep it under the rug and pretend it didn't exist. Good luck, I am sure you will be an asset in this field.
Ridryder 911 Posted July 10, 2006 Posted July 10, 2006 The Old Saying "..... You can't fix what you don't know is broken....." is so true. Yes, I agree basics should be taught; however it is not true that they are. Watch the examinations of basic exams, and NREMT exams, it is a joke! Yes, they go head to toe, checking PEARL, abdomen with the tips of the fingers and not aware that the lower quadrants really are below the belt line. Now, when you ask the basic EMT what does it mean when one does not have equal pupils, the answer will always be ...head injury..okay why ? 99.99% you will receive a blank stare. All levels of EMS students are not really taught detailed assessments. Although it is true most of the time our assessment have to be curtailed and narrowed and not practical in most cases, this should not remove us from having the general knowledge and capability of performing a thorough assessment. It is common comments among the health care professional that Paramedics have very poor assessment capabilities. Would it not be better to have the knowledge of how to perform focused assessments than the usual assessment techniques that is being taught now? How many Paramedics can actually perform a true neuro examination or be able to detect that S[sub:7aa06bb858]3[/sub:7aa06bb858] heart sound with hollow systolic murmur.. and why not? They are wearing that $200 stethoscope Most reasons students and even field personnel are lacking in assessment skills is because they never performed very many or watch and study assessment skills. Again, it goes back to those clinical activities while in school. Did you follow others and watch and ask to perform concurrently while assessment are being performed? Were you checked for accuracy of your assessment skills? ... The only way to know abnormal findings from normal is by doing and performing assessments, hundreds, thousands.. on each and every patient when applicable. The best time is on the non-emergency patients. Perform an assessment, listen to lung sounds, heart tones, check capillary refill time, skin turgor..... where do most patients with edema first have symptoms at?... hint it is not the ankles.... Yes, one has to master assessment skills not only didactically, but clinically as well.. this takes time and one has to keep performing and practicing to continuously be profound at it. Again, practice, practice, practice... watch others, ask questions afterwards, ask for others to watch you to gain insight on your techniques... There are many books I highly recommend : one of them is Bledsoe, Cherry Paramedic Patient Assessment (paperback pocket size ) $19-23.00 http://www.amazon.com/gp/product/013117833...2536043?ie=UTF8 and several others that go into great detail. 'Good luck, R/r 911
Ace844 Posted July 11, 2006 Posted July 11, 2006 Also here's a great link which covers the whole H&P http://medicine.ucsd.edu/clinicalmed/history.htm
rescue25 Posted July 12, 2006 Posted July 12, 2006 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? My BLS protocol for non-traumatic chest pain includes 160-325 mg ASA PO if no sensitivity nor active GI bleed. Patient assessment has been the hardest thing for me to learn and get good at. Fortunately I've always been paired with good ALS providers to guide me and help me learn. Have you had any experience as a Basic or are you starting fresh as a paramedic? I'd be a deer in headlights too, if that's the case! Not a good feeling, for you or your patients. Be proactive in seeking out the help you need and hang in there!
FL_Medic Posted July 26, 2006 Posted July 26, 2006 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 Here is what I did... On every patient you get the key is to keep from getting tunnel vision. You should give every patient a detailed exam. If your patient has medical complaints then stick with your medical exam and a trauma exam for your trauma victims. After a while on the road you will be able to basiclly diagnose most of your patients before you make it to the ER. The key is practice. here is an example. Pt. c/o Shortness of Breath: With all pt.s a good history is prefered. The types of questions you should seek answers for, for this patient are: -When did this start? -Has this happened before? What was done? -Do you have a cardiac Hx? -Do you have COPD, or other breathing problems? -Are you on home O2? -What meds do you take? -What were you doing before this happened? Your questions will change depending on your patients complaint, some questions should always be asked. Lets say on this patient you are unable to obtain a Hx because of the distress and there is no one else present. If you are at the household in this situation you can search for meds and if the patient is able to understand you, you may want to ask yes and no questions. AVPU - lets say the pt. is alert Always start with ABC's Airway - If unable to maintain their own airway than you need to consider RSI, OPA, NPA etc.. Lets say the pt. is able to maintain their own airway which would most likely be the case if they are alert and c/o SOB. Breathing - RPM, Lung sounds, Depth, work to breath, O2 Sat Lets sat the pt. is breathing 24/min., shallow, audible wheezing in all feilds, fighting to breath with pursed lips, 88% on room air. Now we should begin treatment, hopefully having extra hands completing your VS, BP, HR, ECG... With the wheezing, resp. , pursed lips, and sat we can determine that we probably have some broncho-constriction. You put the pt. on high-flow O2 immediatley and ask the pt. if they have a known allergy to albuterol or atrovent. The pt. nods no. As you prepare your updraft you should note the pt.'s HR. And then administer. After you administer your updraft your pt.'s breathing clears up and he is now able to speak. Now would be the time to do a good focused exam and obtain your Hx. things to look for: -barrel chest -clubbed fingers -cyanosis etc.. This is just a quick example for you. You should always treat your life-threataning problems first. Then don't forget to do your focused. It will confirm your suspicions, and make you a better medic. There is no universal exam, or assessment. Every patient is different and every medic assesses differently. I have confidence that you will adapt your own style and do just fine. Check out my EMS system's assessment guidelines LCEMS
future medic 48_234 Posted August 3, 2006 Posted August 3, 2006 Since we're talking assessments, I was wondering what is a pearls assessment?
Ace844 Posted August 3, 2006 Posted August 3, 2006 Since we're talking assessments, I was wondering what is a pearls assessment? Care to be more specific? Are you asking about clinical PEARLS? The things you find in oysters? WHAT?
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