Technology doesn't necessarily equal Diagnosis

[PRPGfirerescuetech]

aussiephil, one question:

How is treating anything possible without first deciding what the problem is, or diagnosing it?

How can you do a field diagnosis without using results from tests you dont have access to. You treat off the most likely from the combinationof symptoms.

Be careful when using diagnosis.

[aussiephil]

How can you do a field diagnosis without using results from tests you dont have access to. You treat off the most likely from the combinationof symptoms.

Be careful when using diagnosis.

Tank you PRPG. at last some common sense. AZCEP, I also stated, which you apear to have overlooked, that you treat what you see. Waht you see is based on your observations, history etc. This can only provide you with a PROVISIONAL DIAGNOSIS, a platform from which to commence any NECESARRY interventions. as has been stated repeatedly, a DIFFERENTIAL DIAGNOSIS can only be done when it has been confirmed by results of tests not available in a pre hospital environment.

It all boils down to what is the role of EMS? Pre Hospital care. Not difinitive care.

[Ace844]

Tank you PRPG. at last some common sense. AZCEP, I also stated, which you apear to have overlooked, that you treat what you see. Waht you see is based on your observations, history etc. This can only provide you with a PROVISIONAL DIAGNOSIS, a platform from which to commence any NECESARRY interventions. as has been stated repeatedly, a DIFFERENTIAL DIAGNOSIS can only be done when it has been confirmed by results of tests not available in a pre hospital environment.

It all boils down to what is the role of EMS? Pre Hospital care. Not difinitive care.

Seems to me we recently had the definitive care debate ing the 'Is EMS Definitive care Thread'; Is EMS definative care?....hmmmmm..Guess are going to end up going back there. A furthere reply will be forthcoming.

ACE844

[Ace844]

Seems to me we recently had the definitive care debate ing the 'Is EMS Definitive care Thread'; Is EMS definative care?....hmmmmm..Guess are going to end up going back there. A furthere reply will be forthcoming.

ACE844

Tank you PRPG. at last some common sense. AZCEP, I also stated, which you apear to have overlooked, that you treat what you see. Waht you see is based on your observations, history etc. This can only provide you with a PROVISIONAL DIAGNOSIS, a platform from which to commence any NECESARRY interventions. as has been stated repeatedly, a DIFFERENTIAL DIAGNOSIS can only be done when it has been confirmed by results of tests not available in a pre hospital environment.

It all boils down to what is the role of EMS? Pre Hospital care. Not difinitive care.

“Aussiephil,”

I disagree with your last statement, and since you have yet to provide ANY evidence as requested, to support your claims, I think now would be a prudent time to make sure we are clear about what we are talking about.It seems we need to be sure of the terms that we are using here freely. Below are a few sources and definitions to help us all. As you will see what we do and what physicians do are relatively one and the same.

="MedTerms medical dictionary AZ List”

Definition of Diagnosis

Diagnosis: 1 The nature of a disease; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies. 3 The identification of any problem. The diagnosis was a plugged IV.

The word diagnosis comes directly from the Greek, but the meaning has been changed. To the Greeks a diagnosis meant specifically a "discrimination, a distinguishing, or a discerning between two possibilities." Today, in medicine that corresponds more closely to a differential diagnosis.

Diagnosis, differential: 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.

Definition of Retrodiagnosis

Retrodiagnosis: Retrospective diagnosis. The proposal that the mysterious illness that killed Alexander the Great more than 2,300 years ago was West Nile fever is an exercise in retrodiagnosis.

=”Dorland's Illustrated Medical Dictionary “

definitive (de•fin•i•tive) (de-fin´ĭ-tiv) 1. established with certainty. 2. in embryology, denoting acquisition of final differentiation or character. 3. in parasitology, denoting the host in which a parasite reaches the sexual stage.

care (care) (kār) [A.S. caru anxiety] the services rendered by members of the health professions for the benefit of a patient. Called also treatment.

Now let’s further see what the other definitions we are using are.

=”Federal Law and Emergency Medicine

Emergency Medicine - Legal Aspects Of Emergency Medicine

Last Updated: February 21, 2006

Author: Robert Derlet, MD , Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief, Division of Emergency Medicine, UC Davis Health System

Robert Derlet, MD, is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, and Wilderness Medical Society

Editor(s): Francis Counselman, MD , Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, eMedicine; Matthew M Rice, MD, JD , Vice President, Chief Medical Officer, Northwest Emergency Physicians, Assistant Clinical Professor of Medicine, University of Washington at Seattle; Assistant Clinical Professor, Uniformed Services University of Health Sciences; John Halamka, MD , Chief Information Officer, CareGroup Healthcare System, Assistant Professor of Medicine, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Assistant Professor of Medicine, Harvard Medical School; and Steven C Dronen, MD, FAAEM , Director of Emergency Services, Director of Chest Pain Center, Department of Emergency Medicine, Ft Sanders Sevier Medical Center"

Definition of an emergency

Federal law defines an emergency medical condition as follows:

"Emergency medical condition" means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:

• Placing the health of the individual (or, with respect to a pregnant woman, the health of a woman or her unborn child) in serious jeopardy;

• Serious impairment to any bodily functions;

• Serious dysfunction of any bodily organ or part; or

• With respect to a pregnant woman who is having contractions:

o That there is inadequate time to effect a safe transfer to another hospital before delivery, or

o That the transfer may pose a threat to the health or safety of the woman or the unborn child.

See Prudent Layperson Definition of Emergency Medical Condition . : The prudent layperson definition of an EMC is widely interpreted yet generally defined as a medical condition that a nonmedical person with an average knowledge of the world would consider as needing emergency care. A recent survey of 1000 laypersons in the field attempted to define the prudent layperson definition for a number of specific complaints. Even among widely divergent socioeconomic groups, there was good agreement on what conditions needed ED care.

Stabilization entitlement for treatment of emergency medical conditions

Federal law requires that all patients with EMCs be stabilized within the capacity of the institution. Stabilization means, with respect to an emergency medical condition as defined, “that no material deterioration of the condition is likely within reasonable medical probability to result from or occur during the transfer of the patient from a facility” (or discharge). Patients must be stabilized regardless of ability to pay. The legal definition of stabilization under EMTALA may mean something different from the medical definition of stabilization. Full stabilization need not always occur in the ED, but in the most appropriate acute area of the hospital. For example, full stabilization of a patient with a gun shot wound to the abdomen may occur in the hospital's operating room, full stabilization of a massive myocardial infarction in the cardiac catheterization laboratory, and full stabilization of an obstetric emergency in the labor and delivery department.

Now lets see another source in addition to all of the above in my original post which support my point and claims.

=“http://en.wikipedia.org/wiki/Diagnosis”

Diagnosis (from the Greek words dia = by and gnosis = knowledge) is the process of identifying a disease by its signs, symptoms and results of various diagnostic procedures. The conclusion reached through that process is also called a diagnosis.[/b]

The term "diagnostic criteria" designates the combination of symptoms which allows the doctor to ascertain the diagnosis of the respective disease.

Typically, someone with abnormal symptoms will consult a physician, who will then obtain a history of their present illness and examine them for signs of disease. The physician will formulate a hypothesis of likely diagnoses and in many cases will obtain further testing to confirm or clarify the diagnosis before proceeding to render treatment.

=“http://en.wikipedia.org/wiki/Diagnosis”

History taking is a fluid process that adapts to the information as it is presented. Almost invariably the patient presents with a complaint. Even the unconscious patient presents with the implicit complaint of being unconscious. This presenting complaint leads to the formation of hypotheses. Rather than consider the myriad of diseases that could afflict the patient, the physician narrows down the possibilities to those conditions likely to account for the presenting complaint. The history taking then proceeds to test these hypotheses, often narrowing down the diagnosis within a few questions. Sometimes the initial hypotheses are ruled out and the physician must then move on to look at other hypotheses or multiple ones. Occam's razor is then invoked to attempt to simplify the number of provisional diagnoses and it is only with some reluctance that a physician will make several provisional diagnoses to explain the symptoms elicited.

The physician then moves on to the physical examination. However, the hypothesis testing does not end at this point. Signs may confirm the provisional diagnosis or cause the physician to consider the question further and even lead to more questioning. An unexpected finding on examination may cause the physician to reconsider the initial diagnosis.

At this point the physician usually has at least a differential diagnosis and probably a provisional diagnosis if not a firm diagnosis. Further tests are then requested, in part to confirm or disprove the diagnosis but also to document the status at that time and before treatment is started. Consultations with other physicians and specialists in the field may be sought.

Treatment itself may indicate a need for review of the diagnosis if there is a failure to respond to treatments that would normally work.

Despite all of these complexities, most consultations are relatively brief, partly because many diseases are common and pattern recognition allows the physician to recognize the diagnosis early, but also because the decision trees of most hypothesis testing are relatively short.

=“http://en.wikipedia.org/wiki/Diagnosis_of_exclusion”The term diagnosis of exclusion (per exclusionem) refers to a medical condition whose presence cannot be established with complete confidence from examination or testing. Diagnosis is therefore by elimination of other reasonable possibilities.An example of such a diagnosis is "fever of unknown origin": to explain the cause of elevated temperature the most common causes of unexplained fever (infection, neoplasm, or collagen vascular disease) must be ruled out.

Hope this helps,

ACE844

[Ace844]

How can you do a field diagnosis without using results from tests you dont have access to. You treat off the most likely from the combinationof symptoms.

Be careful when using diagnosis.

Because 'testing' is not necessarily synonmyous with lab results or radiological surveys. Testing can also mean parts of the P/E and H&P which include psychomotor actions and interactions one on one with a pt. Example, Lung sounds, Kernig's sign, Dolls eyes test, webber-rhine test, caloric test, stereographic function, graphestesia, etc......Those are things whaich could be done in the field, and don't require a hospital or technology.

Out Here,

ACE844

[AZCEP]

We can, and we do diagnose on every call, for every patient that we encounter.

Our diagnosis may be limited, might be "provisional", however, it is still a diagnosis.

You palpate crepitus, do you need a radiologic exam to tell you the underlying structure is damaged? Probably not. You take a series of blood pressures. Do you need any other test to tell you the patient is hyper-, or hypo-tensive? Of course not. Your 12 lead shows you an AMI. Do you wait for lab tests that are less sensitive to tell you the myocardium is dying? Surely not. You perform a finger stick blood sugar, and find that the number is a record low. Do you need to wait until your arrival to diagnose, and subsequently treat the hypoglycemia? Why would you?

Yes, we are limited in what we can diagnose, by the availability of testing resources. Will we be sure it was a pulmonary embolus that caused the arrest? Will we definitively know that the CVA was ischemic/hemorrhagic? Can we determine the abdominal pain was the liver or the gall bladder? Probably not for all of them, but we can use the information that we gather for those conditions to limit the possibilities.