CBEMT Posted March 25, 2007 Posted March 25, 2007 Both of us just finished EMT-I school and are waiting to test so we call the ER and ask for the Dr. So we can start a line and push some D50. So are you Basics who are allowed, with Medical Control, to start IVs and push D50, or are you Basics, awaiting your Intermediate licenses, who wanted to skirt the rules and get a doctor who doesn't know you from a hole in the wall to let you perform an invasive procedure and push a potentially dangerous medication? I'm curious. Dust I agree with you if their medical director didn't haul them into the office. There is something wrong with their system! In my experience, most systems don't have the money for the resources they need daily on the street, nevermind a fulltime Medical Director who can QA every run.
BUCKET Posted March 25, 2007 Posted March 25, 2007 We at our squad also carry it. I am not a big fan of it mainly because I guess I have no patients. lol. I would much rather give D-50, but I do believe it is a good back up in case you are unable to gain I.V. access.
Dustdevil Posted March 25, 2007 Posted March 25, 2007 What's A/O x 4? I thought there were only 3 - person/place/time. It amazes me how many places still teach the 3-parameter mental status report, considering the four parameters have been a professional standard for over twenty years. The fourth parameter is "event." That is, does the patient know what happened to him or her, or why EMS was called for them. You can know who you are, where you are, and what day it is, but still have a significant deficit if you don't know why you are lying flat on your back surrounded by firemonkeys. Regardless, optimal documentation lists exactly what parameters you are utilising, not just "x3" or "x4" because obviously, parameters differ from provider to provider.
anon311 Posted March 25, 2007 Posted March 25, 2007 Unless I'm mistaken, NY state still teaches A/O x 3. It definitely did back when I took the class which was only a few years ago. Of course, even a mediocre assessment would (hopefully?) reveal that a pt. doesn't know what happened (LOC?), resulting in proper documentation/treatment even if they're "A/O x 3."
medic001918 Posted March 25, 2007 Posted March 25, 2007 Regardless, optimal documentation lists exactly what parameters you are utilising, not just "x3" or "x4" because obviously, parameters differ from provider to provider. Excellent advice from Dust. I always document x/3 or x/4 depending on if there's an event that can be tied to the call. An example is a fall, that's where the "event" is cruicial. For a medical such as chest pain, if the patient has called themselves then I'll use x/3. But you should ALWAYS document the parameters you were using. And to Mobey, you have oral glucose in your protocol for an unconcious, hypoglycemic patient? And you think you can only do good with oral glucose? I'm just curious, but isn't one of the direct contraindications for oral glucose having the inability to control their own airway? If a patient can't control it and you give it to them, there is a significant risk of aspiation that could directly be tied to your treatment. Something else to think about is that oral glucose is rather thick, and not the easiest substance in the world to suction. Your best bet would be managing this patient by some other means than giving them cause to aspirate and complicating their condition. Shane NREMT-P
PRPGfirerescuetech Posted March 25, 2007 Posted March 25, 2007 Lets simplify. If you use AOx4 and you list patient is AOx3, could your patient be construed as "without neuro deficit" Just like, if you list your patient as AOx3, could he be construed as not being aware of the "event" that took place, even if you meant he was perfectly normal? Simply stated... "Patient was alert to person, place, time and event" Now back to your regularly scheduled discussion...
CBEMT Posted March 25, 2007 Posted March 25, 2007 You can know who you are, where you are, and what day it is, but still have a significant deficit if you don't know why you are lying flat on your back surrounded by firemonkeys. Lol, I recently had a lesson to be careful with this. My patient knew who she was, where she was, what day it was, and that she was going to the hospital (not really why exactly, because the snf nurse hadn't told her and I was still early in my assessment to get into details). We get to the hospital, I tell the triage nurse that she's alert x 4 etc etc. It was a possible CVA, so nuero status was important. Nurse asks her what year it is. "1998." D'oh....
BUCKET Posted March 26, 2007 Posted March 26, 2007 The area and the squad in which I work for we are well enough trained that we don't have the mother may I system in place. Other areas around us some of which do have that system in place I see their pt's suffer from it. I do however understand how it is a good thing for some ems agencies to have if they are not well enough trained in their skills to know what to do in emergency situations. If this applies to you then I feel deeply sorry for your pt's, because of the extended time the care is delayed. Because as we all know in our line of work seconds mean the difference between life and death.
AnthonyM83 Posted March 26, 2007 Posted March 26, 2007 It amazes me how many places still teach the 3-parameter mental status report, considering the four parameters have been a professional standard for over twenty years.LA County only uses x3...seems like "event" would be a pretty important one.
Dustdevil Posted March 26, 2007 Posted March 26, 2007 The area and the squad in which I work for we are well enough trained that we don't have the mother may I system in place. Other areas around us some of which do have that system in place I see their pt's suffer from it. I do however understand how it is a good thing for some ems agencies to have if they are not well enough trained in their skills to know what to do in emergency situations. Interesting. What I see happening a LOT more often in EMS today is patients suffering from being treated by medics who are trained well in their "skills," but never received an adequate foundational education to actually understand the physiological ramifications of those interventions, and therefore use those "skills" inappropriately. I'll take a hesitant but educated professional over an overtrained, undereducated-but-decisive technician anyday.
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