Assessments

[cfaulknor]

In my paramedic class, our book goes over use of very specific assessments. Many of these procedures, I have never seen done in the field by any medic up here. I am wondering how far into these assessments you guys go when you're on the ambulance.

1. Checking each of the 12 cranial nerves (occulumotor by doing the eye movement pattern, etc.)

2. Checking each spinal nerve impulse (C5, T1, T2, etc.)

3. Examination with an otoscope and ophthalmoscope

4. Range of movement tests

5. Chest Percussion

6. Checking for Bruits and Heart Sounds

How many of these things do you guys do?

Thanks

[chbare]

Cfaulknor, depends on the patient and the situation. In an acutely ill or injured patient I focus on two things. First, the primary assessment to identify immediate life threats. Second, a detailed exam to identify potential life threats. As you well know, in some cases we may not even complete a detailed exam. I.e.: a multitrauma pt with facial trauma, altered LOC, and an obstructed airway. You may not go beyond airway in this guy. However, in many cases we actually assess more than we think. For example; look at the 12 cranial nerves. By just talking with a patient and having him/her shrug, smile, and stick out their tongue, while we assess pupils and EOM's will actually test the integrity of several cranial nerves. In addition, common sense should prevail. If we are taking care of an unrestrained driver who hit the steering wheel at 60 MPH with 6' of intrusion, severe resp distress, and absent lung sounds on one side, we should be able to identify the life threat without percussion. It really comes down to situation and circumstances and using sound clinical judgment when deciding what assessment techniques and styles are appropriate for a given situation.

Take care,

chbare.

[Dustdevil]

I would add to that, a lot of people trained only as paraemedics are working in remote medical positions, practicing clinical medicine these days. Offshore, oilfield, and industrial medics are expected to do all of the above things and much more, since it is a totally different ballpark from EMS, where your clinic is the final destination. Interestingly enough, most medics believe they are eminently qualified for such work. Until they start. Then there is a rude awakening to the fact that even paramedic school is nothing more than advanced first aid. Yet paramedics are increasingly tasked with providing comprehensive, remote clinical medical care. So yes, I use all of the above techniques in my practice. And yes, there is a need to educate paramedics to that standard, whether that is their ultimate plan for practice or not.

After all, even psychiatrists have to learn to deliver babies.