spenac

What is Java?

My thoughts with the family and friends.

Not a loaded question as a couple of people that don't like me implied. This is a question designed to get people talking and thinking. And wow it has gotten people thinking and talking. I agree we do often rely on just what we are told by the patient, take a set or two of vitals, and drop off patients with a report that states what patient said and what vitals were. But is that a proper exam? No it is not. If the patient claims their arm hurts yet I do not expose it or palpate it if not in this scenario the ones that made the rude comments about me would be saying I did not do a proper exam. It is the same principle. So lets say a healthy looking 16 year old female calls 911 for chest pain. Are we going to do proper lung and heart sounds which means touching the skin? Are we going to expose to make sure we have equal expansion? Are we going to palpate to see if pain reproduced by palpation? Are we going to expose to properly place 12 lead? Or are we going to just tell the hospital patient complains of chest pain, denies trauma, here are her vitals, good bye? You can not rule in or rule out anything if you fail to do a proper exam. Oh and thanks to the jerk that gave me a negative.

Patients vital signs can be normal when they are in fact in shock. As they compensate and as they began to decompensate. My point is that if we do not do a focused exam on any area of complaint we have not done a proper exam. If they say their ear hurts. You are going to visualize it. You are even going to examine it with the otoscope hopefully. Yet your findings will not change the care given by the medic in most cases. So why do we look at the ear even if only externally view it and not internally viewed? So we can report redness, swelling, discharge etc. That is the same thing we should do when a patient complains of rectal, vaginal, penile pain discharge etc. We need to see it to properly report it and to properly document it. Can we force the assessment on the patient? No. But if you are acting professional they will allow it. In my many years in EMS I have exposed many a patient and never have I gotten a complaint. I explain what and why as I am doing a proper exam. I have never had a patient refuse to allow an exam. I have had patients refuse backboards, IV's, certain meds etc. So yes patients can refuse any and all exams and treatments. The ER doctor will still examine the patient. Say it's a cardiac patient. The ER doctor will still run EKG's, labs, etc even though he can not fix the problem. Why? So he can properly report to the cardiologist what is going on and help the cardiologist determine the urgency of care the patient needs. We may not fix the problems we see and in fact most patients we do not fix but because of our exams findings we either change hospitals for a more appropriate one, or we notify the doctor that we are coming in with a patient with urgent needs. If you have a reputation with the doctors of doing proper detailed exams when you call and say urgent they will be ready. So we need to do a proper exam so we can call in the proper expert. So we are no different than the ER doc.

Glad to see you back. Long time since you posted. Thanks for answering the question as you seem to be very knowledgeable about the NR.

So because it does not change how we treat we should just ignore it? How many patients lie about what is actually going on? So you ask a female are you bleeding a lot they might answer no only a couple of drops when in fact they may be flowing. But you choose not to look because mommy said it is wrong to look at a girls private parts. Now at the hospital you tell them what she told you. They place her in a low priority and later they find her dead. Why because she bled out because you did not do a complete patient assessment. So do what is right and at least look at the affected area. I mean with the logic provided we should not be removing clothes from the affected areas of a trauma patient. So a patient reports no my arm is not bleeding so we don't roll up or cut off the sleeve to find the bone sticking out of the skin because we relied on what the patient said? Makes no sense does it. Same goes with the no no's, the private parts, the what ever you call the parts you are afraid of looking at. Do the job, do the job right. You are a medical professional and a patient advocate, do a proper assessment so you can properly advocate for your patient.

We are medical professionals and if we do not see the vagina or the testicle that the patient says hurts we can not help nor can we relay accurate report to the doctor. We must do a complete focused exam on the area of complaint and that means looking, listening, feeling. Do not be bashful, do it like you have done it a million times and the patient will have no problem with it and the doctor will respect your report more as you actually relayed patients complaint combined with what you found during exam. It is my pet peeve that so many do not act as professionals and do the job that needs done. As soon as it deals with a persons no-nos they refuse to touch or look, lets just load and go. Vital information could be missed that could delay the care they need.

So here you are on the way back to the station for shift change when you are toned for a sick female. You cuss and scream while on the way but are the professional once on scene. Patient complains of pelvic pain. Do you just load and go and make sure she's stable or do you examine her properly? Do you ask questions then expose and see if there are any visual cues as to the problem? Do you have her open the vagina to expose any possible injury? Do you palpate to check for swelling, deformity, tenderness? Ok same if a guy. Do you expose if complains of testicular or penile pain? Do you palpate?

Welcome to the city. Start your Paramedic program as soon as possible to completing your basic course. This helps you and your patients because you will have more education.

Check with the service you work for and with other area services some offer to pay if you agree to work for them X number of years. If rural might even check with the local hospitals they might fund you.

Thanks for the information. I have wanted to ad it for many years but my service has never been willing to spend the money.

Wish someone would have suggested soft tips on my calipers before that bouncy ride. Hey is there a warning on them? HMMMMMMM Thanks Doc and Tom for some good reasoning on this discussion.

You mean our patients are not text book perfect cases? I am shocked.

Exactly right. If EMS is what you want to do immediately get into a Paramedic program. Delaying your education benefits no one. As young as you are please understand that EMS as it stands today really offers no advancement. Once you reach Paramedic level that's about it. You might eventually become a supervisor but those jobs are few and far between. So truly look at what you want to do. It is harder to start a new career later in life than it is now as a young person.

Ouch.

It's just a cycle. One group gets in office claims its way to save money so they give it to privates. Another group gets in office and sees $x per call and thinks great way to make money but they ignore the warnings that nobody pays so they take it away from the privates. Just a cycle that never ends.

Where did they learn that from? Oh yeah the RNs and Dr.s at the ER.

It's here.

You are welcome. Keep studying EKG's as you lose it if you don't use it. Hope you the best with the job.

Really it is not hard. Use 1 formula and you can find what you need for just about all EMS medications and drips. Amount of Fluid X Dose X Dripset = Amount Of Drug Time or 1 1ml How to use that formula is explained in the math video found at the following site but does cost money: http://emsbootcamp.com/live/?page_id=53&wlfrom=%2Flive%2F%3Fp%3D62 Here is a site with a good free math download: http://ems-safety.com/

Former I took it as a rant against unnecessary procedures being done. It is frustrating when people think we should do something just because we can rather than what is best for the patient. I actually got QA/QI from an ex medical director because they thought I should have done a more advanced procedure than done. I of course politely asked have you followed up on my patient? If you have you know what I did took care of the problem and they were released from the hospital less than 24 hours later. Had I gone more advanced they would have had a longer stay. So I guess my point is I understand where you are coming from.