Abdominal Exam

[ccmedoc]

A&P, yes... The others, no. Right here, right now is the first I heard of needing everything else.

Would I make a better medic with all that above, or will I not make it as a medic at all without the Psych, Algebra, and Speech (to name a few) classes?

hehehe..looks like you asked the right questions..

I believe the best answers to your question have been given above; Dustdevil and Dwayne speak the truth. Heed the words and get an education and not training..you will not regret the extra course work Dust mentioned.

You said you want to be a damn good medic, get the additional education..two semesters or so will make a world of difference in your thinking and understanding of the situations you will encounter

[ccmedoc]

please delete this post...

Edited January 3, 2010 by ccmedoc

[Lisa O]

hehehe..looks like you asked the right questions..

I believe the best answers to your question have been given above; Dustdevil and Dwayne speak the truth. Heed the words and get an education and not training..you will not regret the extra course work Dust mentioned.

Okay. But, honestly, I am getting two different things from Dust and Dwayne. So, if they speak the truth, yet, two different truths, do I combine them and find my own?

Am I overthinking all of this? lol I do that, all-the-time!!!!

So, do I start from ground zero, get all the basics, then go into EMT, then Paramedic?

Do I start with EMT while at the same time getting the basics too, then when done go to Paramedic?

[cosgrojo]

Once I got to the next level I realized how little I knew and probably shouldn't have been allowed to do half the things I did.

But you were allowed, and it was a major component to your learning/educational experience. I do not have a problem with students being allowed to attempt things they don't quite understand yet... if properly explained, they are excellent learning opportunities and can spur the student to get more interested in the subject. If people never tried things they don't understand... there would be no medical community at all.

Lisa O- Education is wonderful... paramount to being a well balanced provider. One does not need experience as an EMT-Basic to become an excellent provider... However, having experience as an EMT does not have to be a negative thing, and does not mean one should feel ridiculed for having it. Not everyone that has 10+ years of EMT-B experience is as dogmatic and backwards as our venerable EMTCity panel suggest. Experience is like education... it is only as good as YOU make it. Don't let anyone tell you otherwise with their blanket statements to further their own agendas'. It is not appropriate to discredit anyone's education/experience when you don't actually know what it really is. You can always learn something from someone. If you approach both education, and experience with an open mind, and a diligent work-ethic, you will do just fine.

Ahhhhh... it's good to be back... happy new year everyone!

And for the record, while I have no fundamental issues with general abdominal assessments (including palpation) by the EMT-B... I would not have allowed my student to touch that abdomen, and I probably wouldn't have touched it myself... I would have gone to the ER, pointed at it, and let the Doc get all handsy.

[ccmedoc]

Okay. But, honestly, I am getting two different things from Dust and Dwayne. So, if they speak the truth, yet, two different truths, do I combine them and find my own?

Am I overthinking all of this? lol I do that, all-the-time!!!!

So, do I start from ground zero, get all the basics, then go into EMT, then Paramedic?

Do I start with EMT while at the same time getting the basics too, then when done go to Paramedic?

I think they both said about the same thing..I do not believe that being a basic for any length of time benefits you...at all. It is a waste of time and effort IMO

I would go to a college, get the additional classes and the basic/paramedic back to back. If there is not a CC near you offering the EMS degree, take a couple courses in the winter, EMT class in the spring and summer, then back to college in the fall..I think a couple of semesters full time is more than enough to get a psychology, A&P 1 and 2,Micro, chemistry, a couple of english classes...it will get you on your way to a degree also, in whatever you choose...A couple of steady years and you are an educated Paramedic, given that you can get into a good program that is not fire based...Another topic about this perhaps in the archives...

I guess I see them (Dust and Dwayne) as on the same page, as I have seen them discuss this many times with others..degreed medics are better medics out of the chute..the additional educational experience adds to the critical thinking, I believe.

How you break up the education is probably going to be a monetary issue also...If it is college or EMT school, choose college....

BTW: Out of curiosity, how do you believe that Dustdevil and Dwayne differ in opinions..maybe I am the one reading things wrong...(now that this thread is hijacked beyond recovery....LOL)

Edited January 3, 2010 by ccmedoc

[VentMedic]

But you were allowed, and it was a major component to your learning/educational experience. I do not have a problem with students being allowed to attempt things they don't quite understand yet... if properly explained, they are excellent learning opportunities and can spur the student to get more interested in the subject. If people never tried things they don't understand... there would be no medical community at all.

Now I cringe to think of the people I could have harmed and may have.

Even now the hospitals don't always contact every ambulance agency for every screw up although it may be documented. You may never know how bad you mucked up until you are called before your company's attorneys.

How many have gone back to see the result of some of those difficult intubations? Ever go back to see if the patient got a trach? Maybe it is all written off as part of "saving a life" but does that mean messing up the cords because you didn't really know what you were doing is okay? Let's say you are an EMT-B and have very little manikin time or a decent instruction on the Combitube. You are allowed to "practice" on a real patient and do serious damage to the cords to where a trach is necessary or rip the esophagus to where the patient would need urgent surgery. Do you feel the patient's complications were warranted just so you could "try it out" on a real person?

Working in the hospital has also given me an opportunity to "attempt to fix" the mistakes made either by myself or by others. Screw up on a ventilator setting and create a pneumo, you get to help decompress but it then really isn't as thrilling as finding a pneumo in the field. Botch an intubation and do many leak tests while corticosteroids are given in hopes the inflammation lessens to where that patient doesn't get a trach and that is on your permanent record. Let an IV infiltrate and do many perfusion checks or maybe Wydase to keep the tissue from becoming necrotic. Screw up an arterial stick and sweat out if the radial nerve or artery will be the same. Screw up doing ETI with suction on a meconium baby and do ECMO for several days until the infant can be weaned off or dies.

Of course, some of these are what we see from the field and many times the Paramedic will never know since they may not be immediately obvious. If you cause a pneumo, we might speculate that it was you in the field but may not be able to prove it. Some of the damage might be from the circumstances surrounding the incident. Some might be part of that "what happens in the truck stays in the truck" mentality which has been a factor that prevents tracking medical errors in EMS so that there can be an improvement. Also, FDs do enjoy have some limits on their liability as a agency of some government entity. Essentially if your patient dies, you can say they may have died anyway. However, occasionally something is caught and it may even make headlines so you do get to enjoy the equal status in medicine with the other health care professionals.

Edited January 3, 2010 by VentMedic

[fiznat]

In any healthcare profession you are not allowed to do certain assessments until you have mastered a certain level of education and training.

Sooorta dude. I can tell you that my work frequently brings be through two (level-1 trauma) teaching hospitals, and I have witnessed atrocities performed by residents and interns that you might not even believe. Much like we are, doctors in training are quite frequently simply "thrown into the mix" to sink or swim on their own. Yes, they get instruction/training/education/preparation beforehand as you say, but there is a point where palpating the ABD is the only way to really learn how to palpate the ABD, and it often takes a few mistakes in order to really learn how to do something well.

That said, I think there is a bit of paramedic glorification here. Do some of the paramedics here really believe that they have achieved such a level of expertise and delicacy of sensation that they alone are capable of palpating the ABD properly in the back of an ambulance? With few and rare exceptions I'm sure, those people might want to take a step back and look around. We're not doctors. We have limited experience that - for the most part - revolves around anecdote and hearsay. If you want to play yourself up to be some sort of Gregory House M.D. wannabee, you gotta go to more school to be the least bit convincing. *I'm not talking about anyone in specific here, just pointing out that we often talk a bit bigger game than we should be playing, sometimes....

You heard wrong. You certainly didn't hear that here.

Does that mean you are already working hard on your college prerequisite courses, like A&P, Chemistry, Microbiology, Psychology, Sociology, Algebra, English Compositon, Speech Communications, etc... ? If not, then you are not yet serious.

Dusty,

Don't be so dramatic. He's heard it here before, because lots of people (including myself!) have supported that position in the past. This isn't the first of this type of thread, I'm sure you're well aware.... What you mean is-- he didn't hear it from YOU. ...And don't get me started on this ridiculous prerequisite curriculum you've got listed here haha.

Edited January 3, 2010 by fiznat

[VentMedic]

Sooorta dude. I can tell you that my work frequently brings be through two (level-1 trauma) teaching hospitals, and I have witnessed atrocities performed by residents and interns that you might not even believe. Much like we are, doctors in training are quite frequently simply "thrown into the mix" to sink or swim on their own. Yes, they get instruction/training/education/preparation beforehand as you say, but there is a point where palpating the ABD is the only way to really learn how to palpate the ABD, and it often takes a few mistakes in order to really learn how to do something well.

None of the residents or interns in your area are required to take A&P? None of them have done any patient contact clinicals as med students? You seriously are not comparing your education to that of a doctor? What about the differences in oversight? Have you actually seen what happens to a resident when they muck up badly? Let's just say it not a sight for the weak or meant for the ears of those who cry easily when criticized or go off on a "he/she's picking on me" tangent. While there are some skills they may get limited practice with before actually doing the procedure, they do at least have the advantage of the science as well as some of the whys or why nots of the procedure.

That said, I think there is a bit of paramedic glorification here. Do some of the paramedics here really believe that they have achieved such a level of expertise and delicacy of sensation that they alone are capable of palpating the ABD properly in the back of an ambulance? With few and rare exceptions I'm sure, those people might want to take a step back and look around. We're not doctors. We have limited experience that - for the most part - revolves around anecdote and hearsay. If you want to play yourself up to be some sort of Gregory House M.D. wannabee, you gotta go to more school to be the least bit convincing. *I'm not talking about anyone in specific here, just pointing out that we often talk a bit bigger game than we should be playing, sometimes....

In the preveious paragraph you just stated we are doctor like.

Did you not read my post? Did you not see the word "Paramedic" mentioned many times and I used myself as an example?

[Kiwiology]

Upon closer examination it appears the goal of teaching abdominal palpation at our BLS level is simply to document whether the abdomen is soft, tender or gaurded (either uniformaly or over an individual area).

Now I might be a lil' bit niave but I don't see anything of major intrinsic value to the Ambulance Officers' treatment of an acute abdomen but it gives the hospital a few clues to start with anyway.

[WolfmanHarris]

As a EMT ride along student, your primary responsibility is just to observe.

Maybe it's just a terminology gap, but that's plain weird.

I would hope and expect that any field or clinical placement would be to develop a competent provider while under the supervision of a preceptor. During my five months of preceptorship I was expected to take on more and more responsibility such that by the end of my placement my preceptor would be comfortable leaving me to run the call completely. My clinical placements were more restricted as we were operating in the Hospital environment and had to be careful not to interfere with their plans, but I was still expected to perform full pt. assessments, come up with my own differential for the clinical instructor and do things such as state a tx. plan, or explain the patho, etc. We would then follow the pt.'s care as much as possible and when practical ask questions of the staff there. In my program we did do half a dozen "observation" ride-outs, but those were done at the very beginning of the course to provide exposure and context for students; who since they hadn't learned very much yet, couldn't be expected to do more than practice a few skills under supervision.

Some excellent medics make awful preceptors because they are completely incapable of backing off and letting a student fumble through waiting only to intervene when necessary.