DFIB Posted January 1, 2012 Share Posted January 1, 2012 Ask them what flavor barium they prefer. Do they have to drink barium with a hot apendix? Link to comment Share on other sites More sharing options...
aussiephil Posted January 4, 2012 Share Posted January 4, 2012 Not to forget proper differential diagnosis! Abdominal pain and probable appendicitis can cover a bunch of other problems... We are talking pre hospital care. Treat what you see. Is it up to you, at best an intensive care paramedic, to make a differential diagnosis without the appropriate tests, scans etc? Simply no. That's why doctors earn more than we do. We provide a provisional diagnosis that is to be confirmed. Experience may tell us what it is but do we have the semi with all the pathology labs, ct scanner, X-ray, & ultrasound available to us? Until we do we treat what we see. Pain. Dehydration. Vomiting. We posture the patient & transport. That's what we are paid to do. Link to comment Share on other sites More sharing options...
MongoMedic Posted January 4, 2012 Share Posted January 4, 2012 (edited) Haven't we been through this before with you? You say you're going to be an EMS student. Perhaps it's time you started acting like one. Why don't you go look it up and then tell us what you think needs to be done. I think you'll find that you learn and retain the information better when you do that. You're not going to learn the things you need to learn if you don't do the work to learn it yourself. Holy Cow!!!! Are you serious? One thing that veteran Medics should be preachin to anybody interested in EMS or new to EMS, should be to ask as many questions that pop into their brains. They should be able to find out the answers from those that have been in the field and can relate what they have read, seen, and done. Not be bashed in the head when they ask a question. Now I will agree that the best way to learn the information is to maybe talk about what you have learned, and not just pop out random questions. Just my thoughts on that. Now in my carreer as a Medic, I have had about 10 suspected cases of appendicitis. Out of those 10 cases 7 of them were confirmed. Now with that being said, I agree with ER Doc. We do not have the diagnostic equipment in the field and not in any of the remote clinics that I have been in to confirm/rule out appendicitis. Truth be known a good history, thorough physical exam (plenty of resources to find different exams on suspected appendicitis), pain management (depending on how aggresive your service is and what your local protocols allow), antiemetics, and a thourough report to the receiving facility. This is about all you can do other than supportive care. When the patient is to an appropriate facility they will do blood test, ultra-sound, and possibly a CT to confirm/rule out appendicitis. As Medics we do not "diagnose" we give differential diagnoses on what we suspect it might be and treat according to protocols, our findings, and treat accordingly. Ask as many questions as you want. I may not have all the answers but I am pretty sure somebody here will be more than willing to give you an answer. And who knows, it might teach/refresh us old crochity dudes a thing or two in the process. MongoMedic Edited January 4, 2012 by MongoMedic Link to comment Share on other sites More sharing options...
Bernhard Posted January 4, 2012 Share Posted January 4, 2012 (edited) We are talking pre hospital care. Treat what you see. Is it up to you, at best an intensive care paramedic, to make a differential diagnosis without the appropriate tests, scans etc? Simply no. Acute abdominal pain is very unspecific (BTW, sometimes even with all fancy hospital equipment and lab tests). Typical DD for appendicitis would be: A: kidney stone, urethra stone, Meckel's diverticulum, morbus crohn, ovarial cyst, extra uterine gravidity, ovar/uterine tube inflammation B: internal bleedings, perforation, sepsis C: myocard infarct Depending on age, consciousness (incl. emotional state) and other factors, it may even be almost anything in the abdomen which is really the cause. Some of them will change my prehospital treatment plan as well as my decision about transport medium and target clinic drastically (especially type B and C above). So we have to check suspiciously and not just treat what is to be seen, even if it seems to be clear. I'm still proud of the dude presenting with abdominal pain and clear localisation of appendicitis (not talking my language, on the way with a tourist bus with a challenging time frame). This was on a standby duty, no ECG or other equipment available, only EMTs (and I was the youngest one, fresh out of school - it was long ago). Despite all others I diagnosed lead symptoms of a myocardial infarct and insisted to get him transported to an intensive care unit. Which most probably saved his life. Between since then and now I had some more of this type - including myself. That's why doctors earn more than we do. We provide a provisional diagnosis that is to be confirmed. Experience may tell us what it is but do we have the semi with all the pathology labs, ct scanner, X-ray, & ultrasound available to us? Until we do we treat what we see. Pain. Dehydration. Vomiting. We posture the patient & transport. That's what we are paid to do. No, we have a lot other tools & choices: do I give blood thinners, which pain medication would be better, do I prepare for intubation/resuscitation/defibrillation/newborn (including maybe backup staff), do I go to a cath lab, do we need immediate OP capacity or just a willing ER, surgical/medical/neonatal unit, very next hospital with a surgeon available or the other hospital the patient wishes to go, do I choose HEMS or ground transport and so on...? At least a 12 lead and BP + SpO2 monitoring should be standard on every abdominal pain patient, please. BTW: the "do i prepare for ... newborn" is not a joke. Was a real surprise, for ALL (except one) involved. Edited January 4, 2012 by Bernhard Link to comment Share on other sites More sharing options...
paramedicmike Posted January 4, 2012 Share Posted January 4, 2012 Holy Cow!!!! Are you serious? One thing that veteran Medics should be preachin to anybody interested in EMS or new to EMS, should be to ask as many questions that pop into their brains. They should be able to find out the answers from those that have been in the field and can relate what they have read, seen, and done. Not be bashed in the head when they ask a question. Now I will agree that the best way to learn the information is to maybe talk about what you have learned, and not just pop out random questions. Just my thoughts on that. Yes. I am serious. What's funny is that you actually agree with what I'm asking the OP to do. You also agree that it's the best way to learn. The OP has on previous occasions asked questions without having done any ground work or basic research first. He'll come in, pop out a few random questions on very broad topics with the expectation that we'll feed him answers. The first couple times he got a variety of answers to which he followed up with very unguided questions indicating he hadn't done any reading on the topic. I'm more than happy to help people understand topics if they've put in some effort but can't quite understand something. But if a student hasn't even put in minimal effort to learn the material I'm not going to spoon feed it to him/her. This is how it worked when I was in paramedic school. This is how it works with students I have worked with since then. It's how it works for me as a student now that I'm back in school. All that being said I stand by my original comment in this thread. There's an awful lot of responsibility in being a student. If the OP is seriously going to be an EMS student then he needs to start acting like one and accept his responsibility in becoming an active participant in the learning process. He needs to do some basic research before asking questions (unless he's asking questions in an attempt to find relevant resources). He's free to ask any question he wants. But if he hasn't done even the most basic research then my original response to the OP is going to remain the same. Link to comment Share on other sites More sharing options...
aussiephil Posted January 4, 2012 Share Posted January 4, 2012 Acute abdominal pain is very unspecific (BTW, sometimes even with all fancy hospital equipment and lab tests). Typical DD for appendicitis would be: A: kidney stone, urethra stone, Meckel's diverticulum, morbus crohn, ovarial cyst, extra uterine gravidity, ovar/uterine tube inflammation B: internal bleedings, perforation, sepsis C: myocard infarct Depending on age, consciousness (incl. emotional state) and other factors, it may even be almost anything in the abdomen which is really the cause. Some of them will change my prehospital treatment plan as well as my decision about transport medium and target clinic drastically (especially type B and C above). So we have to check suspiciously and not just treat what is to be seen, even if it seems to be clear. I'm still proud of the dude presenting with abdominal pain and clear localisation of appendicitis (not talking my language, on the way with a tourist bus with a challenging time frame). This was on a standby duty, no ECG or other equipment available, only EMTs (and I was the youngest one, fresh out of school - it was long ago). Despite all others I diagnosed lead symptoms of a myocardial infarct and insisted to get him transported to an intensive care unit. Which most probably saved his life. Between since then and now I had some more of this type - including myself. No, we have a lot other tools & choices: do I give blood thinners, which pain medication would be better, do I prepare for intubation/resuscitation/defibrillation/newborn (including maybe backup staff), do I go to a cath lab, do we need immediate OP capacity or just a willing ER, surgical/medical/neonatal unit, very next hospital with a surgeon available or the other hospital the patient wishes to go, do I choose HEMS or ground transport and so on...? At least a 12 lead and BP + SpO2 monitoring should be standard on every abdominal pain patient, please. BTW: the "do i prepare for ... newborn" is not a joke. Was a real surprise, for ALL (except one) involved. I agree, you have used the tools provided to you to assist but can you confirm any of these? No. We treat what we see. If they have pain, we give analgesia. It is not up to us to determine a final diagnosis. On a side note it is well width considering that there are a number of ambulance services using telemetry to broadcast 12 lead ECG's to hospital, providing antithrombolytics & going straight to cath labs. Again the diagnosis of a cardiac event is made by officers on scene, they use the tools but the determination is made by a doctor, not the emt's. Link to comment Share on other sites More sharing options...
DFIB Posted January 4, 2012 Share Posted January 4, 2012 Doctors make more money thatn us because they go to school for 12 + years to learn to do their job very technical, complicated and scientific job. Link to comment Share on other sites More sharing options...
MongoMedic Posted January 5, 2012 Share Posted January 5, 2012 (edited) Yes. I am serious. What's funny is that you actually agree with what I'm asking the OP to do. You also agree that it's the best way to learn. Mike, you got me. I do agree with you..but let me clarify one thing. That is the best way for me to learn. I read it (often more than once or six times) then I talk about it, then I do it. Or I get hands on instructions as I am doing it. Those are the best ways for ME to learn. Who knows what this guy's "best way" to learn is. I don't know this guy from Adam of Batavia maybe he is actually a Medic just trying to stir up S&*^* in here, or maybe this how he learns. I also look at it this way if he asks a question that is totally off the grid of what we do and it bothers you then don't read it and don't reply to it. Really it is that simple don't chastise the guy for asking a question. If you choose to answer it maybe it will remove that little bit of rust that we all get in this biz and maybe help us remember some of that information that we might of once knew but have now forgotten. Edited January 5, 2012 by MongoMedic 1 Link to comment Share on other sites More sharing options...
Eydawn Posted January 5, 2012 Share Posted January 5, 2012 Hey Mongo... just to clarify some... We're not joking- this kid's made a lot of similar posts along the lines of "what do you do for _______" and then not contributed to the discussion. It's not that we don't like him, he's a decent kid and all, but his posts are BS. A real student sees what you tell them, and asks more questions to fill out knowledge gaps. This guy posts one question, in the first post in a topic, then disappears, only to resurface with ANOTHER thread that is identical, just with a different ______ in it. I do agree that we should answer questions of those who ask, as it is a great way to share knowledge... but we also don't take kindly to feeding trolls. A series of several topics as I described above indicates to a lot of us that this is a waste of our time... at least, as far as the OP is concerned. Now, for some of the side discussions, it's been great... Just saying. That's where Mike is coming from- after about the 5th post, it gets OLD answering this kid's very general questions with no further "meat" from him. Wendy CO EMT-B 1 Link to comment Share on other sites More sharing options...
paramedicmike Posted January 5, 2012 Share Posted January 5, 2012 Mike, you got me. I do agree with you..but let me clarify one thing. That is the best way for me to learn. I read it (often more than once or six times) then I talk about it, then I do it. Or I get hands on instructions as I am doing it. Those are the best ways for ME to learn. I think that's the best way for me to learn as well. I think, when it comes down to it, most people learn this way. The key here, though, is we start by reading. Will you just randomly approach a doc and say, "Tell me about subject x" without having done at least a tiny bit of research on the topic? Or without at least having tried to find something on the topic? I'm inclined to think you wouldn't. Nor would I. Nor should any student who wants to be taken seriously. Who knows what this guy's "best way" to learn is. I don't know this guy from Adam of Batavia maybe he is actually a Medic just trying to stir up S&*^* in here, or maybe this how he learns. Could be. But I doubt it. He usually posts and then disappears. If he were trolling as you described I think he'd be a little more involved. I also look at it this way if he asks a question that is totally off the grid of what we do and it bothers you then don't read it and don't reply to it. Really it is that simple don't chastise the guy for asking a question. If you choose to answer it maybe it will remove that little bit of rust that we all get in this biz and maybe help us remember some of that information that we might of once knew but have now forgotten. I think there are two points needed to address this. First, if you think I'm being hostile towards this kid then you're mistaken. Nor am I chastising him.This is not the first time the OP has presented questions like this. This is not the first time he's received responses like this even by members other than me. Sometimes people need to be told several times. This leads me to: Second, sometimes repetition is the only way to get through to people. (You know, kinda' how we both need to read things several times before we get it.) This is not the first time it has been suggested that this kid do some basic legwork before asking questions. I'm guessing it's not going to be the last time it is suggested to him. It's not a matter of being mean. It's a matter of trying to get this student to take responsibility for his own learning. The only thing that bothers me about this kid's posts is that he's not trying. If he is truly interested in pursuing any kind of EMS he needs to break this habit of not trying. You mentioned removing the rust in those of us who've been doing this a while. I agree with you completely. But sometimes those of us who've been doing this a while need to get the gears moving in the younger, up and coming providers to get them to take responsibility for their learning. Because, ultimately, they are going to be taking care of patients and, potentially, us! If telling the OP, repeatedly, that he needs to look it up and then come back in order for him to get it then that's what I'll do. Not because I'm mean. Not because I'm trying to give him grief. Not because I'm trying to bully or belittle him. But because it's my job as someone who's been doing this for a while, as an instructor and as a student myself (both formally and informally as someone who's trying to continuously better myself for the sake of my patients) to make sure that students start taking the steps to learn the material on their own. Senior providers aren't going to be around to answer their questions forever. Link to comment Share on other sites More sharing options...
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