Altered LOC and Prudent questions for the EMT-B

[Ace844]

These are all some good suggestions, but, as my usual caveat, garner as much information on scene as you can, in a timely manner, but don't lose sight of the fact that except for perhaps hypoglycemia who is able to follow directions, advanced medical or surgical intervention is the only thing that is going to help these people. In other words, get them to a hospital, ASAP, and remember, oxygen, oxygen, oxygen, ALS intercept if necessary. Don't play around with people's brains.

Rule out psych history, diabetes, hypoxia (if the person is hypoxic to the point of being AMS, its probably going to be fairly obvious), CVA, ETOH (do the smell drunk?), Narcotics, head injury, hypovolemia (blood pressure), sepsis (have they been sick for a while? Do they have a fever?), there's probably a few others I'm not thinking of. All AMS is caused by the same thing, lack of oxygen to the brain, its what is causing the lack of oxygen that's important.

"Asys,"

As usual good points, still I'm curious how you may discern that an encephalopathic cause of AMS is indeed a lack of cerbral oxyegenation??? just curious.. :wink: :shock: 8)

ACE

[hfdff422]

Yes, every patient gets a full assesment. I made the cardinal mistake here of assuming that you are going to do the assesment (never assume). My point though, is if you have ruled those things I covered out, you are fairly helpless without ALS. But ruling things out is part of our job. We do not diagnose- except, unless, but, etc. We are emergency detectives, and our powers of observation are paramount. We are just limited on what interventions and diagnoses we have. My assesment may assist the ED in determining if there is neurogenic shock, but there is little I can do at the B level other than O2 and diesel (and immobilization if needed).

RID- diesel means transport, it has nothing to do with mode of transport. I have only transported one patient signal 10 (or code 3) because there was no ALS unit available. Usually there is a medic available, and they make the transport decision for those patients who are signal 10 candidates. My take is that the stress of emergent transport is more harmful than losing any time from an easy ride (yes, there are exceptions). It is merely lingo, a saying I heard a few years ago and see repeated alot "treat all things with O2 and diesel." In response to airway- again, my breaking of the cardinal rule, never assume. Airway, airway, airway- the lifesaving intervention across all level of practice, the O2 doesn't do much without it.

Sometimes we are left to out in the cold and have to use what tools we do have as effectively as possible. But freaking out and driving like an idiot truly is the wrong way to treat any ailment. *DUE REGARD*

[Ace844]

Yes, every patient gets a full assesment. I made the cardinal mistake here of assuming that you are going to do the assesment (never assume). My point though, is if you have ruled those things I covered out, you are fairly helpless without ALS. But ruling things out is part of our job. We do not diagnose- except, unless, but, etc. We are emergency detectives, and our powers of observation are paramount.

Unfortunately if you don't diagnose you can never progress to the treatment of any pt...If you do, what exactly are you treating then??? Symptoms??? This is "Cook-Book Medicine" and it leads to unacceptable, uneducated, sub-par, pt care....!!!!

We are just limited on what interventions and diagnoses we have. My assesment may assist the ED in determining if there is neurogenic shock, but there is little I can do at the B level other than O2 and diesel (and immobilization if needed).

You are limited on the interventions you can undertake because of your lack of education as an average BLS provider. The number of Diagnoses is limited only by your clinical abilities. It may not be a final Diagnosis, but in the setting of a comprehensive thorough H&P, you get a DX 90% of the time which ois correct. You only use those other tools; i.e.: Cardiac monitor, BGL, CXR, etc.., ad nauseaum, to confirm and assist in the treatment of your diagnosed disorder. You should not be using them to DX ANYTHING!!!!!!

RID- diesel means transport, it has nothing to do with mode of transport. I have only transported one patient signal 10 (or code 3) because there was no ALS unit available. Usually there is a medic available, and they make the transport decision for those patients who are signal 10 candidates. My take is that the stress of emergent transport is more harmful than losing any time from an easy ride (yes, there are exceptions). It is merely lingo, a saying I heard a few years ago and see repeated alot "treat all things with O2 and diesel." In response to airway- again, my breaking of the cardinal rule, never assume. Airway, airway, airway- the lifesaving intervention across all level of practice, the O2 doesn't do much without it.

Sometimes we are left to out in the cold and have to use what tools we do have as effectively as possible. But freaking out and driving like an idiot truly is the wrong way to treat any ailment. *DUE REGARD*

This "LINGO" as you so aptly put it makes you sound like an uneducated stretcher carrying Monkey...It makes the recipient of that comment get the impression of, " This dude has no clue so he just rushed the pt to the ER.. Because thats all he could do.." :roll: None of our pre-hospital treatments and interventions are completely begnign..REMEMBER THAT!!!!

OUT HERE,

Ace844

[hfdff422]

I am quite aware that "cookbook medicine" is not the way to handle a patient. I am also aware that we are taught to treat only what we can observe. As sad as that is, it is our scope of practice. Is that all we really do- no. My comment about observation and assesment and we don't diagnose- except, unless, but, etc. was meant to allude to doing as much diagnosing as possible, without "playing medic" which is one of the biggest problems in BLS care. You are right, we are limited in what we can do due to limited training. So to suggest that we are able to diagnose things when it is not within our scope of pracitce would be irresponsible. Do I diagnose, tentatively- I have to ensure the best possible care for my patient. I am usually correct, but would never presume to tell anyone what the diagnosis is, just give as much detail in my assesment findings as possible. My findings will usually steer my assesment to a more focused secondary. I simply do not want to make a statement that would lead someone to think it is OK to play medic.

As for the O2 and diesel thing, I have seen much more detrimental things than that saying- such as infighting.

[Ace844]

"hfdff422"

Please pardon my confusion here but you seems to be all over the map on this and contradicting yourself. :study: :shock: :drunken: :bs:

You wrote;

I am quite aware that "cookbook medicine" is not the way to handle a patient. I am also aware that we are taught to treat only what we can observe. As sad as that is, it is our scope of practice.

I somewhat agree with you, except assessment is in your scope of practice at ALL LEVELS, so thus the ability to achieve and arrive at a "working diagnosis" isn't beyond your scope, on the contrary, IT'S THE REASON YOUR THERE!!!

My comment about observation and assesment and we don't diagnose- except, unless, but, etc. was meant to allude to doing as much diagnosing as possible, without "playing medic" which is one of the biggest problems in BLS care.

I'm not sure what you mean by "playing medic"... If your refering to a BLS provider who odies a complete and thorough P/E-H&P, as well as provides adequate care and acts as an advocate for their pt, then I can see nothing wrong with that. If OTOH, you mean the basic starts the IV and puts the monitor then goes ahead and wrongly tells the medic what and how to do stuf..well, thats a whole notha thing entirely. :evil1: :evil2: :evil3:

You are right, we are limited in what we can do due to limited training.

Thanks for conceding the truth.. :wink: 8) :glasses5: :iroc:

So to suggest that we are able to diagnose things when it is not within our scope of pracitce would be irresponsible. Do I diagnose, tentatively- I have to ensure the best possible care for my patient.

Listen, you don't tenatively diagnose ANYTHING... You're either treating a specific issue {I.E.: diagnosis} or a range of co-morbid factors due to your DDX, but without that WORKING DIAGNOSIS you have NOTHING!! You can't even progress to the most basic of treatments because you have no clue what it is your doing and why..!!! You have by that reasoning you've identified NOTHING WHICH WARRANTS EMERGENT INTERVENTION OR RX< BECAUSE YOU"VE FOUND NOTHING!!!!!![/ :sign3: :director: :twisted: :banghead: It is not irresponsible to assess and based on an accurate and thorough, comprehensive assessment obtain a DX and then progress to treatment.

:ky: :ky: :ky: :blob6: :blob6: :banghead: :banghead:

I am usually correct, but would never presume to tell anyone what the diagnosis is, just give as much detail in my assesment findings as possible. My findings will usually steer my assesment to a more focused secondary. I simply do not want to make a statement that would lead someone to think it is OK to play medic.

So what do you mean exactly, is your Dx and treatment a secret that the ER and other providers need to guess at?!?!?!?? You either have a DX or you don't. You then either tell the ER and accepting care provider your P/E, H&P, or you don't...You can't have it both ways...In one scenario your doing your duty, and legal, etical, moral, etc... responsibilties to your pt. In the other your negligent and should end up pushing carriages into a supermarket as your career... Doing the former is in no way "playing medic" It's being a trained, competent, professional.. :happy1:

As for the O2 and diesel thing, I have seen much more detrimental things than that saying- such as infighting.

:pottytrain2: :read2: :read:

Based on some of your own statements you have bigger worries than merely just being concerned with regurging BS you overheard some 'Rescue Randy' spouting off as verbal diahrrea, to make themselves look important...

In closing, Let's not hijak this thread anyfarther and try to allow the opportunity some more learning for "Julian". As for your issues, well feel free to start a new thread and I'll be happy to continue to educate you there!!

Out here,

ACE844

[Ace844]

"Juilian,"

Did the above posts answer your questions, or do you have more??

[Nate]

"How long until my paramedic gets here?" That was a joke for those of you who can't tell.

[Ace844]

"How long until my paramedic gets here?" That was a joke for those of you who can't tell.

Depends on who's askin..for you it could be awhile!! :wink: 8)

This one day in BLS camp we.....{**NEVA MIND**} :oops: :shock: :wink: :arrow: :!: 8)

[Nate]

Depends on who's askin..for you it could be awhile!! :wink: 8)

How about this one; "Is Dustdevil going to make fun of me when I talk about this on the message board?"

[Ace844]

How about this one; "Is Dustdevil going to make fun of me when I talk about this on the message board?"

{Laughing} That's too funny..... 8) Yet...Surely you jest, thats too priceless to be true here...

still...I'm sure that..oh wait, whats this::

:wink: 8) 8)

ACE