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Can you diagnose in the field?


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Wait, wait, wait, I just thought of a really funny response to this topic. *AHEM*

"No, I can't, and that's why I'm having a sit down with my medical director next monday."

BAH DUMB BUMP CHNNNG!

Thank you, thank you, I'll be here all night, be sure to tip your waiter.

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For the most part at the BLS level I have the tool of assessment. Although its not fancy it dosent light up, or beep. It is the most important tool any provider, at any level could possess. Our job is for the most part recognition. Put all the bells and whistles on it you want. If you don't posses the skills of assessment those fancy tools become expensive window dressing.

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Everyone in EMS from the Paramedic to the first responder has to diagnose from what they know about the pt. I will never diagnose a mitochondrial disorder in the field, but damn it, to be able to use a 12-lead EKG (ECG whatever floats your boat) to see the pericarditis (something I can't do as a basic) is what saves the pt's life rather than just prolonging it with CPR after they go into a deadly arrhythmia. Diagnosis saves lives, whether it is legal or not.

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Unfortunately, I don't believe that most EMS providers diagnose illness. They simply recognise a syndrome.

Abdominal pain. Chest pain. Difficulty breathing. Nausea and vomiting. Those are not diagnoses. Those are syndromes.

Cholecystitis. Costochondritis. Acute bronchitis. Otitis. Those are diagnoses. Damn rare to see those on an EMS run report.

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Hmmmm, and if you are wrong?????

Then at least you gave it your best shot. It is better than sitting there going "HMMMM I wonder why this pt looks like a smurf? I love smurfs! That papa smurf was kind of weird! I wonder if he ever....

Even the lowly first responder must begin the diagnosis prosses. He sees the blue pt and belives it is an obstructed airway. If he is right, the pt may lives. If he is wrong, he can still do his best to ventilate the pt.

A diagnosis of hypoglycemia is something a first responder may see. Glucose could save this pt's life but if the first responder does not have the balls to think hypoglycemia when they see the medical alert bracelet then the pt may very well die.

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so...... are you treating the symptoms or making a dx??

For many things, they will go together. Hypoglycemia-->diagnosis based on a readily available bedside lab value, or symptom of another, probably bigger problem.

Hypoxia-->tough to definitively diagnose with the available tools, but when the patient is blue and combative the leap can be made.

Even the syndromes that Dust mentioned, we would be basing our treatment on what we have/have not found. Because definitive diagnosis often can't be made, we must rely on recognizing the patterns that some of these syndromes present with.

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