ALS.... Forgetting the Basics

[rayemtjax77]

Iits sometimes hard to take the focus away from the trauma that your patient has recently suffered. Its also sometimes hard to notice something that is hard to see. But as I have learned, on EVERY patient that you come in contact with, no matter what the illness/injury, take a step back and go back to the basics... Airway.... Breathing... Circulation. I watched a ACLS competition one time and noticed that the medics were so focused on the scene and number of patients, that not one when through the whole ABCs on any patients.

Just take it back to basic... A-B-C's

[medic001918]

Every patient gets the ABC's done on them. It's a matter of if you catch the manner in which I assess them for the ABC's. Do I walk up to them and physically check a pulse? Look for breathing? Not always. If I walk in and a patient is upright and talking to me, then their ABC's are in tact. If they're unresponse, then I do the "look, listen & feel" approach...or part of it. Sometimes I can check these by visualization alone. The inital assessment of a patient should be a matter of seconds. A quick "hello, how are you?" is sometime's all that's needed. You can gauge a lot by a patient's answer to the most basic questions. Couple that with a quick pulse check and you'll have an idea of if they're rate is fast or slow, and if they're pulse is normal, bounding or weak. But yes, every patient gets the ABC's done.

Don't compare a competition to what happens in real life. People act differently when they know they're being scored. It's easy to get worked up in the competition and leave things out. Gauge someone instead by how they conduct themselves when working with real patients.

Shane

NREMT-P

[brentoli]

How can you NOT go through the ABC's?

Airway. They are talking? Its open. Not talking? Adjunct.

Breathing. The chest moves? Breathing. Not moving? BVM

Circulation. No blood to be seen, and they have color and movement? Good. No color, no movement, blood everywhere? Bad.

[Dustdevil]

There is a large perceptional difference between competition and actual practice. In actual practice, you can assess ABC's without announcing it. This is similar to scene safety and BSI. In EMT school, you have to stand there and verbalise it. In actual practice, you just do it and nobody even notices. In fact, a lot of what a good medic does is so smooth and natural that bystanders, partners, and even the patient commonly remark afterwards, "I didn't even notice you doing that."

Perhaps that perception is what leads to the confusion over this issue. But, of course, maybe not. Some people do indeed work with their heads up their arses and make stupid mistakes. We see and hear about it everyday. But it has not been really common in my experience to see even rookies totally overlook the ABCs on a patient. To jump right to intubation without trying anything else first? Sure. I've seen that. But not to totally forsake ABCs altogether.

[whit72]

I never overlook ABC's its the essence of my job. Ambulate Before Carry

In all honesty, it shouldn't be to tough to assess ABC's, that should take you all of 15 seconds on most patients.

The presence of ABC's dosent assure the quality of them. Poor quality in any of the ABC's can be just as detrimental as the absence of them.

I have worked with people who just assume tube someone then see if there is a less invasive solution to the problem. They have the "kill the fly with a sledgehammer mentality" Yeah, sure it will work, that does not mean its necessary.

[rayemtjax77]

That is true. Thats why assessments are done like that.

[Dustdevil]

Can you tell us more about this "ACLS competition?"

At first I thought you were just talking about like a mega-code thing. But after reading the OP again, you're talking about multiple patients and a chaotic scene, so I'm thinking you mean more of an MCI exercise than an ACLS thing. And what exactly do you mean by...

...not one when through the whole ABCs on any patients.

Do you mean they didn't do a head-tilt/chin lift, look listen and feel thing? On conscious or unconscious patients? You do know you don't have to do that on conscious and breathing patients, right? And you do understand that in actual practice, you don't verbalise all your steps like you do in class, right? Sorry, not saying you're stupid or anything, but I have seen many new students not understand these things in the beginning. Or, are you saying that these guys jumped straight to drug interventions on unconscious patients without ever beginning the CPR process?

[rayemtjax77]

Its a Competition between several different departments over the state.. its a MOCK incident that tests you on several areas on ALS protocols and procedures. U have to do everything in a certain amount of time and do it all correct.

[JakeEMTP]

Its a Competition between several different departments over the state.. its a MOCK incident that tests you on several areas on ALS protocols and procedures. U have to do everything in a certain amount of time and do it all correct.

I see. So it was an ALS paramedic competition, not a ACLS competition. There is a huge difference. That's what had me confused

[rayemtjax77]

That was correct.. My mistake.