We just got done learning about emergencies that involve altered levels of consciousness. These include diabetic emergencies, stroke, trauma, and drugs/alcohol. The class is getting really interesting because we spend a majority of the time running through scenarios and discussing possible actions, etc. with classmates.
One of tonight's simulated dispatches was a "66 yr. old male pt. complaining of chest pain." From this simulated dispatch Cliff (my instructor) will quickly ask the class to provide three possible scenarios: how about MI (myocardial infarction, aka. heart attack), trauma, and angina. Formulating these scenarios gets us thinking of what the possibilities are before we actually arrive on scene. Obviously we have to be prepared for anything, but it is good to get the thinking and investigating process started so you are thinking before you even arrive. Cliff always says that he wants to make "thinking EMTs" out of us because "our patients haven't read our book" and therefore won't present in the supine anatomical position with respirations between 12 and 20 breaths/min. and a BP of 120/80, etc. if you get what I mean...
Anyways... After we have this broad plan set up, we 'arrive on scene'. Is the scene safe? Have I taken enough body substance isolation precautions? How many patients do I have? Do I have enough EMTs and treatment capabilities available to me? Do we need to call advanced life support (ALS)? Do we need the cops?! What is the possible mechanism of injury or nature of illness? These questions should all be running through your head before you have even gotten out of the rig. Of course we always have to consider the possibility of spinal injuries, also.
On to patient assessment! First we have to form a general impression... Is the patient hunched over with his hand on his chest gasping for air? Is he even conscious? Is he diaphoretic and pale? We then need to talk to the patient, achieve expressed consent to touch them, and get his chief complaint. We need to check his level of consciousness. Hopefully he will be conscious and talking to you. That way you know he has a patent airway and you can achieve a focused history. After quickly assessing the ABCs (Airway, Breathing, and Circulation) we have to get a set of baseline vital signs.
The focused history ensues... Why did you call us? What hurts? When did the pain start? Does anything make the pain better/worse? Describe the pain... Does the pain move at all? On a scale of 1 to 10 (1 being no pain and 10 being the worst pain you can imagine) how would you rate the pain? Is the pain constant? Does the pain come and go? Have you done anything to try and stop the pain? What are you allergic to? Are you taking any medications? Has this ever happened to you before? What was the last time you ate or drank anything, and what was it? What were you doing when the pain started?
Whew... And then comes the focused physical exam, detailed physical exam, several sets of vital signs, etc. All of this in (ideally) well under 10 minutes. Isn't it awesome!? This person's life depends upon you! You have to think quickly and stay calm and in charge. I love it... Now if I could just get out on a call! My emergency room time is scheduled for March 4 from 11:00pm to 9:00am... That's right, I purposely chose the night shift and I'm hoping to see something awesome like several gunshot wounds or something.
Sound good?
Later folks,
Daniel
Daniel
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