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Pre-hospital Primary Survey

trauma-list@trauma.org trauma-list@trauma.org
Mon, 14 Apr 2003 11:45:52 EDT


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In a message dated 4/14/2003 9:54:13 AM Eastern Daylight Time, 
medic245@mindspring.com writes:

> 
> To the prehospital provider, useless informations includes the 
> following:  Blood Pressure, past medical history, medication allergies, 
> social history (to include EtOH/Substance/etc.,) and ECG monitoring.
> 
> As a general rule, a decent medic should have a fairly good overview of the 
> 
> patient condition within 60 seconds of entering the doorway (i.e. "Damn," 
> or "Crap.")
> 
> Best,
> 
> Jeff Brosius
> Paramedic, etc.
> Atlanta, GA
> 

I think Jeff pretty much covered the details..... a fast, efficient physical 
assessment of the patient, their age and the mechanism tells me whether there 
is time to get the rest of the information on scene or when rapid extrication 
shopuld be coupled with a diesel bolus and treatment enroute.  The rest of it 
is nice to know, if there is time.  But if the patient can't tell me that 
stuff themselves at the scene, that's all I need to know for a "load and go" 
decision and treat/deal with it enroute, whatever "it" is.

ECG might be helpful in a chest wall impact and should be done for a primary 
cardio/respiratory complaint.  In any other case it's just make busy work and 
we don't always have the time or the need for that when a palpated pulse (or 
lack of them) is just as illuminating.  But we don't need the Pulse Ox or the 
autoBP monitor enroute to manage trauma patients, either.  Too many EMS 
providers are assessing/treating the machines and not their patients (more 
than one is too many, IMNSHO).

This does not negate the need for in depth background education on the part 
of EMS personnel.  In fact, I think the more education we have in physiology, 
the easier and more accurate our assessments and decision points get.  Such 
in-depth knowledge gets providers beyond the "I am scared" method of EMS into 
the "critical thinking, let's do this because it's medically the right thing 
to do" phase of patient care.

OTOH, (to echo Jeff's sentiments) good old fashioned "hair on the back of the 
neck" syndrome and/or the immediate "Oh, s*&^" reaction on my part gets a 
judicial amount of consideration; but, in the end, it still comes down to 
"Can you breath?"

Kat Rickey
Paramedic, etc (too!)
New Hampshire


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<HTML><FONT FACE=3Darial,helvetica><FONT  SIZE=3D2 FAMILY=3D"SANSSERIF" FACE=
=3D"Arial" LANG=3D"0">In a message dated 4/14/2003 9:54:13 AM Eastern Daylig=
ht Time, medic245@mindspring.com writes:<BR>
<BR>
<BLOCKQUOTE TYPE=3DCITE style=3D"BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT=
: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px"><BR>
To the prehospital provider, useless informations includes the <BR>
following:&nbsp; Blood Pressure, past medical history, medication allergies,=
 <BR>
social history (to include EtOH/Substance/etc.,) and ECG monitoring.<BR>
<BR>
As a general rule, a decent medic should have a fairly good overview of the=20=
<BR>
patient condition within 60 seconds of entering the doorway (i.e. "Damn," <B=
R>
or "Crap.")<BR>
<BR>
Best,<BR>
<BR>
Jeff Brosius<BR>
Paramedic, etc.<BR>
Atlanta, GA<BR>
</BLOCKQUOTE><BR>
<BR>
I think Jeff pretty much covered the details..... a fast, efficient physical=
 assessment of the patient, their age and the mechanism tells me whether the=
re is time to get the rest of the information on scene or when rapid extrica=
tion shopuld be coupled with a diesel bolus and treatment enroute.&nbsp; The=
 rest of it is nice to know, if there is time.&nbsp; But if the patient can'=
t tell me that stuff themselves at the scene, that's all I need to know for=20=
a "load and go" decision and treat/deal with it enroute, whatever "it" is.<B=
R>
<BR>
ECG might be helpful in a chest wall impact and should be done for a primary=
 cardio/respiratory complaint.&nbsp; In any other case it's just make busy w=
ork and we don't always have the time or the need for that when a palpated p=
ulse (or lack of them) is just as illuminating.&nbsp; But we don't need the=20=
Pulse Ox or the autoBP monitor enroute to manage trauma patients, either.&nb=
sp; Too many EMS providers are assessing/treating the machines and not their=
 patients (more than one is too many, IMNSHO).<BR>
<BR>
This does not negate the need for in depth background education on the part=20=
of EMS personnel.&nbsp; In fact, I think the more education we have in physi=
ology, the easier and more accurate our assessments and decision points get.=
&nbsp; Such in-depth knowledge gets providers beyond the "I am scared" metho=
d of EMS into the "critical thinking, let's do this because it's medically t=
he right thing to do" phase of patient care.<BR>
<BR>
OTOH, (to echo Jeff's sentiments) good old fashioned "hair on the back of th=
e neck" syndrome and/or the immediate "Oh, s*&amp;^" reaction on my part get=
s a judicial amount of consideration; but, in the end, it still comes down t=
o "Can you breath?"<BR>
<BR>
Kat Rickey<BR>
Paramedic, etc (too!)<BR>
New Hampshire<BR>
<BR>
</FONT></HTML>
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