Conflicting info, please help

[skyemt]

actually most testers wouldn't care if you swithed as long as you did it at the beginning.

at our practical, they wanted us verbalizing C-Spine considerations before reaching the patient... they failed every applicant who didn't do it.

 

[skyemt]

Ok, first off, everyone put away your cookboo.... err protocols. Sitting here posting links and quoting protocols over which is first, ABC or LOC is about as stupid as having DCAPBTLS as an acronym. As have been mentioned earlier, if you greet a patient and s/he greets you back than the patient's ABC are grossly intact [i.e. the patient has an airway, is breathing, and has a pulse. Millage in those three categories will vary from patient to patient though.] Real life doesn't have purdy little check boxes and just because you verbalize scene safety and BSI doesn't mean a damn, nor that things will stay the same.

In reality, ABC can be assessed long before LOC [oh, our patient is walking around, therefore he probably has an airway [exception: choking, since I know someone is going to call me out on that one B)], the patient is breathing, and the patient has a pulse [if your patient is walking and doesn't have a pulse, then you need a priest, not a medic].

Ok, now let's look at the question itself.


Ok, A and B requires you to check a pulse before they happen. C requires you to check the patient's airway prior to taking that step. D is the only actual assessment up there. "Lying on the floor" is not "unconscious" and we don't maintain airways in patient's who can maintain their own [Law 13*], especially as basics [show me a system that allows basics to RSI and I'll show you a lawsuit waiting to happen].

To expand further, especially if you want to bring "protocols" into this, thing back to good old CPR. What's the first thing you do? Shake and shout. We just call it checking a patient's LOC instead.

Edit: taking C-spine precautions on all patients is stupid, but that's for a different thread.



*Law 13 of the House of God: The delivery of good medical care is to do as much nothing as possible.

err, thanks for the "info"...

it is all about the order of things... all you stated was what we've been telling him all along.. that LOC comes BEFORE ABC's... thanks for reiterating it though... answer D is the only one that comes before the ABC's.

pretty clear and straightforward, actually.

 

[JPINFV]

Except for page 2, which is mostly comprised of a bunch of posts quoting protocols and how they were taught.

Also, technically speaking, A, B, and C come after ABCs since those are treatments, not assessments.

 

[BlackOut]

Thanks for everyone's input....

I guess my slight confusion arose from the fact that the question's answer was..
"assess patient's level of consciousness"
I can't assume that the pt is either conscious or unconscious since the question never says either....
however if I "assess the pt's level of consciousness ANSWER D", then I can find out if the airway is open or not.....
however if "I make sure the airway is open ANSWER C", I can assess the pt's LOC
it works both ways....this is where the confusion arose

I understand this is not how it is in the field, but for testing purposes, it is a different story.

 

[skyemt]

Except for page 2, which is mostly comprised of a bunch of posts quoting protocols and how they were taught.

Also, technically speaking, A, B, and C come after ABCs since those are treatments, not assessments.

someone needs to back to school!!!

A,B, and C don't come AFTER the ABC's, they ARE the ABC's!

you check and treat the A,B,C as you find them...

"uhh, his airway is not open, but i have to check the B and C first, and then get back to it.."

geez... the basics my friend...

if there is a problem with the A, you fix it RIGHT THERE AND THEN!!! YOU DO NOT GO ON TO B AND C.

YOU TREAT EACH LIFE THREAT AS YOU FIND IT... YOU DO NOT COMPLETE AN ASSESSMENT FIRST, AND THEN GO BACK.

scary!

i have a good basic text, if would like to do some review.

 

[Topher38]

The answer IS D. Think of your skill sheets.


SS,BSI
c-spine?
NOH, or MOH?
Additional help?

General impression
AVPU!!!!!!!!!!!!!
CC

Airway
Breathing
Circulation

 

[JPINFV]

So, please tell me, how do you treat an airway problem if you haven't assessed a patient's airway (gasp, treatment for A comes after assessment for A)? How do you treat a cardiac problem if you haven't taken a patient's pulse? Do you just assume that an unconscious patient is in arrest and start CPR without checking? Answer those questions, and you will see where I'm, and the question, is coming from.

I mean, unless you have that cool little glove thing from the old TV show Earth 2. If that's the case, how much do you want for it?

 

[skyemt]

So, please tell me, how do you treat an airway problem if you haven't assessed a patient's airway (gasp, treatment for A comes after assessment for A)? How do you treat a cardiac problem if you haven't taken a patient's pulse? Do you just assume that an unconscious patient is in arrest and start CPR without checking? Answer those questions, and you will see where I'm, and the question, is coming from.

I mean, unless you have that cool little glove thing from the old TV show Earth 2. If that's the case, how much do you want for it?

i don't know what you are talking about... no one is saying that...

you just are not getting it.

before the ABC's you check LOC..
then, you don't assess ABC's as a unit and then go back and treat...
it is Airway... treat if necessary... Breathing... treat if necessary... Circulation... treat if necessary...

simple... if you go back to the test question, which started this thread... the answer is obvious...

i really don't know why you are trying to spend so much time saying how it is all wrong... you seem kind of confused, i have to say...

this is really as basic and straightforward as it gets...

to prove it, no medics are getting involved in this thread because of all the nonsense replies...

 

[skyemt]

In reality, ABC can be assessed long before LOC [oh, our patient is walking around, therefore he probably has an airway [exception: choking, since I know someone is going to call me out on that one B)], the patient is breathing, and the patient has a pulse [if your patient is walking and doesn't have a pulse, then you need a priest, not a medic].

JPINFV, after reviewing the posts on this thread, especially the one above, i realized that you may not fully understand the ABC's... the point is not to check if the patient is breathing of if he has a pulse... the point is to make sure that they are adequate to sustain life... if you see the patient is walking around, yes, he has a pulse... but is it 80? is it 130? 180? can you hear noisy breathing from looking 30 feet away? can you see rib fx's under his clothes?

see where i'm going here... you are not considering the reality of what the ABC's are about, or you wouldn't say you could assess them BEFORE even reaching the patient...

do you really think the ABC's are as dumb as just looking to see if there are breaths or a pulse?

i sure hope not... but this is all fodder for the "inadequate education of basics" folk...

 

[JPINFV]

JPINFV, after reviewing the posts on this thread, especially the one above, i realized that you may not fully understand the ABC's... the point is not to check if the patient is breathing of if he has a pulse... the point is to make sure that they are adequate to sustain life... if you see the patient is walking around, yes, he has a pulse... but is it 80? is it 130? 180? can you hear noisy breathing from looking 30 feet away? can you see rib fx's under his clothes?

No, I understand that. Of course absence of any of those is the main thing that you are looking for. As far as noisy breathing at 30 feet away, it really depends on the patient [yes, I've had that patient. Fun times in the nursing home...]. Of course if they are having difficultly breathing, they will generally show it. Your hands and ears aren't your only 5 senses. Yes, you can normally tell if a patient is having difficulty breathing/rapid breathing well before you check their LOC. As far as rib fx, I'm sorry, I don't normally think trauma when I see a medical patient. Hear hoof beats, think horses not zebras.

see where i'm going here... you are not considering the reality of what the ABC's are about, or you wouldn't say you could assess them BEFORE even reaching the patient...

So, you can't see a patient's skin color between entering the room and approaching a patient? You don't see if they're breathing prior to getting right next to them? Where exactly are you looking if not at the patient? Really, an assessment isn't some little check mark box that has to go in order 1, 2, 3, 4, 5.

do you really think the ABC's are as dumb as just looking to see if there are breaths or a pulse?

As an initial, "I just reached the patient and I don't even know what the patient called us for yet" assessment, yes, ABCs bring grossly intact is what is important.

i sure hope not... but this is all fodder for the "inadequate education of basics" folk...

The people who think that an assessment is something where the order is set in stone are doing a great job at that. Same thing with the people who are quoting as ground for some sort of order.

 

[skyemt]

convenient how you failed to mention the pulse... didn't quite fit with your argument?? pretty transparent...

anyhow, your arguments have gotten silly... find someone else..

 

[firecoins]

at our practical, they wanted us verbalizing C-Spine considerations before reaching the patient... they failed every applicant who didn't do it.

not at our test. not at others where I was a victim. As long as you held c spine near the beginning, you passed.

 

[JPINFV]

convenient how you failed to mention the pulse... didn't quite fit with your argument?? pretty transparent...

anyhow, your arguments have gotten silly... find someone else..

Show me a patient that's breathing without a pulse and I'll show you a patient that needs a priest, not a medic.

 

[skyemt]

not at our test. not at others where I was a victim. As long as you held c spine near the beginning, you passed.

i think our test followed a period where they were a bit "lax", and had a couple of problems with emt's... so, they went back strictly by the book, for exam purposes anyway...

the other thing they needed to hear on the ABC's was not, "yes, there is a pulse", but "yes, the pulse is not too fast, not too slow, adequate to sustain life"...

i've been trying to relay that point out here, but people are stubborn.

it is not, yes or no to pulse, but quality.

 

[skyemt]

Show me a patient that's breathing without a pulse and I'll show you a patient that needs a priest, not a medic.

i really think you're showing me an emt that needs a book, not a forum...

lol.

 

[JPINFV]

I think someone needs to be shown the definition of a straw man argument.

 

[skyemt]

In reality, ABC can be assessed long before LOC [oh, our patient is walking around, therefore he probably has an airway [exception: choking, since I know someone is going to call me out on that one B)], the patient is breathing, and the patient has a pulse [if your patient is walking and doesn't have a pulse, then you need a priest, not a medic].

we had a straw man in class... i just checked with him, and even he knew you can't check ABC's just from looking at someone ten feet away.

move on, buddy.

 

[JPINFV]

So, do you just close your eyes as you approach the patient? Because, seriously, it's not like the patient is hidden most of the time. Therefore, might I suggest visiting an optometrist?

You know what, never mind. You're just going to drag out another straw man piled up with thinly veiled ad hominem attacks, so never mind.

 

[skyemt]

sorry man... i'm done with the silly stuff.

 

[BossyCow]

actually,

technically, the AVPU is part of the primary assessment, not the scene size-up... don't get that wrong on your exam...

Hmm I though scene size up included how many pts and are they conscious, maybe that's just my protocols