Fresh EMT student confused

[EMTisLife]

Hey guys, so I am a new EMT student who just started and I am confused about the procedure for EMTs. My book says to always perform a primary assessment on patients, which seems counterintuitive. The primary assessment requires AVPU and ABC's, which seems to require at least a few minutes to get through. And if a patient is obviously critical, I am not sure that taking the time to do a complete set of vitals would be wise. ABCs require you to take lung sounds, blood pressure, heart rate, respiratory rate, pupil signs, and skin signs right? Would it be more wise to just transport them first and then take these in the ambulance?

Under what scenarios would you want to do your complete primary assessment before transporting them and when would you transport first?

Thanks!

 

[NysEms2117]

Hey guys, so I am a new EMT student who just started and I am confused about the procedure for EMTs. My book says to always perform a primary assessment on patients, which seems counterintuitive. The primary assessment requires AVPU and ABC's, which seems to require at least a few minutes to get through. And if a patient is obviously critical, I am not sure that taking the time to do a complete set of vitals would be wise. ABCs require you to take lung sounds, blood pressure, heart rate, respiratory rate, pupil signs, and skin signs right? Would it be more wise to just transport them first and then take these in the ambulance?

Under what scenarios would you want to do your complete primary assessment before transporting them and when would you transport first?

Thanks!

what do you think and why?
Wouldn't you need ABC's so your not transporting a corpse?

 

[RocketMedic]

Assessment doesn't take several minutes, and nearly nothing is that time critical. There are times for scoop and run. Those times are not in testing.

 

[NysEms2117]

something i forgot to add was just pass the test, learn how to actually do it in the real world later.

 

[Jim37F]

Hi there, I'm Jim, I'm an EMT with XYZ Ambulance, I'll be taking care of you today., what's your name? Hi Jerry, what can I help you with? Your chest hurts? Ok, really quick, couple silly questions I ask everyone,how old are you...57...ok I need you to tell me what city we're in...ok and what is today?"

Boom 30 seconds, and I have a 57 yo Male (named Jerry) complaining of chest pain, he has an open patent airway because he's talking to me (and here based on how he's talking to I note in the back of my head if he's having any difficulty breathing because I can see any tripoding, accessory muscle usage, if he's talking in full sentences or if he has 2-3 word dyspnea, etc....oh and I'm looking at his skin signs seeing if anything looks abnormal or not, basically does he look big sick or little sick? I also go ahead and check a quick radial pulse whilst talking, now that same 30 seconds, boom I now also know skin color/temp/moisture, I'm not counting specific pulse rate, just feeling if it's too fast or slow, or just about right, if it's string or weak, or even too strong......voila 30 seconds I know the status of their ABCs, as well as AVPU, A&Ox whichever, GCS, name age and chief complaint, and I haven't even opened up my bag to take vitals yet. ) It takes a lot longer to talk through the ABCs than to actually assess them.

Don't forget, vitals are secondary assessment. Knowing if his blood pressure is 120/80 or 130/90 doesn't matter at this stage....if he's talking to me clearly, I know he has more or less clear lungs, I can take a listen a bit later in on the assessment....now if he looks Big Sick with cool pale diaphoretic skins I'll put a higher priority on getting a blood pressure reading...if they're complaining of shortness of breath I'm gonna listen to their lungs sooner rather than later, etc. remember while there's a specific order for school tests....in the real world, things are a little more fluid....and you also have at minimum 1 other person with you....often times (depending on where you're at) a fire company as well so someone can start taking vitals as soon as you walk up and start asking them questions.

 

[DesertMedic66]

. ABCs require you to take lung sounds, blood pressure, heart rate, respiratory rate, pupil signs, and skin signs right? Would it be more wise to just transport them first and then take these in the ambulance?

During your initial ABC check you are not going to be checking a BP. For respiratory rate and heart rate you are only looking and feeling to find out if it is really slow, really fast, or normal. Those shouldn’t take more than 20 seconds.

 

[hometownmedic5]

If you think your primary goal is just to get the person moving towards the hospital, quit emt school and go get a hackney license because all you are is a cab driver at that point.

The purpose of being an emt is to asses, treat, and transport patients. Before you have any idea where to take them and what you're going to do for them, you have to know what's wrong with them. You get that information from your assessment.

The assessment part of patient care is the foundation. It is absolutely mandatory that you both understand this concept and become very proficient at it, as it is your principal skill from which all other skills and decisions are based on.

 

[hometownmedic5]

Also, it takes you "a few minutes" to do this because you're a student. Once you have some solid experience behind you, your "sick/not sick" assessment is largely done during your walk from the doorway to the human. Beyond that, were mostly just quantifying levels of sick.

 

[StCEMT]

Once you get out of class, you will start to forget the cookie cutter outlines you have to spit out when being tested. You will have dispatch notes that (usually) point you in a general direction. Within 5 seconds of seeing the patient, you will decide sick vs not sick. Which of those two your gut tells you will change what you prioritize next based on the information you have and what you know from seeing the patient. You are also checking multiple things at once during your initial assessment. Also remember you have your partner and fire on scene to help collect info. Delegate tasks appropriately and you can knock out a lot of things in a short amount of time.

So in short, no, doing an adequate initial assessment can be done quickly. Follow up details can be done later though.

 

[Chimpie]

@Jim37F had a great reply above, but I wanted to throw my opinions out your way as well.

ABCs require you to take lung sounds, blood pressure, heart rate, respiratory rate, pupil signs, and skin signs right?

ABCs don't require all that you mentioned. ABC stands for Airway, Breathing and Circulation. It's not a full assessment. You just need to make sure that all three are there. As @Jim37F stated, if the pt is talking to you, then you have all three.

Would it be more wise to just transport them first and then take these in the ambulance?

Not always. Remember, the drive to the hospital may be short or long, may be bumpy, loud, too hot, etc. In most cases it will be easier to get a full set of vitals on scene before transporting. That way, as you're transporting, and you get your second, third, etc. set of vitals, you can see how the pt is trending.

Under what scenarios would you want to do your complete primary assessment before transporting them and when would you transport first?

In reality, most scenarios are not "load and go". Taking an extra three to five minutes to complete an assessment won't change the outcome of your pt.

 

[SpecialK]

The primary survey is a very quick assessment to find immediately life threatening problems you need to do something about right now; for example, somebody who is not breathing, in cardiac arrest or bleeding profusely.

If I walk up to a person who interacts with me, is not struggling for air, hasn't got any obvious bleeding (common sense applies here) and doesn't look like they are about to die from shock then there's the primary survey kinda done for you already without even doing anything. The medics talk about the "end-of-the-bed-ogram" and it's kinda similar I guess.

You do not do everything in everybody ... you need to decide what information you need to collect to work out a diagnosis and a plan for that patient and what is going to be clinically significant for them. As an example, a patient who is unconscious with poor airway having been hit by a car about 10 minutes from hospital: is doing a blood sugar important? will it change what you do? no. What about a blood pressure? probably not. What about doing a full neurological assessment? no. For this patient, I would focus on maintaining their airway, doing a respiratory assessment, palpating a pulse, obtaining a GCS (particularly a good motor score) and going quickly to hospital.

On the other hand, somebody who is "non specifically unwell" is going to need more of a detailed workup to figure out what to do with than somebody who has an obvious problem for example STEMI or asthma.

If what you think you should do is not going to change what you do in terms of diagnosis or plan, or will not immediately change what happens to the patient when they arrive at hospital if applicable, then it's probably not really necessary.

In the old days for example, everybody got a BGL or high flow oxygen just "because", "because everybody got one" ... and that sort of old rubbish needs to stay in the past.