Help distinguishing medical emergencies

[GreatJob]

Start my first shift ever as an EMT this Sunday, very excited.

One thing that is tripping me up is how to be able to tell one medical emergency from another when the sign/symptoms are very similar.

For example, Congestive Heart Failure and Asthma have a lot of the same symptoms. But if you interpret a CHF patient as an Asthma patient and give albuterol, it's going to make them a lot worse.

Another one is Hyperglycemia VS Alcohol Intoxication. Luckily we're allowed to use glucometers with our company so I'm not as worried about this one.

What are some other emergencies that can mimic each other, and what do you guys do to tell the difference between the two examples I listed above?

 

[Veneficus]

One thing that is tripping me up is how to be able to tell one medical emergency from another when the sign/symptoms are very similar.

Welcome to EMS. The biggest and ongoing problem in the field is the lack of provider education. The difference is determined by a combination of history, physical exam findings and knowledge of pathophysiology. (To understand patho, you must understand physio first. )

You don't have enough education from an EMT-B clss on either.

On toop of that, you are only taught the most extreme presentations and worst case scanarios.

So like everyone else, you will learn on the job. You will make mistakes, life goes on.

For example, Congestive Heart Failure and Asthma have a lot of the same symptoms. But if you interpret a CHF patient as an Asthma patient and give albuterol, it's going to make them a lot worse.

I think this is really overstated compared to reality. The person would have to be one of the extreme cases detailed above.

What are some other emergencies that can mimic each other, and what do you guys do to tell the difference between the two examples I listed above?

What about the ones you don't even know about?

I went to School.

 

[NPO]

Start my first shift ever as an EMT this Sunday, very excited.

One thing that is tripping me up is how to be able to tell one medical emergency from another when the sign/symptoms are very similar.

For example, Congestive Heart Failure and Asthma have a lot of the same symptoms. But if you interpret a CHF patient as an Asthma patient and give albuterol, it's going to make them a lot worse.

Another one is Hyperglycemia VS Alcohol Intoxication. Luckily we're allowed to use glucometers with our company so I'm not as worried about this one.

What are some other emergencies that can mimic each other, and what do you guys do to tell the difference between the two examples I listed above?

SAMPLE.

Remember what P stands for? If the patient has asthma or diabetes, they will know, and usually someone around them will know. Obviously, there will be times when there wont be someone there to answer these questions for you. Does the semi-couscous man on the floor smell of alcohol? Where is he? In an elevator? Chances are if he doesnt smell of alcohol, hes not intoxicated. Youre going to have to rely on your senses, your common sense being a big one. And there are other times where you just arent going to know. Dont be afraid to ask your partner what he/she thinks. If all else fails, follow local protocols regarding rapid transport and/or ALS intercept.

 

[mycrofft]

OP, some chase-cutting:
1. Are you protocoled to administer albuterol as an EMT?
2. Can you take an EKG?
3. Can you auscultate the chest to differentiate wheezes (asthma) versus rales then rhonchi (CHF, pneumonia, toxic inhalation, pulmonary burns)?
4. What will BP do in CHF that it won't in asthma? Not to mention pulse.
5. Remember to get the history promptly so the pt is still conscious and the bystanders don't take off.

Diabetic ketoacidosis and alcohol sequelae can smell and look similar behaviorally, but a fingerstick will indicate the glucose level (can you do them?), and a sugar bolus (oral or IV) will not hurt an alcoholic, it would help a hypoglycemic, it won't harm someone in DKA, and if they are a diabetic alcohol abuser, good luck.

Or for that matter, an asthma/COPD patient who has CHF?:huh:

You can do it. Think and watch and ask and listen and do. Rinse and repeat.

 

[Clare]

I must strongly disagree that asthma and CHF/APO are similar in presentation, the only similarity is that the patient is short of breath!

 

[mycrofft]

So, at fifty feet, the presentation is identical.
And people say we Americans stand too far away!

 

[FLdoc2011]

Start my first shift ever as an EMT this Sunday, very excited.

One thing that is tripping me up is how to be able to tell one medical emergency from another when the sign/symptoms are very similar.

For example, Congestive Heart Failure and Asthma have a lot of the same symptoms. But if you interpret a CHF patient as an Asthma patient and give albuterol, it's going to make them a lot worse.

Yea I wouldn't worry about this. I take care of plenty sick CHF patients in the hospital, a lot of them having multiple co-morbidities including COPD and I just have not had an issue giving these folks breathing treatments if they need them.

By history and physical you should be able to differentiate between the two after some experience.

 

[mycrofft]

AN EMT doesn't need a medical diagnosis, but rather need to be able to assess and find out if the subjects are hypoxic (give oxygen), apneic (airway and BVM), pulseless (start CPR), in labor (go real fast and act calm), etc.

If a CHF and a COPD patient are sitting next to each other, both are gray, both are tripodded, both have a resp rate of 34, both have a lowered pulse-ox and c/o breathlessness, they are both going to get some oxygen and a ride from the EMT. The paramedic will have some other things to do before and on the way.

 

[medicdan]

Start my first shift ever as an EMT this Sunday, very excited.

One thing that is tripping me up is how to be able to tell one medical emergency from another when the sign/symptoms are very similar.

For example, Congestive Heart Failure and Asthma have a lot of the same symptoms. But if you interpret a CHF patient as an Asthma patient and give albuterol, it's going to make them a lot worse.

Another one is Hyperglycemia VS Alcohol Intoxication. Luckily we're allowed to use glucometers with our company so I'm not as worried about this one.

What are some other emergencies that can mimic each other, and what do you guys do to tell the difference between the two examples I listed above?

Op, if you're interested in more education about development of differential diagnoses in the field (perhaps as you get more experience as a provider), I recommend NAEMT's AMLS course. It doesn't teach as much of see this, do this, but helps you develop your own critical thinking skills.
http://www.naemt.org/education/amls/whatisAMLS.aspx

 

[Handsome Robb]

AN EMT doesn't need a medical diagnosis, but rather need to be able to assess and find out if the subjects are hypoxic (give oxygen), apneic (airway and BVM), pulseless (start CPR), in labor (go real fast and act calm), etc.

If a CHF and a COPD patient are sitting next to each other, both are gray, both are tripodded, both have a resp rate of 34, both have a lowered pulse-ox and c/o breathlessness, they are both going to get some oxygen and a ride from the EMT. The paramedic will have some other things to do before and on the way.

How can you decide what treatment path to go down without forming a differential diagnosis? ... EMS doesn't diagnose is bull:censored::censored::censored::censored:.

I agree EMTs aren't going to do a whole lot but there are plenty of rural systems that give them a wider scope than many are used to. Ask TransportJockey about his protocols at his old agency for EMTs...

 

[mycrofft]

How can you decide what treatment path to go down without forming a differential diagnosis? ... EMS doesn't diagnose is bull:censored::censored::censored::censored:.

I agree EMTs aren't going to do a whole lot but there are plenty of rural systems that give them a wider scope than many are used to. Ask TransportJockey about his protocols at his old agency for EMTs...

It may seem like BS, but that is also what every EMT brought up on malpractice says ("This is buh:censored::censored::censored::censored:, man!"). It's like your 12 year old driving the family car to and from the 7-11 on Sunday mornings for a pop and chips, s'all good til something real happens.

Actually, to make a medical diagnosis with only a technician certificate in most states is illegal. Protocols which are organized under medical diagnosis rather than organ systems or complaints/symptoms (which demands a medical diagnosis in advance) are inadequate. Same for nurses' standardized procedures, by the way. Best yet, ask your EMSA.

Open your EMT text and find the word "differential diagnosis" anywhere in it. Look at your textbook's chapter titles.

Flip to the table of contents of your protocols. If it says "CHF", "COPD", SPIRAL FRACTURE OF THE ULNA", then it is out of bounds. If it says "INJURIES OF THE UPPER EXTREMITY" or "BLUNT TRAUMA/HEAD" or some such, then it is working.

Now, if the pt gives a history of a medical condition (e.g., "I'm a diabetic and I didn't eat supper"), the protocol may allow or dictate some divergence, but again as a technician you are bound by protocol except the situations where the protocol just doesn't make sense.

I remember the days of being an EMT and proudly turning over patients with our diagnoses to the ER staff. Later, I worked as a RN in an ER. We would watch the EMT's walk off and we would sit and talk about their armchair diagnoses which did them nothing except lead them to the brink of treatment error.

Yeah we make a mental or provisional diagnosis in our head to help focus assessment, but when it comes right down to it you give oxygen, traction splint, and do anything above basic first aid on the basis of a protocol and protocols must be based upon symptoms and signs and history, not your making a professional diagnosis.

Rural folks need a much wider scope of training and protocol due to delayed arrivals and longer return times. (What they need are more hospitals). University of North Carolina is working on a two year bridge for Special Forces medics to become PA's to serve rural and underserved areas, but you can bet some MD will be countersigning and overseeing their work. If your protocols' authors (typically includes medical controller unless they are really negligent and derelict) choose to take you out of the NHTSA guidelines and your EMSA approves it, get and document the training, and go for it.

Cry as we might, that's the basic truth.

PS: Some people will find their protocols work fine, others always find items to except them from following them. Remember that as soon as you step off that path, your employer and your EMSA have washed their hands of you. You may be "allowed" to go off-protocol when something goes sideways, but if the protocols are any good, that won't be often unless you are an armchair physician.

 

[NomadicMedic]

I think we've strayed far off topic. Lets get back to the original topic of sharing constructive ideas to help the OP differentiate different presentations encountered as an EMT.

 

[mycrofft]

10-4

 

[wildrivermedic]

Lets get back to the original topic of sharing constructive ideas to help the OP differentiate different presentations encountered as an EMT.

As already said, the patient's history can tell you a lot. Pay attention to the medications they are on. You won't be able to memorize all the drugs out there, but learn to pick out suffixes (-olol, -terol, -oxin...) from the generic names. Many times the suffix can point you to a group of drugs sharing the same action, and that can point you to a medical history. Beware of trade names and exceptions to the rules - but as was also already said, you don't have to / get to diagnose. This is just more information to help you start to see a pattern in your patients.

Keep educating yourself: physiology, pathophysiology, better examination techniques. Understand why you see different symptoms with different conditions (wheezes vs. rales), and how the different treatments work. Look for the patterns. You don't get paid for this, it's gotta come from other motivations like providing the best care you can, and morbid curiosity.

Good luck!

 

[CPRinProgress]

SAMPLE.

Remember what P stands for? If the patient has asthma or diabetes, they will know, and usually someone around them will know. Obviously, there will be times when there wont be someone there to answer these questions for you. Does the semi-couscous man on the floor smell of alcohol? Where is he? In an elevator? Chances are if he doesnt smell of alcohol, hes not intoxicated. Youre going to have to rely on your senses, your common sense being a big one. And there are other times where you just arent going to know. Dont be afraid to ask your partner what he/she thinks. If all else fails, follow local protocols regarding rapid transport and/or ALS intercept.

CHF will have signs of swelling around the ankles plus you could ask then if they have had an asthma attack before and see if it feels the same that is not definitive but it could steer you in the right direction