patient assessment...the house and monk way

[EpiEMS]

I think you have to take it in with the sum total of knowledge and findings.

It is a failure of EMS education and knowledge to apply 1:1 models of assessment.

I have met physicians whose physical exam are as good as any battery of tests. I work hard to become as skilled as they are. But I can say for certain, it requires knowledge and practice. Merk Manuals and simple correlation is just not going to do it.

This is so true. I think you've spelled out a major problem with how EMS educators teach patient assessments.

 

[AnthonyM83]

This is so true. I think you've spelled out a major problem with how EMS educators teach patient assessments.

Increase the course length and hours dedicated to assessments and then maybe they can get somewhere...

 

[EpiEMS]

Increase the course length and hours dedicated to assessments and then maybe they can get somewhere...

True that.

 

[mycrofft]

Touch the eyelash of an unconscious pt and it if blinks he's likely conscious.
Touch the CORNEA and if nothing happens, he's probably dead. Or some cranial nerve thingee. Might want to check pulse as well?

Yeah, I lost leg hair in a pattern below the knees after atrial fib set in with evening edema. For poor circ, look for "chocolate spots" as well.

How about sweating only above the clavicles?

 

[Ghostnineone]

I always thought the house way of assessing patients was to avoid them completely and just read about their symptoms???

 

[mycrofft]

The House Method, pioneered in real life by the famous friend of Conan Doyle, Dr Bell, is to look at people and use your encyclopedic store of medical trivia to deduce what's wrong, often deducing the pt complaints before the pt voices them.

"Joseph Bell: Cheeky Diagnosis

One day Dr. Joseph Bell (Sir Arthur Conan Doyle's medical school mentor and the inspiration behind Sherlock Holmes) assembled a group of students around a patient's bed to demonstrate the deductive method of diagnosis.
"Aren't you a bandsman?" he asked the sick man. Yes, the man politely nodded. "You see, gentlemen, I am right," Bell continued. "It is quite simple. This man has a paralysis of the cheek muscles, the result of too much blowing at wind instruments. We need only inquire to confirm. What instrument do you play, my man?" The patient's reply? "The big drum, Doctor."

endquote
http://www.anecdotage.com/index.php?aid=136

 

[Ghostnineone]

Bahahaha that's hilarious.

 

[Martyn]

That's neat if true, but when you think about the cranial nerves, it doesn't make sense. I looked it up and confirm that the sensory and motor of the eyelids are controlled by the trigeminal (V) cranial nerve, not vagal (X) and glossopharyngeal (IX). It is innervated by some other nerves, but I couldn't find if they were branched off from IX or X.

As far as I am aware it is not to check for and has nothing to do with nerve responses rather than checking the level of conciousness. If the eyelid flickers then there must be a level of conciousness to respond to that touch. Therefore there may well also be enough conciousness to realise someone is shoving a tube down your throat and start the gag reflex. It's a bit like saying what is the longest hair on the body? The ones around your butt hole 'cos if you pull one out it makes your eyes water therefore they must be connected from your butt hole to the back of the eyeball. KISS, don't overthink things.

 

[Martyn]

How about sweating only above the clavicles?

Spinal injury

 

[Martyn]

Can't say I've heard of the lack of leg hair being indicative of a cardiac history.

Plenty of people naturally aren't hair to begin with. Im sooner going to ask a patient or family about their history before I bother/remember to look at their leg hair.

So what about women? Most of them shave their legs!!!

 

[NYMedic828]

So what about women? Most of them shave their legs!!!

Right... Making assessment of leg hair even less useful to us than it already was.

 

[mycrofft]

A House episode actually used two cases from some library book I read decades ago. One was an orange guy (in the book, I believe a German tourist?) who ate too many carrots. The second was a kid suffering organophsphate poisoning because Mom bought discount jeans from a store that stocked damaged shipments and that one had insecticide spilled on it.

Neat book. Had the case of a guy who got a souvenir South Pacific fish spear through the neck and they removed it without having to reconstruct any major structures.