Tests, reflexes, signs...

[Veneficus]

Are you talking EMS or in hospital?

Yes

 

[Ridryder911]

It comes down to knowing when and how to apply knowledge. Should an Emergency Physician assess testicular/abdominal hernia on every male patient? Then again.. I have seen some remarkable diagnosis on patients .. all because a thorough assessment was performed.

One having knowledge will never be wasted, knowing how to apply and use it is the crucial point. For example, I emphasize on dialysis patients (or any potential patient with electrolyte imbalance) to assess for Chvostek's sign and or Trousseau sign.

We do not always have the advantage of lab and other diagnostic equipment, so we should use assessment techniques (when applicable) to aid in our diagnosis.

R/r 911

 

[zmedic]

I just worry a bit that if you are making decisions based on assessment techniques that you have not been formally taught, that are not part of your education or scope of practice that you are going to leave yourself open to trouble if you make the wrong diagnosis or don't give a treatment that you normally would have done so. When I'm in the ER I do things all the time for my education, but I don't document it as part of my exam or medical decision making. (One example is ultrasounds of the heart. In the ER we are looking at basic things like presence of tamponade. I look for things like regurgitation but I don't document it because I'm not credentialed to do so).

Again, I'm not saying not to learn more physical diagnosis. But be careful it it leading you astray or being reassured when a sign is absent.

 

[Brandon O]

I'm not trying to say that scientific evidence is perfect, Vene. In fact, I recognize that for this type of question it's particularly difficult to get good answers from the literature.

But should I take your response to mean that you believe the modern scientific method never has any greater benefit in understanding reality than one's personal experience? That's a fairly strong position to take.

 

[Veneficus]

I'm not trying to say that scientific evidence is perfect, Vene. In fact, I recognize that for this type of question it's particularly difficult to get good answers from the literature.

But should I take your response to mean that you believe the modern scientific method never has any greater benefit in understanding reality than one's personal experience? That's a fairly strong position to take.

That is not what I am saying.

Like what I said above, I think scientific evidence is a tool in the bag.

Like all tools it has a function and limitations.

Sorry for the length, but I am passionate about people thinking because something is published that it is automatically valid.

 

[Brandon O]

That is not what I am saying.

Like what I said above, I think scientific evidence is a tool in the bag.

Like all tools it has a function and limitations.

I think we're on the same page then.

 

[Brandon O]

I just worry a bit that if you are making decisions based on assessment techniques that you have not been formally taught, that are not part of your education or scope of practice that you are going to leave yourself open to trouble if you make the wrong diagnosis or don't give a treatment that you normally would have done so. When I'm in the ER I do things all the time for my education, but I don't document it as part of my exam or medical decision making. (One example is ultrasounds of the heart. In the ER we are looking at basic things like presence of tamponade. I look for things like regurgitation but I don't document it because I'm not credentialed to do so).

Again, I'm not saying not to learn more physical diagnosis. But be careful it it leading you astray or being reassured when a sign is absent.

Just as a final thought: my position has always been that any non-invasive assessment is essentially within the scope of practice of an EMT -- for instance, I find the idea that (as some have heard) listening to lung sounds is not "BLS" utterly bizarre. Certainly there are things we didn't learn in school, but frankly, most of what we know we didn't learn in school; that's not what makes it true.

With that said, if you go out on a limb and make major calls based on something like heart sounds, you had better get it right. People will be looking to sever that limb you went out on just to teach you a lesson; nobody likes a smartass.

In other words, doing the test may be within the scope of practice, but after a certain point, making mistakes is not.

 

[Veneficus]

Just as a final thought: my position has always been that any non-invasive assessment is essentially within the scope of practice of an EMT -- for instance, I find the idea that (as some have heard) listening to lung sounds is not "BLS" utterly bizarre. Certainly there are things we didn't learn in school, but frankly, most of what we know we didn't learn in school; that's not what makes it true.

With that said, if you go out on a limb and make major calls based on something like heart sounds, you had better get it right. People will be looking to sever that limb you went out on just to teach you a lesson; nobody likes a smartass.

In other words, doing the test may be within the scope of practice, but after a certain point, making mistakes is not.

You will never hear me argue against physical exam, but if I could just point out, it really does help to have somebody who knows how to do it teach you and guide you in the beginning.

The most important lessons learned is when your teacher picks out abnormal ones specifically to show you so you can compare them to normal in a relatively short period of time. Obviously this is best done in a hospital.

Reading a book and watching youtube just isn't as good.