Last week’s post was about keeping things basic and starting treatment early. This week we’re looking at treating things as we see it.
First up though, you need to embrace a fairly large paradigm shift. At uni/college you get taught to diagnose and treat the STEMI, or APO or whatever else your book tells you.
But here’s the key thing: we don’t rectify the cause of any conditions: we manage the symptoms.
We don’t treat the fracture in the arm: we treat the pain from the fractured arm. We don’t cure the patient of asthma… we relieve the broncho-constriction from the asthma
Catching what I’m throwing here? The protocols we learn from; that are used to educate us are focused on recognising diagnosed conditions… but what do you do when you you can’t decisively diagnose? As we’ve discussed before, diagnosis can take weeks, with blood tests and all types of scans.
And out in field patients often give poor histories and have many co-morbidities: is this patient having a non-STEMI? Is it muscular, or reflux or something else? I can’t tell. But I can treat the symptomatic inadequate perfusion, I can treat the symptom of pain.
You can recognise that a patient likely has an internal bleed…. but as a paramedic you can’t treat them for that….. you can treat them for the symptoms (hypoxia and hypovolemia) it’s causing though.
Sometimes we need to extend this a step further: Can’t get a history or proper explanation? Mental health case? Treat the entire patient (when appropriate) ; if they’re sad, empathise with them. If anxious, then calm them.
Having protocols is great. But sooner or later you find a patient who doesn’t fit just one protocol. Or who doesn’t fit any at all. Sometimes instead of spending ages trying to focus on everything and getting lost in what’s going on, with alarms from your monitor screaming, a patient looking worse, a blood pressure falling…….
Stop diagnosing and treat the symptoms.
Pain? Well you can manage pain.
Hypoxic? Oxygen and maybe some fluid will help that.
Cardiac related? Well an aspirin is probably a good idea and likely won’t hurt if you’re wrong.
Possibly septic? Some Paramedic services carry antibiotics…. and again fluid and oxygen.
It doesn’t matter where that sepsis is coming from, what that rhythm is or even why they have pain. You’re going to treat it whether it’s coming from the appendix, the gall bladder or somewhere else entirely. No matter what the end diagnosis will be….. that person has won a trip to hospital as soon as you put the first drug in.
All of sudden this job isn’t so scary any more, and guess what? The hospital don’t care what your diagnosis is (sorry to burst your bubble).
When in doubt, treat the symptoms you see. Leave the diagnosis for the guys with x-ray vision.
It makes your life much much easier, and your scene times much much shorter.
(Note: I intentionally left out conditions with different treatment yet similar presentations like asthma vs. APO……. that’s for people smarter than me to teach about.)