Tuesday, April 04, 2006

Back to Basics

I was watching "Grey's Anatomy" last night with a bunch of friends. Something we do every Sunday night. Dinner then "Soparanos" and the "Grey's'' Whatever... beside the point. Anyways...So in the show they were showing one of the interns (Cristina for those familiar with the show) and The Cheif were taking this class about Laperscopic surgery. Cristina, the intern, beat the Cheif with one of demitrations using the Laperscope. During the second one The Cheif was stitching the "patient" using the scope, all while doing it with his eyes closed. When Cristina asked how he did it he said not to Forget the Basics. This statement got me thinking...how many of us as Paramedics have forgetton the basics. How many of us have become flustered, lost our train of thought and forgot some of the basic assessment skills that we learned in our years of training. For years and years Airway, Breathing, Circulation. Disability, Expose...ect. was drilled into our heads. I have, my partner's have...maybe it was ignorance, maybe it was nerves, maybe it was arrogance, but it happens. My mama (the nurse) has always told me even if you have no idea what the hell is worng with your patient, you can always go back to the Basics...ABC. When you have a patient that is just SICK, sometimes that happens they are SAS (Sick as Shit) and need a doctor, not a paramedic, and you can't figure out WHY the hell they are SAS. Your fall-back is ABCs. Make sure your pt as an Airway, that they are breathing and that they have circulation. If they don't that is something you can fix, all w/o knowing the exact cause of SASness. This also works for trauma.

We have a great Head of Trauma Attending at our local Trauma Center. First off he respects the Medics, he know what we do and compleatly trusts us. Second, he trains his residents to LISTEN TO WHAT THE FUCK THE MEDICS SAY. I brought in a Fucked-up trauma, MVA 19y/o Head and chest trauma..oh and bilateral open tib fib fractures. Now, First thing we say when we walk into the Trauma Bays is "okay, Listen up, because we are only going over this once..." Because there is normall close to 20 people in the bay, everyone from Attendings to ER tects to RTs. And so hence you don't want to repeat your turnover 20 times. So Dr N. (the truama attending) was down there for this MVA...and he noticed a few of his residents were not listening. They were asking questions to us that we had already stated the answers too. And SOme others were examining the leg ( it being the bloody gore that draw in the interns) before even the primary assesment has been done. Right in the middle of the trauma Dr N. got up on the CPR stool and started yelling "OK people everybody STOP! We are missing something...Can anybody tell me what we are missing...No. Well for one thing...Can we please listen to the Medics. Contrary to popular beilf they are not just glorified taxi drivers. They are your eyes out there. They can tell you things...things that you need to know....like was your patient talking on scene, or was he always unconscious. Second thing....we have seem to have forgotten our ABCs...So lets start over...A...A is for........." a small voice came from one of the interns, "Airway?"
"Very good...Airway if you pt does not have a Airway lets fix that, Well it seems the medics have fixed that for us with the large tube shoved in the mans throat. Seems that B is also taken care of. But we still need to assess it. How are the Lung sounds?... is the tube properly placed? Did it get moved during transport?" If it has let's fix that"
"Good lung sounds, Equal and clear. No sound heard over the Epigastric" Stated a resident.
"Excellent...No what comes after Breathing...and no despite what the Nurses tell you, Foley cath does not come after Breathing.
"is that a question...or the answer Dr.whatever?
"Good does your patient have a pulse and BP. If not let's fix that..."

He went on like this till about I think the letter T. I didn't know there was something for every letter. I just knew ABCDE...I also quit listening because I had a bloody unit to hose out.

So even doctors need reminding to go back to basic. We all do...it's easy to forget, you know with all the shiny, blinky ,boppy things we have access to like EKG monitors, CPAP machines, and transmitters of all kinds. We can sometimes get so wrapped up in transmitting that 12 lead EKG that we can overlook something else...And that something else can mean the all differance.


Anonymous said...

Isn't it nice to be treated with respect by physicians? I'v eoften wondered if the arrogant ones realized what rest of the medical professionals (us) thought of them.


painter in hiding said...

Makes one think. This particular MD is one of the best Ive ever worked with, and he is a wonderful teacher...and has shown some of the residents under him that not all medics are just "ambulance drivers" we actually do emergency medical care. We do save lives...or more truthfully keep the patient alive so that the patient has a chance. We are the starting line.

Stacey said...

Wow. I really like this guy. Usually around here the docs are pretty good. The nurses though... They seem to think they are way better than us.. they know EVERYTHING ect... I have to do 116 hours of ER rotations for my paramedic class and I have taken to following the doctors around because the nurses arnt allowed to do ANYTHING without asking the DR first. They were all really surprised when I was telling them all the meds that paramedics are allowed to give without permision.

painter in hiding said...

I was going to comment, but i'll just make a post of it...PIH