Tuesday, March 15, 2011

Sick/Not Sick

I was over at the Fire Academy recently, where they have a fabulous library- and quite possibly the world's best librarian.
She has a pretty good idea of what kinds of things interest me, so whenever I stop by, she often recommends new books.  This particular time, there were several.  Unfortunately for someone, a library somewhere else has closed up, but lucky for us, this library was able to acquire much of their collection.

It's a simple concept, really.
Sometimes called a "from the doorway" assessment.

Is the patient really sick, or not?

Sometimes, in some circumstances, we might not be able to tell right away.

But sometimes, we can.

One look, and whether it's something we see, something we hear, or something so subtle that we don't even really know what it is, but we get that "rush" of adrenalin, and we know, without question, THIS patient is in trouble.  Bad trouble.  This one needs us on our toes, alert, focused, and on the top of our game, and they need it right now.

My original EMT-B instructors talked about this a fair amount, but having no experience at the time, I didn't know how I would know. Didn't know what to look for, really.  The first time I had a patient who fit in this category, I missed it.  Didn't recognize right away that this one had a different feel, a different pace.

I learn pretty fast, though.
And some patients are very educational.

A while ago, we had a patient who fit this category.  I can't really tell you why.  He presented pretty much the same as any number of other, similar patients.  Similar demographics- age range, history, chief complaint.  But even though the obvious signs were no different from others I had seen dozens of times before, this one... this one was different somehow.  A higher level of... something.  Something somewhere between desperation and resignation.  As if he knew.  Something in his eyes, maybe.

The call went like many others have gone.  Fairly smoothly, gather information, start what treatment we can provide at the BLS level, transfer care to the medic, and help load him into the ambulance.  Nothing stuck out at the time as out of the ordinary.

He died three days later.

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