If there is any indication of alteration to mental status, I would agree with you - and I don't limit that to clinical findings of disorientation, or decreased GCS. If, for example, I have a patient whose family states that they are acting 'off,' I am probably going to include a blood glucose check in my assessment, even if they can answer my questions accurately. (Trust the people who know your patient!) Incidentally, in that case, I am probably going to do a BGL even the patient isn't diagnosed as diabetic - if I am investigating altered mental status, its a pertinent part of my assessment. However, if they are alert, oriented and acting normally, its difficult to see what I would be looking for with that blood glucose check. It isn't a comfortable thing to have done, and while the risks of an infection are very low, they do exist, especially in certain populations.
A pulse ox only confirms what you're seeing. Do not rely on a pulse ox in your primary assessment. Remember, a patient may sat at 98% on room air, but is the patient working hard to breathe? Based on the scenario, it's appropriate, but when it comes to a fire scene, you cannot rely on a pulse ox for saturation. Overall, you should not be getting numbers in your primary assessment if you're a good practitioner in the pre-hospital field. I rest my case 😤
Thanks for your comments, Christopher. The structure portrayed in this video is consistent with that expected by the EMR licensing body here in British Columbia. I am not sure exactly what your complaint is around the use of pulse oximetry at this point in the call, but it is not examined until after ABCs have been verified. We certainly don't teach anyone to rely exclusively on the pulse oximeter when determining oxygen needs, but in this case, where there is no increased work of breathing, history of inhalation injury, and no injuries consistent with or other indications of shock, applying O2 based on pulse oximetry is entirely appropriate, and helps to target the right amount of oxygen to administer to achieve a target SpO2 greater than 99%. I appreciate your observation that at a fire scene, where there is a risk of CO poisoning or other inhalation injury, the SpO2 isn't a reliable indicator but... this scenario doesn't take place at a fire scene, so I'm not sure the criticism is relevant. A good idea for a future video, though!
I went to school with that guy! Great to see him continuing with practice!
very informative! phenomenal work team 👏👏👏
You get numbers in your secondary assessment. Not the primary; you treat what you are seeing per protocol
Do you really not take blood glucose if Pt is alert/oriented? I'd take it automatically if Pt is diabetic.
If there is any indication of alteration to mental status, I would agree with you - and I don't limit that to clinical findings of disorientation, or decreased GCS. If, for example, I have a patient whose family states that they are acting 'off,' I am probably going to include a blood glucose check in my assessment, even if they can answer my questions accurately. (Trust the people who know your patient!) Incidentally, in that case, I am probably going to do a BGL even the patient isn't diagnosed as diabetic - if I am investigating altered mental status, its a pertinent part of my assessment.
However, if they are alert, oriented and acting normally, its difficult to see what I would be looking for with that blood glucose check. It isn't a comfortable thing to have done, and while the risks of an infection are very low, they do exist, especially in certain populations.
@@CoastWildernessMedicalTraining Thank you! Makes sense.
Great team!
Love the structure of your scenario! It’s very easy to follow with the side notes. Will there be a trauma assessment coming? 🤕🚑
Thoy
A pulse ox only confirms what you're seeing. Do not rely on a pulse ox in your primary assessment. Remember, a patient may sat at 98% on room air, but is the patient working hard to breathe? Based on the scenario, it's appropriate, but when it comes to a fire scene, you cannot rely on a pulse ox for saturation. Overall, you should not be getting numbers in your primary assessment if you're a good practitioner in the pre-hospital field. I rest my case 😤
Thanks for your comments, Christopher. The structure portrayed in this video is consistent with that expected by the EMR licensing body here in British Columbia. I am not sure exactly what your complaint is around the use of pulse oximetry at this point in the call, but it is not examined until after ABCs have been verified. We certainly don't teach anyone to rely exclusively on the pulse oximeter when determining oxygen needs, but in this case, where there is no increased work of breathing, history of inhalation injury, and no injuries consistent with or other indications of shock, applying O2 based on pulse oximetry is entirely appropriate, and helps to target the right amount of oxygen to administer to achieve a target SpO2 greater than 99%. I appreciate your observation that at a fire scene, where there is a risk of CO poisoning or other inhalation injury, the SpO2 isn't a reliable indicator but... this scenario doesn't take place at a fire scene, so I'm not sure the criticism is relevant. A good idea for a future video, though!
Marishely
Thoy