Patient assessment question

[Guest guest]

I'm looking for input from my fellow colleagues in prehospital medicine

regarding a patient assessment question.

Do you believe that EMS providers should carry and be trained in the use of

opthalamoscopes and/or otoscopes?

Thanks!

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

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[Guest guest]

I include otoscope and opthomoscope training in our paramedic program.

Mainly it covers the basics. Fundascopic examination is especially

detailed, and we cover just the basics of how an optic nerve head, the

macula, and retinal vessels should normally appear and a obvious

variants - and the patho behind them. We cover tympanic membrane

appearance and variants such as severe otitis media.

If the medic is going to ever work in a clinic setting or assisting

assessment for a practitioner, these are good skills to have. I suppose

they could be worked into routine care, but I think most medical

directors would want the time a medic used in the oto and optha

examination to be spent with the receiving physician.

-MH

>>> 3/8/2007 2:40 pm >>>

I'm looking for input from my fellow colleagues in prehospital medicine

regarding a patient assessment question.

Do you believe that EMS providers should carry and be trained in the

use of opthalamoscopes and/or otoscopes?

Thanks!

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

________________________________________________________________________

AOL now offers free email to everyone. Find out more about what's free

from AOL at AOL.com.

[Guest guest]

To answer your question Wes, and expand on Mike's answer...why not learn as

much as humanly possible? Every bit of knowledge you add to your " tool

chest " just gives you more information to draw on later. Like Mike said, if

a paramedic enters into employment into a different arena than " EMS " , tools

like this could not only be invaluableclinically but also set you apart from

other candidates seeking those jobs.

Mike

From: texasems-l [mailto:texasems-l ] On

Behalf Of Hudson

Sent: Thursday, March 08, 2007 3:05 PM

To: texasems-l

Subject: Re: Patient assessment question

I include otoscope and opthomoscope training in our paramedic program.

Mainly it covers the basics. Fundascopic examination is especially

detailed, and we cover just the basics of how an optic nerve head, the

macula, and retinal vessels should normally appear and a obvious

variants - and the patho behind them. We cover tympanic membrane

appearance and variants such as severe otitis media.

If the medic is going to ever work in a clinic setting or assisting

assessment for a practitioner, these are good skills to have. I suppose

they could be worked into routine care, but I think most medical

directors would want the time a medic used in the oto and optha

examination to be spent with the receiving physician.

-MH

>>> <ExLngHrn@... <mailto:ExLngHrn%40aol.com> > 3/8/2007 2:40 pm >>>

I'm looking for input from my fellow colleagues in prehospital medicine

regarding a patient assessment question.

Do you believe that EMS providers should carry and be trained in the

use of opthalamoscopes and/or otoscopes?

Thanks!

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free

from AOL at AOL.com.

[Guest guest]

I believe that an otoscope could be useful. A man was

assisting in loading trucks onto train flat cars. His

head was in the wrong place (between the bumpers of 2

trucks, almost popped him like a grape) In the E.D.,

no sign (yet) on CT or X-Ray. But there was blood

behind both tympanic membranes, indicative of a basal

skull fracture. An opthalmoscope would require

darkness in the room, not very practicable in most

situations.

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[Guest guest]

I would certainly go over the usage of these tools. Although becoming good at

using them takes a lot of time. I am not sure I would require a skills exam over

it. For the most part, these are not essential pre-hospital tools, but yet

another set of assessment tools. There are lot of good websites with pictures of

normal vs abnormal TMs and Funduses.

, NREMT-P, PA-C

ExLngHrn@... wrote:

I'm looking for input from my fellow colleagues in prehospital

medicine regarding a patient assessment question.

Do you believe that EMS providers should carry and be trained in the use of

opthalamoscopes and/or otoscopes?

Thanks!

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

__________________________________________________________

AOL now offers free email to everyone. Find out more about what's free from AOL

at AOL.com.

[Guest guest]

I concur with Mike and add the following: We also include otoscope and

opthalmoscope training, but it's in our EMT-Intermediate program.

I think it's important for two reasons:

1. It enhances the student's overall understanding of anatomy and

physiology. They say " The eye is the window to the brain " and what one can

learn from

a fundoscopic exam can be extremely helpful in understanding what's going on

with a patient.

2. As Mike says, if you ever want to work offshore, do clinic medicine, or

enter the world of EMS education, it is essential that you understand how

these devices work and what you can learn from them. It is not a coincidence

that every time I go to my personal physician for a routine checkup, one of the

first things she does is look at my TMs and into my eyes. She must know

SOMETHING!

I think it's not practical for certain service areas. In an urban area with

transport times to a major trauma/medical center being 15 minutes or less,

there would be little time or opportunity to use either device.

However, if one works in the hinterlands, as I do, and there is a minimum

35-45 minute transport time to hospital, there is plenty of time to learn more

about the patient's condition enroute if the situation suggests that it would be

of help or, of interest.

To me it's important for us as medical professionals, if in fact that's what

we are, and some would dispute that, to understand everything possible about

patient assessment. The more one knows the more one brings to bear in the

difficult case. Some will say that we in prehospital medicine do not have

" difficult cases " because it's not up to us to diagnose, just to respond to

signs

and symptoms.

I reject that notion completely. We bring an array of knowledge to what we

do, and the more knowledge we have the better we ought to be in handling the

routine cases as well as the difficult ones.

It drives me crazy to hear medics say " I don't need to know that. " I also

question system administrators, including some EMS medical directors who seem

to be downplaying the value of advanced education and training for EMS

personnel. But it is true that we cannot prove through studies that adding

otoscopes

and opthalmoscopes to ambulance equipment would make any difference in

patient outcomes. By the same token, there is no research that I know of that

shows that when physicians use these tools in the ER it causes any improvement

in

patient outcomes. Intuitively we think it must. But, like many other

things in medicine, we cannot prove it.

Gene Gandy, JD, LP

>

> I include otoscope and opthomoscope training in our paramedic program.

> Mainly it covers the basics. Fundascopic examination is especially

> detailed, and we cover just the basics of how an optic nerve head, the

> macula, and retinal vessels should normally appear and a obvious

> variants - and the patho behind them. We cover tympanic membrane

> appearance and variants such as severe otitis media.

>

> If the medic is going to ever work in a clinic setting or assisting

> assessment for a practitioner, these are good skills to have. I suppose

> they could be worked into routine care, but I think most medical

> directors would want the time a medic used in the oto and optha

> examination to be spent with the receiving physician.

>

> -MH

>

> >>> 3/8/2007 2:40 pm >>>

> I'm looking for input from my fellow colleagues in prehospital medicine

> regarding a patient assessment question.

>

> Do you believe that EMS providers should carry and be trained in the

> use of opthalamoscopes and/or otoscopes?

>

> Thanks!

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

> ____________ ________ ________ ________ ________ ________

> AOL now offers free email to everyone. Find out more about what's free

> from AOL at AOL.com.

>

>

[Guest guest]

After spending 2 years working in the Middle East I wish someone had

taught me how to use these tools. Over the past two years I have

been using them on almost a daily basis. They are a valuable tool

but like said...they can be rather difficult to master. Still a

good tool to have if trained in the proper use.

Leach EMT-P/Instructor

> I'm looking for input from my fellow colleagues in

prehospital medicine regarding a patient assessment question.

>

> Do you believe that EMS providers should carry and be trained in

the use of opthalamoscopes and/or otoscopes?

>

> Thanks!

> -Wes Ogilvie, MPA, JD, EMT-B

> Austin, Texas

> __________________________________________________________

> AOL now offers free email to everyone. Find out more about what's

free from AOL at AOL.com.

>

>

[Guest guest]

" An opthalmoscope would require

darkness in the room, not very practicable in most

situations. "

isn't there an on/off switch for the lights in your ambulance? I don't know

about yours, but the ones I work on do, and the windows are tinted(and our

Horton has privacy windows at the push of a button), so it can get really dark

back there in the day time. also a good way to check pupils, and facilitate

intubations

ReD

red@...

http://redsanders.com

Re: patient assessment question

I believe that an otoscope could be useful. A man was

assisting in loading trucks onto train flat cars. His

head was in the wrong place (between the bumpers of 2

trucks, almost popped him like a grape) In the E.D.,

no sign (yet) on CT or X-Ray. But there was blood

behind both tympanic membranes, indicative of a basal

skull fracture. An opthalmoscope would require

darkness in the room, not very practicable in most

situations.

__________________________________________________________

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Browse Top Cars by " Green Rating " at Yahoo! Autos' Green Center.

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