I've been a paramedic for 21 years. I've developed a knack for catching the unexpected. I'm no Dr. House, but I do appreciate subtlety. This week I was reminded that despite patting myself on the back, I can always use a reminder or two about basic patient assessment techniques.
Techniques like obtaining a chief complaint.
In prehospital EMS, we're taught so often to focus on airway and breathing (the traditional A&B for the ABC's of EMS assessment) that we are likely to ignore other complaints deemed less important if we see shortness of breath. I fell into that trap with a family member.
Despite hearing multiple times that this particular family member was complaining of back pain, I (and my colleagues) were much more concerned about his breathing difficulty. We relegated lower back pain to the back burner. In the grand scheme of things, we thought, lower back pain isn't as important as shortness of breath.
Lower back pain from muscle fatigue or sciatica is a secondary complaint when compared to something as important as breathing. But, what if the back pain was significant and not from muscle soreness? In this case, the back pain was from meningitis.
Diagnosing is a combination of deduction and trial and error. Not realizing the significance of back pain led to a delay diagnosing the real problem. I learned a valuable lesson - never underestimate the patient's chief complaint. Every time I asked this family member if he was having trouble breathing, he said no. His only consistent complaint was for the back pain. It didn't matter that he actually was having trouble breathing, he didn't care in light of the pain.
In the future, I will pay more attention to the chief complaint even if it doesn't seem to be as important as what I think is wrong.
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