ABCs: Back to the advanced
Tim Nowak, AAS, BS, NRP, CCEMTP, SPO, MPO, CADS
We’ve all heard about getting ‘back to the basic,’ but sometimes paramedics need to make sure they get back to the advanced, as well
Not everything can be solved with the basic ABCs of patient assessment and management, at least, not without the right tools to facilitate it.
Yes, paramedics need to maintain their splinting skills, driving practice and stretcher competencies well into their careers, but they also need to maintain the advanced skills that make them an “advanced” life support care provider (and well beyond their initial training, too!).
“Treat the patient, not the monitor.”
True … sort of. Sometimes you need the monitor in order to adequately and appropriately treat the patient. As such, becoming a master of all that is cardiac monitor is a necessity for every paramedic.
Even reverting back to the seemingly “basic” ABCs, we can apply an ALS twist to them that helps paramedics to hone-in on the very advanced concepts that we need to master.
A is still for airway
It’s somewhat mind-numbing to hear about the stats related to unsuccessful intubation attempts, and disheartening. This is a problem – a big one – and one that won’t be fixed by simply taking it out of the equation. Rather, it should be emphasized more and more.
Now, that doesn’t mean that you should attempt an intubation on a patient experiencing a stubbed toe; that’s not the point. My point – my emphasis – is that we need to train significantly more on this skill (even if that means every day or shift).
Other advanced airway skills – bougie use, cricothyrotomy, pediatric airway management – also need to be regularly reviewed and practiced. Along with this practice, proper advanced airway confirmation (and ensuing maintenance) needs to remain our regular training priority.
Breathing (and ventilating)
While physically ventilating a patient might be a basic skill, knowing how often to ventilate and how much volume to provide (especially if you’re using a ventilator) are certainly considerations on any advanced care provider’s mind (and well beyond one breath every 6-8 seconds). A tool – like your capnograph – can help with part of this equation.
Whether you’re confirming advanced airway placement or interpreting capnograph waveforms for your asthmatic vs. COPD exacerbation patient, capnography should be a solid mainstay for any paramedic provider (and a required assessment tool in such instances).
It’s more than just a number; the waveform is the key. It’s equally important to instill the practice of printing the capnograph for formal interpretation and hand-off to the receiving facility. Think of it this way; you wouldn’t just verbalize your 12-lead ECG interpretation to the receiving physician, you would leave him/her a print-out. Well, your capnograph should be no different!
Circulation, cardiology and cardiovascular care
Be it ACLS medications, shock management or electrocardiography, all are essential advanced concepts that paramedics need to stay abreast of (and this is just the beginning).
Acquiring a 12-lead ECG, for that matter, should be the beginning – the baseline – the minimum standard. Acquiring, interpreting and treating based off a 12-lead ECG should be standard practice for paramedic providers, and they should be encouraged to look beyond the standard 12-lead, and toward 15- and 18-lead ECGs as a new gold standard.
Included in diagnostic ECG interpretation, nonetheless, should be a focus on axis deviation interpretation, Sgarbossa criteria, V-tach identification and other electrolyte findings (beyond peaked T-waves in hyperkalemia).
Why? Because they’re all part of the overall clinical picture; not just the minimum standard for interpretation.
If we want to progress as an industry, we need talk the talk, walk the walk, dress the part, and be educated like professionals and perform like clinicians. Yes, getting back to the basics is an important part of the equation; but getting back to the advanced is a key element to keeping the “advanced” in ALS.
This article was originally posted Aug. 23, 2019. It has been updated.
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