One of the more difficult problems in pre-hospital medicine is to determine what the problem exactly is without high-priced diagnostic equipment or labs.
I had written in the past of the methods that a doctor uses to create a diagnosis (Diagnose like a Doctor), but want to make things a bit easier for those of us without many years of medical school and internships.
Almost every problem in the body comes down to a few systems and their interactions. Rather than going into these systems using big medical words I want you to remember:
Shock, Cardiac arrest, hypoxia, acidosis and many others come down to improving the functions of the Lungs (allowing air to come in and out of the system), Pump (Move the O2 around the system), Fluid (to carry O2 and nutrients to the cells) and Pipes (ensuring that the fluid isn’t leaking). Maximizing the functionality of each of these will improve patient outcomes.
As you begin working on these, I want you to think about “What could be the problem with X?” American Heart association uses a mnemonic called H’s and T’s to help people remember the reversible causes of cardiac arrest, but with a bit of a broad stroked brush you will see that they cover just about everything that patients seek treatment
- Hypoxia Coronary Thrombosis
- Hypovolemia Pulmonary Thrombosis
- Hydrogen Ion (Acidosis) Tension Pneumothorax
- Hyper/Hypo Kalemia (electrolyte imbalance) Tampanade
- Hypothermia Toxins
- Hypoglycemia Trauma
This is a very comprehesive list, but difficult to remember. I would suggest that if we still consider Lungs, Pump, Fluid, Pipes that these items become much easier to remember. To clarify, you need all of these working at optimum efficiency to ensure O2 delivery throughout the body (think of trying to get it all the way down to the toes) and remove acid from the system. Please consider this image as a more comprehensive list.
Earlier, I brought up “Sticks” as well as an addition to this infographic. Sticks include all Muscles, bones and nerve impulses that are needed for the movement of the body. In Pre-hospital medicine, spinal injuries, fractures, sprains & bruises cover a significant portion of our calls. While splinting is an easy practice, we still must remember the Lungs, Pump, Fluid and Pipes to ensure that circulation extends beyond the break in the sticks.
While there are other systems that play an important role in our day to day life, these fall much more into the purvue of other specialists and we simply can stabilize and quickly transport (In’s and Out’s (digestive system) and Future (reproductive system).
In medicine, the best that we can do is to help the body return to normal functioning as soon as possible. By supporting, increasing, and determining the underlying malfunction of the Lungs, Pump, Fluid, Pipes and Sticks we can help the body return to normal function much faster and provide better outcomes for our patients.