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Question 1
According to Mick Sanders (2011, p. 491), history taking refers to details gathered during the
interview with a patient. It provides information such as medical and social aspects of a patient’s
life. It also has information on environmental factors which may have impacts on his condition.
This procedure is crucial in the establishment of priorities when it comes to patient care. Graham
Harris (n.d., pp. 7-8), in his General principles of Assessment stated that history, vital signs and
physical assessment helps a paramedic in detecting signs and symptoms of underlying medical
condition of a patient. He further stated that if a paramedic has a good questioning skill, further
history may become available. In the case of Mr. Markantonakis, the paramedic on duty did not
fully exercise proper history taking. Thorough questioning of the patient’s wife and daughter
should have been done in order to be fully informed about the patient’s behaviour prior to their
coming. If the patient’s wife and daughter would be believed, the paramedics did not come
across as caring and professional, not introducing themselves and making sure to do anything to
gain the patient’s trust. Obtaining facts about when the pain started, the severity, the medications
taken and the patient’s medical history was done unprofessionally. The paramedic only learned
of some of them because the patient’s family volunteered the information. With regards to
assessment, like what she did in history taking, the paramedic was unprofessional. Questions
such as “What provokes or relieves the pain?” Is it constant, colicky, sharp or heavy?”; “Any
radiation from site?” (Harris, p. 10) and other such questions were not asked and thus, her overall
impression is not credible. The paramedic based her decisions and advice only on what she has
seen, and not on pertinent information that she should have obtained in the first place. From
asking the proper questions to writing them down, the paramedic has failed in her duty as an
attending paramedic....Click here to get more on this essay.....
Question 2
Potential diagnoses, according to Richard Hogston (n.d.) are those which could arise as a result
or consequence of the actual diagnoses (p. 11). In the case of Mr. Markantonakis, it was said that
he was suffering from lower back pain for several days before being brought to the hospital. If I
were the attending paramedic, the possible potential diagnosis that I would list down would be
the following:
potential risk of further muscle strain due to constant violent movement in response to
severe pain being experienced by the patient
The paramedics were told that the patient was also vomiting and the potential diagnosis would
be:
potential risk of dehydration from vomiting, and
potential risk of suffering from abdominal muscle pain due to vomiting
According to Beebee and Myers (p. 314), when a paramedic is faced with a situation in which
there are several plausible explanations for a pain or disorder, and he cannot narrow the causes
down to one disorder. Considering this, the patient should be treated aggressively and it should
be assumed that the disorder can harm the patient severely.
Possible clinical decisions:
identification of possible neurologic symptoms
with the knowledge that the patient has already taken medication and still suffers from
the pain, hospitalization will be recommended
take into consideration all possible scenarios and causes of the pain3
blood chemistry testing
electro cardiogram (ECG) test
continuous monitoring of patient’s vital signs such as blood pressure, respiration, heart
rate and pulse.Click here to get more on this essay.....
Question 3
Chrisuola stated that the paramedic was “rude” (Finding of Inquest, 3.6). This shows that the
paramedic was unprofessional with regards to communicating with a patient and his family.
My strategies and communication methods would be:
Establish a professional demeanour
greet patient by name and shake hands
be sensitive and courteous
ensure patient safety and comfort
inquire about feelings
watch for signs of uneasiness
ask direct, open-ended questions using understandable language
use therapeutic communication techniques
Knowing that the family of the patient is undergoing stress because of the patient’s condition,
paramedics must show empathy and establish trust between them and the patient and his family.
Behaving otherwise will only result to difficulty in obtaining relevant information.Click here to get more on this essay.....
Question 4
During the handover, the paramedic should have given the triage staff all relevant information
that she should have gathered during their conversation with the patient and his family. Handover
is one of the most important activities in patient care. It can also be dangerous if not done
properly. (Talbot and Bleetman, 2007, par. 5) If the triage nurse was told of the patient’s
treatment and the suprapubic and epigastric pain he developed on the way to the hospital and the
angina and heart history, the triage nurse would probably have treated the case differently and
have given the patient immediate attention.
The paramedic thought the patient was not in severe pain and that it was just a case of “poor
me”. This and considering her irritated mood at having to go back to the patient’s house did not
have the qualities a paramedic should have in terms of behaviour, patience and professionalism.Click here to get more on this essay.....
Question 5
The assessment and the decisions made in the case of Mr. Markantonakis were insufficient due
to the inefficiency and unprofessionalism of the attending paramedic in gathering relevant
information with regards to history making and proper assessment.
According to Gordon, et al. (2005), “high-quality pain management includes appropriate
assessment, including screening for the presence of pain, completion of a comprehensive initial
assessment when pain is present and frequent reassessments of patient responses to treatment;
interdisciplinary, collaborative care planning, including patient and family input; appropriate
treatment that is efficacious, cost conscious, culturally and developmentally appropriate, and
safe; and access to specialty care as needed” (par. 9).5
Pain management treatment plan for Mr. Markantonakis:
completing a thorough medical history of the patient
finding the symptoms of pain in order to identify its cause
pain assessment
propose and give immediate pain relief medication and observation and monitoring for
result
in case medication is ineffective and pain persists, discussion of alternative plans for the
patient must be done with the family, such as hospitalization for a more thorough
assessment
make sure that the patient is comfortable en route to the hospital, by giving the patient hot
or cold pack 6
Bibliography
Beebe, R. and Myers, J. (2010).Professional Paramedic: Foundations of Paramedic Care.
[Internet]. Clifton park, NY, Delmar Cengage Learning.
Gordon, et. al. (2005). American Pain Society Recommendations for Improving the Quality of
Acute and Cancer Pain Management American Pain Society Quality of Care Task Force. JAMA
Internal Medicine [Internet]. 2005, 165(14), pp. 1574-1580.
Graham, H. (n.d.) General Principles of Assessment. [Internet]. Available at: <http://mcgrawhill.co.uk/openup/chapters/9780335241996.pdf> [Accessed 24 March 2013].
Hogston, R. (1999). Managing Nursing Care. In: Hogston, R. and Simpson, P. eds. Foundations
of Nursing Practice: Making the Difference. Basingstoke, UK, Palgrave, Macmillan, pp. 2-20.
Johns, M.F. (2006). Finding of Inquest. Adelaide, South Australia. PDF
Sanders, M. (2011). Mosby’s Paramedic Textbook. 4th Ed. Wall Street, Burlington, MA, Jones
& Bartlett Learning.
Talbot, R. and Bleetman, A. (2007). Retention of information by emergency department staff at
ambulance handover: do standardise approaches work? Emergency Medicine Journal
[Internet]. 2007 August, 24(8). pp. 539–542.
